Many hospitals are introducing structural changes and new procedures to make emergency departments friendlier to seniors, with the American College of Emergency Physicians launching an accreditation program in the spring for emergency departments to adopt a more comprehensive and standardized approach to geriatrics, reports the Washington Post . "Older adults are more vulnerable and have less reserve," says Susan Zieman at the National Institute on Aging. "Somebody might fall and just plunk down on the floor, a 'low mechanism' fall for someone younger. But an older person can do serious damage — break a hip, for example. Also, sometimes they feel less pain, or show up with atypical symptoms, such as nausea, rather than chest pain, when they are having a heart attack. When people get into their 70s and 80s, there are some clear differences, and it takes specialty training to pick up these things." Making the emergency room less uncomfortable for seniors includes comprehensive screening procedures to check all medications, health history, and conditions at home, for the purpose of avoiding hospitalization. "We want to look at all their needs and problems, including medical and social problems," notes West Health Institute's Zia Agha.

A new study from the University of Texas Southwestern Medical Center published in eLife demonstrated that single toxic tau proteins that clump and spread degeneration across the brains of people with dementia have different configurations, reports ScienceDaily . The folds of these molecules contain information that could help diagnose, and possibly eventually treat, early-onset neurodegeneration. The study builds on earlier research documenting a structural "genesis" of Alzheimer's. According to the new study, a single tau molecule that changes shape at the start of the disease process has the information for determining the configuration of the toxic assemblies, suggesting the characterization of the conformation of single tau molecules could predict what nascent disease, whether Alzheimer's or other kinds of dementia, is happening. The team is attempting to translate these findings into clinical tests that examine blood or spinal fluid to spot the first biomarkers of the abnormal tau, before the symptoms of memory loss and cognitive decline manifest. They also are focused on developing treatments to stabilize shape-shifting tau molecules, prevent them from clumping, or encourage their purging from the brain.

A study published in the British Medical Journal tested the hypothesis that mentally engaging activities, like reading, crosswords, and board games, may help fortify the brain against dementia later in life, reports HealthDay News . The study involved about 500 older British adults who had all taken the same intelligence test when they were about 11; starting at the age of 64, they answered questions about whether they engaged in intellectually stimulating activities. Those who said they enjoyed those hobbies were found to be no less likely to show signs of mental decline over time, compared to other seniors. However, they did, on average, see higher scores on standard tests of mental sharpness. "The results indicate that a lifetime of engagement lifts you to a high point from which you decline, and that can be considered as passive cognitive reserve," said the University of Aberdeen's Roger Staff. "Starting from a high point will mean that the threshold at which you are considered impaired will be farther into the future."

A mouse study published in the Proceedings of the National Academy of Sciences found both caffeine and the compound EHT prevent alpha-synuclein from accumulating in the brain, suggesting coffee could help ward off Parkinson's and dementia with lewy bodies, reports London's the Daily Mail . The investigators are hoping caffeine and EHT could be combined into a drug to treat these diseases in humans. The animals used in the experiment were genetically predisposed to have alpha-synuclein aggregate in their brain. They were administered either 50mg/kg of caffeine, 12mg/kg of EHT, or both every day for six months. Neither compound had any effect by itself, but the mice who received both compounds had higher test scores on their motor, learning, and memory skills. Post-mortem examination of their brains showed EHT and caffeine together boosted the activity of the protein PP2A, preventing accrual of alpha-synuclein clumps while also reducing brain inflammation. "It is important that the appropriate amount and ratio of caffeine to ETH be determined so people don't over-caffeinate themselves, as that can have negative health consequences," said Rutgers University's M. Maral Mouradian.

A study published in Family Practice suggests older adults prescribed antidepressants by primary care physicians often fail to start taking them or to continue using them as directed, reports Reuters Health . The researchers analyzed data on about 1,500 people at least 60 years old and diagnosed with depression in 2012 by primary care providers. About 14 percent of those prescribed antidepressants opted not to begin taking the drugs within two weeks. When they did start taking medications on time, about 15 percent missed doses at least 20 percent of the time and 37 percent stopped altogether within 12 months. Study participants tended to do a better job of starting and maintaining the prescribed drug regimen when they were already used to taking multiple daily pills for a variety of other chronic health issues. Persons already on multiple drugs were 11 percent less likely to fail to start antidepressants and 13 percent less likely to take them inconsistently. Side effects of antidepressants may have prompted some subjects to stop taking their drugs, as participants who experienced side effects were 22 percent more likely to take antidepressants inconsistently or cease altogether.

A recent Athena Health analysis found persons older than 60 account for the biggest increase of in-office treatments for sexually transmitted diseases (STDs), reports U.S. News & World Report . Their diagnosis rates for herpes simplex, gonorrhea, syphilis, hepatitis B, trichomoniasis, and chlamydia climbed 23 percent between 2014 and 2017 versus an 11 percent increase among the entire population over age 13. Florida State University Professor Lisa Granville notes this increase is "more prevalent in men than women, and especially with men having sex with men." But she cautions that "everyone who is older is at increased risk." According to University of Chicago Professor Stacy Lindau, the elevation in gonorrhea rates is particularly troubling "because the medications we've used in the past to treat gonorrhea are proving less and less effective" due to antibiotic resistance. Experts agree curbing the incidence of senior STD infections depends on education and communication, both between sexual partners and between healthcare recipients and medical providers.

Volunteers are often the primary caregivers for seniors in rural areas of the United States, according to the Wall Street Journal . One out of four Americans 65 and older — some 10 million people — live in rural and non-metropolitan areas. According to September figures from the Health Resources and Services Administration, nearly 65 percent of areas short of health professionals are rural or partially rural. Meanwhile, the percentage of family caregivers — unpaid relatives or friends — living in rural areas decreased from 31 percent in 2009 to 16 percent in 2015, according to studies by the National Alliance for Caregiving and AARP Public Policy Institute. Throughout the United States, communities, organizations, nonprofits, and foundations are working on ways to meet rural caregiving needs by delivering meals, arranging transportation, and providing companionship. In rural Vermont, for instance, seniors can offer services such as tutoring, sewing, and baking in return for someone shoveling their driveway via the Onion River Exchange. Telemedicine, a two-way, real-time interactive communication between seniors and caregivers and a health professional at a distant site, is increasing in use and offers perhaps the most potential to rural residents in their senior years.

A study at the Human Performance Laboratory at Ball State University and published in the Journal of Applied Physiology determined a lifelong exercise habit may help seniors feel younger and stay stronger by maintaining cardiovascular health, reports National Public Radio . "People who exercise regularly year after year have better overall health than their sedentary counterparts," notes Ball State's Scott Trappe. The study involved Trappe splitting 70 healthy participants into three groups: those in the lifelong exercise group were on average 75 years old and kept their heart rates up via running and cycling; they also had a history of participating in structured exercise four to six days weekly for about seven hours a week. In the second cohort were individuals who were also, on average, 75, but did not engage in structured exercise regimens. Young exercisers, 25 years old on average, formed the third group, and they worked out with the same frequency and duration as the lifelong exercisers. "Lifelong exercisers had a cardiovascular system that looked 30 years younger," Trappe says. This is important because the ability to process oxygen declines by about 10 percent every 10 years after age 30 among average adults. Meanwhile, the lifelong exercisers' muscles were about the same as those of the 25-year-olds.

Many people with Alzheimer's experience a clinical phenomenon called "sundowning," or the emergence or worsening of neuropsychiatric symptoms like agitation, aggression, and disorientation in the late afternoon or early evening, reports the Washington Post . Some physicians suggest sundowning is related to reduced visibility that comes with darkness and shadows, or the shift change of hospital staff in the late afternoon; more recent studies imply a possible connection to disruption of the brain's suprachiasmatic nucleus (SCN), which regulates circadian rhythms. Investigations have shown the phenomenon's prevalence in 10 percent to 25 percent of those with moderate to severe dementia in nursing communities and up to 66 percent of people with Alzheimer's living at home. Its occurrence in some cognitively intact seniors also could be construed as a sign of approaching dementia. Circadian disruptions are one of the earliest symptoms observed in Alzheimer's, with such disturbances happening years before the emergence of more classical symptoms. Moreover, a recent study published in Nature Neuroscience found the SCN also regulates aggression. "This may mean that the body's internal clock regulates emotional patterns, and if you disrupt the circadian pathway that would keep that within the right timing, you can have really profound changes in behavior at certain times of the day," notes Harvard Medical School's William Todd.

A study conducted at the University of Helsinki and the University of California and published in Brain Imaging and Behavior found using two memory tests assessing episodic memory made diagnosis of mild cognitive impairment due to Alzheimer's more precise, reports ScienceDaily . Memory tests helped spot individuals with an increased risk of being diagnosed with Alzheimer's within the next three years. The team investigated baseline differences between cognitively normal individuals and individuals with mild cognitive impairment on the basis of poor memory performance in story recall and word list recall. The differences focused on Alzheimer's cerebrospinal fluid biomarkers, finding that people who performed poorly in both episodic memory tests more closely resembled people with Alzheimer's than those who only did poorly in the story recall test. "During the follow-up stage, brain atrophy in the medial temporal lobes of those who only performed poorly in the story recall test did not differ from the cognitively healthy participants, whereas in those who had poor performance in both the story and word list recall tests, brain atrophy was faster," says Helsinki's Eero Vuoksimaa. Approximately half of the participants who performed poorly in both episodic memory tests within the three-year study period received an Alzheimer's diagnosis, compared to only 16 percent of those with a poor performance in only one memory test.