Health experts are talking about…

…the link between blood sugar and cognitive decline. Your blood sugar levels may help predict whether you need to worry about dementia. For the first time, researchers have associated blood sugar levels that are even slightly higher than normal with risk, and this may signal a new approach to preventing or delaying cognitive decline.

While we already know that people with diabetes have a higher risk of Alzheimer’s disease and other dementias, a new study found that even people with elevated blood sugar that is below diabetic levels have faster cognitive decline over time than those in the normal-to-low-sugar range.

Scientists regularly tested blood sugar levels and cognition in a large group of participants in the United Kingdom (average age, 65.6 at the beginning of the study) for 10 years. Initial blood sugar readings, known as A1c, ranged from 3.6 to 13.7 percent (5.7 percent indicates prediabetes and 6.5 percent means diabetes). Cognitive decline was measured by screening for memory and verbal skills and orientation (for example, knowing the day and date). Those with higher A1c showed greater cognitive decline compared to those with lower blood sugar. The most notable differences were seen in memory and verbal skills.

Diabetes is thought to affect the brain in several ways, according to the Alzheimer’s Association. Too much insulin may cause chemical imbalances and cognitive problems. High blood sugar causes inflammation, which may damage brain cells. And diabetes itself increases the risk of heart disease and stroke, which can damage brain blood vessels.

While more studies are needed to confirm these findings, researchers said you may lower your risk by eating a healthy diet and exercising. The study was published in the April 2018 issue of the journal Diabetologia.

…elimination of therapy limits under Medicare. There is good news if Medicare pays for your physical, occupational or speech therapy. The 2018 US budget bill includes a provision that permanently removes the limit, or cap, on these treatments.

Previously, therapists were required to seek exceptions for patients needing long-term, outpatient, rehabilitation therapy. Without a waiver, patients either had to stop therapy or pay out of pocket once the cap was reached. The bill eliminates that restriction.

Medicare had also previously required that patients show improvement in their condition to continue therapy. That provision was lifted after a 2013 court settlement mandated that Medicare pay for therapy to improve, maintain or slow further deterioration of a patient’s condition. That ruling protects all Medicare beneficiaries who need ongoing, related services, including those with chronic conditions like Parkinson’s disease or multiple sclerosis.

The combination of the repeal on therapy caps and the court case means that people on Medicare can now get rehabilitation therapy for as long as their doctor or therapist says it is “medically necessary.”

…how a “smart” cane can predict fall risk. You have a smart phone, so why not a smart cane?

The Intellicane looks like, and provides support like, a regular cane but comes equipped with sensors that can analyze your gait to determine your risk of falling. It calculates that risk as accurately as a physical therapist, according to the engineers at Vanderbilt University who developed the device. The idea is to reliably estimate probability so interventions can begin well before someone suffers a serious fall.

To estimate fall risk, physical therapists rate how a person walks in different ways: slow and fast, looking right and left, stepping over obstacles, up and down steps and blindfolded. But this test is limited by its controlled environment. The smart cane could provide richer data by tracking gait during everyday activity, without the use of body sensors.

The developers say the Intellicane may have several benefits for those who use it regularly, such as detecting a faltering sense of balance. Researchers hope the device could one day alert doctors to these changes or even provide enough data to help diagnose diseases that can affect gait or balance.

Every year, one of every three people over 65, and one in two over 80, fall due to problems with walking, balance or vision, or from medication side effects, illnesses or conditions like Parkinson’s disease. Falls can lead to fractures, brain injury, loss of independence and even death, according to the National Institute on Aging. And fear of falling can make people avoid even basic activities like walking and shopping and can lead to social isolation.

…why having a regular doctor is important. If you don’t have a regular doctor you see for checkups, you may be putting yourself at risk. That’s especially true for people on Medicare, say researchers.

Without a personal physician, you’re less likely to get preventive care like screenings, vaccinations or checkups. That affects your overall health and has serious consequences if you’re older or at risk for certain conditions, researchers said. Regular care is also a key part of reducing health disparities among groups.

Experts from several academic institutions, the RAND Corporation and the Centers for Medicare and Medicaid Services analyzed data from 272,000 older Medicare beneficiaries who participated in a national survey about health care. They described a regular doctor as someone you would see for a checkup, if you were sick or hurt or to ask for advice about a health problem.

Even with access provided by Medicare, which insures almost everyone age 65 and older, about 5 percent of people said they didn’t have a regular physician. While that may not sound like much, it amounts to more than two million people. This group was more likely to be on traditional Medicare and not have the part D drug plan. In addition, those who identified as African American, Hispanic, Asian/Pacific Islander or American Indian/Alaska Native were more likely than whites to not have a regular health provider, and so were participants with lower incomes, people without a high school diploma, and men (compared to women).

While those without a regular doctor were generally younger and in better physical health compared to the people in the study with regular physicians, their mental health was worse, they reported more trouble accessing care when needed and they had difficulty getting medications.

Researchers say addressing these disparities, especially access to care, is important for older adults, who tend to have more health issues than younger adults. The study results may help pinpoint barriers to care, like navigating the health system or a shortage of primary care doctors in some parts of the United States. The research was published in the April 2018 issue of the journal Medical Care.