Senior caregiving is straining the resources of rural communities, reports the Dodge City Daily Globe . According to National Rural Health Association spokesperson Brock Slabach, "every day, more than 10,000 Americans turn 65 years old, and one in four of those American seniors live in small towns or rural areas." Rachel Monger with LeadingAge Kansas emphasizes the seriousness of the problem. "Frankly, unless we do something drastic very soon ... it will be because it's our rural parts of the state that are aging the most and the most rapidly," she warns. "The staffing issues that we're seeing, the closures that we're seeing of nursing communities, all of those issues are accelerating and will continue to." Monger notes certain rural communities are not sufficiently bolstered to address seniors' needs, and one way to close this service gap is by diversifying and providing many services through one organization. Slabach sees hope in the form of incentivizing more senior services through Medicare.

A study published in The Lancet Neurology found adults 59 and older with higher levels of frailty were more likely to exhibit both Alzheimer's-related brain changes and symptoms of dementia, reports Psych Central . "By reducing an individual's physiological reserve, frailty could trigger the clinical expression of dementia when it might remain asymptomatic in someone who is not frail," said Dalhousie University Professor Kenneth Rockwood. "This indicates that a 'frail brain' might be more susceptible to neurological problems like dementia as it is less able to cope with the pathological burden." The researchers modeled 456 participants who had either no dementia or Alzheimer's dementia, and who subsequently died and had brain autopsies. The team also devised a frailty index using 41 combined components of health status, including fatigue, joint and heart problems, osteoporosis, and mobility. Generally, 8 percent of subjects had substantial Alzheimer's-related brain changes without having been diagnosed with dementia, and 11 percent had Alzheimer's dementia but little disease-related brain changes. Frailty and Alzheimer's-related brain changes were found to independently contribute to dementia status, while an association between frailty and Alzheimer's-related brain changes was also observed after ruling out activities of daily living from the frailty index and adjusting for other risk factors, like stroke, heart failure, high blood pressure, and diabetes.

The U.S. Senate has approved legislation to extend certain Medicaid policies following House approval last week, reports Politico Pro . Included in the bill is a nearly three-month extension of spousal impoverishment rules to allow married couples to guard certain assets while seeking coverage for home- and community-based services. It also features $112 million for an approximately three-month extension of the Money Follows the Person demonstration that helps state Medicaid programs switch older adults and people with chronic illnesses back into their communities. Both the House and Senate had passed the extensions in the last session, but in different proposals that were never reconciled or signed into law. Last month, the Senate folded the extenders into the continuing resolution, but the partial government shutdown over border wall funding delayed the vote.

As part of its All of Us Research Program, the U.S. National Institutes of Health (NIH) has announced that anyone who owns a Fitbit and has enrolled in the program can share their Fitbit account's health data with NIH researchers, reports MobiHealthNews.com . "Collecting real-world, real-time data through digital technologies will become a fundamental part of the program," stated All of Us Research Program Director Eric Dishman. "This information in combination with many other data types will give us an unprecedented ability to better understand the impact of lifestyle and environment on health outcomes and, ultimately, develop better strategies for keeping people healthy in a very precise, individualized way." The goal of the program is to create a dataset of demographic, health, genomic, and other health information for research purposes. "This is a tremendous opportunity for Fitbit users who choose to participate ... by providing information that can help pave the way to a healthier future for all of us," said Fitbit Health Solutions General Manager Adam Pellegrini. "Every day we learn more about the potential for wearable data to inform personalized healthcare and through All of Us, the research community will gain an even better understanding of the role wearable data can play in helping to prevent and treat disease."

According to the U.S. Centers for Disease Control and Prevention (CDC), primary care physicians in rural areas are still prescribing opioids at a significantly higher rate than in cities, even as state and federal policies try to curtail their use, reports Politico Pro . An analysis of prescribing rates of 31,422 primary care doctors serving 17 million people in urban and rural areas between January 2014 and March 2017 determined rural beneficiaries were 87 percent more likely to receive an opioid prescription than those in large metropolitan areas. Prescribing rates fell in all regions after the release of CDC guidelines in 2016, which urged limiting initial opioid prescriptions; however, they remained higher in rural regions. Deadly overdoses climbed nearly 10 percent last year and nearly 25 percent of those fatalities involved a prescription opioid. Rates of opioid-related deaths have been consistently higher in rural areas like Appalachia, where more opioids are prescribed per person than in the rest of the nation. Researchers suggest the higher rates of opioid prescribing among primary care doctors in rural and non-metropolitan areas may be partly on account of higher rates of chronic pain among residents in those regions.

A study published in Health Affairs suggests a new federal law permitting people to buy hearing aids over-the-counter beginning in 2020 may not improve access to hearing care, reports Reuters Health . The investigators learned many older people who already wear hearing aids do not see doctors to check that the devices are working properly. Nearly 11 percent of Medicare beneficiaries enrolled in the study used a hearing aid in 2013, even though Medicare offers no coverage for hearing exams, hearing aids, or exams for fitting hearing aids. In addition, only about 33 percent of the people with hearing aids used hearing care services as well. "The concern is that for individuals with hearing aids who do not get hearing care services, they may continue to have suboptimal hearing outcomes, or become frustrated with their hearing aid and not use it as often or at all," says the Johns Hopkins Bloomberg School of Public Health's Amber Willink. The researchers claim the new law is likely to make hearing aids more affordable and increase the number of people using them for mild to moderate hearing loss, but it could also mean more older adults with impaired hearing will not receive care from specialists.

Apple and Johnson & Johnson have partnered on a study to determine whether the newest Apple Watch, working with an app from Johnson & Johnson, can accelerate atrial fibrillation (AFib) diagnosis and help prevent stoke, reports USA Today . The study will concentrate exclusively on American adults 65 and older who wear the Apple Watch Series 4. The watch features an irregular heart rhythm notification tool and a electrocardiogram app designed to detect AFib, which have both been approved by the U.S. Food and Drug Administration. According to Johnson & Johnson's Paul Stoffels, "the goal is to identify early on AFib and prevent stroke by combining the physical know-how from Apple and what we have from the medical and scientific know-how." The pharmaceutical firm intends to collect aggregate data from study participants, rather than monitoring individuals. Paul Burton with Johnson & Johnson notes the Apple Watch's detection rate for AFib is good, but false positives are always a possibility. If the device detects the condition, wearers are advised to seek a formal diagnosis from their medical provider.

Although the need for more protein intake is higher among seniors, up to 33 percent of older adults opt not to consume an adequate amount because of reduced appetite, dental problems, impaired taste, swallowing difficulties, and limited financial resources, reports Kaiser Health News . A study published in the Journals of Gerontology: Series A determined seniors who ate the most protein were 30 percent less likely to become functionally impaired than those who ate the least. A separate study published in the Journal of the American Geriatrics Society found people who ate the least amount of protein were almost twice as likely to have problems walking or climbing steps as those who consumed the most. The Recommended Dietary Allowance for protein among seniors is 0.8 grams of protein per kilogram of body weight daily. A 2013 study in the Journal of Post-Acute and Long-Term Care Medicine revised this recommendation to 1 to 1.2 grams of protein per kilogram of body weight daily. Seniors with acute or chronic diseases were suggested to consume 1.2 to 1.5 grams per kilogram of body weight. Also recommended was for seniors to choose to spread protein intake evenly throughout the day.

A Harvard Business School study determined employers underestimate employees' struggle to balance their professional and caregiving responsibilities, reports the Wall Street Journal . Nearly three-quarters of U.S. workers have some kind of caregiving responsibility, and 32 percent of that number say they have left a job because they were unable to balance work and family duties. More than 80 percent say their home responsibilities are limiting their professional productivity, and 28 percent say those obligations were adverse for their careers because they did not get challenging assignments or they had been denied raises or promotions. Employers are too often not aware of these trends. The survey estimated that 80 percent of workers said their productivity had been reduced by their caregiving duties, yet only 24 percent of employers agreed. Employees aged 26 to 35 were more likely to have departed a job due to caregiving responsibilities, and higher-earning employees and those in managerial or executive positions also were more likely to have left. More than 50 percent of polled employers did not track employee responsibilities outside the office, claiming they saw no need to collect data on caregiving or were concerned about worker privacy. Harvard Business School Professor Joseph Fuller recommends companies retain data on employees' caregiving responsibilities to get a better idea of costs from employee turnover and diminished productivity.

A study published in the Journal of Nursing Regulation found graduates of for-profit nursing programs are more likely to fail their licensing examinations on the first try versus peers who went to public or not-for-profit schools, reports Modern Healthcare . Analysis of over 13,000 nursing school degree programs across 41 states and the District of Columbia calculated that students who graduated from for-profit nursing school programs between 2011 and 2015 had a higher average fail rate the first time they took the National Council Licensure Examination compared with students from public school programs. Not-for-profit nursing school grads also had lower rates of passing the licensing exam the first time compared with public-school nursing students. This gap was much wider among for-profit graduates, whose average first-time pass rate was 68 percent across all degrees. The average pass rates among not-for-profits were 84 percent and 88 percent among students in public nursing programs. "I think that the policies that nursing leaders implement should not be targeting for-profits necessarily — they should be applied to any kind of nursing program — but there's clearly some very low performers that are slipping through the cracks," notes George Washington University Professor Patricia Pittman.