Experiencing daytime sleepiness is something that is usually perceived as a minor inconvenience, but for older adults, it could be an early warning sign of Dementia. This neurodegenerative disease leads to the progressive decline of brain cells. This eventually

affects memory, cognition, and personality, making everyday tasks more difficult. As one of the fastest-growing neurological disorders across the world, dementia poses a significant health threat to ageing populations.

Is Dementia Linked To Poor Sleep?

For this study, researchers followed 445 older adults (average age 76) over three years, aiming to determine whether poor sleep could increase the risk of mild cognitive impairment (MCI), which often leads to dementia. At the start, none of the participants had MCI, but by the end of the study, 36 individuals had developed the condition.

The researchers discovered that participants with poor sleep were more likely to develop MCI compared to those who slept well. However, when depression symptoms were taken into account, the link between poor sleep and MCI became less pronounced, suggesting that while sleep issues are a concern, mental health also plays a key role in dementia risk.

To assess sleep quality, the Pittsburgh Sleep Quality Index (PSQI) was used, evaluating factors such as sleep duration, disturbances, and daytime alertness. Among these, "daytime dysfunction"—defined as excessive sleepiness and low energy during the day—was most strongly associated with an increased risk of MCI. Those experiencing daytime dysfunction were more than three times as likely to develop MCI as those who didn’t report such symptoms.

There are many types of dementia:

Dementia is not a specific disease. According to the Centers for Disease Control and Prevention (CDC), it is an overall term that describes a decline in mental ability that interferes with daily life. People with dementia often have symptoms like trouble remembering, thinking, or making everyday decisions. These symptoms tend to get worse over time.

Alzheimer’s disease is the most common type of dementia, and it mostly affects the elderly. Each form of dementia has a different cause. Though dementia mostly affects older adults, it is not a part of normal ageing. An estimated 6.7 million older adults have Alzheimer's disease in the United States. That number is expected to double by 2060, as per data from the CDC.

In 2022, 3.8% of men and 4.2% women in US were diagnosed with dementia. The percentage of people increase with age from 1.7% for those aged 65-74 to 13.1% for those aged 85 and older. Alzheimer's accounts for 60 to 80% of all dementia cases and it is most prevalent in California, Florida, and Texas, as these states have the highest number of people.

The US Food and Drug Administration (FDA) recently expanded the approval of Anktiva (nogapendekin alfa inbakicept-pmln), a bladder cancer treatment, to include adults with high-grade papillary bladder cancer that has not responded to Bacillus Calmette-Guérin (BCG) therapy.

The decision provides a new treatment option for patients whose cancer persists or returns despite standard immunotherapy.

The approval specifically covers BCG-unresponsive, high-grade papillary-only non-muscle-invasive bladder cancer (NMIBC). Anktiva was already approved in April 2024 for certain patients with BCG-unresponsive NMIBC involving carcinoma in situ, with or without papillary tumours.

The latest development is significant because patients with high-grade papillary-only disease previously had fewer approved bladder-preserving treatment options after BCG failed.

The FDA based its decision on evidence supporting Anktiva's earlier approval, alongside scientific similarities between the two forms of bladder cancer.

“We listen to patients, clinicians, and researchers, and we act when the science supports a new approach,” said R. Angelo de Claro, MD, director of the FDA's Oncology Center of Excellence.

“For Anktiva, our review of the similarities between these cancers allowed us to build on the results in patients with CIS and expand treatment options for people with high-grade papillary tumors alone. This approach may also help guide the development of future treatments.”

What Is BCG-Unresponsive Bladder Cancer?

BCG is a form of immunotherapy used to treat high-risk non-muscle-invasive bladder cancer. Although the name comes from a bacterium originally used in tuberculosis vaccination, BCG is administered directly into the bladder to initiate an immune response against cancer cells.

NMIBC refers to bladder cancer that has not grown into the muscle layer of the bladder wall. Treatment often involves removing visible tumours through a procedure called transurethral resection of bladder tumour (TURBT), followed by BCG therapy to destroy remaining cancer cells and reduce the risk of recurrence.

However, some cancers return despite treatment. These are described as BCG-unresponsive, and patients may need alternative therapies or surgery to remove the bladder.

More About Anktiva

Anktiva is an interleukin-15 receptor agonist, a type of immunotherapy designed to strengthen the body's immune response against cancer.

It activates and expands immune cells, including natural killer cells and T cells, which help recognise and attack abnormal cells. When administered with BCG, Anktiva provides an additional immune stimulus to help the body fight cancer within the bladder.

The medicine is delivered directly into the bladder through a catheter, a procedure known as intravesical instillation. This allows treatment to act locally rather than being administered through an intravenous infusion.

Treatment begins with weekly doses for six weeks. Depending on the patient's response, additional induction and maintenance treatment may be given, with the overall treatment period extending up to 37 months.

FDA's Approval For Anktiva

The FDA's original approval was supported by the QUILT-3.032 clinical trial, which included 77 adults with BCG-unresponsive, high-risk NMIBC involving CIS, with or without papillary tumours.

The study found a complete response rate of 62%. This means that no high-grade cancer was detected during the relevant assessments. Among patients who achieved a complete response, 58% maintained it for at least 12 months, while 40% maintained it for at least 24 months.

For the expanded approval, the FDA considered these findings alongside laboratory evidence indicating that CIS and high-grade papillary-only tumours share key biological features. Both can recur or progress when BCG treatment fails.

The agency concluded that the earlier evidence of effectiveness could be applied to patients with high-grade papillary-only disease.

The United States shelved the decision to vaccinate poultry as a bird flu prevention measure due to HHS Secretary Robert F. Kennedy Jr.’s skeptical vaccine views

According to a Politico report, the move came as highly pathogenic avian influenza, especially the H5N1 strain, continues to affect poultry farms, threatening bird populations, disrupting egg supplies and raising concerns about transmission to humans.

According to Politico's findings, five people who were involved in the decision-making said that Agriculture Secretary Brooke Rollins pulled back an internal strategy for vaccinating poultry and hens that lay eggs.

The plan was initially intended to be shared with governments of other countries, industry leaders and other stakeholders to help boost bird flu response.

However, it remains unclear whether Kennedy directly asked Rollins to halt the strategy. However, concerns about how poultry vaccination would be received by the health secretary reportedly influenced the decision to keep the document away from wider circulation.

Why Was The Poultry Vaccination Plan Shelved?

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The US Department of Agriculture (USDA) announced a $1 billion bird flu response strategy in February 2025. The plan included $500 million for farm biosecurity, $400 million in financial relief for farmers and $100 million for vaccine research.

Despite the resources, an internal poultry vaccination strategy reportedly failed to be executed as planned. One person familiar with the process told Politico that the technical and communication components were already in place by the summer of 2025, but the final document was circulated among fewer than a dozen people.

Kennedy has publicly opposed vaccinating poultry against bird flu, arguing that vaccines that do not completely prevent infection could allow the virus to continue evolving.

In a March 2025 interview with Fox News host Sean Hannity, Kennedy warned that using vaccines that do not provide complete protection could turn poultry flocks into “mutation factories”.

He argued that allowing the virus to circulate among birds could help identify animals with natural immunity. The proposal attracted criticism from veterinary and vaccine experts, who warned that permitting uncontrolled infections could, in turn, increase viral replication and create opportunities for mutations.

Dr Gail Hansen, a former state veterinarian for Kansas, criticised the idea of allowing bird flu to spread through poultry populations, calling it a “really terrible idea, for any one of a number of reasons”. She warned that a virus circulating through a flock containing millions of birds would have many opportunities to evolve or mutate, which increases the risk to other animals and farm workers.

Also read: US Health Secretary Wants To Expand Vaccine Injury Reporting: Benefits And Risks Explained

Can Vaccinating Poultry Help Control Bird Flu?

Vaccination is one the effective tools for reducing bird flu infections and containing transmission. However, vaccines do not always provide sterilising immunity, meaning vaccinated animals may still become infected even if they are protected against severe disease.

So, if vaccination reduces visible symptoms without fully preventing infection, infected birds may be harder to identify unless monitoring systems are efficient.

However, this does not mean vaccination inevitably creates dangerous mutations. The evolution of viruses occur naturally, and vaccination can reduce the number of opportunities for viral replication. The overall effect depends on the vaccine effectiveness, surveillance, biosecurity and how the nature of the virus.

Countries including France, China, Egypt and Mexico have used poultry vaccination against avian influenza. In the US, the USDA granted conditional approval for an avian influenza vaccine in 2025, but poultry vaccination has not been adopted yet.

H5N1 has infected people following exposure to infected animals, but sustained human-to-human transmission has not been established yet. Hence, preventing infections in poultry remains important for reducing opportunities for the virus to spread and evolve.

The Keralam government has introduced the Keralam Senior Citizens (Care and Protection of Rights) Bill, 2026, to regulate elderly-care facilities and services. It proposes mandatory registration of care centers and caregivers, prescribed standards, caregiver certification, and penalties for violations.

Referred to the Assembly’s subject committee, the Bill would establish a legal framework for elderly care if passed.

Keralam introduced its first elderly-care policy in 2006, updated it in 2013, and released a draft State Policy for Elder Persons in August 2025. The state also enacted the Kerala State Senior Citizens Commission Act, 2025, and has a dedicated department for senior citizens’ welfare.

Why Does Keralam Need The Bill?

Also read: Healthy Lifestyle Changes Improve Memory, Thinking In Older Adults At Dementia Risk: The Lancet

Chief Minister V. D. Satheesan introduced the Bill, expressing confidence that it would make Kerala a model for elderly care.

“Nobody should feel that they are alone or abandoned. The way a society treats its elderly determines how civilized it is,” he said.

Keralam has one of India’s largest elderly populations, partly due to its high life expectancy. Older adults are projected to account for 22.8% of the state’s population over the next decade, up from 18.7%, highlighting the growing need for care services.

What Does The Bill Propose?

• Dignity and care: Promotes ageing in place, home-based care, safety, and social inclusion.
• Access and rights: Seeks better access to healthcare, legal aid, safe public spaces, digital inclusion, and abuse-reporting mechanisms.
• Protection units: Proposes state and district-level bodies to monitor care services and address complaints.
• Care-centre regulation: Requires registration of senior citizen care centres and sets service standards.
• Caregiver certification: Proposes training, phased certification, a Keralam Geriatric Care Certification Framework, and a state register of caregivers.
• Cybercrime safeguards: Proposes a Senior Citizen Cyber Fraud Cell at every cyber police station.
• Welfare funding: Calls for a state reserve fund for care, protection, welfare, and social security.
• Penalties: Provides for punishment for violations of the proposed law and related rules.

Why Elderly Care Needs A Broader Approach

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Speaking to HealthandMe, Dr. Rajeev Jayadevan, Ex-President of IMA Cochin and Convener of the Research Cell, Kerala, said the principles outlined in the Bill could eventually apply across India, particularly as Keralam has a higher proportion of older adults than many other states.

With shrinking nuclear families and urbanization, fewer family members may be available to provide full-time care, increasing reliance on state-supported services, including home care, medical consultations, and palliative care.

He emphasized that older adults have distinct care needs and highlighted patient autonomy in end-of-life decisions. Living wills allow people to document their medical-care preferences in advance, helping families and healthcare professionals understand their wishes and potentially avoid unwanted interventions.

Dr. Rajeev also stressed the need for trained, certified caregivers, effective oversight of care providers, and safeguards against elder abuse.

As older adults increasingly use digital platforms for services such as banking, digital literacy and protection against online scams and financial fraud are also essential, he noted.

What Are The Health Challenges Facing Older Adults?

READ: Normal Ageing or Alzheimer's? Doctors Explain Six Key Differences to Watch For

India’s senior citizen population is projected to reach around 230 million by 2036, or approximately 15% of the population. Southern states, along with Himachal Pradesh and Punjab, have larger elderly populations, with regional disparities expected to widen.

Moody’s Ratings said in September that India’s population is expected to age significantly as fertility falls below replacement levels.

Older adults often face chronic conditions such as diabetes, high blood pressure, and high cholesterol, alongside complications including diabetic kidney disease, diabetic retinopathy, cataracts, and glaucoma. These health needs underscore the importance of accessible, coordinated long-term care.