The U.S. Census Bureau forecasts that older Americans will outnumber children younger than 18 by 2035, reports U.S. New & World Report . This inundation is expected to hit regions like the rural Midwest sooner, since growth in the younger working-aged populace has trailed coastal metropolitan regions. Older adults also are less likely to stay employed into their late 60s and 70s in these areas, adding to a significant labor shortage. "In Minnesota, we're right on the cusp right now of our older adult population outnumbering our school-aged population," says Allison Liuzzi with the Minnesota Compass data hub. "That has implications for policy and where you put tax money and where your priorities are." No two states' coping strategies for the expected senior tide are identical, with older men and women opting to remain in the workforce past retirement in certain parts of the country more than others. Maine Council on Aging Executive Director Jess Maurer also notes seniors often need specific types of caregivers, transportation choices, and community engagement opportunities that further stress local labor markets. Maine, Wisconsin, Minnesota, Colorado, and Hawaii score highest for their efforts to manage the senior boom.

A Johns Hopkins University (JHU) survey published in JAMA Internal Medicine suggests seniors with type 2 diabetes are downplaying medical and social factors that underlie professional recommendations for fewer drugs and less aggressive treatment of high blood sugar, reports Medical Xpress . "What our study found is that many geriatrics . . . 65 years or older, with type 2 diabetes perceive their treatment plans much differently than do their care providers, and may be more likely to choose a more aggressive treatment plan than what guidelines recommend, which poses greater risk for complications, injury, or even death," said JHU Professor Nancy Schoenborn. Many seniors particularly disagreed with recommendations to discontinue a medication. "We need to do a better job helping them understand the benefits and consequences of making changes to treatment regimens that must evolve over time on an individualized basis," Schoenborn emphasized. American Diabetes Association guidelines generally advise less aggressive treatment for persons with long-standing diabetes, but 60 percent of survey respondents felt that the longer one lived with diabetes, the more aggressive treatment should be. Less aggressive treatment also is recommended for seniors with other health conditions and those who already have had complications from diabetes — but 76 percent of respondents thought those who already have complications should be treated more aggressively than those lacking. Sixty-seven percent agreed people with other health conditions need more aggressive treatment as well.

A Harris Poll survey commissioned by Anthem and the National Association of Area Agencies on Aging estimated that although 79 percent of older Americans are prepared to age well, 68 percent are at least somewhat worried about their health as they get older and 46 percent need help understanding health insurance benefits once they have selected a plan, reports Business Wire . Sixty-five percent of respondents said they had some form of Medicare insurance coverage, while 42 percent think a better understanding of insurance benefits leads to better health management. Fifty-nine percent still find at least one aspect of the healthcare system difficult, like understanding their benefits or diagnoses and deciding on treatment, or communicating effectively with healthcare providers. Resources they are searching for include dialogue with doctors, health insurance providers, and navigators to help them manage the logistics of their care and the healthcare system. Meanwhile, over half of non-retired older adults agree on a certain level that they need help understanding their benefits once they have chosen a plan, versus two in five retired adults. The poll also found women are more likely than men to report at least one challenge with navigating the healthcare system, and less likely than men to be confident in having all the information they require to make informed health insurance decisions. Men are more likely to agree than women that talking to their health insurance provider would help improve their healthcare system navigation.

A cross-sectional study by Florida Atlantic University (FAU) published in the Journal of Nutrition in Gerontology and Geriatrics sought to assess differences in protein intake, nutritional status, and physical health among older African Americans, European Americans, and Hispanic Americans, reports Medical Xpress . Significant differences were observed among the groups, suggesting that interventions are needed to improve diet and physical health. Protein intake was significantly greater among Hispanic Americans, followed by European Americans and African Americans. Average intake among all groups was lower than newer recommendations, implying consumption of at least 1.0 grams to 1.2 grams of protein per kilogram. The researchers noted low nutritional status, grip strength, chair rise, and timed-up-and-go scores in African Americans and European American females, which were consistent with lower protein consumption. Energy intake did not significantly differ among the groups, with dietary protein intake not significantly differing between those receiving and not receiving Medicaid. Consumption was highest among Hispanic Americans, despite this group having the greatest proportion of participants enrolled in Medicaid. "The findings . . . highlight the need for further education and evidence-based interventions to support this vulnerable population," concluded FAU Professor Safiya George.

A study in JAMA Network Open found the of alcohol older adults consume affects their risk for dementia differently depending on whether they have mild cognitive impairment, reports Healio . "Our findings provide some reassurance that alcohol consumed within recommended limits was not associated with an elevated risk of dementia among older adults with normal cognition," said Manja Koch at the Harvard T.H. Chan School of Public Health. "Nevertheless, physicians should provide individualized risk assessments when counseling persons about alcohol intake." The investigators analyzed data from participants in the Gingko Evaluation of Memory Study, which included 3,021 adults, median age 78 years, of whom 473 had mild cognitive impairment at baseline and 2,548 did not. Those who drank 7.1 to 14 alcoholic drinks weekly had less risk for dementia compared with those who drank less than one drink weekly, in both the mild cognitive impairment and non-impairment cohorts. The risk for dementia increased for those with mild cognitive impairment when they consumed more than 14 drinks a week, versus less than one drink a week. Consuming less than the recommended amount of alcohol daily corresponded with a lower dementia risk among those without mild cognitive impairment, compared with those who did not drink daily, but who did drink to excess when they did.

The American Academy of Ophthalmology suggests strategies to help older Americans with low vision maintain their independence, reports Newswise . One tip is to improve contrast by positioning dark placemats under white place settings, purchasing rugs that contrast with the floor, and kitchen towels and cutting boards that contrast with the countertop. Contrasting colored tape also should be used along the edges of rugs, stair steps, and lampshades. Also recommended is better lighting, particularly in staircases and dark hallways. Rugs should be removed from hallways to prevent tripping, while task lighting in the kitchen can make food preparation safer and less difficult. Decluttering and organization offers benefits like better navigation and fewer falls and aggravation, and giving each item a specific place and a high-contrast label makes it easier to find items needed for everyday living. People with low vision also should see an ophthalmologist and a low vision specialist. The former can ascertain the full extent of vision loss and the location of blind spots, and then either the ophthalmologist or low vision specialist can determine the best methods and devices for helping older Americans surmount their individual challenges.

A survey from the Provision Living senior living community found 62 percent of seniors 65 and older who are still employed are working for financial reasons, most commonly because they cannot afford retirement, reports the Motley Fool . The average retirement savings balance among still-employed seniors is just $133,108, and a yearly annual 4 percent withdrawal rate leaves only $5,324 in yearly income. The current $1,471 average monthly Social Security benefit adds up to $17,652 annually, further compounding the affordability problem. Forty-seven percent of survey respondents said they wish they were already retired, while 20 percent admitted they would prefer working with fewer hours. To avoid working past retirement, it is recommended to start saving for retirement at an early age and eventually maximizing Social Security benefits.

A study published in Drugs & Aging determined older adults in Ontario with chronic obstructive pulmonary disease (COPD) were twice as likely as normal older adults to use prescription synthetic oral cannabinoids, reports ScienceDaily . "Our study showed that older adults and clinicians are turning to cannabinoids more frequently to manage the symptoms associated with COPD, but little is known about the potential dangers associated with this medication class," said St. Michael's Hospital's Nicholas Vozoris. The team learned that synthetic oral cannabinoids were used more regularly in subgroups of seniors with COPD at elevated risk for adverse events, such as those with psychiatric disease and those receiving other sedating psychoactives. In addition, seniors with COPD more often used synthetic oral cannabinoids in potentially worrisome ways, such as more frequently at higher doses and for longer periods. "Without careful monitoring of the way they're being prescribed and used now, we could end up with larger problems in the future," Vozoris warned.

The New York Times is reporting that more and more older Americans are exploring housing alternatives, such as villages and home-sharing. Cohousing, shared housing, and village organizations appeal to those seniors hoping to avoid the costs of nursing care or at least stave them off for as long as possible. These approaches date back years, of course. But "we are seeing a resurgence of people wanting different models of housing," observes Kirby Dunn, executive director of HomeShare Vermont. Shared housing matches people who have unused space with people who are in need of housing. Typically in such scenarios, at least one party is age 60 or older. Cohousing functions quite differently. A like-minded community forms, then looks into buying land and building a housing complex — or converting an existing building — where members can live together. The newest innovation, though, is the village movement. It currently comprises 280 organizations in cities, towns, neighborhoods, and even apartment communities and is growing by 20 percent annually, observes Barbara Hughes Sullivan, national director of the Village to Village Network.

Baby boomers are reaching retirement at a faster rate than millennials can replace them in the workforce, and researchers argue companies should entice older people back to work and give them meaningful, important jobs, reports the Harvard Business Review . Many people, especially those who have had long and meaningful careers, like working, and studies show older, more tenured people are more successful at being entrepreneurs. The solution is to overhaul career systems, pay systems, and recruitment and assessment systems to avoid age discrimination. Research indicates that although raw mental horsepower slips after 30, knowledge and expertise continue to gain even past 80. Evidence also suggests traits like drive and curiosity are triggers for new skill acquisition, even in late adulthood. Cognitive diversity is another competitive advantage that older workers can bring to companies.