A new study published in the European Journal of Clinical Pharmacology suggests prescribing patterns for antidepressant treatment can play a role in increasing risk for suicidal behavior in older adults, reports Medscape . More than 185,000 Swedish residents aged 75 years or older who initiated antidepressant treatment late in life participated, and the investigators noticed three prescription patterns associated with both suicide and suicide attempts. Those patterns indicated that 14.8 percent of the participants used two or more antidepressants, and 50.8 percent concomitantly used other psychiatric medications. Of this latter cohort, 32 percent used hypnotics, 19.9 percent used anxiolytics, 7.6 percent used antipsychotics, and 5.8 percent used antidementia drugs. A total of 295 completed suicides and 654 suicide attempts occurred in the follow-up period. The incidence rates of suicides and attempts for women were 25 and 94 per 100,000 person-years, respectively, and 106 and 167 per 100,000 person-years for men. The adjusted subhazard ratios for participants who switched to another antidepressant treatment compared to those who did not were 2.42 for suicides and 1.76 for attempts. Those who concomitantly filled prescriptions for hypnotics were at a substantially higher risk for both suicide and attempts, while those also using antipsychotics were at a higher risk for suicide, but not suicide attempts. Takers of antidementia drugs plus antidepressants had a significantly decreased risk for suicide attempts.

A 2017 survey from RAND Corporation, the non-profit research firm, found almost 40 percent of workers over 65 had previously, at some point, retired, reports the New York Times . Dr. Nicole Maestas, an economist at Harvard Medical School, used longitudinal data from the national Health and Retirement Study to find that the decision to resume working does not usually stem from unexpected financial problems or health expenses. "It looks like something people are doing intentionally, instead of an oh-my-god response: 'I'm running out of money; I have to go back to work,'" she said. "It's much more about a choice." Longer lives, better health, and less physically taxing jobs than in previous generations help provide that choice, Dr. Maestas pointed out.

Harvard Business School Professor Susanna Gallani notes companies frequently hold "tournaments" based on relative performance to incentivize employees, but how motivated workers are to improve performance may hinge on how fair they perceive them to be, reports Working Knowledge . A study Gallani co-authored determined those perceptions can have a lot more to do with how employees are encouraged than the actual consequences they receive. Given it is impossible to specify how employees' roles will need to expand to meet every contingency, employers rely on employee motivation to exceed the contract and do what is in the best interest of the company. In some instances, tournament incentives are organized so that when some workers succeed, others fail. Gallani says the determination of winners and losers in such a reward system is seldom based on purely objective measures, and to compensate managers often add subjectivity into the competition to even out the scores by weighing factors that might be outside of the control of the employees or contingencies not foreseeable at the time the worker signed the contract. But although subjectivity can improve the performance evaluation's accuracy, it also could be susceptible to bias. Tests showed that employees were more motivated by the feeling of getting an unexpected bonus or penalty than actually getting a bonus or penalty they earned, possibly because they saw it as a result of bias either for or against them by their bosses.

Findings from Netflix about subscribers' viewing habits can be applied to low levels of employee engagement, reports journalist Roger Trapp in Forbes . Netflix found more than 33 percent of its U.S. watchers and 20 percent of those in Britain admitted to watching their favorite shows on the job. "It is just that now — thanks to technology — demotivated employees have something else they can do when they are not sufficiently excited by what they are supposed to be doing," Trapp writes. "Sitting in front of a screen, the modern employee simply has many more options than his or her forebear, who was largely restricted to simple repetitive tasks on a production line." Trapp cites the work of Rasmus Hougaard and Jacqueline Carter, which calls on leaders to be mindful of their own needs with a view to making themselves more capable of providing the kind of leadership required in the modern world. "Leaders who adopt the approach they advocate are more likely to put people at the center of their organizations and as a result meet their needs for being connected, having meaning, being valued and being happy," Trapp says. "It all sounds beguiling and it, of course, makes sense that happy people are more likely to work harder and more effectively. But will being happy at work stop them trying to sneak a look at the latest Netflix hit?"

A study published in Nature Communications indicates that the daily consumption of the nicotinomide riboside (NR) dietary supplement emulates caloric restriction (CR), reports ScienceDaily . Twelve out of 24 lean and healthy people ages 55 to 79 were given a placebo for six weeks, then administered a 500 mg twice-daily dose of NR chloride, while the other 12 took NR for the first six weeks, followed by placebo. The researchers determined 1,000 mg daily of NR boosted levels of nicotinamide adenine dinucleotide (NAD+) by 60 percent. NAD+ is essential for activation of sirtuin enzymes that play a large role in beneficial CR effects. "The idea is that by supplementing older adults with NR, we are not only restoring something that is lost with aging (NAD+), but we could potentially be ramping up the activity of enzymes responsible for helping protect our bodies from stress," says University of Delaware Professor Chris Martens. The study also found in 13 participants with elevated blood pressure or stage 1 hypertension, systolic blood pressure was about 10 points lower following supplementation. The researchers think such CR-mimicking compounds could provide another option, in addition to recommended dietary changes and exercise, for people whose blood pressure is not yet sufficiently elevated to warrant medication but who are still at risk for a heart attack.

A survey published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association determined stigma associated with Alzheimer's disease may discourage Americans from learning about their risk and from participating in clinical trials for potential new treatments, reports HealthDay News . Researchers gave a random sample of 317 adults a hypothetical description of someone with mild cognitive impairment or dementia from Alzheimer's, and told them the person's condition would worsen, improve, or stay the same. Fifty-five percent of respondents expected the subject would be discriminated against by employers and excluded from medical decision-making, and 47 percent thought data in the individual's medical records would lead to limits on their health insurance. Those numbers climbed when respondents were told that the person's condition would worsen over time; and when they were told the subject would improve, 24 percent to 41 percent fewer respondents said they expected discrimination or exclusion from medical decisions. "Concerns about discrimination and overly harsh judgments about the severity of symptoms were most prevalent," says the University of Pennsylvania's Shana Stites. The survey implied that advances in therapies to improve the prognosis of people with Alzheimer's could help reduce stigma. "By understanding what the biggest concerns are about the disease, we can help develop programs and policies to reduce the stigma," Stites says.

President Trump has ousted Veterans Affairs (VA) Secretary David Shulkin and nominated his personal physician, Rear Adm. Ronny Jackson, as his replacement, reports Reuters . VoteVets' Will Wischer noted his group hopes Jackson will block any attempt to privatize the VA or its health services. "If Dr. Jackson can do that, immediately, he will do a lot to help his chances at confirmation," he said. The VA delivers care at more than 1,200 facilities, including 170 VA Medical Centers, to more than 9 million veterans.

Companies are using artificial intelligence (AI) for help with hiring and firing, as well as to gauge employees' feelings toward their bosses, reports the Wall Street Journal . For example, SPS Companies is using the AI-based Xander software to rate responses to employee surveys. The software analyzes text to interpret open-ended questions based on language and other data, tagging employees with attitudes or opinions. Some employers also are using software to read differences between what employees say and how they feel. Xander helped First Horizon National rapidly analyze worker poll feedback to gain insights much faster than human resource staffers could. A Deloitte study estimates that more than 40 percent of employers worldwide have implemented AI processes of some kind, but regulators are lagging behind such deployments. The availability of AI tools to help companies make hiring, firing, and compensation decisions are worrisome for employees who do not like the idea of being psychoanalyzed by software, while employment attorneys are concerned that AI programs might contain prejudices that could lead to workplace discrimination. Lawyer Garry Mathiason says any algorithmic bias is likely to have an outsize impact on minorities and other protected classes of workers. Meanwhile, the Equal Employment Opportunity Commission has yet to issue official rules governing how AI can be used in HR decisions, and a 2016 panel concluded that the technology can potentially create new barriers for opportunities.

GOP aides on Capitol Hill say the House Energy and Commerce health subcommittee will hold the last of three major hearings to address the opioid crisis on April 11, and it hopes to bring a legislative package to the floor before the Memorial Day break, reports STAT . The hearing will center on insurance coverage, payment issues, and prescription regulations for Medicaid beneficiaries. "It's part of our bipartisan, comprehensive effort to deliver relief to every American community, which continues to battle this costly epidemic," says subcommittee Chairman Rep. Greg Walden (R-Ore.). "Time is of the essence and we are working across the aisle to get legislation to the President's desk as quickly as possible." Bills to be discussed include requirements for state Medicaid providers to integrate prescription drug monitoring programs into their clinical workflow to guarantee that pharmacists and providers contracting through Medicaid check a database on a per-beneficiary basis prior to dispensing a controlled substance. In addition, state Medicaid providers would be mandated to enforce limits for "at-risk" beneficiaries who have filled opioid prescriptions at multiple pharmacies or otherwise drawn scrutiny from state drug-utilization review programs. The bill would ensure they cover all beneficiaries, including those using managed care programs.

A new report released by Sen. Claire McCaskill (D-Mo.) says the costs for each of the 20 most-prescribed brand-name drugs for older adults have risen dramatically every year for the past five years, reports The Hill . The prices rose by an average of 12 percent every year for five years, nearly 10 times higher than the rate of inflation. A dozen drugs had prices increase by more than half, six had increases of more than 100 percent, and one drug's cost soared 477 percent. The drug's maker, Pfizer, refuted that number, saying its price increased 228 percent. In addition, prescriptions for top brand-name drugs fell by 48 million and revenue rose by $8.5 billion over the last five years. "This report demonstrates that the pricing decisions made by these drug companies are outrageous," McCaskill said. In 2013, the latest year for which data was available, prescription drugs comprised nearly $1 in every $5 that Medicare beneficiaries spent out-of-pocket on healthcare services. Democrats are demanding that Medicare negotiate directly with drugmakers on prices, while Republicans want to introduce more generic drugs to boost competition in the market. McCaskill is one of several bipartisan sponsors of legislation to ban "pharmacy gag clauses" that can hide potential savings on prescriptions from consumers at the pharmacy counter.