Block grants are the latest chapter in an unfolding fight between the White House and Capitol Hill Democrats over the future of Medicaid, the Washington Post reports. Seema Verma, administrator of the Centers for Medicare and Medicaid Services, and Health and Human Services Secretary Alex Azar last week announced the "Healthy Adult Opportunity" program, in which states can agree to receive a lump-sum payment to finance care for adults who become eligible for Medicaid when the 2010 health-care law expanded it. As with many current health policy debates, the rhetoric around this issue has often been heated and emotional. Republican legislators have long complained that the safety-net program is not only overly burdensome to state budgets, but doesn't contain enough incentives for people to better their own lives. Verma contends that the block grants will give states greater control over their own spending and allow them to more nimbly respond to the needs of their enrollees.

A study in Occupational and Environmental Medicine yields insights that could help older adults who work night shifts sleep better, reports Bel Marra Health . The researchers learned that older people who work nights may feel more alert and sleep longer if they stay up longer after getting off work, then stay in bed for eight hours and wake up near the beginning of their shift. The authors enrolled two groups of nine adults, ranging in age from mid-50s to early 60s, who spent eight-hour simulated work shifts in a lab but slept at home. Subjects were required to "work" from 7 a.m. to 3 p.m., then took a day off and worked four-night shifts from 11 p.m. to 7 a.m. They could sleep when they wanted after day shifts, but after night shifts one cohort had to stay out of bed until at least 1 p.m. then stay in bed for eight hours, while the other group only had to postpone sleep until 1 p.m. Both groups spent about eight hours in bed and asleep before the study and during day shifts, but during night shifts, those told to stay in bed for eight hours got as much sleep as before — while those with no instructions spent less and less time every day in bed during night shifts. Participants told to sleep only in the afternoon and stay in bed for eight hours averaged two hours extra sleep each day than the comparison group.

Updated American Academy of Neurology and American Psychiatric Association metrics published in Neurology and the American Journal of Psychiatry advise clinicians to screen people with dementia for pain at every visit, reports MedPage Today . The authors noted the latest Dementia Management Quality Measurement Set contains improvements that show how care metrics are reinforced by current medical literature. "We refined the language and added key phrases that are likely used in clinical practice as examples to aid clinicians in identifying persons who are appropriate to have the quality measures applied to their care," said the University of South Florida's Susan Schultz. Areas covered by the metrics include: reporting diagnoses to customers and caregivers; supporting caregivers; assessing functional status; behavioral and psychiatric screening; safety risk screening; driving risk screening; discussing advance care planning; pain screening; and discussing drug treatments or lifestyle adjustment, if appropriate. The authors stressed that these metrics cover care for people with dementia only.

A Swedish study in Acta Ophthalmologica suggests older adults could improve their vision by getting glasses or a new prescription, according to U.S. News & World Report . The investigators evaluated 1,200 70-year-olds and found while most were satisfied with their eyesight, many did not actually see as well as they believed they did. "Above all, it was reduced contrast sensitivity that made people think their sight was poor. Impaired visual acuity or visual field defects had less of an impact on how they perceived their own eyesight," said University of Gothenburg Professor Madeleine Zetterberg. The researchers estimated that 61.5 percent of participants could substantially improve their vision by getting glasses or changing the power of their current lenses. Both men and women tended to have glasses of incorrect power just as often, although men tended to have slightly better vision — possibly due to a higher frequency of cataracts among women. "Visual impairment can creep up on you, making it difficult to notice that your eyes are getting worse," noted Gothenburg's Lena Havstam Johansson. "So it's a good idea to visit an optician regularly when you get older, even if you don't feel your sight is deteriorating."

A study in the Journal of Experimental Medicine suggests activating a specific class of immune cell called group 2 innate lymphoid cells (ILC2s) could reduce age-related cognitive decline and counter age-related neurodegeneration, reports SciTechDaily . Analysis of the brains of young and old mice found ILC2s accrued with age in the choroid plexus, which produces cerebrospinal fluid and is near the hippocampus — an area that plays a critical role in learning and memory. Older mouse brains had as much as five times as many ILC2 cells as younger brains, and large concentrations of ILC2s also were observed in the choroid plexus of older humans. Activating ILC2s in older mouse brains by adding the cell signaling molecule IL-33 generated proteins that stimulated the formation and survival of neurons. ILC2s from older mice also were able to live longer and produce more ILC2 upon activation than ILC2s from younger mice. Treating old mice with IL-33 or injecting them with pre-activated ILC2s enhanced their cognitive performance. ILC2 activation also produced the signaling molecule IL-5, which in old mice boosted neuron formation in the hippocampus and reduced the amount of potentially damaging inflammation — and improved cognitive performance. "Targeting ILC2 cells in the aged brain may provide new avenues to combat these diseases in humans," said Albany Medical College's Kristen L. Zuloaga.

A study in the Scandinavian Journal of Medicine & Science in Sports found an association between cardiovascular mortality, various cancers, and dementia and inactivity among older adults, reports HCPLive . The researchers analyzed databases for systematic reviews and meta-analyses of longitudinal observational studies on the relationship between physical activity and any physical or mental health outcomes for adults older than 60. They uncovered 24 studies indicating a lower risk of all-cause and cardiovascular mortality, breast and prostate cancer, fractures, recurrent falls, activities of daily living disability and functional limitation and cognitive decline, dementia, Alzheimer's disease, and depression among physically active older adults. Those individuals also tend to have healthier aging pathways, improved quality of life, and better cognitive functioning when they are physically active. "This research highlights the benefits of physical activity to our physical and mental health in older age," said Conor Cunningham at Ireland's Institute of Public Health.

The University of Louisville (U of L) has started offering an online master's degree program for healthcare executives as the population gets older and their medical needs increase proportionally, reports WDRB . The university forecast that health industry jobs should grow by 1.9 million through 2028, and its new online executive Master of Science in Health Administration "will prepare health organization executives to broaden their management competencies and pursue career advancement." U of L added that the two-year degree is intended "for healthcare professionals with at least five years of experience and admits both administrative and clinical leaders including physicians, dentists, nurses, and allied health providers." Craig Blakely, dean of U of L's School of Public Health and Information Sciences, expressed excitement about the new degree, noting it "is one of many ways we offer top-tier education beyond the physical campus to meet the demand of modern learning." The university declared that the degree will prepare students for "higher-level leadership and responsibilities such as overseeing and managing services, programs, staff, budgets, facilities, and systems."

A study in Clinical Obesity suggests older adults with type 2 diabetes and normal body mass index (BMI) may be in greater danger of cognitive decline if they have elevated visceral fat area, reports Healio . Researchers assessed the cognitive function of 677 Asians 60 or older with type 2 diabetes and without dementia via the Repeatable Battery for the Assessment of Neuropsychological Status. Higher scores connoted greater cognitive function. BMI-based obesity was defined as a BMI of at least 23 kilograms/square meter and visceral fat area-based obesity as a visceral fat area of at least 100 square centimeters. "Our findings revealed that visceral fat area outperformed other surrogate indices of central obesity as an independent associate of reduced cognitive performance in older multiethnic Asians with type 2 diabetes, thus highlighting the adverse effect of visceral obesity on cognition," the authors wrote. "Assessment of visceral adiposity and interventions that target visceral adiposity may help to prevent cognitive decline in older adults with diabetes and reduce the global burden of dementia in aging populations."

The Administration for Community Living (ACL) recently announced the second meeting of the advisory council established by the Recognize, Assist, Include, Support and Engage (RAISE) Family Caregivers Act. The two-day, virtual meeting is set for Feb. 11 and 12, running from 1 p.m. to 4 p.m. ET each day. It is open to the public, and no registration is required to attend. Access links for each meeting day will be provided on the RAISE webpage . There is also limited space for public participation at ACL's central office in Washington, D.C. Registration is required for each day a member of the public plans to attend in person, however, because of security concerns in federal office buildings. The RAISE Family Caregiving Advisory Council not only provides recommendations on effective models of family caregiving and improving coordination across federal government programs.

A study from University of Wisconsin (UW) researchers published in Brain Plasticity details a relationship between regular aerobic exercise and lower vulnerability to Alzheimer's among high-risk adults, reports New Atlas . Twenty-three subjects with normal cognitive health but at a heightened risk of Alzheimer's due to family history and genetics participated. All followed a sedentary lifestyle, with half given information on being more active and then left on their own. The other half was assigned a personal trainer and underwent a "moderate intensity" treadmill training course over 26 weeks. The active group exhibited improved cardio fitness and became less sedentary, and scored higher on cognitive tests of executive functioning. Brain scans also found significant differences in brain glucose metabolism in the posterior cingulate cortex, a region associated with Alzheimer's. "The findings are especially relevant to individuals who are at a higher risk due to family history or genetic predisposition," said UW's Ozioma C. Okonkwo.