Since many older Americans at 65 are healthy, vigorous, and mentally sound, with no urgent need to change doctors, the question of switching to a geriatrician can be complicated, reports the Washington Post . Nils Barzilai at the Albert Einstein College of Medicine says choosing to see a geriatrician "should never be age specific. Biological age and chronological age are not the same. Asking what age to start seeing a geriatrician is not the right question. The right questions are: 'What conditions do you have? Are you mobile? Are you starting to get frail? Are you losing weight, or not walking well? Can you shop? Can you get to your apartment? Can you live by yourself?'" American Geriatrics Society President Laurie Jacobs recommends a geriatrician for anyone who is frail and with multiple health conditions requiring numerous medications. "They probably need someone to organize all their care," she says. "If someone has troubles functionally or cognitively, a neurologist can evaluate, but doesn't take care of you." However, the United States is in the grip of a national shortage, with the American Geriatrics Society estimating that only 6,910 certified geriatricians, including 3,590 full-time practicing geriatricians, are in the country. Still, many primary care providers may lack certification but nevertheless have considerable experience treating geriatrics.

A national survey from KRC Research found that older adults and persons with disabilities face significant transportation-related difficulties once they no longer drive, reports PRNewswire . Respondents perceive a lack of accessible and reliable transportation alternatives, preventing them from doing the things they need and want to do and causing feelings of frustration and isolation. Other poll findings include the pivotal role that caregivers play in helping older adults and those with disabilities meet transportation needs, and that providing or arranging rides can be very time consuming. The lack of a single "go-to" resource for alternative transit options also was cited as a barrier by many respondents. To help remedy this situation, the National Aging and Disability Transportation Center (NADTC) has started a campaign to boost awareness of local transportation options for older adults and the disabled in communities nationwide. "There are excellent transportation programs available and the Aging Network is aggressively advocating for more resources to ensure all communities, including rural areas, are prioritizing transportation services for older adults and people with disabilities," said NADTC Chief Executive Sandy Markwood. NADTC Assistant Vice President Carol Wright Kenderdine added that the organization "recently funded 10 community grants to support planning for alternatives, such as volunteer transportation, rideshare options, and expanding transit."

The Social Security Administration (SSA) has released its cost-of-living adjustment (COLA) notices online, reports USA Today . The notices display how retirees' monthly federal paycheck will be impacted by the 2.8 percent COLA hike for 2019 announced in October. Retirees can log onto their My Social Security account at https://secure.ssa.gov/RIL/SiView.action to estimate their new 2019 payment. The COLA notice will be posted in the message center. SSA's Dorothy Clark says the agency started mailing its paper notices on Dec. 3, and will continue doing so through Dec. 21. The SSA also began mailing COLA notices for supplemental security income benefits on Nov. 26 and will continue through Dec. 14. Retirees will in the future be able to choose to get their COLA notices online instead of via mail. Representative payees, individuals with overseas mailing addresses, and those who pay higher Medicare premiums because of income will not receive online notices this year, but the SSA intends to provide Web-based notices to more people in the future.

A study published in Alzheimer's & Dementia details a blood test for Alzheimer's developed by researchers from Brigham and Women's Hospital that aims to be accurate, more cost-effective, and less uncomfortable, reports Medical News Today . According to the researchers, the test may be able to identify Alzheimer's biomarkers before the manifestation of obvious symptoms. The team first devised a technique to detect the specific subset of tau molecules that appear at high levels in Alzheimer's, focusing on various ways of identifying different types of molecules in both blood and cerebrospinal fluid. They then tested these methods in samples of plasma and cerebrospinal fluid from two cohorts of 65 and 86 individuals, respectively. The researchers evaluated five tests for tau molecules, ultimately determining the most effective to be an "NT1 assay," demonstrating both sensitivity and specificity. "A blood test for Alzheimer's disease could be administered easily and repeatedly, with subjects going to their primary care office rather than having to go into the hospital," says study author Dominic Walsh. "Ultimately, a blood-based test could replace cerebrospinal fluid testing and/or brain imaging."

A 20-year Harvard University study of about 28,000 men published in Neurology determined subjects who drank a small glass of orange juice were 47 percent less likely to have cognitive difficulty, reports London's the Daily Mail . The effect on brain health was measured by testing the men's thinking and recall skills when they were 73 years old, on average. Generally, 6.6 percent who ate the most vegetables developed poor cognitive function and performed badly on the tests, compared with 7.9 percent of those who ate the least. Overall, fruit consumption did not seem to influence the risk of moderate cognitive problems, but consumption of orange juice did. Only 6.9 percent of people who drank orange juice daily developed poor cognitive function versus 8.4 percent of men who drank orange juice less than once a month. "The protective role of regular consumption of fruit juice was mainly observed among the oldest men," notes Harvard's Changzheng Yuan. "Since fruit juice is usually high in calories from concentrated fruit sugars, it's generally best to consume no more than a small glass four to six ounces per day."

A study published in Neurology found a scientific approach to investigating therapeutic targets based on the biology of aging is becoming increasingly credible as a way of preventing and treating Alzheimer's, reports News-Medical . "Decades of research have revealed common processes that are relevant to understanding why the aging brain is vulnerable to Alzheimer's disease," notes Alzheimer's Drug Discovery Foundation Founding Executive Director Howard Fillit. "New therapeutics for Alzheimer's disease will come from this understanding of the effects of aging on the brain." Fillit suggests the most effective Alzheimer's treatment will be combination therapy, which he says is "the standard of care for other major diseases of aging, such as heart disease, cancer, and hypertension." Fillit says although clinical trials to remove or lower the production of beta-amyloid have been largely unsuccessful in altering the progression of Alzheimer's, scientists gained valuable information from those trials, even if they did not immediately lead to treatments. He also suggests recent clinical trials imply that difficulties with clearance of beta-amyloid may yet be significant. "It is currently not known if these classic pathologies (amyloid and tau) represent valid drug targets and if these targets alone are sufficient to treat Alzheimer's disease," Fillit acknowledges. "Targeting the common biological processes of aging may be an effective approach to developing therapies to prevent or delay age-related diseases, such as Alzheimer's."

A study of 1,054 senior U.S. veterans published in JAMA Network Open found many are unwilling to stop regular colonoscopies, even though most thought it was reasonable to use age in choosing when to start screening, reports Reuters Health . Almost half of respondents said age should never factor in the decision to end screening, and nearly 33 percent said they opposed doctors considering life expectancy in deciding whether a recipient should get a colonoscopy. Veterans were more likely to be comfortable with a halt to screening if they had a higher level of trust in their doctors and if they rated their own health as good. Michigan Medicine Professor Sameer Saini said these findings indicate that "efforts to individualize screening in older adults are going to be met with some resistance, especially if we're being explicit with the subject about using risk calculators to make decisions." He suggested the problem may be partly due to the fact that doctors often do not emphasize, or even raise, the issue that colonoscopy has risks that tend to increase with age. Saini's recommendation is that persons over 75 discuss the pros and cons of repeat colonoscopies with physicians. "I think people should think carefully about the potential benefits and harms of any medical procedure they are getting," he said.

The Trump administration reported a slowdown in national health spending in 2017 to $3.5 trillion, a 3.9 percent year-over-year gain versus 4.8 percent in 2016, according to the New York Times . Although healthcare spending comprised 17.9 percent of the U.S. economy last year, the growth rate for the major categories — medications, doctors, and hospitals — was slightly down compared to recent years. Health spending expanded at about the same rate as the general economy, reflecting a stabilization in healthcare's economic portion. "The relatively low rate of health spending growth in 2017 was similar to the average annual growth during 2008-13, which predated the major coverage expansions," noted Anne B. Martin with the U.S. Department of Health and Human Services. She and her colleagues suggested the slowdown may have been partly driven by a moderate decline in the number of Americans with health insurance last year. More insured people also have high-deductible health plans, which tend to make them cost-conscious. The administration also said federal healthcare spending jumped nearly 11 percent in 2014, mainly due to the expansion of Medicaid under the Affordable Care Act, but the growth has decelerated every year since then. Also considered factors were reductions if generic drug prices, lower price hikes for existing brand-name drugs, and fewer prescriptions for pain medications.

Many baby boomers are opting to start their own business as they get older, and LendingTree examined U.S. Census data from 50 U.S. metropolitan areas to find the best places for these older entrepreneurs to start companies, reports TheStreet.com . A wider gap between median and average business income indicates that although there is plenty of revenue to be made, fewer people are earning it. San Jose, Calif., is rated No. 1 by LendingTree, representing both high business income and the largest concentration of boomer business founders. Second place goes to San Francisco due to the city's excellent earnings potential relative to the other listed areas, and the data suggests boomers there are sharing in the general prosperity of self-employed entrepreneurs. Boston scores third, while Sacramento is ranked fourth. Rounding out the rest of the top 10 are Nashville, Tenn.; Hartford, Conn.; Houston; Austin, Texas; Los Angeles; and Memphis, Tenn.

A study published in the Journal of Nutrition determined the addition of hazelnuts to the diet of older adults for several months can improve their levels of two key micronutrients, reports Medical Xpress . The researchers enrolled 32 people 55 and older to eat about 57 grams of hazelnuts every day for 16 weeks, which led to higher blood concentrations of magnesium and elevated urinary levels of a breakdown product of vitamin E. Oregon State University Professor Maret Traber says her team employed an alpha tocopherol metabolite to discover that hazelnuts had improved participants' vitamin E levels. Blood analysis also indicated decreases in glucose and low-density lipoproteins, as well as elevated magnesium levels. "All of which says that hazelnuts are good for you," Traber notes. "The findings demonstrate the power of adding hazelnuts to your diet, of just changing one thing. Vitamin E and magnesium are two of the most underconsumed micronutrients in the U.S. population, and there's much more to hazelnuts than what we analyzed here. They're also a great source of healthy fats, copper and B6. People don't like taking multivitamins, but hazelnuts represent a multivitamin in a natural form."