The Centers for Medicare and Medicaid Services (CMS) has proposed to phase-in changes to the way it estimates risk adjustment payment to Medicare Advantage plans, reports Healthcare Finance News . Beginning in 2020, CMS will calculate payments with a combination of 50 percent of the risk adjustment model first used for payment in 2017 and 50 percent of the new risk adjustment model proposed, but not finalized, in the 2019 rate announcement. The new model adds factors that count the number of conditions a beneficiary may have, including additional condition categories for mental health, substance use disorder, and chronic kidney disease. It also features technical updates such as calibrating the model with more recent data and selecting diagnoses with the same technique used for encounter data. Furthermore, CMS is presenting an alternate payment condition count model that includes additional condition categories for pressure ulcers and dementia. Under the 21st Century Cures Act, CMS must report to Congress on the Part C risk adjustment model and the end-stage renal disease risk adjustment model every three years, starting with a report due no later than Dec. 31. The initial report on risk adjustment in Medicare Advantage required by the 21st Century Cures Act is being issued at the same time as Part I of the 2020 Advance Notice.

A startup in Waterloo, Canada, has published six hardcover books for people with dementia, with plans to release another 10 on their new digital platform, reports CBC News . Marlena Books' new reading app will go live this week, and company founder Rachel Thompson says its development was driven by customers requesting more new titles than they could afford to print, as well as their translation into languages other than English. Another factor was people losing their ability to read as their dementia progressed. The app is designed for use on Apple products, enabling readers to choose between 15 different stories and a list of accessibility options. Readers can alter font size, activate automatic page turning, and personalize the story by swapping the main character's name out for their own, according to Thompson. Planned for rollout later this year is an option for users to hear the story read aloud to them. Thompson says Marlena Books intends to issue a second version of the app, which would include translation to different languages, by next spring.

The House on Wednesday evening passed the BOLD Infrastructure for Alzheimer's Act that directs the Centers for Disease Control and Prevention to take action on several issues addressing dementia research and care. The bill, which the Senate already has approved and President Trump is expected to sign, would establish Alzheimer's Centers of Excellence designed to increase education and research about the disease and cognitive decline, provide technical assistance to public health officials and others to aid in implementing interventions such as reducing risk, award grants, and expand partnerships addressing cognitive impairment and health disparities; award cooperative agreements to public health departments and other organizations to aid them in implementing actions identified in the Healthy Brain Initiative's Public Health Roadmap such as early detection and diagnosis; and Increase data collection, analysis, and timely reporting through grant projects that would utilize tools such as the Behavioral Risk Factor Surveillance System and the National Health Interview Survey, and to monitor the progress of related objectives in the Healthy People 2020 report. The Building Our Largest Dementia Infrastructure for Alzheimer's Act authorizes $20 million for these projects for each of fiscal years 2020 through 2024.

A study published in International Psychogeriatrics found more people reported feeling moderate to severe loneliness during their late 20s, mid-50s, and late 80s than in other life periods, reports CNN . "Loneliness is defined as 'subjective distress,'" says University of California, San Diego Professor Dilip Jeste. "It is the discrepancy between the social relationships you want and the social relationships you have." According to Jeste, an inverse relationship exists between loneliness and wisdom. "In other words, people who have high levels of wisdom didn't feel lonely, and vice versa," he notes. Cornell University Professor Anthony Ong says this inverse association is "suggestive of the role of personality in the development and persistence of loneliness over time." Jeste says his team theorized that people would report more loneliness in old age, based on the "usual assumption that as people get older, they become more alone," but were surprised when they discovered a mid-50 peak in addition to the one in the late 80s. "The mid-50s is the midlife crisis period," Jeste notes. Usually, this is when health starts declining and many people learn that they have pre-diabetes or heart disease. "And the late 80s is, of course, a period when, if you're lucky to have survived to that age, then things start getting worse," Jeste says. Most surprising was a 76 percent prevalence of moderate to severe loneliness, up from an expected prevalence of about 33 percent.

With baby boomers projected to be over 65 by 2030, a conversation on overhauling old models of senior housing needs to happen now, reports Next Avenue . At the Washington Innovation in Longevity Summit, a key topic was why older consumers were not choosing senior living options. Explanations included products being out of line with consumer desires. "The vast majority of people want to live at home because we have not offered options that can compete well with the home," said HumanGood's Dan Hutson. "And we have not done a good job of educating people as to the value benefits of community living." Hutson cited the appeal of congregant living, like co-housing situations, roommates, and similar supportive communities, as a value benefit. "We don't provide enough variety," he said. "We do not have choices. We don't have options for people to look at and say, 'This is the kind of community that will meet our needs.'" Other reasons mentioned included a lack of affordability, and roughly 70 percent of the market cannot currently qualify for affordable housing or senior living communities. Hutson noted senior living communities are highly valued for preventing social isolation, while developers also should consider ways to attract people looking to expand their horizons as they get older.

Companies like MyndVR and Visual are offering services to help mobility-challenged individuals improve their quality of life with virtual reality (VR) experiences, reports Next Avenue . "In the past VR user interfaces have been engineered for millennials and gamers," says MyndVR CEO Chris Brickler. "We set out to reimagine a very senior-friendly interface and content streaming platform so we can offer them this world of immersive content." MyndVR currently works with about 30 senior living operators across the United States, produces 20 percent of the VR video content themselves, and outsources the remainder to New York-based VR aggregator Littlstar; this arrangement allows MyndVR to stream fresh content every month. MyndVR will soon launch a VR program for older adults who are aging in place, with an all-in-one VR headset that could be administered by caregivers or family members. Meanwhile, Visual has performed research on the impact of VR on older adults via its WellnessVR platform. It worked with some 25 residents of a senior living community in Minnesota, guiding them through 10-minute VR sessions twice a week for five weeks; 90 percent of participants said they felt more relaxed and rated their well-being higher than previously. "We're not thinking of VR just as pure escapism, but how we can use it to benefit people's lives," says Visual CEO Chuck Olsen.

A study published in NeuroImage associated higher levels of several key nutrients in the blood with more efficient brain connectivity and performance on cognitive tests in older adults, reports ScienceDaily . The researchers examined 32 key nutrients in the Mediterranean diet, which previous research linked to better brain function in aging. The study included 116 healthy adults 65-75 years old, with better brain health and cognition tied to specific patterns of a handful of nutrient biomarkers in the blood, including omega-3 fatty acids, omega-6 fatty acids, lycopene, alpha- and beta-carotenoids, and vitamins B and D. Analysis determined a strong connection between higher levels of several nutrient biomarkers in the blood and enhanced performance on specific cognitive tests. These nutrients, which appeared to work synergistically, included omega-3 and omega-6 fatty acids, carotenoids, lycopene, riboflavin, folate, vitamin B12, and vitamin D. Furthermore, a pattern of omega-3s, omega-6s, and carotene was associated with better functional brain network efficiency. "Our study suggests that diet and nutrition moderate the association between network efficiency and cognitive performance," said University of Illinois Professor Aron Barbey. "This means that the strength of the association between functional brain network efficiency and cognitive performance is associated with the level of the nutrients."

A study published in the Annals of Thoracic Surgery found major heart surgery does not cause significant memory decline in older adults, reports HealthDay News . The study included some 1,200 people who underwent heart surgery, while another 1,900 had cardiac catheterization. All subjects were 65 or older. "We expected to find a bigger difference in the surgery group, since there are many anecdotes about serious cognitive mental decline after heart surgery," says Elizabeth Whitlock with the University of California, San Francisco. She notes the outcomes "suggest that there isn't a major long-term impact when these two methods of correcting serious heart problems are compared. We think this is because severe heart disease itself probably has a cognitive impact." The implication is that the loss of memory and thinking skills in the weeks after surgery is likely transitory, and possibly caused by small strokes during surgery, tissue inflammation, or medication.

The Building Our Largest Dementia (BOLD) Infrastructure for Alzheimer's Act (S 2076) will be voted on today. The measure will be managed by Rep. Greg Walden (R-Ore.) or his designee. The Democratic manager will be Rep. Pallone (D-N.J.) or his designee. The Senate passed the bill by voice vote on Dec. 12. This bill establishes Alzheimer's disease and related dementia public health centers of excellence and converts an existing demonstration program that addresses dementia into a program of cooperative agreements between the federal government and health departments that address dementia by reducing cognitive decline and meeting the needs of caregivers. The measure authorizes $20 million for these projects for each of fiscal years 2020-24. Under the bill, HHS is required to give preference to applicants that focus on addressing health disparities, including populations and areas with the highest prevalence of dementia. The Congressional Budget Office (CBO) estimates that the bill would increase spending by $20 million per year for fiscal years 2020-24.

Come February, Nevada will be the first state in the country to have a majority female legislature after the Clark County Commission appointed two women Democrats to open seats in the state assembly, Fox News reports. Rochelle Nguyen will replace Assemblyman Chris Brooks, who was appointed to the state Senate, and Beatrice "Bea" Duran is replacing Assemblywoman Olivia Diaz, who resigned this month and plans to run for a seat on the Las Vegas City Council. With the appointments, women will have 32 out of 63 (51 percent) of the seats in the state legislature. Both appointments were unanimous. Women hold approximately 25 percent of legislative seats nationwide, according to the National Conference of State Legislatures. In November, 117 women won elections across the country, though only about one in five members in the new Congress will be female.