A study published in JAMA Internal Medicine found more and more Americans are choosing urgent care over their primary physician, reports CBS New York . The number of people treated at urgent care centers has risen more than twofold since 2011, while visits to primary care doctors and emergency rooms (ERs) for non-life-threatening conditions are decreasing. "We are a lot more convenient. Recipients can look at our wait times live online," says the Northwell Health-GoHealth Urgent Care Center's JD Zipkin. He notes such centers treat a broad spectrum of maladies, but cautions that urgent care should not replace regular doctor visits, while real emergencies always require an ER visit. Most urgent care visits cost considerably less than ER visits, are similar in expense to a primary care visit, and are typically covered by insurance. Urgent care centers also can alleviate demand in crowded and costly hospital ERs, and they frequently refer complicated cases to the main hospital. Subsequently, many urgent care centers are owned by major hospital systems.

A study published in JAMA Internal Medicine found seniors with renal failure are often pressured by their doctors to get dialysis against their wishes, reports Reuters Health . The researchers traced the records of 851 veterans, average age 75, who chose to forgo dialysis. They learned some doctors repeatedly steered seniors toward dialysis using various tactics to change their minds, while doctors facing intransigence questioned the seniors' mental competence. In another scenario, doctors concluded that dialysis was inappropriate without discussing that decision with the beneficiary, while in a third instance those who refused dialysis were told that their doctor had little to offer in way of alternatives. The researchers think physician training may underlie the difficulty in accepting seniors' decision to skip dialysis. The study stresses the need for doctors to take the beneficiary's age into consideration when making dialysis recommendations, according to Johns Hopkins Bloomberg School of Public Health Professor Albert Wu.

A study published in Circulation found a hormone, brain natriuretic peptide (BNP), commonly associated with heart disease also might predict when someone is more likely to grow frailer or lose their ability to balance before they reach the age of 70, reports Medical Xpress . Persons in their early 60s with higher-than-normal BNP levels walked slower and were less able to raise themselves from a chair and balance on one leg up to nine years later. "We were surprised that BNP turned out to be the best predictor of our simple measures of aging," notes Yoav Ben-Shlomo with University College London. The peptide is mainly generated in the left ventricle, typically when the heart is overtaxed in pumping blood. Ben-Shlomo suggests a blood test that grades someone with higher-than-normal BNP levels in their 30s or 40s could be applied to reduce their risk of aging more rapidly with more exercise and better nutrition. He says boosting physical activity in mid-life might ward off a later physical decline for people with high BNP levels. "The theory is if you can reach a higher peak in young adulthood, you have more room to decline later in life — as we all do," Ben-Shlomo concludes.

A study published in eLife suggests a signaling pathway governed by transforming growth factor beta (TGF-beta) could play a role in the progression of age-related macular degeneration (AMD), reports ScienceDaily . The interruption of TGF-beta signals to immune microglia induces the cells into an activated, inflammatory state, and damages the retina in ways similar to cellular effects seen in AMD. The researchers engineered genetically modified mice in which the microglial cells' ability to detect TGF-beta could be repressed. The cells immediately reconfigured, moved to incorrect locations, and started proliferating while also decreasing their expression of sensory proteins. Another group of retinal support cells, Müller glia, became distressed, causing retinal neurons to fail and die. Furthermore, abnormal microglia worsened the growth of new blood vessels in an AMD model. The implication is that microglia and TGF-beta signaling may help fuel disease progression in humans.

Certain senior living communities in Florida are running Multi-Sensory Environments as therapeutic tools for residents with dementia, reports Florida Today . These settings are typically equipped with total blackout capabilities, including lighting effects like bubble lamps, fiber optics, mirror balls, and projectors that diffuse light patterns throughout the room. Other accoutrements include interactive wall panels with changing textures to encourage a tactile experience, sound effects such as calming music and nature sounds, rhythmical music, and environmental control systems like vibrating toys. Such sensoriums are used for Snoezelen therapy, designed to relax and alleviate participants' agitation and anxiety while also enhancing beneficiary-caregiver engagement. The Chateau Madeleine community in Suntree, Fla., recently incorporated a Snoezelen sensorium for use with people with Alzheimer's and dementia. "The benefits to the resident ... include greater awareness and attention along with an overall improvement in quality of life," says Kristen Malfara of the nonprofit M.O.R.G.A.N. project.

A study from Baycrest published in the Canadian Journal on Aging suggests memory loss in older adults could be a sign of hearing loss rather than cognitive disorders, reports Interesting Engineering . Baycrest found 56 percent of study participants assessed for memory and thinking issues had some form of hearing loss, yet 25 percent exhibited no brain disorder symptoms. However, only about 20 percent were using hearing aids. "We commonly see clients who are worried about Alzheimer's disease because their partner complains that they don't seem to pay attention, they don't seem to listen, or they don't remember what is said to them," says Baycrest neuropsychologist Susan Vandermorris. "Sometimes addressing hearing loss may mitigate or fix what looks like a memory issue. An individual isn't going to remember something said to them if they didn't hear it properly." As a result of the study, Baycrest's Neuropsychology and Cognitive Health Program and Hearing Services have incorporated general hearing screenings into their evaluations, while Baycrest also is providing educational materials on these findings to clients.

A study published in Nature Medicine details how a simple blood test can reliably identify brain damage in people with Alzheimer's before the onset of symptoms, reports Medical Xpress . The test detects neurofilament light chain, a structural protein that forms part of the internal framework of neurons; when brain neurons are damaged or dying, this protein leaks into the cerebrospinal fluid within the brain and spinal cord, and then into the bloodstream. The team examined more than 400 people, including 247 carriers of an early-onset genetic variant and 162 of their unaffected relatives. Participants with the faulty gene variant had protein levels that were higher at baseline and increased over time, while those with the healthy form of the gene exhibited low protein levels that generally did not change. This difference was identifiable 16 years before cognitive symptoms were expected to arise. Brain scans also showed how rapidly the protein levels rose in parallel with the speed with which the precuneus — a region of the brain related to memory — thinned and contracted. The researchers collected data on 39 people with disease-causing variants when they returned to the clinic an average of two years after their last visit. Persons whose blood protein levels had previously increased rapidly were most likely to manifest brain atrophy and diminished cognitive abilities when they revisited the clinic.

A new study by the University of California, Los Angeles (UCLA) Center for Health Policy Research warns California's public mental health workforce is ill-prepared to address older adults' mental health needs, reports UCLA Newsroom . The study estimated that between 8 percent and 16 percent of non-institutionalized older American adults have symptoms of depression, which often go undiagnosed. Further, suicide rates for older men are four times higher than for any other age group, and suicide is more often attempted among older adults than younger adults. In addition, alcohol and prescription drug misuse is especially high among adults 60 and older, and older addicts are more likely to have undiagnosed psychiatric and medical problems. The Center for Health Policy Research's Janet Frank faults the California Behavioral Planning Council's proposed five-year workforce education and training plan for omitting workforce needs for older adults. "Mental health professionals with geriatric training are retiring, and there is a limited number of doctors, psychiatrists, and nurses with adequate geriatric training to take their place," she notes. "The state can be proactive and plan ahead to make sure behavioral health workers are trained to serve the increasing number of older adults." The study recommends providing stipends and other financial incentives to trainees specializing in geriatric behavioral health services; state funding for behavioral health training programs that include geriatric content; and county peer training programs.

Up to 33 percent of older adults have inadequate protein intake because of reduced appetite, dental issues, impaired taste, swallowing problems, and limited financial resources, reports the Washington Post . A 2018 study "suggests that older adults who consume more protein have better outcomes," notes Tufts University's Paul Jacques. Seniors afflicted with acute or chronic diseases are suggested to consume 1.2 to 1.5 grams of protein per kilogram of body weight each day, although researchers caution that the exact amount needed "depends on the disease, its severity," and other factors. "Protein becomes much more important during events in an older adult's life that force them into a situation of muscle disuse — a hip or knee replacement, for instance," adds McMaster University's Stuart Phillip. Also recommended for older adults is to spread their protein consumption evenly throughout the day, with research finding that seniors are less efficient at processing protein in their diet and may require a larger "per-meal dose." According to University of Texas Professor Elena Volpi, "The total dose that you eat may not matter as much as the dose you eat at a given meal. If I eat too little protein during a meal, I may not adequately stimulate the uptake of amino acids into skeletal muscle. If I eat too much ... I won't be able to store all of it away."

Seniors in Dublin, Ohio, are trying out a new micro-transit service through a partnership with SHARE, a transportation startup, reports the Columbus Dispatch . Dublin urban planner Joanne Shelly says the free service is designed to fill gaps in the existing transportation network for older adults. The Senior Circulator program offers three routes across Dublin, going to destinations like a Kroger supermarket, the Mall at Tuttle Crossing, and the Dublin Community Recreation Center. The program has five senior living communities in the city serving as starting and ending points for the routes. Also included is UFiT, a local physical-therapy provider for people with developmental disabilities. "This program will allow our residents to have more freedom," says Senior Star Executive Director Ron Keller at Dublin Retirement Village. SHARE Chief Executive Ryan McManus says if the program is extended past the six-month trial, officials would like to make it more personalized. Dublin ultimately hopes to have "multiple partners to share the costs" of the program, concludes Shelly.