A study published in Annals of Family Medicine found the Visual Association Test (VAT) may help identify people with declining Mini-Mental State Examination scores who are at higher risk for dementia, reports Healio . The researchers assessed the change in Mini-Mental State Examination scores in 2,690 individuals over two years and VAT scores at two years, with the average follow-up period 6.7 years. Subjects with a Mini-Mental State Examination score that fell by two points or more over a two-year period had a greater risk for dementia. Those with the same decline in that score, along with an imperfect VAT score, had even higher risk. However, a one-point decline in Mini-Mental State Examination score raised the chances for dementia only when the VAT score was imperfect. "The Visual Association Test score has incremental value in discriminating between older adults with and without increased risk of dementia, especially among those with a minor decline in Mini-Mental State Examination score," the researchers wrote. "This simple test may help distinguish older adults who need further cognitive examination from those in whom a watchful waiting policy is justified."

The U.S. Centers for Medicare and Medicaid Services (CMS) has issued an interim final rule raising Medicare payments for durable medical equipment (DME) to ensure beneficiaries have access to critical medical devices, reports HealthPayerIntelligence . These payments will be increased from June 1, 2018, to Dec. 31, 2018, within rural areas not subject to the DME Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). The agency calculates that Medicare will pay an additional $290 million in benefit payments and $70 million in beneficiary cost sharing for DME services during the six-month interval. CMS says many small DME providers and businesses undergo financial challenges under current DME payments rates, and raising them would ensure that these businesses can maintain financial stability and provide beneficiaries with devices. Last year and the year before, the DMEPOS CBP adjusted payment rates for devices such as oxygen tanks and enteral nutrition systems in rural regions catalogued as "non-bid" areas. These areas experienced adjusted payment rates that were 50 percent lower than unadjusted rates in parts of the country participating in the DMEPOS CBP. DME providers in rural areas will now receive "blended rates" that are calculated by combining half of DMEPOS CBP rates and half of the traditional fee-for-service payment rates. "Going forward, CMS will continue to review data and information about rates for DMEPOS items and services," the agency says. "CMS intends to undertake subsequent notice-and-comment rulemaking to address the rates for durable medical equipment and enteral nutrition furnished in 2019 and beyond."

U.S. Department of Health and Human Services (HHS) Secretary Alex Azar announced yesterday that the Trump administration is considering expanding Medicare's authority to negotiate drug costs by giving private payers a role in setting the price of medications administered in hospitals and doctors' offices, reports Reuters . Azar noted that the president views tougher negotiation as key to the plan, and his agency will consider an alternative system for purchasing Medicare Part B drugs, which are administered by a healthcare provider and covered directly by the government. The administration would seek to permit private payers to negotiate the price of those medicines, as health insurers and pharmacy benefit managers (PBMs) currently do in Medicare Part D, which covers drugs that beneficiaries get at the pharmacy. HHS officials said at a press briefing that they could trial the transfer of certain drugs from Medicare Part B to Part D in a pilot program, but did not state when that might begin. However, the American Enterprise Institute's Joe Antos noted most expensive drugs will remain in Part B, constraining the proposal's ability to significantly lower prices. Leerink analyst Ana Gupte said firms best positioned to participate in the new proposal would be insurers that have their own PBMs, Part D plans, and Medicare Advantage business, such as UnitedHealth Group, Humana, Anthem, and Cigna if the Trump administration sanctions its merger with Express Scripts.

Although President Trump promised last week to "bring soaring drug prices back down to earth" by promoting competition among drug companies, he has jettisoned the populist proposals of his presidential campaign, reports the New York Times . Trump has chosen not to have the federal government directly negotiate lower drug costs for Medicare, nor to permit American consumers to import low-cost medicines from overseas. Instead, private firms would be given the means to negotiate better deals on behalf of consumers, insurers, and employers. The White House's plan calls for reducing out-of-pocket costs for Medicare beneficiaries by requiring prescription drug plans to pass on some of the discounts and rebates they get from drug manufacturers. Medicare officials say there concurrently could be a modest rise in premiums for Medicare drug coverage. Health policy experts welcome this policy because it reduces the burden on persons with serious chronic illnesses and diffuses the expense of needed medications across the entire insured population. However, Democrats warn Trump's plan comes up significantly short of what is needed, especially compared to the populist promises he made during the 2016 campaign. "The president is apparently abandoning his campaign promise to authorize Medicare to negotiate directly with drug companies to lower prices," says Rep. Elijah E. Cummings (D-Md.).

The 2018 Happiness Survey from One4all Rewards queried employees from different age groups, genders, and industries in Britain about the impact their happiness at work has on productivity, and found 42 percent of workers in the healthcare sector would work harder if they are happy in their current role or workplace, reports Open Access Government . In addition, 27 percent of employees said they would be more willing to work overtime or for longer when they are happy. Meanwhile, unhappy employees tend to stick around and have a negative impact on productivity. When asked what employers could do to improve their happiness, respondents said awarding pay raises of either 10 percent or 20 percent would be most impactful. However, 26 percent of healthcare professionals cited increased recognition from their boss for their work and the contributions they make as boosting their workplace morale, while 18 percent cited being thanked by bosses more often. Token gestures such as gift cards or free lunches could be applied to reinforce these displays of gratitude as well. "It's important that healthcare managers regularly take stock of morale within their organizations and make an effort to improve it where necessary," advises One4all Rewards' Alan Smith. "Ensuring staff are happy in their roles and willing to work hard for the business can go a long way to help it succeed. Bosses shouldn't just assume that if they have low staff turnover they have a happy workforce."

Nursing communities have launched programs, training, and policies to stop bullying, reports the Associated Press . Following bullying incidents, San Francisco's 30th Street Senior Center partnered with the Institute on Aging to develop an anti-bullying program. All staffers received 18 hours of training that included lessons on what constitutes bullying, causes of the problem, and how to manage such conflicts. Seniors were then invited to similar sessions, held in English and Spanish, teaching them to notify staff or intervene themselves if they see bullying. Existing studies suggest about one in five seniors encounters bullying, says Arizona State University Professor Robin Bonifas. She sees it as an outgrowth of frustrations typical of communal settings, as well a reflection of issues unique to aging. Many seniors see their independence and sense of control disappear and becoming a bully can feel like regaining some of that lost power for some. There is far less recognition of bullying as a problem among seniors versus young people, with even bullies unaware how problematic their behavior is until it is labeled. Campaigns throughout the United States have sought to raise awareness, including a booklet circulated in 2017 by the National Center for Assisted Living.

The Centers for Disease Control and Prevention (CDC) has estimated the number of deaths from falls among the 65-years-or-older U.S. population between 2007 and 2016. The agency found the overall rate of older adult deaths from falls rose 31 percent from 2007 to 2016, while nationally, 29,668 residents in the studied age range died from fall-related causes in 2016. The largest AAPC in mortality rates from falls occurred in Maine, followed by Oklahoma and West Virginia, while 30 states and the District of Columbia experienced a significant increase in fall-related death rates from 2007 to 2016. In 2016, death rates from falls were higher among adults aged about 85 years, males, and whites than among corresponding groups. Meanwhile, rates increased among all demographic subgroups except American Indians/Alaska Natives. The yearly rate increase was larger among adults about 85 years old than among those aged 65-74 and 75-84 years old. The CDC suggests differences in rates among states might partly stem from differences in the racial composition or general health of their residents. Another possible contributor could be differential coding practices for external causes of injury on the death certificate. Furthermore, certain states require a medical examiner to complete a death certificate, whereas others employ coroners. As the number of Americans in the 65-years-or-older age range increases, the growing number of deaths from falls in this demographic can be addressed by screening for fall risk and intervening to address modifiable risk factors such as polypharmacy or gait, strength, and balance issues.

New York's Long Island State Veterans Home is using virtual reality to bring exotic experiences to residents, many of whom are too old or ill to travel and want a better quality of life, reports Newsday . The community has acquired 10 virtual-reality headsets that allow users to visually immerse themselves in artificial experiences, such as swimming with dolphins or following the flight of a hummingbird. The community leased the gear from MyndVR via a $20,000 grant from Bowlers to Veterans Link. "We believe virtual reality is the next step in providing better care for our residents," says veterans home deputy director Jonathan Spier. The headsets are cellphone-sized video screens with sensors that detect where in the scene the viewer's gaze is directed, and the video software shifts the scene in a way that simulates the perspective of a user scanning left or right, up or down. The user can choose from a library of video scenes by peering at a menu at the lower edge of their field of vision. Experts believe virtual reality is well-suited to former soldiers whose age or service injuries make travel difficult. Therapists say the technology can not only help them overcome physical limitations, but also address the depression that can come as people transition from independent lives to the confines of nursing communities.

A review of 198 studies published in Psychological Medicine determined that poor mental or physical health, problems such as agitation or apathy, and unmet needs are tied to poor quality of life for people with dementia, reports HealthDay News . Variables the researchers associated with better quality of life included positive relationships, social engagement, better daily functioning, good physical and mental health, and high-quality care. They saw no association between gender, education, marital status, income, age, or type of dementia with quality of life. "We now need to develop ways to put these findings into action to make a difference to people's lives by supporting relationships, social engagement, and everyday functioning, addressing poor physical and mental health, and ensuring high-quality care," says University of Exeter Professor Linda Clare.

Living apart together (LAT) is a relationship among older couples that is starting to draw interest from researchers, with a 2005 survey by the National Social Life, Health, and Aging Project noting 7 percent of individuals between 57 and 85 years old described themselves as being in a LAT situation, reports Kaiser Health News . Meanwhile, a more recent analysis of about 7,700 Wisconsin adults age 50 and older surveyed found married couples made up 71.5 percent of that group, singles accounted for 20.5 percent, and people who were "partnered but unmarried" comprised 8 percent. Thirty-nine percent in the third cohort were in LAT relationships, versus 31 percent who were dating and 30 percent who were cohabiting. "Older adults really see LAT as a lifestyle choice, not a relationship of convenience," says University of Missouri Professor Jacquelyn Benson. Her 2016 study published in Family Relations of 25 older adults in LAT relationships found various drivers, including desire for "intimate companionship" while maintaining their own homes, social circles, customary activities, and finances. Divorcees or people in unhappy earlier marriages did not want to tie themselves down again and preferred a degree of distance to day-to-day companionship. Furthermore, several women who were previously caregivers for sick parents or husbands wanted to avoid such responsibilities again.