A study published in Acta Psychiatrica Scandinavica found the use of benzodiazepines and related drugs (Z drugs) was associated with a modestly higher risk of Alzheimer's disease, which was similar irrespective of the drugs' half-life, reports News-Medical . Included in the study cohort were all Finnish community dwellers with newly diagnosed Alzheimer's in 2005-2011 and their age, sex, and region of residence matched controls. Medicine use since 1995 was taken from the Finnish Prescription Register. Many chronic disorders, substance abuse, socioeconomical position, and use of antidepressants and antipsychotics were accounted for. Drug use within five years before Alzheimer's disease diagnosis was not taken into account so reverse causality was covered. Although the higher risk for Alzheimer's was small in this study, the threshold for prescribing benzodiazepines and related drugs should be sufficiently high because of several adverse effects and events, such as falls. These medications are commonly administered for sleep problems, but their effectiveness for this indication diminishes over weeks or months. However, the risk of adverse events remains in longer-term use.

U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma wants digital health information to replace the use of fax machines in doctor offices to send patient data, reports Healthcare Finance News . At a recent interoperability forum, Verma said CMS and the U.S. Office of the National Coordinator for Health Information Technology (ONC) are teaming up to achieve a health ecosystem that sees the free flow of information between patient, provider, and payer. Related to this, CMS is seeking Blue Button 2.0 app developers interested in building consumer-friendly applications for Medicare beneficiaries to connect their claims data to the applications, services and research programs they trust. "If I could challenge developers on a mission, it's to help make doctors' offices a fax-free zone by 2020," she said.

A new research report by Morningstar warns that assumptions about working longer can actually be detrimental if retirement comes sooner and savings fall short, reports Reuters . "What people are doing is picking unrealistic ages," said David Blanchett, head of retirement research at Morningstar and author of the report. "You might say that you want to work until 67, but a lot of things can go wrong." Most formal retirement plans are built around a specific retirement age. But health problems, job loss, or just plain burnout often produce a different outcome. Blanchett found that for anyone planning to retire after age 61, the chances of meeting income and standard-of-living goals can fall sharply if a person does not work at least to that age. "In other words, if your plan predicts a 90 percent chance of meeting your goals if you work until your late sixties, you might really only have a 60 percent chance of meeting that goal," he said.

Experts warn the aging American population will face a lack of transportation options for nonemergency medical appointments, reports the New York Times . Missed appointments because of this shortage cost beneficiaries and the healthcare system a lot in the long term if a mild illness becomes chronic or debilitating, according to a study from SCI Solutions. Some technology startups have been founded to address this need, creating online portals that comply with federal regulations under the Health Insurance Portability and Accountability Act. The portals make it easy to find, book, and track customized rides. Each startup partners with healthcare communities and transportation companies, which matches skilled drivers with beneficiaries' needs as well as managing insurance. RoundTrip, for example, allows a beneficiary or social worker to log onto its portal and book a ride. The beneficiary receives phone calls or texts, with real-time updates on the status of the ride that can cost up to 40 percent less than a taxi voucher, and the ride can be booked in about a minute and be tracked from start to finish. RoundTrip has 15 healthcare partners and 200 transportation organizations in its network in more than 23 states. The AARP Public Policy Institute's Jana Lynott says about 21 percent of people older than 65 do not drive, mainly for health reasons; moreover, many of them do not have children or spouses to drive them to medical appointments. She says she would ultimately like to see all travel and healthcare companies access the same portal to simplify transport services nationwide.

The Trump administration has proposed to revamp an Affordable Care Act program designed to control soaring Medicare costs by encouraging doctors and hospitals to work together to coordinate patients' care, reports National Public Radio . Using the argument that accountable care organizations (ACOs) have led to higher Medicare spending, the administration could drastically shrink the number of participating health providers. About 82 percent of the 561 Medicare ACOs are currently set up so that they are not at risk of losing money from Medicare, sharing in any savings they realize. The remaining 18 percent can obtain a higher share of savings, but also risk paying back money to Medicare if they fail to meet their savings targets. Medicare officials say those ACOs have been more successful in saving money. The White House plans to phase out the no-risk model starting in 2020, but a poll found 70 percent of ACOs would rather quit than assume such financial risk. Centers for Medicare and Medicaid Services Administrator Seema Verma says it is unreasonable to have ACOs that can only make profits but not risk any losses. Current ACOs will have 12 months to transition to a model accepting financial risk while new ACOs will have 24 months, earning Medicare $2.2 billion in savings over the next decade.

A study presented at the annual convention of the American Psychological Association found simple strategies to boost physical activity or feeling more in control may help older adults feel subjectively younger and improve their cognitive abilities, longevity, and quality of life, reports Medical Xpress . The researchers enrolled 116 older adults and 106 younger adults, who were asked to respond to a series of statements on the level of control they felt they had each day, and how old they felt that day. There was significant day-to-day variability in subjective age in both cohorts, and a significant association between perceived level of control every day and subjective age in the older adult group but not the younger group. "Shaping the daily environment in ways that allow older adults to exercise more control could be a helpful strategy for maintaining a youthful spirit and overall well-being," suggests Friedrich Schiller University's Jennifer Bellingtier. "For example, some interventions could be formal, such as a regular meeting with a therapist to discuss ways to take control in situations where individuals can directly influence events, and how to respond to situations that they cannot control. Smartphone apps could be developed to deliver daily messages with suggestions for ways to enhance control that day and improve a person's overall feeling of control." Bellingtier also says an intervention could take the form of giving nursing community residents the opportunity to make more choices in their daily lives so that they can exercise more control. Another study said a second approach for maintaining a younger subjective age and enjoying the associated benefits could be increasing physical activity.

A cross-sectional study published in the Journal of the American Geriatrics Society sought to determine the proportion of older Americans at risk for obstructive sleep apnea (OSA) who receive evaluations, diagnosis, and treatment, reports Healio . The researchers analyzed data from a poll of 1,052 community-dwelling Medicare beneficiaries 65 and older. More than half had a high risk for OSA, but just 8 percent were assessed and 94 percent were diagnosed with OSA. Of those who had confirmed OSA, 82 percent got treatment via positive airway pressure. "We were surprised to see that among those older Americans at risk for obstructive sleep apnea, very few received evaluations with overnight sleep studies," says the University of Michigan's Tiffany J. Braley. The researchers concluded that the study's outcomes indicate a missed opportunity for identifying millions of older adults with OSA.

A study published in the Clinical Journal of the American Society of Nephrology found older adults who initiate hemodialysis for kidney failure are more likely to be diagnosed with dementia and Alzheimer's, carrying a high risk of early death, reports ScienceDaily . The researchers analyzed information on 356,668 American hemodialysis recipients aged 66 years. The one- and five-year risks of dementia diagnosis after initiating hemodialysis were 4.6 percent and 16 percent for women and 3.7 percent and 13 percent for men. The respective risks of receiving an Alzheimer's diagnosis were 0.6 percent and 2.6 percent for women and 0.4 percent and 2 percent for men. The team calculated that the 10-year risk of a post-hemodialysis dementia diagnosis is 19 percent for people aged 66-70 years, climbing to 28 percent for those 76-80 years. The strongest risk factors for dementia and Alzheimer's were age, being black and female, and institutionalization. In addition, older people on hemodialysis with a diagnosis of dementia or Alzheimer's were twice as likely to die early.

Experts Laura Gitlin and Nancy Hodgson emphasize that people with dementia need better life options, reports the Washington Post . Drexel University's Gitlin and the University of Pennsylvania's Hodgson advise people newly diagnosed with dementia to take advantage of assistive resources such as the Alzheimer's Association, the Lewy Body Dementia Association, the Association for Frontotemporal Degeneration, and the government's alzheimers.gov website. They also recommend individuals and families secure referrals to senior law attorneys, financial planners, adult day centers, respite services, and caregiver support services. "People are not given access to the resources they need to plan for the future," notes Hodgson. Although most people with dementia live at home, few professionals query into their living arrangements, even though these environments are key to shaping people's safety and well-being. Hodgson says when on their own, individuals with dementia and their caregivers "tend to move inwards and away from their communities, which fosters isolation, which worsens their sense of despair." Among the strategies she and Gitlin suggest for better living are paying attention to the home environment and removing potential hazards, perhaps by hiring an occupational therapist to assess the home and recommend changes. Another suggestion is setting routines to instill predictability and structure to help people with dementia get through the day.

A study published in Neurology found orthostatic hypotension may be a risk factor for stroke and dementia in later years, reports the New York Times . Orthostatic hypotension is triggered by a sharp drop in blood pressure when rising from a supine position. The researchers collected data on 11,709 middle-aged people, average age 54, without a history of coronary heart disease or stroke. A total of 552 had orthostatic hypotension, and there were 1,068 cases of dementia and 842 of stroke over the next 25 years. People with orthostatic hypotension were estimated to have a 54 percent higher risk of dementia and more than twice the risk of stroke. Johns Hopkins University Professor Rebecca F. Gottesman says this sensation may be a marker of vascular disease. She notes experiencing this feeling on a regular basis should prompt a visit to the doctor. "This will give you and your doctor an opportunity to review your vascular risk factors and make sure they are under control," Gottesman says.