Many older adults develop postoperative cognitive dysfunction (POCD) after surgical intervention, and the symptoms can range from memory problems to difficulty multitasking and gaining new knowledge to problems following multistep procedures or setting priorities, reports Kaiser Health News . In most cases, POCD is temporary and people recover in several months; in other circumstances, POCD persists up to a year or longer. A document outlining standard definitions for POCD is expected to be published simultaneously in six scientific journals in June, while researchers will discuss the latest developments at a two-day summit. A simple test for POCD does not currently exist. Usually, a series of neuropsychological tests are administered before and after surgery, and they frequently are given one week and again three months following surgery. However, the tests used and time frames differ in various studies. Studies also classify POCD differently, using varying criteria to evaluate the kind and extent of cognitive impairment that people experience. Different studies produce different estimates of the POCD population, while the risk of developing POCD after surgery is exacerbated in people who are older, have low levels of education, and cognitive concerns that predate surgery. Adults age 60 and older are twice as likely to experience POCD as younger adults.

Yale University Professor Thomas Gill and colleagues have identified examples of what are often, but not always, considered to be indicators of normal aging for people who practice good health habits and get recommended preventive care, reports Kaiser Health News . A decline in stamina is one such indicator, which accelerates in the 50s, as does a decline in resilience from injuries or sickness. Meanwhile, people's susceptibility and negative response to flu, pneumonia, and shingles increase as they get older, as does the importance of vaccines for those illnesses. A loss of hearing also is a common affliction, and Gill notes the chances of developing some form of dementia doubles every five years beginning at age 65, according to a report in the American Journal of Public Health . Gill also says people in their 60s might start recognizing a slowdown of information retrieval. "This doesn't mean you have an underlying disease," he says. In their 70s, chronic conditions — such as hypertension, diabetes, or dementia — often arise. "A small percentage of people will enter their 70s without a chronic condition or without having some experiences with serious illness," Gill says. Furthermore, people in their 70s lose bone and muscle mass, which makes them more vulnerable to serious injury or fracture. Mobility issues are another growing symptom for people in their seventh decade. In their 80s, fear of falling becomes prominent, and Gill says by age 90, people have about a 1-in-3 chance of manifesting signs of Alzheimer's-related dementia.

Four congressional hearings on fighting the opioid crisis are scheduled for this week as the House and Senate step up efforts to pass legislation in this spring, reports CQ Roll Call . The Senate Health, Education, Labor, and Pensions Committee plans to discuss a bipartisan package revealed while the House Energy and Commerce Health Subcommittee will consider 34 bills. In addition, the Senate Judiciary Subcommittee on Crime and Terrorism is holding a hearing on how to combat fentanyl, and the House Oversight Committee Subcommittee on Healthcare, Benefits, and Administrative Rule is looking at local responses to address the crisis. The Health Subcommittee will examine legislation related to improving the ability of Medicaid and Medicare to care for beneficiaries, which will touch on increasing telehealth to treat opioid use disorder, requiring Children's Health Insurance Program plans to cover substance use disorder treatment, and ordering the Centers for Medicaid and Medicare Services to assess the use of abuse-deterrent opioids in Medicare plans. Both chambers' legislative packages have similar language including a bill called Jessie's Law, which would help doctors learn more easily if someone has a history of abuse. The House ands Senate also are examining legislation to boost the interoperability of state prescription drug monitoring programs.

A study has found significant wellness incentives and high-deductible health plans (HDHPs) are becoming less popular as employee healthcare cost fixes, reports Workforce . HDHPs currently represent just 30 percent of medical plans offered by employers. "Increasingly, employers are realizing that true, long-term cost management will come from a combination of tools and that they need to enlist employees in the effort in a meaningful way," says DirectPath's Kim Buckey. She notes wellness programs and private exchanges could yield short-term relief but not singlehandedly address the challenge. Meanwhile, the HDHP option has failed to resolve employees' lack of health literacy and health insurance comprehension. About 31 percent of employers offer wellness incentives today, compared to 58 percent in 2017. "That was surprising because using incentives to drive employee behavior was a big component of most companies' strategies across the past couple years," says Gartner's Brian Kropp. "What companies are finding in a lot of cases is that the incentives were most likely used by healthiest people whose healthcare costs were already quite low." The study also suggests the erosion of incentive use may be partly explained by concerns about the future legality of such plans, as a federal judge ruled last year that the EEOC's incentive rules will expire at the end of 2018.

A national study published in the Journal of the American Geriatrics Society measured the effect of the Medicare Annual Wellness Visit on early identification of cognitive impairment, and found it has only minimal impact on detection of cognitive impairment as well as on subsequent cognitive testing and care, reports Medical Xpress . Change was found to be insignificant in the rate of new diagnoses of Alzheimer's disease and related cognitive impairment, and in the rate of brain imaging or neuropsychological testing used to diagnose cognitive impairment. However, the researchers identified an increase in the use of laboratory testing for thyroid dysfunction and vitamin B deficiency, which may be used to spot possible causes of reversible causes of cognitive impairment. The results indicated no variance by gender, race, age, or health status. "Our study shows that implementing a policy — mandating inclusion of detection of cognitive impairment as one of the required elements of the Medicare Annual Wellness Visit — without guidance on how to implement, means it isn't being done," says Nicole Fowler with the Indiana University Center for Aging Research. "Brief tools that have been validated in primary care could be employed and coupled with a plan for follow-up if cognitive impairment is suspected, but it does not appear that is being done across the United States."

A study published in Nature Medicine demonstrates for the first time how the most well-known genetic risk factor for Alzheimer's disease manifests in human brain cells, and how the gene can be corrected, reports Medical News Today . The researchers sought to locate and understand the fine yet crucial difference between the E3 and E4 variants of the apolipoprotein (APOE) that makes the APOE4 gene so destructive. They simulated the disease in human cells, examining the effect of APOE4 on human brain cells. The team applied stem cell technology to skin cells from people with Alzheimer's who had two copies of the APOE4 gene in order to create neurons. They determined in human brain cells, the APOE4 protein has a "pathogenic conformation" that prevents it from functioning properly, leading to various disease-causing problems. "APOE4-expressing neurons had higher levels of tau phosphorylation, which was unrelated to their increased production of amyloid-beta peptides, and ... they displayed GABAergic neuron degeneration," the researchers noted. They then compared neurons that did not generate either the E3 or the E4 variants with cells that had APOE4 added to them. The former continued to behave normally, while adding APOE4 led to Alzheimer's-like pathologies. The researchers fixed the faulty gene using a previously developed APOE4 "structure corrector" This rearranged the structure of APOE4 so that it looks and behaves more like the APOE3. Applying this compound to human APOE4 neurons corrected the defects.

A major study published in Lancet Psychiatry determined traumatic brain injury (TBI), even a single mild injury, is tied to a higher risk of dementia, reports the New York Times . The researchers investigated Danish health databases that included all residents as of Jan. 1, 1995, who were at least 50 years old at some time during the 36-year follow-up, from 1977 to 2013. Among 2,794,852 people, they found 258,827 who had suffered at least one TBI. Following adjustment for medical, neurological, and psychiatric illnesses, the team found that compared with people who had never had a TBI, those who had had any exhibited a 24 percent greater risk for dementia, while those who had had five or more had nearly three times the risk. Even a single mild TBI elevated the risk by 17 percent. For their initial TBI diagnosis, 85 percent were this mild variety. Nevertheless, University of Washington School of Medicine Professor Jesse R. Fann says the absolute risk of developing dementia as young as 50 is quite low. "I don't want people to think that just because you've had a head injury you're bound to get dementia," he notes.

A new forecast by the Congressional Budget Office (CBO) expects Medicare spending to increase to $1.2 trillion by 2028, reports Becker's Hospital CFO Report . CBO attributes the current slow spending growth to higher premium revenue, and predicts Medicare enrollment will climb by 2.7 percent this year, versus 2.6 percent last year. For 2019-2028, the office says Medicare spending will rise an average of 7 percent annually, "driven by the rising per-beneficiary costs of medical care." CBO specifies that cost growth reflects almost 5 percentage points of the gain, while increasing enrollment only accounts for the rest. In addition, Medicaid's government cost should be higher mostly on account of rising per-capita costs. After 2018, CBO expects Medicaid spending will grow at an average rate of 5.5 percent yearly. Only 1 percent of the spending reflects growth in enrollment, while almost 5 percent is due to cost.

Sens. Elizabeth Warren (D-Mass.) and Rand Paul (R-Ky.) in March unveiled legislation that could make it easier for hearing-impaired Americans to get help by permitting Medicare to pay audiologists to teach beneficiaries how to adjust to and use their hearing aids and manage communication with other people, reports Kaiser Health News . Currently, Medicare is authorized to reimburse audiologists for diagnosing hearing loss in older adults but not for providing assistance to fit, adjust, and learn to maximize use of hearing aids. The Senate proposal follows a law signed last summer instructing the Food and Drug Administration (FDA) to establish and regulate a new category of hearing aid to be sold over the counter for people with mild to moderate hearing loss. People can purchase products off the shelf without consulting an audiologist or hearing aid dispenser, and standards for online sales will be tightened. The FDA has three years to devise consumer protection standards. However, the new law fails to address insurance coverage, as neither traditional Medicare nor most private insurers usually cover hearing aids. Studies estimate just 10 percent to 20 percent of people with hearing loss have ever used hearing aids, while lack of access to care and the stigma associated with wearing a hearing aid also discourage users. "The over-the-counter law will lower the cost and make hearing aids more accessible," says Nicholas Reed at the Johns Hopkins Bloomberg School of Public Health. "But if the services aren't covered, people, especially older adults with health literacy issues, will stop using them."

The latest World Economic Outlook report from the International Monetary Fund (IMF) says developed nations such as the United States, Japan, and Britain need to admit more migrant workers or risk being inundated by their aging populations, reports The Guardian . The IMF warns working-age adults will need to support twice the number of seniors that they do now in the next several decades, straining welfare systems and wiping out as much as 3 percent of potential economic output by 2050. "Dramatic shifts in demographic structure projected in advanced economies could overwhelm the ability of policies to offset the forces of aging," the report says. "This underscores the need to rethink migration policies to boost labor supply in advanced economies." The IMF forecasts the current labor force participation rate could decline by up to 5.5 percent on average across advanced economies over the next 30 years without government intervention. Meanwhile, the U.K. government's Office for Budget Responsibility calculates that British healthcare spending will have to nearly double from 6.9 percent of gross domestic product in the early 2020s to 12.6 percent by the mid-2060s due to the aging populace. The IMF says governments could attempt to offset this through better policies to help people balance family life and work, while also urging more investment in education to get people into work and increase their odds of staying in a job longer.