Experts say older adults who own firearms, especially those struggling with dementia, can be an even greater danger to themselves and others, reports the New York Times . Coincident with a climbing rate of gun sales in the United States is an increase in suicide rates. "Suicide risk is elevated in people with dementia, but it's more of a factor early in the illness," says Dr. Yeates Conwell at the University of Rochester School of Medicine. Later, "people are less able to organize a suicide attempt and more apt to be under supervision." Seniors die more often even though they attempt suicide less frequently than younger people, partly because they use such lethal methods; however, healthcare providers who ask older people about driving and wandering may not inquire about firearms. The University of Colorado School of Medicine's Dr. Michael Victoroff says gun owners at the very least should use locks and safes to secure firearms, while those adamant on keeping loaded weapons handy could use an inexpensive rapid access safe with a keypad. Meanwhile, Marian Betz at the University of Colorado School of Medicine has proposed a family firearm agreement, in which the signer concedes that while he wants to control his firearms as long as possible, "the time may come when I can no longer make the best decisions for the safety of myself and others." The agreement also delegates an individual to tell the signer when that time comes.

Lawmakers have introduced a bill that would enhance the use of electronic prior authorization (ePA) in Medicare Part D, reports Health Data Management . Currently, prior authorization — a process that requests additional information about a patient to determine if an insurance plan will cover a drug — is completed through paper forms, faxes, and telephone calls. However, the Electronic Prior Authorization in Medicare Part D Act proposes the use of ePA through a common electronic system. This would ensure patients have speedier access to alternatives to opioid medications for chronic and acute pain, and better access to medication-assisted treatment to treat opiate addiction. Health IT Now's (HITN) Opioid Safety Alliance — a working group of stakeholders championing the use of technology to combat the illegitimate use of opioids — applauded the proposed legislation. "The nationwide opioid epidemic is a public health emergency that demands policymakers use every last tool at their disposal to prevent and treat cases of addiction, including technologies such as ePA," said Joel White, executive director of the HITN Opioid Safety Alliance. "Private insurers, doctors and pharmacies are already using ePA to great success — decreasing provider burden and limiting the potential for medication mismanagement, including in cases of powerful opioids. It is past time we bring that same technology into the Medicare space."

A new brief from the Center for Retirement Research at Boston College seeks to explain the underlying trends behind the yawning gap in retirement ages based on retirees' level of education. The brief notes that less-educated people experience less improvement in health, tend to face more physically demanding jobs and less flexible work schedules, have slower increases in longevity and therefore less to gain from holding off on Social Security, and face steeper declines in marriage rates, providing less incentive to stay employed longer in order to retire with a younger spouse. These factors make it more difficult for those with less education to ensure a secure retirement.

The Substance Abuse and Mental Health Services Administration estimates that opioid abuse nearly doubled among Americans over age 50 between 2002 and 2014 even as it declined among 18- to 25-year-olds, reports the Washington Post . At last week's hearing by the Senate Special Committee on Aging, lawmakers noted that senior addicts tend to be overlooked. "In 2016, one in three people with a Medicare prescription drug plan received an opioid prescription," said Sen. Robert P. Casey Jr. (D-Pa.). "This puts baby boomers and our oldest generation at great risk." Experts also testified that Medicare makes the epidemic worse by funding needed opioids that can be abused, without funding the care and medicines to combat addiction. "Medicare does not pay for drug and alcohol treatment in most instances, nor does it pay for all of the medications that are used to help people in the treatment and recovery process," stressed Pennsylvania Recovery Organizations Alliance Executive Director William B. Stauffer. "Methadone, specifically, is a medication that is not covered by Medicare to treat opioid use conditions." Stauffer also noted older adults are at high risk for drug misuse because of pain, sleep disorders/insomnia, and anxiety. "They are more likely to receive prescriptions for psychoactive medications with misuse potential, such as opioid analgesics for pain and central nervous system depressants like benzodiazepines for sleep disorders and anxiety," he said.

Companies can ensure that their resident service does not practice racial or gender bias by following a specific roadmap, reports the Harvard Business Review . The first step is to map out employee-resident touchpoints, including methods for handling complaints, to determine whether differential service treatment is present and flag high-priority interfaces requiring review. The second step is determining which groups should be compared in this review. Third is clearly defining the behaviors to be tested, with the audit designed to zero in on specific practices that frontline workers should employ. Factors that could muddle the results of the review should then be identified and excluded, and frontline workers should not be made aware of the investigation. Concurrently, when selecting auditors, it is vital to confirm that they have no personal stake in the audit's outcomes. Once an audit is complete, companies should devise anticipatory service protocols that standardize employee-resident interactions, and then develop employee feedback channels. A third point is to emphasize "equal" service in addition to "best" service to eliminate inconsistency, and diversify workers' experiences afterward via hiring and employee rotations.

A randomized controlled trial published in the Canadian Medical Association Journal looked at CP@clinic, a community-based health promotion program from McMaster University offered by paramedics in low-income, subsidized apartment buildings in Ontario, Canada, reports News-Medical . The study compared buildings receiving the weekly drop-in health program for seniors for 12 months, in addition to usual healthcare and wellness programs, with buildings that only had usual healthcare and nonparamedic wellness programs. CP@clinic provides blood pressure, diabetes, and falls assessments, along with identification of high-risk individuals, referral to healthcare, and health education. It is unique in that it supplies continuous reports back to family doctors. The buildings offering CP@clinic had significantly fewer emergency ambulance calls versus buildings that did not offer the clinics, adding up to 22 percent fewer calls. The clinics detected undiagnosed hypertension in 52.5 percent of participants and elevated blood pressure in 54.7 percent with previously diagnosed hypertension. After attending CP@clinic, average blood pressure for participants with hypertension fell significantly. "We estimate that an average of 10-11 calls per 10 apartment units could be avoided each year with programs like this," says McMaster's Dr. Gina Agarwal. "We think that the difference in ambulance calls in the short term was due to improved healthcare access, linkage to healthcare resources, and knowledge about when to access these services."

Scientists and senior care communities are investigating the use of digital companions, including robots and chatbots, to assist older adults without overwhelming health systems, reports the Wall Street Journal . Such devices are being developed to do everything from monitoring chronic health conditions to encouraging seniors to stay active and engaged. Intuition Robotics co-founder Dor Skuler says natural-language processing technology has advanced to better realize automation applications for senior care, and some digital assistants have enabled certain health systems to scale back nurse home visits and prevent unnecessary trips to the emergency room. "Robots that help people connect with and maintain their relationships with others are becoming increasingly important," says Northeastern University Professor Timothy Bickmore, who is developing a digital assistant to help seniors cope with the final stages of life. University of Southern California Professor Maja Mataric also notes seniors lacking companionship tend to be receptive to having automated friends, which give them the illusion of a physical companion. "It isn't actually very hard to project empathy," she says. "Empathy is what you do, not what you feel." However, developers of digital companions and assistants stress that these devices are not designed to replace human interaction.

At the recent Alzheimer's Disease Research Summit 2018: Path to Treatment and Prevention, government, academia, industry, and nonprofit experts presented recommendations providing guidance for an integrated, multidisciplinary research agenda to inform priorities for Alzheimer's disease and related dementias, reports the U.S. National Institutes of Health . Participants stressed a precision medicine approach to Alzheimer's treatment and prevention. "We must continue to foster creative approaches that leverage emerging scientific and technological advances, establish robust translational infrastructure for rapid and broad sharing of data and research tools, and work with funding partners and other stakeholders to cultivate and sustain an open science research ecosystem," said National Institute on Aging Director Richard J. Hodes. The recommendations centered around topics that included developing a better understanding of the causes of disease; enabling research for developing interventions that can address the underlying disease process and symptoms, and be customized to a person's unique disease risk profile for Alzheimer's; augmenting the research infrastructure and developing translational tools to accelerate therapy development; supporting development of novel therapeutics that target the many aspects of Alzheimer's; understanding the impact of the environment and its interaction with genetic and biological factors to advance effective prevention strategies for Alzheimer's; exploiting emerging digital technologies and big data approaches to improve the ability to discover early markers of disease, better track responsiveness to treatment, and provide improved care; and convening multiple stakeholders to build a new research ecosystem based on open-science precepts.

North American Securities Administrators Association President Joseph Borg says states are making progress in the battle against senior fraud and financial abuse, reports Financial Advisor . He notes 14 states have embraced laws requiring or urging financial advisers to disclose any suspected abuse of clients older than 65 to the proper state senior protection agencies, and some statutes are voluntary while others are mandatory. The association's model act states that any eligible person who reasonably believes financial exploitation of a senior is occurring must report it to Adult Protective Services and the state securities regulator. Borg says other states are considering this or similar proposals. "In Alabama, we have passed legislation to increase the statute of limitations to five years from the date of discovery instead of five years from the occurrence," he notes. "We have also issued guidelines on what red flags to look for." Annual senior financial abuse costs range from $3 billion to $36 billion, and these numbers exclude social costs, says Federal Reserve Bank of Philadelphia President Patrick T. Harker. The state push coincides with Congress' passage of the federal Senior Safe Act, which encourages advisers and their firms to report the financial exploitation of seniors by shielding them from liability and violation of privacy laws.

A new House bill mandates the application of discounts for drugs in Medicare's prescription drug program when the medications are purchased at the pharmacy, to ensure customers get the full discount instead of some of the money going to insurers and drug intermediaries, reports the Washington Examiner . The Phair Pricing Act of 2018 is built on a platform released by President Trump, highlighting little transparency in the negotiations over rebates to reduce prices for drugs in Medicare Part D. "Pharmacy benefit managers PBMs maneuver in the shadows to block savings from reaching the beneficiaries who depend on them to afford their medications," said bill cosponsor Rep. Doug Collins (R-Ga.). The legislation would direct "all price concessions, incentive payments, and price adjustments" to be included when a senior purchases the medication from the pharmacy. "The bill brings transparency to a notoriously complex industry by compelling PBMs to disclose concessions and programs that they employ," states an official release. U.S. Department of Health and Human Services Secretary Alex Azar has intimated that the Trump administration could rescind rebate agreements for Medicare drugs and instead set fixed price discounts applied at the point of sale.