President Trump on Wednesday signed a law to revamp the Department of Veterans Affairs (VA) and expand access for veterans to VA-funded care in the private sector, reports USA Today . Determining precisely how and when this will be realized is now the responsibility of agency officials tasked with drawing up regulations under the law. If confirmed, Trump's VA director nominee Robert Wilkie would spearhead that effort. Criteria to be taken under consideration include wait times for VA appointments, quality of VA care, and distance from a VA center. The VA MISSION Act instructs the VA to integrate a number of existing private-care programs, including the so-called Choice program. The new statute also sets up a commission to recommend which VA centers are worth repairing, where new ones should be constructed, and which ones should be closed and care provided in the private sector instead. The law includes some incentives to help the department hire more healthcare providers, enabling the agency to offer scholarships to medical students in return for VA stints. Moreover, the law provides pre-9/11 veterans with benefits to help cover the cost of in-home caregivers, as well as establish pilot programs to test how to deliver better care more efficiently, including with public-private alliances.

Since 2007, Ohio's Opening Minds Through Art program has been offering people with Alzheimer's and dementia opportunities to create art, and the Springfield Art Association has now taught classes over a fall and spring session, reports NPR Illinois . Students are teamed with volunteers across a weekly program that lasts about three months. Helping to supervise the program is the SIU School of Medicine's Greg Kyrouac, with the program underwritten by a grant from the Illinois Department on Aging. Its purpose is to provide community outreach to persons with dementia. Part of the mission is to enable students to make decisions, such as choosing the colors of paint they use and naming their works. "We all want to make our own decisions," Kyrouac says. "That's what a part of our humanity is. But for the art program, we don't overwhelm them with choices." Erin Svendsen with the Springfield Art Association notes she has seen how the program helps participants build self-confidence. "The person with dementia doing the art project can tell, 'Hey, I'm doing this. It's actually turning out like the example,'" she notes. "That feeling of success and accomplishment stays with them and helps them be happy and excited and thrilled with their project."

Groups such as Advocacy and Services for LGBT Elders (SAGE) hold events such as potlucks to connect older and younger members of the rural LGBTQ community each year, reports Next Avenue . SAGE's 2017 events attracted more than 3,500 participants across the United States. Experts say rural LGBTQ seniors' resilience will help them as they age. They opted to remain in a rural area and have learned to surmount or navigate around bias without the supportive political and social networks that are common in metropolitan areas. However, isolation is a significant problem, with University of Washington Professor Karen I. Fredriksen Goldsen noting "at times of need, they might not have the access to support. But it's not an all-negative story. There are strengths there and we need to learn to build on those." One study published in the Journal of Gerontological Social Work comparing LGBTQ seniors in rural and urban areas showed rural seniors were significantly less "out" than their urban counterparts. Housing is an important issue and some persons moving into nursing or assisted living communities have to consider if going back to concealing their gender orientation is a safer way of avoiding harassment. Enhancing social networks is a key way for a community — rural or urban — to help LGBTQ older adults.

Drug companies such as Eli Lilly and GlaxoSmithKline (GSK) say they are investing in more automated drug discovery in order to develop better therapies more efficiently as research and development becomes more labor-intensive amid growing traction for personalized medicine, reports the Wall Street Journal . HighRes Biosolutions CEO Peter Harris notes robots are appealing to pharmaceutical companies because they are "relentless ... they never stop." He also says the software governing the robots "is able to keep track of many more things in parallel than a human." A new Eli Lilly research center in San Diego uses robots to accelerate scientific discovery, and one application features glass-enclosed robotic arms growing cells, isolating DNA, and depositing samples into small plastic "plates" that resemble miniature muffin trays. Lilly's Dan Skovronsky says the robots also shuttle samples between various equipment, noting "we want to have humans focus mainly on what they're best at: thinking and strategy rather than mixing and purifying and shaking samples, which humans do today." Skovronsky says Lilly is testing these proteins as potential treatments for cancer, diabetes, and cognitive disorders. Meanwhile, GSK's Philip Dell'Orco notes automation could hypothetically ensure better reproducibility. Since robots can perform the same task in exactly the same way, every test should be uniform, boosting the value of experimental data for drug candidate screening.

For people in their late 60s, 70s, and older, the effects of surgery can be just as beneficial as for younger persons, but determining surgical risk holistically is vital, according to U.S. News & World Report . Special considerations to be taken for older adults include possible frailty, chronic illness, current medications, and mental health status. Their place of residence, how they function, and their individual health goals also are essential, while watchful waiting may be preferable to invasive surgery for some individuals. Signs that clinicians should keep an eye out for include the degree of frailty, which raises the risk of complications; readmission to the hospital after leaving; and having to go to a nursing community or rehabilitation center post-surgically, says the University of Michigan's Dr. Matthew Corriere. Meanwhile, chronic medical conditions also are important considerations, because even if they are seemingly unrelated to a surgical procedure, they can affect their outcomes afterward. Because older adults frequently take multiple medications to treat various conditions, it is important to review drug regimens with each individual, including any over-the-counter medications and nutritional supplements. The Coalition for Quality in Geriatric Surgery Project has developed best practice guidelines for healthcare providers on assessing older persons throughout the operative process. Their recommendations include how to evaluate decision-making capacity; heart, lung, and functional status; frailty and nutritional status; and advice on medication management and preoperative counseling.

The National Committee for Quality Assurance's (NCQA) recently-announced Person-Driven Outcome Measures Project will seek to improve care quality and encourage person-centered care by helping older people with complex health needs meet their goals, reports Health IT Analytics . The demonstration project will be conducted over the next three years and involve more than 800 participants. "In order to achieve truly person-centered care, we have to incorporate what matters most to older adults into every healthcare conversation," says SCAN Foundation CEO Bruce Chernof. "This project will show how health systems can ask what matters in a sustainable way, and the value this knowledge brings to both provider-person interactions and the overall quality of care." An earlier study entailed NCQA's development of a strategy for collecting person-driven outcomes using personalized and standardized person-reported outcome measures to monitor care goals over time. It determined this approach was viable and advantageous to discussions about care planning for both provider and participant. It also showed the importance of having specific care plans and a system deployed to follow up and change these plans when needed. The Person-Driven Outcome Measures Project will more fully test these strategies across organizations and demonstrate the value of quality measures stemming from the use of person-driven outcomes. "By streamlining and focusing quality measures — and all of healthcare — on what truly matters to older adults living with complex conditions, we can achieve better outcomes and greater value for payers, providers, and older persons and their families," says John A. Hartford Foundation President Terry Fulmer.

A study of Japanese adults aged 60 years and older published in the Journal of the American Geriatrics Society found short and long daily sleep duration were risk factors for developing dementia and early death, reports ScienceDaily . Among 1,517 adults who were tracked for two decades, 294 developed dementia and 282 died. Age- and gender-adjusted incidence rates of dementia and all-cause mortality were higher in those with daily sleep duration of less than five hours and 10 hours or more, compared with those with daily sleep duration of five to 6.9 hours. However, participants with short sleep duration who were very physically active did not have a greater risk of dementia and death. "Given the beneficial effects of physical activity on risk of sleep disturbance, these findings indicate that not only maintenance of appropriate sleep duration, but also modification of lifestyle behaviors related to sleep may be an effective strategy for preventing dementia and premature death in older adults," the authors concluded.

The Collington nonprofit retirement community in Maryland offers a program in which students get free room and board for participating in activities that entertain senior residents; it is one of many new intergenerational programs designed to get young and old to engage with each other, reports the New York Times . A joint Ohio State University/Generations United survey of 180 such programs indicates that they have strong public support. Benefits include reducing loneliness for older adults and boosting levels of interaction for adults with dementia who engaged with children. Among adult participants, 97 percent said it let them feel happy, interested, loved, younger, and needed. Child participants exhibited higher levels of empathy and a greater ability to rein in their behavior than non-participants. "This is the wave of the future among senior housing providers," says Generations United Executive Director Donna Butts. The report notes shared sites can foster new settings "to confront ageism, break down the barriers of age-segregation, and forge long-lasting and life-changing intergenerational bonds. Intergenerational programs bring purpose to the lives of young and old." In promoting social engagement, the programs offer "one of the pillars of healthy aging," says Dr. Annette Medina-Walpole at the University of Rochester School of Medicine & Dentistry. "This is very much in line with what needs to be happening to engage our older adult community."

For the second week of June, which the National Safety Council (NSC) has designated National Safety Month, the NSC is concentrating on wellness, with specific focus on the costs of substance abuse in the workplace, reports safety.BLR.com . The highest rates of on-the-job substance use disorders are concentrated in the construction and entertainment, recreation, and food service industries. Tenet Diagnostics estimates that up to 20 percent of work-related fatality victims test positive for drugs or alcohol, and 40 percent of all industrial workplace deaths are caused by substance abusers. The opioid crisis and the legalization of marijuana for medical and/or recreational purposes in many U.S. states also contribute to this trend, and employers are advised to devise clear policies dealing with the hazards of substance use on the job and articulate their expectations about such use. Costs of on-the-job substance abuse include absenteeism, healthcare expenses, missed productivity, higher turnover, and greater risk for accidents and injuries on the job. The NSC has worked with the Shatterproof nonprofit and the University of Chicago's NORC research institution on an interactive calculator that estimates the costs of substance use for a given employer based on location, size, and industry. The NSC recommends employers invest in employee wellness and provide treatment options for substance use disorders, and it estimates that each employee who recovers from a substance use disorder saves their employer more than $3,200 annually.

A study published in Radiology determined the combination of conventional dual-energy x-ray absorptiometry (DXA) screening for osteoporosis with quantitative computed tomography (CT) beginning at age 55 could lower a woman's lifetime risk of hip fracture while offering cost-effective prevention, reports Radiology Business . The researchers used TreeAge Pro modeling software to construct a virtual, hypothetical cohort of 1 million post-menopausal women who all had risk factors for fracture. Should the subjects meet existing criteria for osteoporosis, they were assumed to be treated with oral bisphosphonates. The team found DXA plus quantitative CT reduced a woman's lifetime risk of hip fracture to 12.8 percent while also being cost-effective. Women who waived screening had an 18.7 percent lifetime risk of hip fracture, while those screened with DXA alone had a 15.8 percent risk.