U.S. Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma said the Trump administration is firmly opposed to lifetime limits on Medicaid benefits, reports MedPage Today . When CMS recently rejected Kansas' request for a 3-year lifetime cap for its Medicaid recipients, "We indicated we would not approve lifetime limits, and have made that pretty clear to states," she said. However, the agency is encouraging states that want to include some form of work requirement—known at CMS as "community engagement"—for able-bodied adults in the Medicaid program. Community engagement programs usually require recipients to either be working, going to school, or volunteering in the community. Older adults, recipients with disabilities, and children are exempted. Verma noted that other federal-state programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF), also include work requirements. Verma worked to distinguish the two types of populations in the Medicaid program now that some states have expanded it. For the Medicaid expansion population, which mostly includes able-bodied individuals, "the goal should be not only to provide healthcare coverage but also to provide a pathway out of poverty." She was more cautious about Wisconsin's request to test its Medicaid recipients for drugs. States may want to consider "ideas around risk assessment and not only identifying substance abuse but also performing a comprehensive health assessment to look at all the health issues a person may be facing," she said.

A survey from the Associated Press-NORC Center for Public Affairs Research found young adults are more likely to feel stressed out by the experience of caring for older loved ones, reports Associated Press . The poll found 35 percent of American adults younger than 40 have already provided care for an older relative or friend, and another 34 percent expect to be called upon to do so in the next five years. Seventeen percent of young adults are currently providing long-term care to an older loved one, and another 19 percent have done so in the past. Seventy-five percent of younger caregivers spend less than 10 hours weekly providing care, versus most caregivers over age 40 who provide at least 10 hours of weekly unpaid care. However, despite putting in fewer hours of unpaid work, younger caregivers are more likely than older caregivers to say their care duties are at least moderately stressful. Most caregivers also say they are receiving most or all of the support they need, with young caregivers especially likely to say they are supported by relatives. They also are more likely than older ones to depend at least in part on social media for the support they require. Most young adults doubt that government safety-net programs will be available for them as they age, while only 16 percent think they will have the financial resources to meet their own care needs when they get older. Concurrently, only about 10 percent expect Social Security, Medicare, or Medicaid to provide at least the same level of benefits when they need them.

Many companies are strengthening their internal talent management capabilities by instituting the position of chief talent officer, tasked with overseeing all aspects of human resources, reports Forbes . Chief talent officers must deploy initiatives that serve to foster future generations of leaders via transparency and communication, a powerful employee value proposition (EVP), and diversity and inclusion (D&I). New approaches to talent cultivation may require organizational leaders to rethink such things as work-life balance, encouraging leaders to develop their own leadership styles, offering opportunities for career development, and nurturing more technology-driven initiatives. It is the responsibility of the chief talent officer to identify new amenities through the corporate culture and brand a strong EVP. They set the platform for a compelling EVP, and must meet promises made in the proposition to the candidate after they are hired. Talent acquisition teams have to pitch positions to the candidate, and selling the candidate on the organization as a great place to work. A properly implemented and employed EVP will ensure that the corporate brand aligns with the employee's perception. Chief talent officers can quantify the EVP's effectiveness through employee engagement surveys and performance reviews. They also should expand the discussion of D&I beyond personal attributes such as age, race, gender, and sexual orientation to include more socioeconomic factors.

A new evidence-based clinical practice guideline published in Canadian Family Physician is designed to help doctors safely deprescribe benzodiazepine receptor agonists (BZRAs), including benzodiazepines, zopiclone, and zolpidem, in adults, reports Medscape . BZRAs continue to be widely prescribed as a long-term treatment for insomnia in adults, but although their short-term use can slightly improve sleep onset latency, prolonged use may lead to physical and psychological dependence. BZRA use in seniors has been associated with falls, dementia, motor vehicle accidents, and physical addiction. "This guideline outlines these harms and, through a systematic review, demonstrates the efficacy of deprescribing using tapering regimens in people who were willing to enter deprescribing trials," the researchers say. They rate Choosing Wisely Canada's recommendation to taper the dose of BZRA in seniors as "strong," and the recommendation to deprescribe BZRAs in younger adults as "weak" due to the reduced risk for adverse effects associated with prolonged use of these drugs in this population. The guideline states clinicians should discuss the need to slowly taper BZRAs in all seniors irrespective of treatment duration, as well as in those aged 18 to 64 years who have used BZRAs for more than four weeks. The authors note this guideline does not apply to people with other sleeping disorders, unmanaged anxiety or depression, or other physical or mental health problems that might induce or worsen insomnia.

Recent Georgia State University graduate Larry Johnson, 66, represents a growing trend in the United States, reports MarketWatch . About 512,000 students at least 50 years of age or older were enrolled in undergraduate institutions in the fall of 2015, according to government data analyzed by Seton Hall University Professor Robert Kelchen. That figure accounts for about 2.9 percent of all students enrolled in college. Although older Americans have comprised approximately the same percentage of overall college students since 2003, their enrollment patterns diverge from other economic and educational trends. During the Great Recession, as more students entered college to re-skill, the population of older college students also grew, surpassing 612,000 in the fall of 2009. Lori Trawinski with AARP's Public Policy Institute says economic pressures and longer life spans have made college a more appealing prospect for students who might otherwise be considering retirement. Nonprofits, state and local governments, and colleges themselves are starting to step up with programs to support older Americans. AARP's Foundation works with community colleges and employers to help train workers 50 years and older for in-demand jobs in their area, while divinity schools also are increasingly offering opportunities for older adults to participate in programs leaning toward a paying or volunteer career working towards social good.

A study published in Frontiers in Aging Neuroscience found older adults with mild cognitive impairment (MCI) exhibited significant improvement with certain thinking and memory skills after exergaming, reports News-Medical . The researchers first enrolled more than 100 seniors for the study, and over six months, 14 persisted with regular exergaming. Their average age was 78, and the initial seven-person group was assigned to pedal along a scenic virtual reality bike path several times weekly. The second group had to pedal while playing a video game that included chasing dragons and collecting coins. The special bikes were installed at hospitals, community centers, and independent living communities. The results were compared against data collected from a cohort of eight seniors who played video games on a laptop but did not pedal, and a cohort from earlier research who only rode a traditional stationary bike with no gaming component. Participants in both the group that pedaled along a virtual path and those that chased dragons and collected coins had significantly better executive function. "The goal is to explore even more effective ways to prevent or ameliorate cognitive decline in older adults by tailoring accessibility and level of mental engagement in interactive cognitive and physical exercise," says Union College Professor Cay Anderson-Hanley. "The results suggest that the best outcome for brain health may result when we do both: move it and use it."

Two studies published in JAMA Neurology found novel positron emission tomography (PET) radiotracers exhibited increased uptake in key regions of the brain that could predict risk of early onset Alzheimer's disease, reports AuntMinnie . The use of PET with the tracer flortaucipir, which binds to amyloid and tau-based neurofibrillary tangles, was analyzed in the first study , while PET plus flutemetamol was used to predict which subjects might develop Alzheimer's disease in the short term in the second study . In the first study, greater flortaucipir uptake was observed in the inferior temporal and medial temporal regions of the brain in subjects with subcortical vascular cognitive impairment than in normal controls. In the second study, flutemetamol-PET scans revealed positive beta-amyloid results for 98 individuals while 134 were negative. Three years later, 81 subjects received a diagnosis of probable Alzheimer's disease, while 52 of those with positive baseline PET scans received the same diagnosis and 29 with negative initial PET scans had a similar progression to probable Alzheimer's disease.

New research suggests many seniors are depressed by the perception of becoming irrelevant, driving their desire to stay social and relevant and avoid the loneliness often associated with aging, reports Kaiser Health News . When people reach their 60s, opportunities to offer advice decline, and a 2016 study published in Social Psychology Quarterly found one in five people in their 60s said they did not give advice to anyone in the past year, dropping to one in four people 70 and older. Moreover, a SCAN survey of 1,000 adults age 64 and older conducted in August determined nearly 25 percent of respondents agreed "they aren't important to anyone anymore." "Maintaining ... social engagement can give you a greater sense of purpose and give a sense of motivation that can make you behave in ways that are better for your health," says Patricia Thomas at Purdue University's Center on Aging and the Life Course. Meanwhile, a 2017 study published in the Journals of Gerontology: Social Sciences found that "becoming actively engaged in volunteering in later life is related to lower levels of subsequent disability."

A U.K. care provider will deploy robots in senior communities in September through a partnership with the University of Bedfordshire and Advinia Health Care, reports the Daily Express . The four-foot-tall "Pepper" robots have artificial intelligence called Caresses which is designed to interact with residents. The Peppers are equipped with tablets on their chests which residents can use to skype-call a relative, play games, videos, or music, or remind them when to take their medication. "These robots are able to adapt, learn, and tailor their conversations according to what they find out about an individual just as two people might do in a normal conversation," says Bedfordshire's Dr. Chris Papadopoulos. He notes the machines can learn about a person's cultural background and values and adapt accordingly. "The software is in this way groundbreaking," Papadopoulos says. "We want to explore to what extent they might prevent loneliness and isolation, improve mental health, and reduce family caregiver stress." Papadopoulos cautions that the robots are not intended to replace caregivers, but to "complement the team by increasing the workforce and allowing a robot to be present with someone who would otherwise be by themselves." Not everyone is pleased with this, with Judy Downey of the Relatives and Residents Association charity arguing, "The key to looking after someone is having a relationship in which you might notice if someone is upset after a phone call or if they look unwell. What matters is the smile, the human touch."

A study published in the Journal of the American Geriatrics Society found Medicare and Medicaid have covered about 75 percent of costs for nonfatal older adult falls in the United States, reports U.S. News & World Report . A new initiative in Baltimore, Md., seeks to use hospital data to quickly identify neighborhoods where falls occur most often. Officials will then target interventions to those areas to reduce the fall rate by 20 percent over the next decade. Baltimore City Health Commissioner Dr. Leana Wen says the project could potentially save $14 million in yearly medical costs, "not to mention the lives saved and human impact on families." Baltimore's data surveillance system will be combined with hospitals' provision of fall-related data to Maryland's health information exchange, which hands the data over to the city health department. "We are not sharing protected health information with community partners," insists Baltimore City Health Department CIO Mike Fried. "We are not telling our friends who fell or where they fell. What we are doing is trying to guide the interventions that are happening." Fried says the department will have access to data on falls one week to one month after they occur, helping to prevent more falls in hot spots. "Real-time data allows us to pinpoint areas of concern and to evaluate interventions immediately," Wen notes. "We need data quickly, and we are facing challenges that are really life-and-death. We have to be able to implement in real time."