Debt Ceiling Fight Looms Over Medicare, Medicaid

Axios | Peter Sullivan
 
House Republicans don't have much of a path to get major health care changes passed with a Democratic Senate and president, with one possible exception: the debt ceiling fight. 
 
Why it matters: It's not clear which spending cuts House Republicans will push for in exchange for expanding the government's borrowing authority later this year — but at least some say health care programs like Medicare and Medicaid should be on the table. 

• Others, mindful of how the mere talk of entitlement cuts has brought political repercussions, are saying they want to steer clear of the programs. 

What they're saying: "We're going to have to look at the whole board," conservative Rep. Barry Loudermilk (R-Ga.) told Axios, including mandatory spending like Medicare and Medicaid. "The easiest to start with is discretionary, but the main driver of the national debt is the mandatory."

• "Everything's on the table," he added. 
• Asked about entitlement reform, Speaker Kevin McCarthy told reporters Thursday that "as Republicans we will always protect Medicare and Social Security," but did not get into specifics. (He also did not mention Medicaid).
• "We will protect that for the next generation going forward, but we are going to scrutinize every single dollar spent," he added. 

What to watch: Rep. Morgan Griffith (R-Va.), a Freedom Caucus member who is also on the Energy and Commerce Committee, said any changes to Medicare would not take place immediately.

• "Anytime we talk about those cuts people always panic," he told Axios. "Nobody needs to panic. If we're going to do something, it will be out in the future years a long way out and people will understand it and will have time to adjust for it."
• He cited the possibility of raising the Medicare eligibility age from 65 to 67 as one possible change, while keeping it lower for people who had careers doing manual labor and have trouble continuing to work later in life. 

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Blood Test for Early Alzheimer’s Detection

One of the first stages of Alzheimer’s disease involves formation of toxic aggregates, called oligomers, of the protein amyloid beta (Aβ). These oligomers can start to form more than a decade before symptoms appear and before other known disease markers form. The ability to detect these oligomers would permit early disease diagnosis. This would make strategies to intervene before irreparable brain damage occurs possible.

An NIH-funded research team led by Valerie Daggett at the University of Washington developed a method to detect toxic Aβ oligomers in patients’ blood. They tested the assay, called the soluble oligomer binding assay (SOBA), on nearly 400 banked human blood plasma samples. Results appeared on December 13, 2022, in the Proceedings of the National Academy of Sciences.

Toxic Aβ oligomers have a structure known as an alpha sheet that isn’t normally found in proteins. Alpha sheets tend to bind to each other. SOBA takes advantage of this distinct structural feature. The researchers designed a synthetic alpha sheet molecule to bind to the alpha sheets in Aβ oligomers. They showed that their designed molecule, called AP193, bound to the subset of Aβ with alpha sheets but not to other, non-toxic forms of Aβ.

Aβ oligomers normally reduce signaling in cultured neurons. Adding AP193 prevented this reduction in signaling. AP193 might thus form the basis for future therapeutic strategies.

When the team applied SOBA using AP193 to a cerebrospinal fluid sample from a person with Alzheimer’s disease, they detected Aβ oligomers. They did not detect oligomers in cerebrospinal fluid from a person who had no cognitive impairment.

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Hospice Services Pulled for Dementia Patient

I got a letter about a hospice agency ending services for a woman whose only diagnosis was dementia . As sad as I am to hear those stories (and I get many) I am not surprised. These families have had the comprehensive services of hospice for months, even a year or so and then they are  withdrawn because the person is no longer eligible.

These discharges are happening because dementia doesn’t play by the rules for end of life. It isn’t until eating becomes a problem that the dying process really begins. 

Dementia seems to be in a category of its own. It doesn’t fit into Home Health services that focus on getting people better. It doesn’t really fit Palliative Care, although maybe it could. 

There is a huge void in our medical system that so many families living with dementia fall into. These families have a loved one too sick and require too much care without hope of getting better. Yet because they have not yet entered the dying process they do not qualify for most health care services, let alone hospice care…

Hospice, to its credit, has stepped in to fill this void, but is tied by the six month prognosis clause in the hospice medicare benefit. If they can’t report continued decline toward approaching death after 6 months of care they must discharge a person from services.

If you find yourself in the situation where your special person is being discharged from hospice due to not declining fast enough, have the hospice social worker advise and help you get into community services that are available in the area. Check national resources like AARP. Services that can help support you in the loving care you are giving.

Ask about where you can get medical equipment, assistance in physical caregiving, even volunteer support. Also check end of life doulas in your area. Talk to them, see what they can offer and how much they charge. What about support from a church? Also some places now have dementia doulas. Do an internet search to see if any are in your area.

None of the above will be as comprehensive as the services hospice has provided, but use the hospice social worker while you have her/him.

Study: Falls Rate Nearly 50% for U.S. Seniors with Dementia; 3 Factors Raise Risk

McKnight’s Long-Term Care | Alicia Lasek
 
Nearly half of American seniors with dementia had one or more falls in the preceding year, according to a new analysis of 2016 data. Three factors were most highly associated with risk, the researchers say.

Data came from the National Health and Aging Trends Study from 2015 and 2016, which examined health and disability trends and outcomes in adults aged 65 years and older in the United States. Fully 45.5% of older adults living with dementia experienced one or more falls in 2016, compared to 31% of older adults without dementia, investigators found.

Impaired vision, living with a spouse versus living alone, and a history of falls within the prior year were strongly linked to greater likelihood of falls, reported the authors, from Drexel University in Philadelphia and Johns Hopkins University in Baltimore.

They also pinpointed key falls risk factors for older adults living without dementia. These included financial hardship, a history of falls, fear of falling, poor lower extremity performance, depressive symptoms and home disrepair.

The study is the first national one to compare risk factors for senior Americans living with dementia to those without dementia, according to the researchers. The results support tailored falls prevention strategies for people with dementia that consider key risk factors during screening, they added.

“Overall, our findings demonstrate the importance of understanding and addressing fall-risk among older adults living with dementia,” said Safiyyah Okoye, PhD, of Drexel. “It confirms that fall-risk is multidimensional and influenced by environmental context in addition to health and function factors.”

Full findings were published in Alzheimer’s & Dementia.