June10

RI ARA

Affiliated with the Rhode Island AFL-CIO “Fighting for the future of our members.”

“NOW, more than ever!!!”

Publication 2018 Issue 23 Published in house by the RI ARA

June 10, 2018 E-Newsletter

All Rights Reserved RI ARA 2018©

Social Security’s Finances Remain Strong

Rich Fiesta

Making Prescription Drugs More Affordable Would Give Medicare a Boost

The following statement was issued by Richard Fiesta, Executive Director of the Alliance for Retired Americans, regarding the Trustees reports issued today on the Social Security and Medicare Trust Funds: “Social Security remains strong and able to meet its obligations well into the future.

The 2018 Social Security Trustees report found that Social Security will be able to cover all

payouts and expenses until 2034.

This is unchanged from last year.

Given Social Security’s efficiency and near universality, the clear solution to the nation’s looming retirement income crisis is to increase Social Security’s modest benefits.

“Social Security becomes a more important part of millions of American families’ retirement plans every year. We call on our elected leaders to safeguard and expand Social Security benefits, provide a more accurate formula for cost-of-living adjustments, and lift the cap on earnings for the wealthiest Americans.

“The Medicare Trust Fund for hospital care now has sufficient

funds to cover its obligations until 2026, three years sooner than projected last year. Congress and the Administration should act now to make changes that will strengthen the program for the future while reducing costs to retirees, such as reining in the prices of prescription drugs.

There is no reason that Americans should continue to pay the highest prices in the world for their medications.

“Sixty-six percent of voters are more likely to back candidates who support expanding and increasing Social Security benefits, compared to only 18% who are less likely.

“In addition, Congress should

sop preventing the Social Security Administration from spending just a few tenths of a percent more of its surplus on administration, so that it can restore the hours of field offices and open new locations. Since 10,000 Americans are turning age 65 every day and disability backlogs are shamefully high, this is a necessary change from current policy.

“Americans have earned their Social Security and Medicare benefits through a lifetime of hard work. We can support the next generations as they retire if we the take the appropriate steps to sustain them.”

The Supreme Court majority is quietly barring workers from having their day in court Above all the Roberts Court is strongly pro-business. The court recently demonstrated that again when it closed the courthouse doors to the ability of many workers to sue for wage theft, harassment, and discrimination.

In Epic Systems v. Lewis, the court in a 5-4 decision ruled that an employer may lawfully require its employees to agree, as a condition of employment, to take all employment-related disputes to arbitration on an individual basis and to waive their right to participate in a class action suit or class arbitration.

The case involved an effort by workers to file a class action suit against an employer for violating the federal minimum wage law.

The employer sought to dismiss the case because it had insisted as a condition of employment that the employees waive their ability

to go to court or be part of a class action; any dispute had to be resolved out of court in an arbitration.

This should be an easy case. The National Labor Relations Act, a federal law adopted in 1938, protects a right for employees to engage in “concerted activities for the purpose of . . . mutual aid or protection.” As Justice Ruth Ginsburg explained in her dissent: “By joining hands in litigation, workers can spread the costs of litigation and reduce the risk of employer retaliation.”

But Justice Neil Gorsuch, joined by the conservative justices – John Roberts, Anthony Kennedy, Clarence Thomas, and Samuel Alito – rejected this and said that the arbitration clause in the employment contract that was insisted upon by employers had

to be enforced and the workers could not go to court or even have a class action in arbitration.

The Supreme Court invoked the Federal Arbitration Act, a law adopted in 1925, which provides that arbitration clauses in contracts shall be enforced.

There are many serious flaws with the majority’s reasoning. To begin with, the Federal Arbitration Act never was meant to apply to employment contracts. In fact, the law explicitly states “but nothing herein contained shall apply to contracts of employment of seamen, railroad employees, or any other class of workers engaged in foreign or interstate commerce.”

Moreover, there is a wellestablished principle of statutory interpretation that says that a later statute should be seen as

modifying an earlier one.

Yet, the court gave the 1925 federal law precedence over one adopted in 1938. There also is a principle that great deference should be given to the statutory interpretation of federal agencies.

For 75 years, the National Labor Relations Board always said that the right to engage in concerted activity includes a right to be part of class action suits and that employers cannot insist on arbitration as a condition for employment.

Justice Gorsuch’s majority opinion began with a false premise. In his first sentence he asked, “Should employers and employees be allowed to agree that any disputes between them will be resolved through one-onone arbitration?” ...Read More

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In the Face of Janus, AFL-CIO Launches Nationwide Ad Campaign Calling on Working People to Organize The AFL-CIO today announced a major, national print and digital ad campaign calling on workers to join together in the face of continued corporate assaults on the freedom to join together in union.

An open letter to working people, penned by AFL-CIO President Richard Trumka, will run in USA Today, the Washington Post and regional newspapers in nine states, including Florida, Illinois, Michigan, Minnesota, Nevada, Ohio, Pennsylvania, Wisconsin and Massachusetts.

Trumka’s letter offers an urgent call to action: “If you want a raise, better benefits and the dignity of having a voice on the job, we’re saving a seat for

you. Join us— be a part of the fight to build a brighter future for you, your family and working people everywhere.”

An accompanying digital ad campaign will target workers online and direct them to FreedomToJoin.org, a new website that outlines efforts by wealthy corporate interests to take away the freedoms of working people.

Additionally, the website offers background on Janus v.

AFSCME, Council 31, an upcoming Supreme Court case funded by the Koch brothers to deprive teachers, firefighters and other public-sector workers of their freedom to join together. It also offers resources for forming

a union and new union members last year, information more than three-quarters were about ongoing under the age of 35. organizing This trend has continued campaigns. steadily into 2018. Last month, This comes as a wave of nearly 15,000 workers organized collective action has continued unions in a single week, ranging to sweep the country. As striking from nurses and flight attendants teachers march and secure raises to Harvard graduate workers. even in anti-labor states, “From the boardroom to the working people from all steps of the Supreme Court, a backgrounds are embracing the dark web of corporate interests power of solidarity. Unions’ is trying to stop us with approval rating has broken everything it has,” writes above 60%, while Trumka. “But no matter what dissatisfaction with corporations any CEO or lobbyist does, we’re has risen to similarly high levels. standing up for the freedom to Young people, who are join together in a union.” disproportionately impacted by Contact: John Weber (202) corporate-driven policy 637-5018 decisions, have been leading the Major ad buy seizes on wave most recent surge in of collective action. unionization. Of the 262,000 See the ad HERE.

Media Backgrounder for Release of 2018 Social Security Trustees Report As reporters prepare to cover the soon-to-bereleased 2018 Social Security and Medicare Trustees Reports, Social Security Works provides you with this background analysis which summarizes what are likely to be the Social Security Report’s key findings (based on last year’s forecasts), and puts them in context. Please note that this backgrounder addresses only the Social Security’s cash benefits Trustees Report (Old Age, Survivors, and Disability Insurance Trustees Report), and not the Medicare Trustees Report.

In addition to reviewing this backgrounder, we invite you to speak with our president, Nancy Altman, who is a nationally recognized Social Security expert. (See her bio below.) We also urge you to review our fact sheet that discusses, among other things, misinterpretations

by non-experts caused by overemphasis of unrealistically long valuation periods. You may also want to read Columbia Journalism Review’s “Report Card on Social Security Coverage,” written in response to coverage of the 2012 Trustees Report.

The most important takeaways from the 2018 Trustees Report will be that (1) Social Security has a large and growing surplus, and (2) Social Security is extremely affordable. At its most expensive, Social Security is projected to cost just around 6 percent of gross domestic product (“GDP”). Indeed, in

three-quarters of a century, Social Security will constitute just around 6.17 percent of GDP. That is consider ably lower, as a percentage of GDP, than Germany, Austria, France, and most other industrialized countries spend on their counterpart programs today! (In 2018, according to last year’s report, Social Security was projected to constitute just 4.93 percent of GDP.) The report will show that Social Security is fully and easily affordable. The question of whether to expand or cut Social Security’s modest benefits is a question of values

and choice, not affordability.

Indeed, in light of Social Security’s near universality, efficiency, fairness in its benefit distribution, portability from job to job, and security, the obvious solution to the nation’s looming retirement income crisis, discussed below, is to increase Social Security’s modest benefits. The average annual benefit received by Social Security’s over 61 million beneficiaries is less than $15,000 this year. ...Read More

SOON-TO-BERELEASED REPORT WILL SHOW THAT SOCIAL SECURITY CONTINUES TO WORK FOR AMERICA An Expanded Social Security Will Work Even Better

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Medicare Rights Opposes Potential New Medicare Model that Puts Beneficiaries at Risk Last week, the Medicare Rights Center submitted comments to the Center for Medicare & Medicaid Innovation (CMMI) in response to a request for information on a potential new Medicare model. CMMI—an offshoot of the Centers for Medicare & Medicaid Services (CMS), which is the agency that oversees the Medicare program—was created to develop and test new ideas in health care delivery. Most of these ideas involve different ways of paying providers such as doctors or hospitals.

In this request for information, CMMI asked interested parties to provide input on ways to design and test a model for Direct Provider Contracting (DPC). In a DPC model, a beneficiary could choose to join a primary care or specialty provider’s practice and potentially gain certain benefits such as reduced cost sharing or increased services that Medicare does not generally pay for.

While this idea may be intriguing, CMMI did not provide any detail on how such a model would work, which

leaves some dangerous options on the table.

For example, CMMI did not rule out a DPC model including what is known as “private contracting” or “balance billing.” If private contracting were permitted, Medicare providers would be allowed to require beneficiaries to negotiate individually for their care and to sign contracts obligating them to pay costs in excess of Medicare’s allowed fees. Beneficiaries would not be able to rely on current Medicare rules that set limits on what participating providers can charge. This means providers could charge whatever they chose, and some people with Medicare would be priced out of health care. Losing this essential protection is just one of the ways a DPC model could potentially put beneficiaries at risk.

Another potential aspect of a DPC model—a per-person permonth or capitated payment— might encourage doctors and

hospitals to withhold care. With a capitated payment, as seen in most managed care plans, providers may have an incentive to provide less care because they are not paid more for additional services. We also spotted areas where a DPC model design might encourage providers to discriminate against people with poorer health or chronic conditions. It is important that models be designed so that there is no “cherry picking” of healthier patients to save money on care. These issues make it necessary for CMMI to ensure there is robust oversight of any DPC model.

While Medicare Rights supports innovations in Medicare that increase access, quality, and affordability of care, we do not support ideas that strip beneficiaries of their fundamental protections, lead to worse outcomes, or increase costs. Because CMMI was not clear about what any future DPC model might include, we

responded to many potential ideas that were not necessarily being contemplated. In our comments, we urged CMMI to provide further opportunities to comment on DPC proposals as details are fleshed out. We also requested that CMMI engage Medicare beneficiaries in all levels of model design to ensure these vital voices are heard.

We will continue to monitor and comment on model development to ensure beneficiaries have the protections they need in all aspects of the Medicare program.

Read our comments.

Read more about the request for information.

Read more about consumer protections in CMMI models.

CMS Expands the Extension of Needed Relief for Marketplace Enrollees Who Missed Medicare Enrollment This week, the Centers for Medicare & Medicaid Services (CMS) expanded the timelimited equitable relief opportunity to people who are enrolled in Marketplace plans but could have enrolled in Medicare Part B during their Special Enrollment Period (SEP), which was available to them after they lost their or a spouse’s job-based insurance.

Time-limited equitable relief lifts the burden of lifetime late enrollment penalties and gaps in health coverage for people with Marketplace plans who mistakenly missed signing up for Medicare.

Last October, CMS announced a yearlong extension of time-limited equitable relief, through September 30, 2018, a critical exception for certain Marketplace enrollees who delayed or declined Medicare enrollment.

CMS’ decision to expand equitable relief will help even more people hampered by costly penalties and those going without needed health care.

Medicare Rights applauds CMS for doing right by people new to

Medicare, and we look forward to working with our agency  Call the Medicare Rights partners, State Center’s free national Health helpline at 1-800-333-4114 Insurance Assistance Programs  Call the State Health (SHIPs), local Social Security Insurance Assistance Offices, and others to help Program (SHIP) at 1-877people access this critical relief.

839-2675 or visit the shiptacenter.org For more information on time-  Contact the Social Security limited equitable relief and how Administration at 1-800to apply, see Medicare Rights’ 772-1213, or go online resource, to socialsecurity.gov, or  Medicare Interactive, and: visit your local Social  Read the Fact Security office Sheet updated by CMS

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Highlighting Medicare Rights’ National Helpline Trends In March, the Medicare Rights Center released its annual helpline trends report outlining ongoing challenges facing people with Medicare, heard through nearly 17,000 calls to the National Consumer Helpline. The report, Medicare Trends and Recommendations: An Analysis of 2016 Call Data from the Medicare Rights Center National Helpline, reexamines the top three recurring issues heard on the helpline in prior years.

Part B enrollment confusion, Medicare Advantage plan denials, and prescription drug costs continue to pose problems for people with Medicare.

Samantha Morales, associate director of client services, and Julie Carter, federal policy associate, who authored the report, illustrate these trends with client stories. The stories and data highlight how helpline

counseling informs Medicare Rights’ work with partners, policymakers, and the Centers for Medicare & Medicaid Services (CMS) to address persistent issues and create change.

Medicare Rights helpline counselors responded to over 1,000 questions about Medicare Part B enrollment in 2016. One client, Ms. B, was undergoing cancer treatment when she was left without health insurance due to misinformation from her employer about coordination of benefits with COBRA and Medicare. To help prevent enrollment mistakes like Ms. B’s, Medicare Rights developed the Beneficiary Enrollment Notification and Eligibility Simplification (BENES) Act, bipartisan legislation which would modernize and simplify

the Part B enrollment process.

Hearing the real life struggles of people with Medicare firsthand helps Medicare Rights prioritize clients’ concerns in our policy work.

Similar to previous years, coverage- and denials-related calls were most common, representing 34% of all helpline calls in 2016. Many people with Medicare Advantage (MA) plans are denied coverage for receiving care from out-ofnetwork providers. Some live in rural areas far from in-network doctors, and others face long wait times. Questions related to Medicare affordability are also frequent, representing 20% of 2016 calls. “Specialty tier” prescription drugs in particular present challenges, as current regulations exclude them from

cost reductions. Medicare Rights urges a change to these rules that unfairly penalize people who need specialty drugs. We are listening to client needs, and we will continue our efforts to improve consumer education surrounding MA plans and to support health care affordability.

Although Part B enrollment, Medicare Advantage plan networks, and prescription drug affordability remain persistent issues, Medicare Rights continues to work on behalf of its clients—and all people with Medicare—to address them. Its dedicated helpline staff and volunteers assist clients one at a time, while the policy team takes what they learn from the helpline to the nation’s capital to incite change for people with Medicare.

Trump Plan to Lower Drug Prices Could Increase Costs for Some Patients When President Trump unveiled his plan to lower prescription drug prices in a Rose Garden speech last month, he said he would inject more competition into the market by bolstering negotiating powers under Medicare. But experts analyzing the plan warn of a possible side effect: The proposal could significantly increase outof-pocket costs for some of the sickest people on Medicare.

At the heart of the president’s plan is a proposal to switch some expensive drugs from one part of Medicare to another part — moving them from Part B, the medical benefit created in the original 1965 Medicare law, to Part D, the outpatient drug benefit added by Congress in 2003.

Under Part D, the government contracts with private health insurance companies to manage the benefit and negotiate discounts with drugmakers.

There is no such negotiation for

the drugs covered by Part B, which are administered by infusion or injection in doctors’ offices or hospital outpatient departments.

But Medicare beneficiaries typically pay a larger share of the costs for Part D drugs. Many beneficiaries have supplemental insurance, such as a Medigap policy, to help pay their share of the bill for drugs covered under Part B. Medigap policies are not allowed to cover Part D expenses.

AARP, the lobby for older Americans, and advocates for cancer patients are already expressing concerns. The problems are not inevitable, they say, but will be difficult to solve.

“People may see a lot higher out-of-pocket costs if a drug moves from Part B to Part D,” said David M. Certner, the legislative policy director of AARP.

Under Part B, beneficiaries are generally responsible for 20 percent of the Medicare-approved charges for drugs and doctors’ services, but the most popular Medigap policies cover the beneficiary’s share. By contrast, in Part D, beneficiaries may be responsible for 30 percent of the cost of some drugs, or more, depending on the terms of coverage set by their drug plan.

Another potential problem is that nine million Medicare beneficiaries who are enrolled in Part B do not have drug coverage under Part D. The White House has not said how their drug bills would be paid.

Administration officials and Republicans in Congress often describe Part D — proposed by President George W. Bush and pushed through Congress by Republicans — as a success that shows the value of competition.

Benefits are delivered entirely by competing private health plans.

“President Trump has called on us to merge Medicare Part B into Part D, where negotiation has been so successful on so many drugs,” said Alex M. Azar II, the secretary of health and human services.

Dr. Steven B. Miller, the chief medical officer of Express Scripts, one of the nation’s largest pharmacy benefit managers, said he was confident that his company could save money for beneficiaries and the government if it could manage drugs now covered by Part B of Medicare.

“Part D has been under budget every year, and member satisfaction is extraordinarily high,” Dr. Miller said. “It’s a very successful program. That’s why people are excited about moving drugs into Part D.” ...Read More

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Domestic Violence’s Overlooked Damage: Concussion And Brain Injury Hundreds of survivors of domestic violence have come through the doors of neurologist Glynnis Zieman’s Phoenix clinic in the past three years.

“The domestic violence patients are the next chapter of brain injury,” she said.

Zieman begins every new patient visit with a simple question: “What are the symptoms you hope I can help you with?”

For most, it’s the first time anyone has ever asked how they may have been injured in the first place. “I actually heard one patient tell me the only person who ever asked her if someone did this to her was a paramedic, as she was being wheeled into an ambulance,” Zieman said. “And

the husband was at the foot of her stretcher.”

While many patients initially seek out the clinic because of physical symptoms, such as headaches, exhaustion, dizziness or problems sleeping, Zieman’s research shows that anxiety, depression and PTSD usually end up being the most severe problems, she said.

Studies of traumatic brain injury have revealed links to dementia and memory loss in veterans and athletes. And TBI has also been linked to PTSD in current or former service members.

But survivors of domestic violence may be suffering

largely in silence.

About 70 percent of people seen in the emergency room for such abuse are never identified as survivors of domestic violence.

It’s a health crisis cloaked in secrecy and shame, one that Zieman is uncovering through her work at the Barrow Concussion and Brain Injury Center.

She runs what she said is the first program dedicated to treating traumatic brain injury for survivors of domestic violence.

“About 81 percent of our patients had so many hits to the head, they lost count, which, you compare that to athletes, is

astronomical,” Zieman said.

Zieman said it’s not just the sheer number of injuries that makes these patients’ cases so complex.

“One single athletic concussion is hard enough to treat, but these patients are beyond that,” she said. “Unlike athletes, they do not have the luxury, if you will, of recovering after an injury before they are injured again.”

Domestic violence is estimated to affect more than 10 million people each year. Head and neck injuries are some of the most common issues, and Zieman is uncovering how frequently traumatic brain injury is part of the picture…..Read More

Link between depression and cognitive decline explored A new study, published in the journal Psychological Medicine, reports a link between depression and accelerated aging of the brain. Its authors suggest their findings may help to inform future dementia research.

Depression can affect anyone at any stage of their life.

According to the Centers for Disease Control and Prevention (CDC), about 1 in 6 people in the United States will experience depression at some point in their life.

Scientists do not know the exact cause of depression, but many believe it is a combination of psychological, genetic, biological, and environmental factors.

Certain risk factors are already known; for instance, having relatives who have had depression, experiencing traumatic events, going through a major life change, and using alcohol or drugs.

Depression and dementia Previously, scientists have

identified an association between depression and an increased risk of dementia later in life.

A 2015 study published in JAMA Psychiatry, for example, found that people with depression had an 83 percent increased risk of acquiring dementia compared with people who did not have depression.

The same study also found that people who had depression and type 2 diabetes were at even higher risk of developing dementia, with a 117 percent increased risk compared with people who had neither condition.

A linked commentary to the 2015 study said that, while scientists at this stage do not yet know whether treatment of depression may offer protection against cognitive decline and onset of dementia, the "hypothesis is plausible."

The new study — conducted

by psychologists at the University of Sussex in the United Kingdom — is the first to provide substantial evidence of the relationship between depression and impairment of overall cognitive function in the general population.

The researchers conducted a systematic review of 34 longitudinal studies (long-term observational studies) that had investigated links between depression or anxiety and cognitive decline. This included assessing data from 71,000 participants.

To get a clearer picture of how depression might influence the aging brain, the authors excluded any participants who were diagnosed with dementia at the start of the study.

The team concluded that people who had experienced depression had more extensive cognitive decline later in life

than people who had not experienced depression.

What does this mean for patients?

The researchers believe that these findings could have implications for dementia research, and that they may help provide clues to potential early interventions.

"This study is of great importance — our populations are aging at a rapid rate, and the number of people living with decreasing cognitive abilities and dementia is expected to grow substantially over the next 30 years."

Co-lead study author Darya Gaysina Gaysina continues, "We need to protect the mental well-being of our older adults and to provide robust support services to those experiencing depression and anxiety in order to safeguard brain function in later life….Read More

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Driving Safety and Alzheimer's Disease Good drivers are alert, think clearly, and make good decisions. When a person with Alzheimer's disease is not able to do these things, he or she should stop driving. But, he or she may not want to stop driving or even think there is a problem.

As the caregiver, you will need to talk with the person about the need to stop driving. Do this in a caring way.

Understand how unhappy the person may be to admit that he or she has reached this new stage.

Safety First A person with some memory loss may be able to drive safely sometimes. But, he or she may

not be able to react quickly when faced with a surprise on the road. Someone could get hurt or killed. If the person's reaction time slows, you need to stop the person from driving.

Here are some other things to know about driving and memory loss:  The person may be able to drive short distances on local streets during the day but may not be able to drive safely at night or on a freeway. If this is the case, then limit the times and places the person can drive.

 Some people with memory problems decide on their own not to drive, while others may deny they have a problem.

Signs that the person should stop driving include new dents and scratches on the car. You may also notice that the person takes a long time to do a simple errand and cannot explain why, which may indicate that he or she got lost.

To find out if a person with Alzheimer's is still competent to drive, watch him or her drive at different times of the day, in different types of traffic, and in

different road conditions and weather. If riding with the driver is not possible, follow the driver in another vehicle. Over time, a picture will emerge of things the driver can and cannot do well….Read More

Read More on Alzheimer’s Safety  Disaster Preparedness for Alzheimer's Caregivers  Home Safety Checklist for Alzheimer's Disease  Home Safety and Alzheimer’s Disease

Study: A Social Circle is Key to Protecting the Aging Mind KEEP YOUR FRIENDS CLOSE as you age, because they may be the key to keeping your brain healthy, according to a new study.

The study, published Thursday in the journal Frontiers in Aging Neuroscience, found mice housed in groups had better memory and healthier brains than those living in pairs. The findings influence "a body of research in humans and animals that supports the role of social connections in preserving the mind and improving quality of life," according to Elizabeth

Kirby, assistant professor of behavioral neuroscience at The Ohio State University Wexner Medical Center and lead author of the study.

The study used mice that were 15 months to 18 months old during the experiment – a time of significant memory decay.

Some of the mice lived in pairs, while others were housed in groups of seven for three months. The first test required the mice to recognize that a toy, such as a plastic car, had been moved to a new location.

A mouse with a healthy brain would recognize something has been relocated, and mice that lived in larger groups generally fared better on this assessment, according to Kirby.

"We found that mice housed in groups remembered objects better," Kirby says.

In another maze-based memory test, mice were placed on a table with holes, and both groups of mice were tasked with finding new escape routes every time. With four total trials a day, it was noted that both groups

improved their escape routes each time. However, the coupled mice did not complete the test faster when it was repeated several times. But the group-housed mice improved performance with each trial, suggesting they used their hippocampus, an area of the brain associated with memory.

"One of the holes had an escape hatch," Kirby says.

"Every day we'd place the hatch in a new location. We found that all mice [found the hatch] quickly, but the difference was in how they did it."...Read More

How much should seniors exercise to improve brain function?

To boost their reasoning skills and the brain's processing speed, seniors may need to exercise for 52 hours over a period of 6 months, concludes a new study.

The good news is that lowintensity exercise such as walking has the same benefits — as long as it's carried out for this length of time.

As more and more research keeps pointing out, exercise does wonders for our brain.

For instance, a recent study

that Medical News Today reported on shows that running protects our memory from the harmful effects of stress.

Additionally, research has shown that exercise helps to prevent the aging of the brain and to keep mild cognitive impairment (MCI) — a precursor of dementia in seniors — at bay.

But exactly how much exercise do seniors need in order to fully reap these cognitive benefits?

And for how long do they have to do it?

To find out, researchers led by Joyce Gomes-Osman, Ph.D. — from the University of Miami Miller School of Medicine in Florida — set out to conduct a meta-analysis of existing studies.

More specifically, they examined all of the randomized controlled trials in which a group of seniors exercised for a minimum of 4 weeks and had their memory and reasoning skills compared with those of a control group at the end of the intervention....Read More The findings were published in the journal Neurology: Clinical Practice.

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Seniors Slow to Embrace Online Access to Doctors Many doctors have internet portals to help patients manage their care. But that doesn't mean older folks will use them.

A University of Michigan poll found only about half of patients 50 to 80 years old have set up an online account with their health care provider.

"The health care system has provided patient portals as an efficient way for patients to communicate with their providers. But many older adults are uncomfortable with electronic interactions substituting for a phone call or in-person conversation," coassociate poll director Sarah Clark said in a university news release.

Researchers found that better educated patients with higher incomes are most likely to use these systems. But poorer

people with less education often have more health-related needs, the researchers said.

People over 65 were more likely than those in their 50s and early 60s to say they don't like using the computer to communicate about their health.

They were also more likely to voice discomfort with technology in general.

Among those who hadn't linked up to a patient portal, 52 percent cited concerns about using the internet to monitor their health information.

Half said they didn't see the need for this kind of access to their health information. And about 1 in 4 said they hadn't gotten around to setting up their

account. These folks tended to be in their 50s and early 60s.

The poll included more than 2,000 older adults.

Over the past several years, the U.S. government has required hospitals, health systems and other health care providers to offer patient portals to patients if they want extra funding from Medicare.

This gives patients access to records and test results that are part of electronic medical records.

Of those who have set up online accounts, 84 percent have viewed results from blood or other tests, the researchers found.

Far fewer patients use other

functions available online. For instance, only 43 percent refilled prescriptions online, 37 percent scheduled an appointment online and just over a quarter used the portal to get advice about a health problem.

Nearly half of patients said speaking with their doctor was a better way to explain their problem.

"Many older adults still prefer telephone contact with their providers," said poll director Dr. Preeti Malani, a professor at the university's medical school. "We hope providers, and health systems, will take these findings into consideration when designing the ways patients can interact with them."

More information The U.S. National Institute on Aging talks about doctorpatient communication

Many breast cancer patients can skip chemo, big study finds Most women with the most common form of early-stage breast cancer can safely skip chemotherapy without hurting their chances of beating the disease, doctors are reporting from a landmark study that used genetic testing to gauge each patient's risk.

The study is the largest ever done of breast cancer treatment, and the results are expected to spare up to 70,000 patients a year in the United States and many more elsewhere the ordeal and expense of these drugs.

"The impact is tremendous," said the study leader, Dr. Joseph Sparano of Montefiore Medical Center in New York. Most women in this situation don't need treatment beyond surgery and hormone therapy, he said.

The study was funded by the National Cancer Institute, some foundations and proceeds from the U.S. breast cancer postage stamp. Results were discussed Sunday at an American Society of Clinical Oncology conference

in Chicago and published by the New England Journal of Medicine. Some study leaders consult for breast cancer drugmakers or for the company that makes the gene test.

MOVING AWAY FROM CHEMO Cancer care has been evolving away from chemotherapy — older drugs with harsh side effects — in favor of genetargeting therapies, hormone blockers and immune system treatments. When chemo is used now, it's sometimes for shorter periods or lower doses than it once was.

For example, another study at the conference found that Merck's immunotherapy drug Keytruda worked better than chemo as initial treatment for most people with the most common type of lung cancer, and with far fewer side effects.

The breast cancer study

focused on cases where chemo's value increasingly is in doubt: women with early-stage disease that has not spread to lymph nodes, is hormone-positive (meaning its growth is fueled by estrogen or progesterone) and is not the type that the drug Herceptin targets.

The usual treatment is surgery followed by years of a hormoneblocking drug. But many women also are urged to have chemo to help kill any stray cancer cells. Doctors know that most don't need it, but evidence is thin on who can forgo it.

The study gave 10,273 patients a test called Oncotype DX, which uses a biopsy sample to measure the activity of genes involved in cell growth and response to hormone therapy, to estimate the risk that a cancer will recur.

WHAT THE STUDY FOUND About 17 percent of women

had highrisk scores and were advised to have chemo.

The 16 percent with low-risk scores now know they can skip chemo, based on earlier results from this study.

The new results are on the 67 percent of women at intermediate risk. All had surgery and hormone therapy, and half also got chemo.

After nine years, 94 percent of both groups were still alive, and about 84 percent were alive without signs of cancer, so adding chemo made no difference.

Certain women 50 or younger did benefit from chemo; slightly fewer cases of cancer spreading far beyond the breast occurred among some of them given chemo, depending on their risk scores on the gene test….Read More

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