A study published in the Journal of the American Medical Association found the effect of opioids is uncertain for chronic pain, reports NBC News . The drugs are most important for pain associated with cancer, but are often overprescribed for back pain, headaches, post-surgical pain, and other conditions. "Compared with placebo, opioids were associated with small improvements in pain, physical functioning, and sleep quality; unimportant improvements in social functioning; and no improvements in emotional functioning or role functioning," note McMaster University researchers. They also say "opioids were associated with increased vomiting, drowsiness, constipation, dizziness, nausea, dry mouth, and pruritus (itching)." The study is consistent with the Centers for Disease Control and Prevention's (CDC) determination that opioids are not effective for controlling many types of pain. The agency has been pushing for doctors to prescribe opioids only when absolutely necessary, and to prescribe as low a dose as possible for the shortest time possible. The CDC recommends Tylenol or drugs such as ibuprofen or naproxen, as well as low-tech options such as ice, physical therapy, and massage. "When opioids fail to provide pain relief, a common response by clinicians may be dose escalation rather than reconsidering use of the drug," says Michael Ashburn and Lee Fleisher of the University of Pennsylvania.

A study published in JAMA Surgery suggests only about a quarter of U.S. seniors with chronic health problems prepare documents detailing their treatment preferences prior to risky surgery, reports Reuters Health . The 393 study subjects, all 65 or older, had multiple illnesses and underwent high-risk surgery. Only about 25 percent had advance care planning documents noting their preferences for treatment options. Just 31 percent of those who died within a year after surgery had prepared such documentation. "Advance care planning can be as little as identifying who your decision maker may be if you are not able to make your own decision," noted Victoria Tang of the University of California, San Francisco. The study also found persons 85 or older were more likely to have prepared advance directives than people 65 to 74; those who made more frequent doctor visits and those diagnosed with mild cognitive impairment also were more likely to have such documents ready. Harvard Medical School Professor Zara Cooper said informal documents are often turned over to family members or primary care doctors as a testament to a comatose individual's preferences when deciding medical treatment. "There's a large cultural concern about taking away hope and discussing death and so a lot of clinicians are uncomfortable," she pointed out.

A study published in the Scandinavian Journal of Medicine and Science found older women who dance are 73 percent less likely to need help with routine tasks such as bathing, dressing, and eating, reports London's The Daily Mail . The researchers monitored more than 1,000 women aged 75 to 84 for eight years, and while participants took part in 16 different types of exercise, dance was the only one linked to better daily life skills. Women who danced were found to be less likely to have a disability in which they required partial or total help with activities of daily living (ADL). Only dancing reduced women's risk of needing help with walking, eating, bathing, dressing, and using the bathroom. "Although it is unclear why dancing alone reduced the risk of ADL disability, dancing requires not only balance, strength, and endurance ability, but also cognitive ability — adaptability and concentration to move according to the music and partner, artistry for graceful and fluid motion, and memory for choreography," said the Tokyo Metropolitan Institute of Gerontology's Yosuke Osuka. "We think that these various elements may contribute to the superiority of dancing in maintaining a higher ADL capacity." The study authors noted earlier research suggests "dancing is a more useful exercise for maintaining brain structure and balance ability in older adults compared to walking, strength, and flexibility exercise."

A study published in the Journal of the American Geriatrics Society found mind-body exercises can improve global cognition, cognitive flexibility, working memory, verbal fluency, and learning in older adults, reports News-Medical . The meta-analysis included 32 randomized controlled trials with 3,624 older adults with or without cognitive impairment. The researchers said mind-body exercise, as a therapy that combines mental concentration, breathing control, and body movement, is beneficial for improving flexibility and mental health, but no previous studies have assessed the effects of all major forms of mind-body exercise in a single investigation.

New Hampshire businesses and organizations are undergoing the simulated experience of having dementia to boost awareness and better communicate with people who have the disease by taking classes organized by Alyssa Mackey with The Residence at Salem Woods, an assisted living and memory care community, reports the New Hampshire Union Leader . Such training programs help caregivers, librarians, municipal and business employees, and emergency responders learn to be slower, more patient, gentle, and plain-spoken with afflicted seniors. There are more than 24,000 known cases of Alzheimer's in New Hampshire and another 50 percent yet undiagnosed. As baby boomers get older and the number of persons with dementia rises across the country, training programs offer strategies to make life more manageable, predictable, and pleasant. Music and redirected thoughts and conversation can soothe agitation in persons who may be disturbed by sudden noises, bright or flashing lights, and questions and answers they do not understand. "More than what you say, they will remember how you made them feel," says Melissa Grenier with the Alzheimer's Association in New Hampshire, which offers training for caregivers, businesses, police, and fire departments.

U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma announced that she is moving to establish an office for regulatory reform as one of her priorities for next year, reports Politico Pro . Verma said the office would seek to reduce "regulatory burden" created by the agency, criticizing how CMS' regulations have hampered providers and beneficiaries. CMS already has committed a team to its "Patients over Paperwork" initiative, and Verma aims to make that effort permanent. Verma also lauded staff for quickly responding to last Friday's court decision that the Affordable Care Act (ACA) is unconstitutional, suggesting the ruling did not impede ACA sign-ups. "We were able to have a very successful close to open enrollment," she said. Verma restated that Medicare Advantage is the model for how she views the overall Medicare program. Her goals include modernizing Medicare into a beneficiary-oriented program with affordable choices based on market principles that encourage innovation.

Constructive performance reviews with high-achieving employees are possible with three methods, reports Forbes . The first is to assign challenging goals to high performers, with goal difficulty characterized by the need to learn new skills, take employees out of their comfort zones, and have a level of difficulty that is at least equal to workers' most significant previous accomplishments. Performance reviews should devote more attention to goal-setting. The second technique is to provide hyper-specific feedback, to raise the odds that employees will know which of their behaviors the employer wants to see repeated in the future. The third strategy is to encourage a more meritocratic atmosphere that welcomes friendly competition, values creativity and intelligence, and where the best performance wins regardless of status or tenure. The performance review scores of high-achieving employees should thus reflect that achievement.

Next year will see five changes in the technology space for older adults, according to K4Connect's Kuldip Pabla in Forbes . His first prediction is consolidation in the senior-care vendor market, requiring corporate executives to deal with fewer vendors, drive additional value, and expedite tech adoption. Pabla's second forecast is for the commencement of digital transformation in senior care, which he stresses "is not technology replacing jobs, but rather technology solutions that will provide caregivers with the ability to scale impact." His third prediction anticipates new tech-enabled business models in senior living communities. "Smart technology solutions such as smart home, smart wellness, and smart living will unlock the ability for communities to drive new lines of revenue and expanding their impact by serving these new sets of customers," Pabla says. He also expects the end-to-end voice first user experience to go deeper, and successful service providers and communities will be those who concentrate on enterprise deployment, enterprise management, enterprise support, and enterprise analytics. Pabla's final prediction for 2019 is the rollout of data and machine learning for predictive healthcare analytics. "Senior living communities, home care and health agencies, and even insurance companies will be interested in predictive healthcare as it will help them foresee and avoid (or delay) impending health events all while empowering the older adults they serve to live richer, more engaged lives," he notes.

A study by the University of Warwick published in PLoS One found the cost of heating and cooling the home, and increasing social isolation, are significant factors in health risk of older adults during extreme weather, reports News-Medical . Moreover, poor understanding of the dangers of extreme heat or cold also influences how well older adults cope with adverse weather conditions. "The findings of this research are comparable to that in the U.K., France, U.S., New Zealand, and internationally that also found that low educational levels, low income, lack of mobility, lack of housing insulation, and weak social networks had adverse consequences on older adults' ability to respond to extreme temperatures," says Warwick's Raquel Nunes. "We show that the vast majority of older adults face restrictions in availability and access to assets that impact on their ability to respond to extreme temperatures. Despite this, participants in this research revealed a range of opportunities for enhancing their adaptation strategies, drawing on assets that they would welcome." Participants with the lowest literacy and with a poor understanding of what to do during hot or cold weather preferred personalized advice from specialists over general advice such as leaflets or information in the media. Social interaction with family, neighbors, and services were seen as a "lifeline" as their advice was perceived as more trustworthy. "Local and community organizations and institutions would be most appropriate to implement adaptation measures, as they are closer and more accessible to older people," Nunes concludes.

A study from University College London found regular trips outside the home may be more emotionally impactful for seniors than assumed, with the finding that trips to experience "cultural engagement" can help adults over 50 avoid depression, reports Consumer Affairs . "People engage with culture for the pure enjoying of doing so, but we need to be raising awareness of their wider benefits too," stresses University College London's Daisy Fancourt. The researchers analyzed responses from more than 2,000 participants, and assessed their responses to various questionnaires and one-on-one interviews on how often they went to art galleries, museums, the theater, or movies. Participants who took trips to the opera or to concerts more often were more likely to do better emotionally. Those who went out once monthly were nearly 50 percent less likely to develop depression, while those who went every few months were 32 percent less likely. The team attributes the results to a mix of light physical activity, social interaction, mental stimulation, and creativity. "Cultural engagement is what we call a 'perishable commodity,'" Fancourt notes. "For it to have long-term benefits for mental health, we need to engage in activities regularly."