Experts in SHRM offer six tips for managers to set clearly defined expectations for employees. Betterworks' Luane Tierney says there needs to be emphasis on objectives every quarter, along with "actionable key results that will allow the employee to achieve those objectives." 15Five's Jeff Smith recommends setting expectations with employees from their first day at work, adding that "employees have a clear understanding of what they should be focusing on and how it contributes to the company's overall strategy." Tammy Perkins with PMI Worldwide stresses that team leaders must ensure that staffers understand their accountability for reaching goals, "by following up, establishing shared goals, and setting milestones to allow the team to gauge progress." She also says giving workers meaningful feedback is essential, with storytelling a recommended method. Surehand CEO Chris Brenchley offers leveraging employee motivation as a fifth tip, which "will give you clear insight about what they're planning and how the goals you set will be able to take them where they want to go." The sixth and last suggestion, also from Brenchley, is to provide measurable goals.

A study published in Alzheimer's and Dementia identified 216 novel gene variants that contribute to the risk of developing late-onset Alzheimer's disease by examining carriers of certain genomes that defy their tendency to compound or decrease the likelihood of getting the disorder, reports EurekAlert . "We wanted to test if people who show paradoxical outcomes might have other genetic variants that blunted the risky or protective effects of the APOE genotype they carry," said Baylor College of Medicine Professor Olivier Lichtarge. The researchers used algorithms to compare and contrast the genetic variants present in each subject, in conjunction with a high-throughput fruit fly screen. After discovering the novel gene variants, the team experimentally tested their biological relevance in modifying Alzheimer's disease pathogenesis. "The robotic assays provided us with a quantitative assessment of the actual neuronal impairment," said Baylor's Ismael Al-Ramahi. "We used movement-specific behavioral assays as the main readout of nervous system function. Additionally, we obtained precise information of how variants in each gene modified its physiological function, meaning whether the impact on neuronal function was a result of the gene's under-performance (loss-of-function) or over-performance (gain-of-function). This information is critical for the future development of these biomarkers for therapeutic interventions, either by inhibiting or activating these genes in the future."

Fierce Healthcare says a report funded by the Better Medicare Alliance looked at healthcare use, outcomes, and costs between Medicare Advantage (MA) and traditional Medicare plans. "Medicare Advantage beneficiaries had 49 percent and 11 percent higher rates of vaccination for pneumonia and the flu and the contrasts are even more pronounced among high-need, high-cost beneficiaries," said Better Medicare Alliance CEO Allyson Schwartz. "For example, beneficiaries with major complex chronic conditions had 57 percent lower rate of avoidable hospitalizations for acute conditions in Medicare Advantage than in traditional Medicare." MA also scored higher on clinical visits two weeks after a hospital discharge, with 74 percent of frail and senior MA participants having such a visit versus 52 percent of traditional Medicare beneficiaries in the same category. In addition, inpatient hospital costs were 9 percent to 23 percent lower among high-need, high-cost populations in MA relative to fee-for-service Medicare, while Part D drug costs were 38 percent to 44 percent lower. The report associated the better results to key features of the MA program like risk-adjusted capitation payments and strong value-based care performance incentives to "enable plans to offer care management interventions that help meet the complex care needs of vulnerable beneficiaries in ways that achieve positive health outcomes." The report added that MA also plans to have an incentive to push for more preventive services and care management to boost plan efficiency.

Medical News Today reports that a recent article in JAMA suggests the social isolation from loved ones that seniors are experiencing during the COVID-19 pandemic may not necessarily translate into deteriorating mental health. Researchers at institutions in Massachusetts, California, and Pennsylvania considered early data from several global studies on older adults and mental health during the crisis. Although older adults are considered a vulnerable group for severe COVID-19 and related death, the investigators found they were less negatively affected by mental health strain than younger peers. For example, a report from the U.S. Centers for Disease Control and Prevention concluded that older adults were less likely to start or increase substance use and less likely to consider suicide. According to the evidence, the authors suggested older adults better endure the mental health stress of the pandemic due to increased resilience and a motivation to stay connected with others. "However, despite this early resilience, older adults expressed concerns about their longer-term physical and financial well-being," the authors acknowledge. Resilience also might correlate with wisdom, with analysis indicating that having wisdom is associated with higher levels of compassion and reduced loneliness. The researchers said more access to technology could improve resiliency in older adults who do not have smartphones, for instance.

A small randomized study of the omega-3 fatty acids EPA and DHA published in Atherosclerosis determined that they have different effects against chronic inflammation, reports News-Medical . The researchers found that DHA reduced the genetic expression of four types of pro-inflammatory proteins, while EPA lowered only one type. DHA also lowered white blood cell secretion of three types of pro-inflammatory proteins, whereas EPA lowered only one type. Moreover, DHA reduced levels of an anti-inflammatory protein, while EPA did not. However, after metabolization, EPA generated by-products associated with immune function regulation and worked differently from those stemming from DHA. "These results suggest that DHA is the more powerful of the two on markers of inflammation in the body, but that's not the end of the story," said Stefania Lamon-Fava with the Human Nutrition Research Center on Aging at Tufts University. She also stressed that each omega-3 "has distinct effects. Our results provide insight for future research to explore why that is the case and who would benefit from one or both of these healthy fats."

The Washington Post reports that a growing number of people are being diagnosed with atypical forms of dementia in midlife, including behavioral variant frontotemporal dementia, primary progressive aphasia, posterior cortical atrophy, Lewy body dementia, and early-onset Alzheimer's in people with no family history. These diseases manifest in people in their 50s and 60s, sometimes even earlier and sometimes a bit later, and possess some of the same underlying pathology seen in people with typical Alzheimer's — amyloid plaque and tau tangles in the brain. According to the U.S. National Institute on Aging, early-onset dementia cases represent about 5 percent of the total number of Alzheimer's patients. Efforts to understand the pathology include the Longitudinal Early-Onset Alzheimer's Disease Study enrolling 500 cognitively-impaired people between 40 and 64 with early-onset dementia caused by Alzheimer's. The researchers are conducting annual clinical and cognitive assessments, imaging, biomarker, and genetic studies. Their goal is to define patients and characterize their symptoms and rate of disease progression, then enroll them into clinical trials. "No one knows why these diseases start in specific regions of the brain but we think it is influenced by the normal organization of brain networks," said Massachusetts General Hospital's Bradford Dickerson. "These circuits talk to one another. There is a shared vulnerability to these disease pathologies."

Medical Xpress reports that a study in IEEE Access found that the early detection of Alzheimer's dementia (AD) can stabilize or even curtail neural deterioration. Queensland University of Technology (QUT) researchers crafted automatic machine learning models using language features to identify multiple stages of dementia, including Mild Cognitive Impairment (MCI), possible AD (PoAD), and probable AD. "Early stages of dementia can be efficiently diagnosed through linguistic patterns and deficits using machine learning models," explained QUT's Ahmed Alkenani. "Early, accurate diagnosis is important to enable clinicians to intervene in time to delay or prevent Alzheimer's dementia." The study examined language samples from DementiaBank, a database of language samples from people in various stages of cognitive impairment and dementia. "We studied 236 language samples from people diagnosed with probable AD, 43 samples from people with MCI, 21 samples belonging to people with possible AD, and 243 from healthy people," said Alkenani. "We found people with dementia leaned towards using fewer nouns but more verbs, pronouns, and adjectives as dementia progressed compared to healthy adults." Alkenani added that the ultimate goal "is to develop a conversational agent or chatbot that could be used remotely to facilitate the initial diagnosis of early stage dementia as an attempt to replace traditional screening tests."

United Press International says a new study found people with Alzheimer's can start making poor financial decision even before symptoms appear. The study in JAMA Internal Medicine determined that older people diagnosed with dementia or Alzheimer's were more likely to miss credit card payments up to six years before their diagnosis, compared with those without dementia. Those with dementia also were more likely to have lower credit scores in the three years before diagnosis than those without dementia, and these deficits were more frequent among people with less education. "Given the patterns that we're seeing, along with other research suggesting that people who are more susceptible to fraud in hypothetical survey questions are more likely to develop dementia in the future, I would definitely view falling for a phone scam as a potential early sign/symptom that I would monitor," said Johns Hopkins University Bloomberg School of Public Health Professor Lauren Hersch Nicholas. She also was adamant that "earlier detection of dementia can help protect patients from these financial errors. When dementia is diagnosed, it is important to make sure that patients are also receiving assistance in managing their money."

Newswise reports that a team from Rensselaer Polytechnic Institute (RPI) will use a U.S. National Institutes of Health grant to explore links between the brain, bone, and gut microbiota as they relate to Alzheimer's disease. The researchers are investigating osteocalcin, a bone-specific protein that affects multiple physiological processes, including energy consumption and glucose levels. Osteocalcin also can traverse the blood-brain barrier, where it binds to neurons and influences the synthesis of neurotransmitters. "Our theory is that . . . osteocalcin . . . gets modified or not modified by the microbiome and then affects the brain function," said RPI's Deepak Vashishth. "We are trying to determine if there is a correlation and a mechanistic link between the two, especially in the context of Alzheimer's disease." An altered composition of gut bacteria could affect the production of vitamin K, and change the level of osteocalcin in the body. Distorted osteocalcin concentration may impact glucose metabolism, leading to the formation of advanced glycation end-products, which are tied to Alzheimer's disease and diabetes-related skeletal fragility.

KXXV reports that assisted living and nursing communities in Texas will be among the first to receive a COVID-19 vaccine once they become available, and Temple, Texas-based communities like Mercy House are preparing residents. "The plan is to offer the vaccinations to both residents and staff on a completely volunteer basis," explained Mercy House administrator John Darby. "There won't be any requirement to take the vaccination." Mercy House presently serves 28 residents with dementia and has about 25 people on staff. "At this point, our communication is just to let families know that Mercy House has signed up for vaccination, that their loved one is eligible for the vaccination, and that when we have more information, we'll make it available to them," Darby said. He also observed that there are currently about 75,000 people living in assisted living communities throughout Texas, and another 90,000 living in nursing communities. "We're expecting a million doses here in Texas starting on Dec. 14," Darby stated. "While they haven't released a distribution schedule yet, I would imagine that to get to all of us isn't going to be real speedy."