A study of older adults in the United States, Canada, and Australia published in the Journal of the American Geriatric Society found the use of benzodiazepine among seniors "remains inappropriately high — particularly in those aged 85 and older — which warrants further attention from clinicians and policy-makers," reports Medscape . Using prescription claims data from the U.S. Department of Veterans Affairs, the Ontario Drug Benefit Program, and the Australian Pharmaceutical Benefits Scheme, the researchers analyzed annual incident and prevalent benzodiazepine use among people 65 or older between January 2010 and December 2016. The entire cohort included more than 8.2 million individuals. There was a significant and linear decline in prevalent benzodiazepine use in all three countries during the study period. It declined from 9.2 percent to 7.3 percent in the U.S., from 18.2 percent to 13.4 percent in Ontario, and from 20.2 percent to 16.8 percent in Australia. Incident use of benzodiazepine also fell significantly in the U.S. and Ontario, but its decline in Australia was nonsignificant. Nevertheless, the team says "in spite of consistent messaging about the hazards of using benzodiazepines in this population, the rates of benzodiazepine use in older adults remain high," perhaps associated with a tendency by both clinicians and recipients to minimize the risk these drugs pose. High use among the oldest adults in Canada and Australia was especially worrisome, given the greater potential for harm in this demographic.

The Center for American Progress proposed a new initiative dubbed "Medicare Extra for All," which would build on Medicare to guarantee coverage to consumers, reports the Associated Press . Preventive care, treatment for chronic disease, and generic prescription drugs would be free. Employers and individuals would have a choice of joining Medicare Extra, but it would not be required. Low-income people would pay no premiums or copays, which for others would be determined according to income. Medicare Extra would use Medicare's payment system as a framework to pool working-age people and their families, low-income people now covered by Medicaid, and older adults. The plan's authors acknowledge significant tax increases would be required. Options include rolling back some of the recently enacted GOP tax cuts for corporations and upper-income people, raising Medicare taxes on upper-income earners, and higher taxes on tobacco and sugary soft drinks.

A study published in the International Journal of Geriatric Psychiatry demonstrated that a creative in-home intervention to support couples affected by dementia can improve both caregiver and recipient communication behaviors in only 10 weeks, reports ScienceDaily . The Caring About Relationships and Emotions intervention was designed to boost helpful communication in the caregiver and sociable communication in the recipient, as well as to reduce disabling behavior in the caregiver and unsociable behavior in the recipient. Couples were given a manual at the beginning of the intervention with 10 weekly modules on various communication issues. Researchers met weekly with the recipient and caregiver separately, followed by a meeting with the couple together. The couples were asked to talk unobserved while being videotaped for about 10 minutes on a topic of their choosing at the end of the session. The team evaluated caregivers' learning needs, boosted their communication self-awareness, knowledge about communication decline in dementia, common care receiver emotional reactions to lost abilities, and how to use communication strategies to maintain a caring relationship. Researchers also conversed weekly with care recipients to encourage them to voice their thoughts, feelings, preferences, and needs. "This intervention is important because there are no other programs specifically developed for couples where one has Alzheimer's disease or dementia," says Florida Atlantic University Professor Christine L. Williams. "While marital counseling is available, it's very different when you have one partner who is losing their ability to communicate. We don't teach families how to communicate with someone with dementia and it is desperately needed."

Some companies are discarding parental-leave policies that encode distinctions between mothers and fathers, arguably holding women back at work and relegating men to secondary roles at home. Instead, they are offering gender-blind time off for all new parents. The companies are now framing the first months of a baby's life as a time for mothers and fathers alike to bond with their children and establish a more equal sharing of responsibilities, reports the Wall Street Journal . Such policies are rare in the United States, the only industrialized nation with no federally mandated paid parental-leave policy. The advantages of a gender-blind approach extend far beyond the baby. There is mounting evidence that women's professional and economic prospects are hampered when mothers bear a greater share of home and family duties than their partners.

The Administration for Community Living has drafted a new issue briefing entitled The Opioid Public Health Emergency and Older Adults . It states that opioid misuse and addiction has become a national issue that extends to people of all ages, income classes, ethnicities, races, genders, and geographic areas. Older adults are included in this demographic because they frequently use prescription opioids to deal with painful chronic conditions, such as arthritis, or procedures, such as surgery. Chronic pain may spur older adults to use prescription opioids in the long term, which creates a risk for developing an opioid use disorder. Furthermore, as people get older, medications affect them more strongly and are slower to leave their systems, potentially increasing the severity of opioids' side effects. Death, hospitalization, and use of emergency departments are among the risks older adults face. The National Aging Network offers opportunities to teach older adults about opioids and bring them into contact with useful resources when they seek to reduce or eliminate use of opioids and obtain treatment if they have developed an opioid use disorder. Education resources are accessible from the Centers for Disease Control and Prevention and the Substance Abuse and Mental Health Services Administration. Treatment resources include federal programs such as Medicare, which covers various treatments for substance use disorders. Medicaid treatment coverage also is available, while the Veterans Health Administration could help veterans access to treatments for the disorders and to non-opioid treatments for pain. The issue briefing is available here .

A study published in the Annals of Internal Medicine examined the effects of opioids on the human immune system, reports the New York Times . The research team examined 1,233 people with invasive pneumococcal disease, which is fatal in about 10 percent of cases, with higher death rates among seniors. These subjects were compared with 24,399 controls. Persons with invasive pneumococcal disease were 62 percent more likely than those in the control group to be using prescription opioids. The linkage was strongest for high-potency drugs such as oxycodone and for long-acting drugs such as methadone and transdermal fentanyl. The study controlled for factors that included sex, race, alcohol use, cardiovascular disease, and diabetes. "We can't say that there's proof of a causal link here," notes Vanderbilt University's Andrew D. Wiese. "But providers should consider these findings when deciding whether to prescribe opioids, and in choosing what formulation to use. That's true for anyone, but especially for those we know are already at high risk for infection, like older adults."

A study published in the Journal of the American Geriatrics Society has determined how people with Alzheimer's disease use medical services during their final months, reports Medical Xpress . The team studied information from more than 1,100 people with Alzheimer's living in Belgium who died in 2012, comparing two cohorts diagnosed with the disorder. One cohort had death certificates that listed Alzheimer's as the cause of death, while the other included individuals diagnosed with Alzheimer's but whose certificates listed a different cause. Seventy-seven percent of the subjects had something other than Alzheimer's listed as the cause of death on their certificate, while 22 percent, average age 85 and mostly women, died of Alzheimer's disease. Individuals who died with Alzheimer's were more likely to have had at least one hospitalization and more intensive care unit (ICU) stays. People in both cohorts had about 12 visits with a physician in the last six months of their lives. However, those who died with Alzheimer's received fewer palliative care services, and spent fewer days in a nursing community. People whose cause of death was listed as something other than Alzheimer's also were more likely to have invasive procedures versus those who died of Alzheimer's. The conclusion was that older adults whose cause of death was Alzheimer's used fewer healthcare resources than individuals whose cause of death was listed as something else even though they had been diagnosed with Alzheimer's.

A study published in Neurology details how simple walking tests can accurately diagnose a form of dementia that may sometimes be reversed when spotted early and quickly treated, reports CNN . Idiopathic normal pressure hydrocephalus (iNPH) affects seniors' walking ability and mobility, and mild cognitive impairment or dementia can be additional symptoms. The study suggests the walking test can differentiate iNPH from progressive supranuclear palsy (PSP) up to 97 percent of the time. The researchers analyzed and compared the gaits of 38 persons diagnosed with PSP, 27 diagnosed with iNPH, and 38 healthy volunteers. Most participants were about 70 years old, but did not need a cane or aid to walk 30 feet or more. In three tests, participants walked at their preferred speed, then at a slow speed and finally at their fastest speed. In a fourth test, subjects walked while counting backward, while in a fifth test they walked while carrying a tray. The team determined those with PSP tend to fling their legs forward while walking, and turn suddenly and uncontrollably. Meanwhile, people with iNPH appear as if their feet are glued to the floor, and some swing their arms in an exaggerated way. Those with PSP also fall more often than those with iNPH, but in both disorders, hitting the ground is thought to be related to motor and cognitive impairments. Persons with iNPH had worse stride, moving more broadly from side to side. The investigators diagnosed those with PSP and those with iNPH 82 percent of the time according to gait, and 97 percent of the time when adding in scores from the dual-task tests.

The Centers for Medicare and Medicaid Services (CMS) has announced a shift away from Obama-era Medicare goals that sought to significantly reduce the cost of the U.S. healthcare system, reports the Washington Post . The Obama administration had a specific timeline, including a goal of linking 30 percent of Medicare payments to quality-based payment models by the end of 2016, which it realized a year early. CMS' new focus is on reviewing "the impact of new payment models on patients and providers," says CMS spokesperson Raymond Thor. CMS Administrator Seema Verma has in recent months criticized certain Obama administration tactics while withdrawing from some of her predecessor's projects to pay healthcare providers quality-based compensation. "We are analyzing all innovation center models to determine what is working and should continue, and what isn't and shouldn't," Verma said in a Wall Street Journal op-ed piece last fall. CMS in November partially discontinued two programs changing reimbursements for joint replacement and cardiac rehabilitation procedures by using "bundled payments," in which providers get a flat payment covering the duration of a procedure and recovery. If their costs come in under the fee they can keep the difference, or they lose money if their costs top the fee. Community Catalyst Deputy Director Sue Sherry believes CMS must give clear guidance to doctors, hospitals, and other providers on the types of payments they should expect in the near future.

A team of children from Edlin School in Reston, Va., designed an aging-friendly urban model that won first place in this year's annual Future City Competition, reports the Washington Post . More than 40,000 teams entered the contest, and 44 regional winners from the United States, Canada, China, and Egypt presented their concepts in Washington, D.C., this past weekend. Edlin's model city was inspired by Richmond, the capital of Virginia, and the team consulted with Richmond officials and groups that represent the interests of seniors to inform their model. One concept involved having several public transit methods, including a maglev train. The winners earned a trip to Space Camp and $7,500 for Edlin's science and technology program.