A study from the American Heart Association published in Circulation predicts the cost of informal caregiving for Americans with heart disease and stroke will increase more than twofold from $61 billion in 2015 to $128 billion by 2035, raising the association's predicted 2035 price tag for cardiovascular disease (CVD) total costs to $1.2 trillion a year, reports Medical Xpress . "By 2035, the number of Americans living with heart disease and stroke will rise to 131.2 million — 45 percent of the total U.S. population," says American Heart Association CEO Nancy Brown. "Understanding the escalating burden this will place on the family members and friends who care for these individuals is essential if we are to address this looming crisis." The association cites five steps for policy officials, lawmakers, and healthcare leaders to follow to address this crisis, starting with complying with recommendations from the National Academies of Sciences, Engineering, and Medicine, which call for developing mechanisms within Medicare, Medicaid, and Veterans Affairs to support informal caregivers; setting up payment reforms to spur providers to engage caregivers in healthcare delivery and federal policies that provide economic support for caregivers; and vetting state efforts that address caregiver needs. The other steps include making palliative care available for people with advanced CVD by expanding access in all hospital and community-based settings, embedding caregiver engagement and outcomes in performance and payment reforms, putting more funding into caregiving research and focusing on priorities such as healthcare delivery reforms, and deploying the Recognize, Assist, Include, Support, and Engage Family Caregivers Act.

The Brittingham Social Enterprise Lab run by University of Southern California (USC) undergraduates is this year concentrating on creating products for seniors by following a human-centered design model, reports USC News . "This isn't sort of market research," says lab founder Adlai Wertman. "This is a much deeper dive into understanding communities." Brittingham Executive Director Abby Fifer Mandell notes the community the lab is currently focusing on belongs to the ONEGeneration Senior Enrichment Center, which serves older adults living below the poverty line. "As a country, we haven't tended to the housing needs, the health needs, the consumer goods, the emotional needs ... of this population that will soon be the single largest population in this country," Mandell says. Wertman notes the community is planning an alliance with the USC Leonard Davis School of Gerontology to produce business opportunities within the world of seniors. During the current semester, teams of students are developing prototypes. One team is developing incontinence underwear for older women based on senior feedback, and Mandell praises their work and that of the other Brittingham teams. "They are having these paradigm-shifting, attitude-changing encounters with populations of people they might not engage with," she says.

Older travelers are increasingly interested in taking classes, volunteering, or working abroad as part of their trip, reports the New York Times . Diversity Abroad founder Andrew Gordon says older travelers often want to continue to learn and have an impact on the world, and his company connects and advocates for nontraditional students who want to study overseas. Meanwhile, the nonprofit Road Scholar has started offering educational travel adventures worldwide. Participants may focus on a specific ecosystem they are visiting, attend class on a college campus, or spend 115 days going around the world on an ocean liner with experts researching destinations' histories and cultures. The average age of such "road scholars" is 70, and the company provides family caregiver grants and other scholarships. "We had seen a decline in enrollment for programs heavily weighted to classroom time," says Road Scholar's JoAnn Bell. "People want to get out and experience the country for themselves." GoAbroad.com's Megan Lee notes there has been growth in searches for activities targeting people in their 30s through retirement age. "There's an increase in searches for 'adult gap year,' 'adult study abroad,' 'retirement volunteer abroad,' and even 'adult intern abroad,'" she says. Furthermore, an AARP study observed that at least half of travelers in all age groups were interested in "authentic" international experiences such as touring or dining with locals. Lee stresses programs for older adults should be customized to their needs.

Scientists are proposing a new way to define Alzheimer's disease that is based on biological indicators instead of memory loss and other standard symptoms, reports Medical Xpress . Their goal is to improve research by using more objective criteria such as brain scans to choose study subjects and enroll them sooner in the course of their illness, when therapy may be more effective. The Mayo Clinic's Dr. Clifford R. Jack Jr. led an expert committee, working with the Alzheimer's Association and the National Institute on Aging, to update Alzheimer's guidelines recently published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association . The guidelines outline the use of amyloid and tau proteins over a spectrum of mental decline, starting with early brain changes, through mild impairment and dementia. Jack advises people who are concerned and want such tests for themselves or a family member to refrain from getting them, because "there's no proven treatment yet." Instead, he suggests anyone with symptoms or family history of dementia, or even healthy people worried about the risk, should enroll in one of the many studies underway. "We need more people in this pre-symptomatic stage" to determine if treatments can help ward off decline, says Dr. Eliezer Masliah at the Institute on Aging.

A study from the University of Southern California (USC) and Yale University published in Demography found Americans appear to be aging slower than before, which may help explain recent increases in life expectancy, reports HealthDay News . The researchers compared how biological age changed in the United States compared to chronological age, investigating national health surveys conducted in 1988-1994 and 2007-2010. "This is the first evidence we have of delayed 'aging' among a national sample of Americans," says USC Professor Eileen Crimmins. Older adults had the highest gains in biological age, while men experienced greater declines than women. These differences were partly accounted for by changes in smoking, obesity rates, and medication use. "While improvements may take time to manifest, and thus are more apparent at older ages, this could also signal problems for younger cohorts, particularly females, who — if their improvements are more minimal — may not see the same gains in life expectancy as experienced by the generations that came before them," says Yale University Professor Morgan Levine. The researchers also observed that the pace of aging and increasing longevity could have major social and economic ramifications. "Life extension without changing the aging rate will have detrimental implications," Levine warns. "Medical care costs will rise, as people spend a higher proportion of their lives with disease and disability."

WeSpire's sixth State of Employee Engagement report indicated a decline in the number of companies that are engaging employees in sustainability strategy, reports GreenBiz . Possible reasons for this slippage could be employee unawareness of company sustainability programs, participants lagging behind specialized, role-based engagement programs, a loss of "ownership" for engagement among sustainability teams, and too few companies measuring and communicating the business benefit of sustainability engagement. Suggested remedies for the first problem include the company viewing the engagement program as a vital effort worth communicating about regularly through various channels. To meet the second challenge, the recommendation is to include implementing role-based imperatives focused on employees with the ability to drive significant material impact; broader work-related projects to fuel innovation, and culture change; and personal activities that feel like the company cares about the employee at home and at work. Solving the third problem entails first unifying the design and delivery of engagement efforts, and then having each engagement area appoint or maintain a manager to make sure that the specific programming content is accurate and that the measurement strategy is in alignment with goals. Tackling the fourth challenge involves giving employees the means to understand the impact sustainability and other engagement programs are having on human resources by connecting program participation to employee engagement scores.

A study published in Circulation suggests staying physically fit can help stave off heart trouble, even if your genetics put you at higher risk for cardiovascular disease, reports HealthDay News . The examination of about 500,000 middle-aged and older adults determined people with higher fitness levels were less likely to develop heart disease over six years, even among those who carried gene variants that raise the odds of heart problems. "It's likely that if you try to improve your fitness level through exercise, you'll benefit," says Stanford University Professor Erik Ingelsson. The researchers studied how people's fitness levels correlated with their risk of developing heart disease over the next six years. Irrespective of the genes people carried, higher fitness levels meant a lower risk of heart trouble. The one-third of people with the highest scores were considered high risk, while one-third were deemed intermediate risk, and the rest low risk. Among the 33 percent of people at highest genetic risk, those with the highest fitness levels were 49 percent less likely to develop coronary heart disease, versus the least fit. They also were 60 percent less likely to develop atrial fibrillation. Ingelsson's team assigned each person a "genetic risk score," based on whether they carried various genetic variants that have been tied to heart disease risk. Over six years, slightly fewer than 21,000 people suffered a heart attack, atrial fibrillation, or other cardiovascular complications. People in the high genetic risk cohort were 77 percent more likely to develop coronary heart disease compared to people at low genetic risk.

A study published in the Journal of the American Geriatrics Society found using anti-epileptic drugs elevates the risk of developing Alzheimer's disease and dementia, reports Medical Xpress . The continuous use of anti-epileptic drugs for a period exceeding 12 months was associated with a 15 percent higher risk of Alzheimer's disease in a Finnish dataset, and with a 30 percent greater risk of dementia in a German dataset. Comparison of different anti-epileptic drugs determined the risk of Alzheimer's and dementia was associated with drugs that impair cognitive function, which carried a 20 percent increased risk of Alzheimer's and a 60 percent increased risk of dementia. A higher dose of a drug that impairs cognitive function also raises the risk of dementia, although anti-epileptic drugs that do not impair cognitive processing were not associated with the risk. "More research should be conducted into the long-term cognitive effects of these drugs, especially among older people," argues Heidi Taipale from the University of Eastern Finland.

Dental care is not covered by traditional Medicare, even though half of beneficiaries have some form of periodontal disease or infection of structures around teeth, including the gums, reports the New York Times . Furthermore, paying for dental care out of pocket is difficult for many beneficiaries. Half have yearly incomes of less than $23,000, while tens of thousands of Americans go to Mexico each year for dental work for less cost. A study published in Health Affairs found in a given year, 75 percent of low-income Medicare beneficiaries do not receive any dental care at all, compared to about 25 percent of higher-income beneficiaries. "The separation of coverage for dental care from the rest of our healthcare has had dramatic effects on both," says Amber Willink at Johns Hopkins Bloomberg School of Public Health. "As a consequence of avoidable dental problems, the Medicare program bears the cost of expensive emergency department visits and avoidable hospitalizations. It's lose-lose." Traditional Medicare will only cover dental procedures that are integral to other covered services. Willink's study estimated that a Medicare dental benefit that covered 75 percent of the cost of care would boost Medicare premiums by $7 a month, or about 5 percent; the rest would need to be funded by taxes. The cost of such a benefit might be partly countered by reductions in other healthcare spending.

People are increasingly going to retail clinics and urgent care centers in strip malls or shopping centers, where simple health needs can usually be met by professionals at far less expense than in a doctor's office, reports the New York Times . Meanwhile, office visits to primary care doctors fell 18 percent from 2012 to 2016, even as visits to specialists rose, according to analysis of insurance data by the Health Care Cost Institute. New mergers between insurers and major corporations also are straining small practices and threatening them with extinction. "With all of these deals, there is so much we don't know," says American Academy of Family Physicians President Dr. Michael Munger. "Are Aetna beneficiaries going to be mandated to go to a CVS MinuteClinic?" Physicians such as Pennsylvania pediatrician Dr. Susan Kressly are worried about losing customers to retail clinics or urgent care centers, while even more concerning is the risk of such customers receiving inappropriate treatment at those outlets. Dr. Mark J. Werner with the Chartis Group warns the convenience of care at such clinics is not equal to quality, nor is less expensive care. Opponents of retail clinics say customers are given short shrift by health professionals unfamiliar with their history, and may receive unnecessary prescriptions. However, researchers argue neither has been proved in studies.