Under consideration by Oklahoma lawmakers is a telemedicine pilot to train rural providers to treat people with Alzheimer's, reports mHealth Intelligence . If approved, the measure would set up a Project Extension for Community Health Outcomes (ECHO) program, which would employ a hub-and-spoke model to link rural and remote practitioners with specialists to discuss cases that would otherwise be referred to distant health systems. Sen. Adam Pugh's (R-Okla.) proposal would appoint a neurologist to educate rural primary care providers (PCPs) on recognizing and treating Alzheimer's and dementia, who would run the virtual care network without remuneration. According to advocates, Project ECHO would help improve care management for rural Oklahomans who lack easy access to healthcare providers, as well as help rural PCPs care for more residents locally. The Oklahoma State University Center for Health Sciences already has established a Project ECHO platform for training on addiction and hepatitis C, and last year it added an Alzheimer's education module. The Oklahoma branch of the Alzheimer's Association backs Pugh's bill, and says Oklahomans face a six- to-nine-month wait to see a neurologist in person.

A study published in JAMA Neurology suggests women's greater susceptibility to Alzheimer's compared to men could be because their brains have more tau and beta amyloid protein concentrations, reports United Press International . "These findings may be important in targeting appropriate prevention therapies for women, ideally preventing the accumulation of both amyloid and tau pathology as early as possible," says Reisa Sperling with Brigham and Women's Hospital. She adds that women exhibit higher levels of tau in neurofibrillary tangles, as estimated via tau positron-emission tomography imaging. This is especially pronounced in women with elevated levels of amyloid, who are at risk for memory loss. The distinction in genders is most apparent in the entorhinal cortex, where tangles accrue as people age and start spreading throughout the cortex as memory impairment manifests itself. "This study may help us personalize treatment for Alzheimer's disease in the future," Sperling concludes. "We may need to target specific disease-modifying treatments at very early stages of the disease to reduce the risk of memory decline."

The bipartisan Social Security Advisory Board last year urged the Social Security Association (SSA) to "research and evaluate the order of preference for payee selection," which was followed by enactment of the Strengthening Protections for Social Security Beneficiaries Act of 2018. Section 204 of the act mandates the SSA Commissioner to review and reassess the selection and replacement process for payees. The board has uncovered no empirical scientific findings on the optimal model for preference ordering. An absence of data needed to inform revisions to the selection process therefore behooves SSA to collect it as quickly as possible. In keeping with federal efforts to enhance federal evidence-based policymaking, the board recommends SSA fortify its capacity to compile and apply all appropriate programmatic data to inform and support payee program decisions.

The Social Security 2100 Act introduced by Rep. John B. Larson (D-Conn.) is gaining momentum on Capitol Hill. The bill represents a shift in mindset after decades dominated by concern that aging baby boomers would bankrupt the government as they begin drawing benefits from Social Security and other entitlement programs, reports the New York Times . The proposal would provide an across-the-board benefit hike equivalent to about 2 percent of the average Social Security benefit, as well as raise the annual cost-of-living adjustment to reflect the fact that older Americans tend to use more services such as healthcare. The measure also would increase the minimum benefit to ensure that employees with many years of low earnings do not retire into poverty. The Social Security 2100 Act seeks to slash federal income taxes on Social Security benefits for about 12 million middle-income people while raising taxes elsewhere. The payroll tax rate would climb to 14.8 percent over the next 24 years from 12.4 percent, and the payroll tax would be imposed on earnings in excess of $400,000 annually. "Our bill, supported by more than 200 members of the House, would enhance and expand the nation's most successful insurance program, which touches the lives of every American," says Larson.

The Trump administration has proposed terminating rebates to middlemen to reduce prescription drug costs for American consumers, reports the Salt Lake Tribune . U.S. Department of Health and Human Services (HHS) Secretary Alex Azar late last week announced new rules under which drug manufacturers can offer discounted prices directly to consumers, without giving rebates to pharmacy benefit managers. These rules would be applicable to older Americans who purchase drugs under Medicare plans and low-income enrollees in Medicaid managed-care plans. Supportive drug policy analysts expect government insurance plans to set a strong example for private insurance firms. HHS officials estimate that drug prices following rebates tend to be 25 percent to 30 percent lower than the list price, but many consumers pay the list amount as part of their insurance deductibles and other co-payments. Officials also argue the rebate system discourages the use of lower-cost generic medications. America's Health Insurance Plans President Matt Eyles counters that insurers and the pharmacy benefit managers "are not middlemen — we are your bargaining power. We cannot achieve those savings if our leverage and negotiating power is weakened through harmful actions like this proposed rule."

Americans 60 and up are being squeezed by both their student loan debt and that of their children, which amounted to $86 billion at last count, reports the Wall Street Journal . Student loan borrowers in their 60s owed an average of $33,800 in 2017, a 44 percent increase from 2010, according to TransUnion. Total student loan debt climbed 161 percent for those 60 and older from 2010 to 2017, marking the largest gain for any age group. About 40,000 people 65 and older had their funds garnished from their Social Security checks, tax refunds, or other federal payments in fiscal year 2015 because they defaulted on student or parent loan debt. That represents a whopping 362 percent rise from 10 years before, reports the U.S. Government Accountability Office. TransUnion also calculated that Americans 60 and older owed roughly $615 billion in credit cards, auto loans, personal loans, and student loans as of 2017. That is up 84 percent since 2010. Seniors must work longer, and depend on credit cards and personal loans to pay for basic expenses. About 93 percent of all new private student loan dollars extended to undergraduates during the current academic year included parent or other adults' signatures on them, versus 74 percent in the 2008-09 school term.

A study published in the Journal of Parkinson's Disease suggests a Parkinson's pandemic is on the horizon, with the number of people living with the disease doubling to more than 6.2 million between 1990 and 2015, reports Medical News Today . Experts forecast that 12 million people will have Parkinson's by 2040. Evidence that Parkinson's is approaching pandemic levels includes global concern of the disease in every region of the planet, and its growing prevalence in all scientifically-assessed regions. The geographic proliferation in a West to East trajectory is implied as demographics gradually shift. Parkinson's primarily affects people as they age, and steadily increasing human longevity means an unavoidable increase in the prevalence of Parkinson's. Among the factors the researchers cite as elevating the risk of Parkinson's is a reduction in smoking tobacco, which appears to lower the risk. Also thought to play a role is industrialization, with the authors noting, "numerous byproducts of the Industrial Revolution, including specific pesticides, solvents, and heavy metals, have been linked to Parkinson disease." The researchers urge an increase in activism to mitigate a potential pandemic, as well as financial support, in addition to the development of more effective medications.

The U.S. Bureau of Labor Statistics reports that its January jobs report found the government shutdown did not slow hiring in the healthcare sector, which made 41,600 new hires last month for a year-over-year gain of almost 20,000, reports Modern Healthcare . Healthcare was the third-largest job generator in January after leisure and hospitality and construction. Hiring declined by 15 percent in January compared to December hires, which totaled 48,900. Ambulatory care services were the leading new hires in the healthcare sector, amounting to 22,100 in January, followed by hospital hires with 18,800.

A study published in the American Journal of Physiology — Cell Physiology suggests exercise-induced muscle changes could help improve depression in older adults, reports Medical Xpress . The expression of transcription factors help regulate gene expression and the processing of the mood-enhancing chemical tryptophan. Tryptophan is similar to serotonin, whose concentration in the blood is low in people with depression. Tryptophan metabolism occurs almost completely through the kynurenine pathway, which branches out into either a path protective of brain tissue or into one that is damaging. The former path requires the KAT enzyme to function, and aerobic and resistance exercise promote KAT activity and tryptophan metabolism via the neuroprotective branch. For the study, a group of healthy men 65 or older, without history of depression, participated in a 12-week trial involving resistance exercise and high-intensity interval training on a stationary bicycle. Their gene and protein expression in the muscles before, during, and after the trial were measured. The researchers observed that the expression of transcription factors and KAT rose significantly during the trial, which was consistent with previous research performed in younger adults.

The American Geriatrics Society (AGS) approves of the U.S. Senate's bipartisan Geriatrics Workforce Improvement Act, a bill to guarantee communities across the country can access health professionals and other critical resources, reports EurekaAlert . Introduced by Sens. Bob Casey (D-Pa.) and Susan Collins (R-Maine), the bill seeks to address the shortfall in health professionals trained to care for seniors, and advances support for older adults, caregivers, and the interprofessional teams that deliver quality care. The measure would formally set up and authorize $45 million in annual funding through 2024 for the Geriatrics Workforce Enhancement Program, the only federal initiative designed to boost the number of health professionals with the skills and training to care for senior men and women. The bill also would reauthorize the Geriatrics Academic Career Awards, a program that facilitates career development for clinician-educators. "The future we're working for at the AGS — a future when all older Americans have access to high-quality, person-centered care — begins by building the workforce to make that possible, and by ensuring that workforce can connect us to the tools and supports we need as we age," says AGS Chief Executive Nancy E. Lundebjerg. "We commend the bill's sponsors for working with us and our partners to make that future a reality with the Geriatrics Workforce Improvement Act. By standing behind this legislation, we're committed to a future when all Americans can look forward to affordable, high-quality, and person-centered care."