The Medicare Diabetes Prevention Program launched on April 1 seeks to prevent seniors and other disabled individuals from developing Type 2 diabetes, but experts say the program's road has been rough so far, reports the Washington Post . They note the program is currently up and running at only few sites, and finding out where it is available is problematic. The program is freely available to older adults and disabled people with Medicare Part B coverage who have prediabetes. Community organizations such as YMCAs and senior centers will supervise the program instead of doctors and hospitals, but many locations are grappling with Medicare's contracting mandates and are reticent to take on burdensome administration, says Brenda Schmidt with the Council for Diabetes Prevention. Although Medicare Advantage plans are now obligatory for offering the program to beneficiaries, they are not doing active outreach due to a lack of program sites. The Centers for Disease Control and Prevention's Ann Albright says patience should be exercised, as building an infrastructure of community organizations to deliver these services "hasn't been done before." Meanwhile, a Centers for Medicare & Medicaid Services spokesperson says approximately 50 of more than 400 eligible programs are currently submitting applications, while an online resource identifying approved programs is being developed and outreach to Medicare beneficiaries is "planned for the coming months."

The U.S. Preventive Services Task Force (USPSTF) recommends that older adults avoid taking vitamin D and calcium supplements and instead perform exercises to improve balance and coordination so as to prevent falls and fractures, reports Reuters . "Vitamin D should not be taken to prevent falls in older adults, and lower doses of vitamin D and calcium do not prevent fractures in postmenopausal women," says USPSTF Vice Chair Alex Krist. "If healthy people are taking vitamin D solely for these reasons, they should probably stop. We know that there are more effective interventions for people concerned about falls, like exercise." Getting vitamin D and calcium from foods has been associated with a lower risk of osteoporosis, which can contribute to falls and fractures among older adults. However, the USPSTF says there is insufficient evidence to determine the benefits and drawbacks of taking vitamin D or calcium supplements to prevent fractures in men or women who have not experienced menopause. "Our findings suggest that while vitamin D may possibly prevent people with known vitamin D deficiency from falling, the evidence to-date does not support a benefit on fall prevention in the general population of older adults, and it appears that mega-high doses of vitamin D can actually cause harm," says the University of Washington's Janelle Guirguis-Blake.

The Office of Personnel Management (OPM) inspector general has recommended OPM devise a backup plan for the Federal Long Term Care Insurance Program (FLTCIP) after an audit of a bid process that produced only one application to administer the plan, reports Government Executive . In 2015, OPM opted to let its contract with John Hancock Life and Health Insurance expire after the company determined it needed to raise premiums to fully fund the FLTCIP. However, at the conclusion of the bid process, John Hancock was the sole bidder to administer the program, and it got a new seven-year contract. In August 2015, the insurer imposed premium hikes for new enrollees, which varied wildly depending on a participant's age and choice of plan. Premiums for existing participants rose by an average of 83 percent in November 2016, after John Hancock was granted a new contract. Although the inspector general found OPM followed all federal regulations during its year-long bidding process in the intervening years since FLTCIP was founded, the market for long-term care insurance has practically dissolved. "Considering the rapidly changing environment of the long-term care insurance industry, OPM should develop a contingency plan to prepare for future FLTCIP procurement challenges," the inspector general urges. "Although some changes may require regulatory or legislative actions, OPM should be proactive in planning for any changes that could arise in the future."

An op-ed published in JAMA by economists Jonathan Skinner at the Dartmouth School of Medicine and Amitabh Chandra at Harvard University shows a strong correlation between employment and spending in the healthcare sector, and they warn job growth is due to suffer for the sake of cost control, reports FierceHealthCare . The authors note rising employment among healthcare organizations is closely linked to cost growth, and the nonprofit status of many systems frequently leaves fewer places to divert excess profits outside of service expansion. Moreover, technological innovations in medicine have raised demand for additional employees. The authors refer to an annual 2.1 percent boost in healthcare jobs in the United States between 2013 and 2017, when costs climbed to 18 percent of GDP. The concurrent rise in the cost of care has mitigated its positive effects of job growth overall. "The challenge of job gains in the healthcare sector is higher healthcare costs, job loss in other sectors ... and stagnant take-home pay for those who manage to keep their jobs," Skinner and Chandra say. On account of this, the U.S. push to control healthcare costs will eventually demand slower job growth industry-wide. Skinner and Chandra advise human resources department to start preparing by exercising restraint in their current hiring and seeking out better efficiency. "The urge to expand employment using unexpectedly healthy profit margins should be resisted because it is easier to create new positions than it is to lay off workers in a less sanguine future," they say.

A study published in Psychological Science sought to determine whether persistent negative feelings over daily stresses impacts long-term health, via analysis of data from a nationwide survey of more than 1,100 adults, reports the National Institutes of Health . Participants answered questions about the number and type of daily stressors they experienced over 24 hours, then rated how often they felt different emotions during that day on a scale of 1 to 4. About a decade later, the participants answered questions about their physical health, concerning whether they had experienced any of 26 chronic illnesses in the last year, or heart disease or cancer. They also were asked about their ability to perform day-to-day activities, and to rank how much they felt their health interfered with these activities on a scale of 1 to 4. Participants who continued to experience negative feelings the day after a stressful event, on days without a stressful event happening, exhibited more chronic physical health conditions and limitations in their daily activities a decade later. "This means that health outcomes don't just reflect how people react to daily stressors, or the number of stressors they are exposed to — there is something unique about how negative they feel the next day that has important consequences for physical health," says the University of California, Irvine's Kate Leger. "Stress is common in our everyday lives. It happens at work, it happens at school, it happens at home and in our relationships. Our research shows that the strategy to 'just let it go' could be beneficial to our long-term physical health."

The documentary Still Dreaming chronicles how a group of former actors collaborated to stage a production of A Midsummer Night's Dream at the Lillian Booth Actors Home, reports Next Avenue . In the movie Ben Steinfeld and Noah Brody, two founders of Fiasco Theatre in New York City, guide their actors along an occasionally rough course from auditions to the final performance. The actors, some of whom have Alzheimer's, Parkinson's, and other medical conditions, are offered the opportunity to revitalize their passion for performing, all while memorizing lines of Shakespeare, in order to present the play for their families and fellow residents. "Even though Noah and Ben really had no idea what they were getting into, they always brought high expectations for the people involved to be honest actors," says filmmaker Jilann Spitzmiller. "It was very exhausting for them, but it was admirable how they were really able to pull it off." Co-filmmaker Hank Rogerson says the intergenerational element of featuring young directors was appealing to him and Spitzmiller. "That's a really important part of creative aging and working with older adults," he notes. "It creates a nice dialogue and a positive experience."

Author Raymond Pole wrote about his personal experiences during World War II as a young boy being evacuated from London in 1939 in his book The Evacuee Who Became a St. Ivian , reports Silverado . Pole currently lives with Alzheimer's, and a Silverado team arranged to celebrate his accomplishment with a book signing event. Such an event exemplifies Silverado's philosophy at work, in which dignity and a fulfilling existence come from celebrating abilities, not limitations. The joy that Pole and his wife experienced at the event are the moments that inspire what the Silverado team does.

Former first lady Barbara Bush's recent announcement of her decision to seek "comfort care" coincides with a national push to define and document older persons' wishes, and consider alternatives, before they are subjected to medical interventions aimed at prolonging life, reports Kaiser Health News . "It makes perfectly good sense at her age, with her failing health, that she would say at some point, 'Life's been good, and while you always want more, it's enough,'" says Dr. Joanne Lynn at Altarum Institute. However, Dr. Haider Warraich at Duke University Medical Center says the Bush family announcement also sows confusion about the meaning of comfort care, with the suggestion that it involves the cessation of medical treatment. Palliative care experts have been refuting that mischaracterization on Twitter. "One of the common myths about palliative care is that they are being denied medical help," Warraich notes. He says comfort care for people with heart failure typically means opting not to use a breathing machine or CPR. Yet recipients still receive medical treatment, including morphine to ease shortness of breath, and diuretics to remove excess fluid from their lungs. "By bringing this into the sphere of discussion, we can start thinking about comfort and palliation long before they are in the clutches of death," Warraich argues.

The United States is currently dealing with a severe worker shortage, reports the Wall Street Journal , prompting businesses of all sizes to explore the labor market's youngest echelon. Employers ranging from General Electric to Michelin North America Inc. are expanding their hunt to teens. In March, the 12-month average unemployment rate for teens was 13.9 percent, the lowest year-round average since 2001. Some employers are plucking skilled students from high school vocational programs. Others are dropping age and experience requirements so they can consider teens. Teens' median pay is half that of older adults, and they typically do not demand perks such as healthcare benefits or retirement contributions. They hone skills learned at high schools, which are beginning to re-emphasize technical education amid worries about student debt at four-year colleges. This comes as the share of working teenagers is increasing for the first time since the 1990s, to 30.7 percent last month.

Baltimore Mayor Catherine E. Pugh and Baltimore City Health Commissioner Dr. Leana Wen have announced a new citywide falls prevention strategy to lower fall-related emergency department (ED) visits and hospitalizations for older adults in Baltimore, reports the Baltimore City Health Department . The strategy will supply leaders, partners, and the general public with information on where falls are occurring and where to locate interventions and resources to prevent future falls for all of Baltimore's older adults. The strategy will concentrate on mapping where falls are occurring throughout the city via near-real-time hospital data, targeting fall prevention activities in areas of high fall numbers and rates, and educating the general public that falls can be prevented and resources are available. Almost 5,000 older adults in Baltimore visited the ED last year because of a fall, and falls-related ED visits in the city top the statewide average by more than 20 percent. The city's rate of falls-related hospitalizations also is 55 percent higher than the state's. The average cost of a fall-related hospitalization is $39,000, or $60 million a year in Baltimore City. "Our citywide strategy uses innovative, evidence-based methods to go to where people are, by using science to map out where falls are occurring, providing holistic services such as help with medications and housing interventions, and educating residents on how to prevent falls," said Dr. Wen. "The Baltimore City Health Department is glad to convene partners across all sectors and lead this collective impact strategy to improve health."