tag:theconversation.com,2011:/es/topics/older-people-5646/articlesOlder people – The Conversation2024-02-12T13:26:57Ztag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
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<figcaption><span class="caption">How to find your way back if you feel that you’ve lost yourself in a caregiving role.</span></figcaption>
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<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
<p><iframe id="4L0re" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/4L0re/2/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
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<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2212102024-01-30T19:08:35Z2024-01-30T19:08:35ZHow do I handle it if my parent is refusing aged care? 4 things to consider<figure><img src="https://images.theconversation.com/files/571318/original/file-20240124-17-qpq0ml.jpg?ixlib=rb-1.1.0&rect=0%2C13%2C3000%2C1980&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-woman-hugging-her-old-mother-440621344">De Visu/Shutterstock</a></span></figcaption></figure><p>It’s a shock when we realise our parents aren’t managing well at home.</p>
<p>Perhaps the house and garden are looking more chaotic, and Mum or Dad are relying more on snacks than nutritious meals. Maybe their grooming or hygiene has declined markedly, they are socially isolated or not doing the things they used to enjoy. They may be losing weight, have had a fall, aren’t managing their medications correctly, and are at risk of getting scammed.</p>
<p>You’re worried and you want them to be safe and healthy. You’ve tried to talk to them about aged care but been met with swift refusal and an indignant declaration “I don’t need help – everything is fine!” Now what?</p>
<p>Here are four things to consider.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-a-home-care-package-and-who-is-eligible-112405">Explainer: what is a home care package and who is eligible?</a>
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<h2>1. Start with more help at home</h2>
<p>Getting help and support at home can help keep Mum or Dad well and comfortable without them needing to move.</p>
<p>Consider drawing up a roster of family and friends visiting to help with shopping, cleaning and outings. You can also use home aged care services – or a combination of both.</p>
<p>Government subsidised home care services provide from one to 13 hours of care a week. You can get more help if you are a veteran or are able to pay privately. You can take advantage of things like rehabilitation, fall risk-reduction programs, personal alarms, stove automatic switch-offs and other technology aimed at increasing safety.</p>
<p>Call <a href="https://www.myagedcare.gov.au/">My Aged Care</a> to discuss your options.</p>
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<a href="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older man with a serious expression on his face looks out a window." src="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=388&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=388&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=388&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=488&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=488&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571315/original/file-20240124-23-fslren.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=488&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Is Mum or Dad OK at home?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-elderly-man-lost-thought-164848472">Nadino/Shutterstock</a></span>
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<h2>2. Be prepared for multiple conversations</h2>
<p>Getting Mum or Dad to accept paid help can be tricky. Many families often have multiple conversations around aged care before a decision is made.</p>
<p>Ideally, the older person feels supported rather than attacked during these conversations. </p>
<p>Some families have a meeting, so everyone is coming together to help. In other families, certain family members or friends might be better placed to have these conversations – perhaps the daughter with the health background, or the auntie or GP who Mum trusts more to provide good advice.</p>
<p>Mum or Dad’s main emotional support person should try to maintain their relationship. It’s OK to get someone else (like the GP, the hospital or an adult child) to play “bad cop”, while a different person (such as the older person’s spouse, or a different adult child) plays “good cop”.</p>
<h2>3. Understand the options when help at home isn’t enough</h2>
<p>If you have maximised home support and it’s not enough, or if the hospital won’t discharge Mum or Dad without extensive supports, then you may be <a href="https://academic.oup.com/gerontologist/article/60/8/1504/5863160">considering a nursing home</a> (also known as residential aged care in Australia). </p>
<p>Every person has a legal right to <a href="https://humanrights.gov.au/our-work/9-your-right-choose-where-you-live">choose where we live</a> (unless they have lost capacity to make that decision).</p>
<p>This means families can’t put Mum or Dad into residential aged care against their will. Every person also has the right to choose to take risks. People can choose to continue to live at home, even if it means they might not get help immediately if they fall, or eat poorly. We should respect Mum or Dad’s decisions, even if we disagree with them. Researchers call this “dignity of risk”.</p>
<p>It’s important to understand Mum or Dad’s point of view. Listen to them. Try to figure out what they are feeling, and what they are worried might happen (which might not be rational). </p>
<p>Try to understand what’s really important to their quality of life. Is it the dog, having privacy in their safe space, seeing grandchildren and friends, or something else? </p>
<p>Older people are often understandably concerned about losing independence, losing control, and having strangers in their personal space. </p>
<p>Sometimes families prioritise physical health over psychological wellbeing. But we need to consider both when considering nursing home admission. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9826495/">Research</a> suggests going into a nursing home temporarily increases loneliness, risk of depression and anxiety, and sense of losing control.</p>
<p>Mum and Dad should be involved in the decision-making process about where they live, and when they might move.</p>
<p>Some families start looking “just in case” as it often takes some time to <a href="https://www.abc.net.au/everyday/questions-to-ask-when-choosing-an-aged-care-home-for-a-loved-one/10302590">find the right nursing home</a> and there can be a wait. </p>
<p>After you have your top two or three choices, take Mum or Dad to visit them. If this is not possible, take pictures of the rooms, the public areas in the nursing home, the menu and the activities schedule.</p>
<p>We should give Mum or Dad information about their options and risks so they can make informed (and hopefully better) decisions.</p>
<p>For instance, if they visit a nursing home and the manager says they can go on outings whenever they want, this might dispel a belief they are “locked up”.</p>
<p>Having one or two weeks “respite” in a home may let them try it out before making the big decision about staying permanently. And if they find the place unacceptable, they can try another nursing home instead.</p>
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<a href="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older Asian woman sits with her daughter." src="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/571321/original/file-20240124-15-jhtqbj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">You might need to have multiple conversations about aged care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/exhausted-tired-asian-senior-woman-touching-1685125546">CGN089/Shutterstock</a></span>
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<h2>4. Understand the options if a parent has lost capacity to make decisions</h2>
<p>If Mum or Dad have lost capacity to choose where they live, family may be able to make that decision in their best interests.</p>
<p>If it’s not clear whether a person has capacity to make a particular decision, a medical practitioner can assess for that capacity. </p>
<p>Mum or Dad may have appointed an <a href="https://www.tag.nsw.gov.au/wills/appoint-enduring-guardian/what-enduring-guardian">enduring guardian</a> to make decisions about their health and lifestyle decisions when they are not able to.</p>
<p>An enduring guardian can make the decision that the person should live in residential aged care, if the person no longer has the capacity to make that decision themselves. </p>
<p>If Mum or Dad didn’t appoint an enduring guardian, and have lost capacity, then a court or tribunal can <a href="https://www.tag.nsw.gov.au/guardianship/information-about-guardianship">appoint</a> that person a private guardian (usually a family member, close friend or unpaid carer). </p>
<p>If no such person is available to act as private guardian, a public official may be appointed as public guardian. </p>
<h2>Deal with your own feelings</h2>
<p>Families often feel <a href="https://link.springer.com/article/10.1007/s12144-023-04538-9">guilt and grief</a> during the decision-making and transition process.</p>
<p>Families need to act in the best interest of Mum or Dad, but also balance other caring responsibilities, financial priorities and their own wellbeing.</p><img src="https://counter.theconversation.com/content/221210/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low has received funding from aged care providers HammondCare, and The Whiddon Group, and collaborated with HammondCare, The Whiddon Group, BaptistCare, Catholic Heatlhcare, Scalabrini Aged Care, Montefiore Aged Care, Chinese Association of Social Services, Multicultural Care, Australian Nursing Home Foundation, Summitcare and Silverchain.
She has also received funding from the NHMRC, MRFF, Dementia Australia, NSW and federal governments.</span></em></p>You’re worried and you want to see them well cared for. You’ve tried to talk to them about aged care but been met with swift refusal. Now what?Lee-Fay Low, Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2168272023-11-10T02:06:24Z2023-11-10T02:06:24ZAbout 1 in 6 older Australians experiences elder abuse. Here are the reasons they don’t get help<p>Each year, many older Australians experience abuse, neglect or financial exploitation, usually at the hands of their adult children or other close relatives. </p>
<p>A recent <a href="https://aifs.gov.au/research/research-reports/national-elder-abuse-prevalence-study-final-report">national prevalence study</a> revealed one in six older Australians living at home experiences elder abuse. This may encompass various forms of abuse, such as emotional, financial, social, physical and sexual abuse, or neglect.</p>
<p>Despite elder abuse being such a common problem, older people often don’t get the help they need. With the right responses, we can make it easier for those working with older people, and the wider community, to support them. </p>
<p>Our <a href="https://www.wa.gov.au/system/files/2023-11/everyones_business_research_into_responses_to_the_abuse_of_older_in_wa_report.pdf">new research</a> reveals the key reasons older people experiencing harm do not receive the support they so desperately need. </p>
<p>Our study included a survey of nearly 700 service providers throughout Western Australia. Respondents worked in diverse fields including healthcare, law, aged care, financial services and law enforcement. We found four key obstacles to people getting help with elder abuse. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-elder-abuse-and-why-do-we-need-a-national-inquiry-into-it-55374">Explainer: what is elder abuse and why do we need a national inquiry into it?</a>
</strong>
</em>
</p>
<hr>
<p><strong>1. Older people are too scared to report abuse.</strong></p>
<p>Older people are often afraid to report abuse because they fear repercussions both for themselves and for the perpetrator, usually an adult child or other close relative. </p>
<p>These concerns can mean an older person endures abuse for a long time. They may only seek help when the situation escalates to an extreme level or when someone else notices the ongoing mistreatment.</p>
<p>Equally important, they may fear other negative outcomes of reporting abuse. They may fear having to leave their home and enter residential care. They may fear increased isolation and loneliness, or that the abuse will get worse. </p>
<p>All these fears combined create a formidable barrier to older people promptly reporting abuse and getting the help they need.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1720567529200918550"}"></div></p>
<p><strong>2. Older people don’t know where to turn for help</strong> </p>
<p>Elder abuse cases are often complex, involving long family histories and complicated relationships. Older people trying to improve their situation may need support from multiple service providers. The challenge of accessing the right services and acting on their advice can be daunting. </p>
<p>Addressing complicated matters may require intensive support and advocacy for an extended time. In the words of one experienced advocate, </p>
<blockquote>
<p>People don’t need to know the next ten steps. They need to know one step, maybe two, and then see where they are at.</p>
</blockquote>
<p>Helping older people feel empowered to seek help requires simple, accessible channels of assistance, promoted through multiple formats and outreach efforts.</p>
<p><strong>3. Government-funded responses to family violence are more focused on intimate partner violence and child protection, leaving elder abuse out of the picture</strong> </p>
<p>Most programs targeting family violence prioritise intimate partner violence and child protection, inadvertently sidelining elder abuse. Services such as shelters and perpetrator programs are not always compatible with the distinct characteristics of elder abuse. </p>
<p>Additionally, the gendered nature of family violence responses fails to address the diverse demographics of elder abuse, which includes older men. As a result, older people, regardless of gender, may struggle to access supports suited to their needs. </p>
<p>A refuge manager explained: </p>
<blockquote>
<p>When a bed becomes available we have this awful job of deciding who’s more high-risk and who gets the bed. If an older person needs the bed, as opposed to a single mum with a newborn, unfortunately we would go with the mum. That really presents a barrier where there isn’t refuge accommodation specifically for older people.</p>
</blockquote>
<p>There is a pressing need for a shift in focus to better recognise elder abuse as a significant issue and tailor responses to meet the specific needs of older people. This includes creating safe and accessible refuge options and providing specialised support services to address the multifaceted nature of elder abuse.</p>
<p><strong>4. There’s low public awareness about what elder abuse looks like or how to respond</strong></p>
<p>Awareness of elder abuse remains surprisingly low, hindering effective responses. Changing this requires clear public information campaigns and community-wide conversations about abuse. This includes greater awareness of the challenge for well-meaning adult children who might limit the choices of their older relatives, thinking they know best. This can result in unintended social isolation or even neglect.</p>
<p>A society that speaks openly about elder abuse, without stigma, is better equipped to support victims and intervene. By building public knowledge and promoting a culture where such issues can be freely discussed, we lay the groundwork for reducing its incidence.</p>
<p>We are living longer lives than ever before, meaning we can expect to spend more years in older age than previous generations. This is good news, but also means we need to do more work to support people to age well. Positive steps we can all take include tackling ageism when we see it and normalising conversations about abuse so older people can feel confident to seek help when it’s needed.</p><img src="https://counter.theconversation.com/content/216827/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Catriona Stevens has received funding as an initiative of the WA Strategy to Respond to the Abuse of Older People (Elder Abuse) 2019-2029.</span></em></p><p class="fine-print"><em><span>Professor Loretta Baldassar has received funding as an initiative of the WA Strategy to Respond to the Abuse of Older People (Elder Abuse) 2019-2029.</span></em></p><p class="fine-print"><em><span>Eileen O'Brien does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Elder abuse is common and can be devastating. New research has uncovered four key reasons older people do not seek the help they need with the abuse.Eileen O'Brien, Professor of Law, Discipline of Law, Justice and Society, University of South AustraliaCatriona Stevens, Forrest Prospect Fellow in Sociology and Anthropology, Edith Cowan UniversityLoretta Baldassar, Vice Chancellor Professorial Research Fellow, School of Arts and Humanities, Edith Cowan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2150742023-11-02T19:13:32Z2023-11-02T19:13:32ZI was a geriatrician on Old People’s Home for Teenagers. Here’s why I joined this TV experiment<figure><img src="https://images.theconversation.com/files/555958/original/file-20231025-23-112he5.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6884%2C4565&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Many people will have heard about “intergenerational practice” via the TV.</p>
<p>This is the purposeful <a href="https://www.mdpi.com/1660-4601/19/18/11254">bringing together</a> of different generations, aiming to benefit all involved. It’s the idea central to ABC TV’s <a href="https://iview.abc.net.au/show/old-people-s-home-for-teenagers">Old People’s Home for Teenagers</a>, and its predecessor <a href="https://iview.abc.net.au/show/old-people-s-home-for-4-year-olds">Old People’s Home for 4 Year Olds</a>. Both show the positive aspects of mixing age groups, for the older people featured, as well as the teenagers or preschoolers.</p>
<p>I’m a <a href="https://anzsgm.org/publicinformation/">geriatrician</a>, a doctor who specialises in the medical care of older people, one of two geriatricians who took part in this TV experiment. Here’s why I got involved.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-get-old-190142">Curious Kids: why do people get old?</a>
</strong>
</em>
</p>
<hr>
<h2>The benefits of mixing it up</h2>
<p>The positive aspects of mixing age groups may seem intuitive. Just think of how special it can be when grandparents spend time with their grandchildren. When older and younger people are together, each <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajag.12761">can share</a> their experiences and perspectives. Meaningful connections can develop.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Addison talking with Annalise during filming" src="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meaningful connections can develop, such as between teenager Addison and Annalise.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>But in Australia today, many older people have no such opportunities. Multi-generational households are the exception, not the norm. </p>
<p><a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/housing-and-living-arrangements">One quarter</a> of people aged 65 and over living in private homes live alone. <a href="https://www.propertycouncil.com.au/media-releases/retirement-villages-approaching-capacity-where-will-our-seniors-live-2">Nearly 200,000</a> live in retirement villages and <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/2021-22-GEN-Topic-Updates/People%20using%20aged%20care/People-using-aged-care-fact-sheet_2022.pdf">around the same number</a> live in residential aged care. Both of the latter, by definition, accommodate only a single generation. </p>
<p>Intergenerational programs overcome these barriers by creating a <a href="https://shop.earlychildhoodaustralia.org.au/product/rip2101/">structured and supported</a> forum in which two age groups can regularly connect. </p>
<p>These programs can involve <a href="https://www.metronorth.health.qld.gov.au/news/grandfriends-reduces-loneliness-isolation">different populations</a>: from toddlers through to university students, from independent, active retirees through to aged care residents and hospital patients.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-project-shows-combining-childcare-and-aged-care-has-social-and-economic-benefits-99837">A new project shows combining childcare and aged care has social and economic benefits</a>
</strong>
</em>
</p>
<hr>
<p>Programs can take several forms, for example:</p>
<ul>
<li><p>playgroups are <a href="https://journals.sagepub.com/doi/10.1177/1476718X211059662">conducted in</a> aged care facilities</p></li>
<li><p>childcare and aged care facilities are <a href="https://agedcarenews.com.au/2022/06/21/the-herd-proudly-blazing-a-trail-for-the-future-of-intergenerational-care-and-learning/">in the same location</a></p></li>
<li><p>older volunteers in the community take part in <a href="https://www.abc.net.au/news/2023-10-03/ophft-making-connections-in-your-community/102908402">formal mentorship programs</a> for young adults.</p></li>
</ul>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/33567363/">common aim</a> is to improve wellbeing, restore purpose, and bring joy to older participants, while helping to develop social skills, confidence and empathy in young people. These programs can potentially also address <a href="https://www.who.int/health-topics/ageism#tab=tab_1">ageism</a>, by creating understanding and empathy for each generation and by challenging negative stereotypes. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-dressing-up-as-older-people-is-harmless-fun-right-no-its-ageist-whatever-bluey-says-212607">Kids dressing up as older people is harmless fun, right? No, it's ageist, whatever Bluey says</a>
</strong>
</em>
</p>
<hr>
<h2>There are challenges ahead</h2>
<p>There are wide-ranging challenges ageing may throw at us – an <a href="https://pubmed.ncbi.nlm.nih.gov/21925398/">increased burden</a> of chronic disease and frailty, a decline in physical and cognitive abilities, or changes in hearing, vision and balance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Maz with walker, taking a puppy for a walk, Ayden holds out hand to puppy" src="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The program encouraged both young people, such as Ayden, and older people, such as Maz, to be more active.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/steep-physical-decline-with-age-is-not-inevitable-heres-how-strength-training-can-change-the-trajectory-213131">Steep physical decline with age is not inevitable – here's how strength training can change the trajectory</a>
</strong>
</em>
</p>
<hr>
<p>Changes in occupational and social roles often also occur as we get older, for instance, as older people retire from paid work or care for a sick partner. Conversely, older people may lose their role as caregivers, after grandchildren grow up, or after the loss of a loved one. </p>
<p>All these ageing-related changes can lead to a loss of social connection and <a href="https://theconversation.com/i-tell-everyone-i-love-being-on-my-own-but-i-hate-it-what-older-australians-want-you-to-know-about-loneliness-166109">loneliness</a>. Loneliness itself is bad for health. Loneliness <a href="https://www.nature.com/articles/s41572-022-00355-9">increases risks</a> for depression, cardiovascular disease, dementia and may even lead to a shorter life span. Reducing loneliness in older adults remains a challenge.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-tell-everyone-i-love-being-on-my-own-but-i-hate-it-what-older-australians-want-you-to-know-about-loneliness-166109">'I tell everyone I love being on my own, but I hate it': what older Australians want you to know about loneliness</a>
</strong>
</em>
</p>
<hr>
<h2>How I got involved</h2>
<p>So when a chance to become involved in Old People’s Home for 4 Year Olds, I eagerly jumped on board. This featured an experimental intergenerational preschool. Young and old took part in a series of structured and supported activities such as playing dress-ups, going on walks and having a sports carnival.</p>
<p>At the time, intergenerational programs were far from mainstream, especially in Australia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Annelise and Alix walking outside on grass, trees in background" src="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Annelise said she was lonely at the start of the series, but formed a bond with teenager Amelie.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>I joined the TV program with a panel of experts including a physiotherapist and psychologist. </p>
<p>We screened the older adults at the start of the experiment for issues such as <a href="https://dementiaresearch.org.au/wp-content/uploads/2016/06/geriatric_depression_scale_short.pdf">depression</a>, and assessed signs of <a href="https://academic.oup.com/biomedgerontology/article/56/3/M146/545770?login=false">physical frailty</a> including speed of walking, muscle strength and activity levels. We then assessed them again after six weeks.</p>
<p>While we were cautiously hopeful, the overall improvements were better than anticipated, and some of the individual transformations were extraordinary. </p>
<p>For instance, three of four participants who originally screened positive for depression had scores in the normal range by the end of the program. For one woman in her 80s her score improved by eight points on a 15-point scale. Improvements in fitness levels across the group were impressive too.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dale and Abi outside, standing on grass, trees in background" src="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dale was concerned about how her visual impairment affected her day-to-day life, but soon connected with Abi.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Since then, the series has evolved to involve differing populations: from residents of aged care facilities and retirement villages, to older adults living in the community, and from preschoolers to teenagers.</p>
<p>Each program has been adapted to the needs of each group involved. At times, we have focused on a particular issue, such as loneliness, depression, concerns about memory, physical frailty and falls.</p>
<p>But in each we have continued to see benefits for both age groups, in line with what a <a href="https://www.sciencedirect.com/science/article/pii/S1568163721001471">growing evidence base</a> is telling us about the potential benefits of such programs. </p>
<p>This is perhaps even more so in the Old People’s Home for Teenagers series, with the second season currently on air. The teenage participants are articulate in describing how truly valuable it is for younger people to spend enriched time with older mentors. Their confidence increases, they take on new challenges, and new meaningful connections develop, many of which continue to <a href="https://www.abc.net.au/news/2023-10-01/old-peoples-home-for-teens-ongoing-intergenerational-friendships/102885166">enrich lives</a> long after the cameras stop rolling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-think-my-teen-is-depressed-how-can-i-get-them-help-and-what-are-the-treatment-options-206702">I think my teen is depressed. How can I get them help and what are the treatment options?</a>
</strong>
</em>
</p>
<hr>
<p>No-one is pretending such intergenerational programs are going to end loneliness for all older people, or can remove all the challenges they may face later in life. And equally, people do not need to be lonely, frail or isolated to participate.</p>
<p>Alongside the TV programs, there has been an <a href="https://www.abc.net.au/news/backstory/2023-10-03/old-peoples-home-4-year-olds-impact-and-success/102868168">upswing</a> in community interest in intergenerational practice, from researchers to educators to aged care providers, to hospitals/health services and schools. </p>
<p>We need continued investment into workforce training, support for such programs to develop, and robust evaluation of each program to ensure they meet the goals of all the stakeholders involved – especially those of the participants themselves. </p>
<p>The “Old People’s Home” model did not invent the concept of intergenerational programs. Nor are the models of practice used in each series the only way intergenerational programs must run. But they do demonstrate what intergenerational programs could achieve. </p>
<hr>
<p><em>Learn more about <a href="https://aiip.net.au/resources/">intergenerational programs</a> in Australia and find one <a href="https://aiip.net.au/about-us/intergenerational-programs-in-australia">near you</a>. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/215074/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Ward has received some financial compensation for her time spent involved in the Old People's Home for 4 Year Olds/ Teenagers series for the Australian Broadcasting Commission and EndemolShine Australia. She has previously been a recipient of a research training stipend for a PhD on sleep apnoea and dementia risk. She is a chief investigator on several studies that have received funding from the National Health and Medical Research Council and the Medical Research Future Fund. Stephanie Ward is also a geriatrician at the Prince of Wales Hospital, Sydney.</span></em></p>Could teenagers get on with older people and vice versa? Turned out, they could. And both flourished.Stephanie Ward, Senior Research Fellow, Centre for Healthy Brain Ageing (CHeBA), UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104552023-10-03T20:23:30Z2023-10-03T20:23:30ZLGBTQ+ Americans feel they are just getting by in retirement and face greater financial risks<figure><img src="https://images.theconversation.com/files/543816/original/file-20230821-33177-njffxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even financially comfortable LGBTQ+ Americans may find themselves vulnerable to economic shocks.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lesbian-couple-paying-bills-and-using-laptop-at-royalty-free-image/1400799722">MoMo Productions/DigitalVision via Getty Images</a></span></figcaption></figure><p>While preparing for retirement can be difficult for anyone, LGBTQ+ Americans face unique challenges that can cast a shadow over their golden years. For example, LGBTQ+ people over age 60 leave the workforce sooner, are less likely to believe that their retirement savings are on track and struggle more to pay medical bills than their straight and cisgender counterparts. They’re also twice as likely to report having experienced discrimination in the past year.</p>
<p>These findings are based on <a href="https://www.ncoa.org/article/a-profile-of-lgbtq-older-adults">our analysis</a> of data from the Federal Reserve Board’s annual <a href="https://www.federalreserve.gov/consumerscommunities/shed.htm">Survey of Household Economics and Decisionmaking</a>, or SHED. We used data from 2019 to 2021 to compare the nearly 500 LGBTQ+ respondents age 60 and older with their cisgender counterparts. </p>
<p>When asked how they were managing financially, most older LGBTQ+ adults considered themselves to be either “living comfortably” or “doing OK.” However, they also said they faced big economic challenges that could threaten their long-term well-being. </p>
<p>For example, they had a harder time affording dental care. Significantly fewer LGBTQ+ respondents said they owned their home, which means they have less opportunity to build equity that can be used later in life. </p>
<p>Retired LGBTQ+ respondents were somewhat younger and more likely to leave the workforce for reasons other than reaching traditional retirement age. In fact, nearly 1 in 3 retired because of health problems, 1 in 4 retired because of disliking their work, and almost 1 in 6 said they were forced to retire. Far smaller shares of straight and cisgender respondents reported similar outcomes – for example, only 1 in 9 said they were forced to retire.</p>
<p><iframe id="PwDan" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/PwDan/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>We also found that a greater percentage of older LGBTQ+ adults had annual incomes under $25,000 compared with their straight and cisgender counterparts – 15% versus 12%.</p>
<p>Finally, a bigger share of LGBTQ+ older adults said they had trouble paying bills like their rent or mortgage, and many more relied on government food and housing assistance programs compared with non-LGBTQ+ older adults.</p>
<h2>Why it matters</h2>
<p>How older LGBTQ+ adults fare during their later work years and in retirement is an issue of growing importance, since the overall LGBTQ+ population has reached an estimated <a href="https://hrc-prod-requests.s3-us-west-2.amazonaws.com/We-Are-Here-120821.pdf">20 million</a>, or nearly 8% of all American adults. Many younger people who identify as LGBTQ+ experience discrimination, whether <a href="https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/">on the job</a> or in their <a href="https://www.hrw.org/report/2018/07/23/you-dont-want-second-best/anti-lgbt-discrimination-us-health-care">access to health care</a>, which can have repercussions later in life.</p>
<p>People identifying as LGBTQ+ are significantly more likely than non-LGBTQ+ respondents to experience bias while receiving or even scheduling medical care. This is consistent with other research showing that LGBTQ+ adults are more likely to report that their health care provider <a href="https://www.kff.org/report-section/lgbt-peoples-health-and-experiences-accessing-care-report/">doesn’t believe them</a>, often blames them personally for having a health problem and dismisses their concerns. Not surprisingly, such discrimination can and does lead to <a href="https://doi.org/10.7759/cureus.1184">needless sickness</a> and even early death. </p>
<p>Prejudice is also common in the workplace: According to a <a href="https://news.nationwide.com/download/1190709/nfm-22096ao.pdf">Nationwide Retirement Institute report</a>, half of LGBTQ+ employees personally experienced or witnessed anti-LGBTQ+ comments at work, which, together with other forms of discrimination, can lead to fewer advancement opportunities and pay gaps. </p>
<h2>What still isn’t known</h2>
<p><a href="https://ncoa.org/article/80-percent-of-older-americans-cannot-pay-for-long-term-care-or-withstand-a-financial-shock-new-study-shows">Recent research</a> shows that most <a href="https://ncoa.org/article/80-percent-of-older-americans-cannot-pay-for-long-term-care-or-withstand-a-financial-shock-new-study-shows">older Americans can’t afford</a> their share of health care costs or long-term care. In fact, 80% of adults age 60 or older lack the savings needed to pay for more than two years in a nursing home and would not be able to absorb a financial shock such as a major illness or home repair.</p>
<p>For older LGBTQ+ adults, who experience greater levels of discrimination and have fewer financial resources than their straight and cisgender counterparts, the proportion of those who couldn’t afford later-life expenses would surely be higher. Yet researchers still don’t know how this population fares when faced with potential financial shocks or the need for long-term care. </p>
<p>For example, given that LGBTQ+ people are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371094/#:%7E:text=As%20well%20as%20experiencing%20health,stages%20of%20life%20%5B4%5D.">less likely to have spouses or relatives</a> to serve as their caregivers, are they able to pay for long-term care if needed? Are they more likely to have to rely on institutional care rather than aging at home like their straight and cisgender counterparts? These and other questions require further study.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/210455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging. </span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging.</span></em></p><p class="fine-print"><em><span>Molly Wylie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gays, lesbians and other sexual minorities can face significant economic challenges with age.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center, UMass BostonJane Tavares, Senior Research Fellow and Lecturer of Gerontology, LeadingAge LTSS Center @UMass Boston, UMass BostonMolly Wylie, Ph.D. Candidate in Gerontology, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124332023-09-25T12:21:28Z2023-09-25T12:21:28ZAerobic and strength training exercise combined can be an elixir for better brain health in your 80s and 90s, new study finds<figure><img src="https://images.theconversation.com/files/549420/original/file-20230920-21-t9p644.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5475%2C3630&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pilates is a form of mind-body exercise that involves weight resistance and strength training. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-doing-mermaid-exercise-on-pilates-royalty-free-image/944882744?phrase=seniors+exercise&adppopup=true">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><p>People in the oldest stage of life who regularly engage in aerobic activities and strength training exercises perform better on cognitive tests than those who are either sedentary or participate only in aerobic exercise. That is the <a href="https://doi.org/10.1007/s11357-023-00885-4">key finding of our new study</a>, published in the journal GeroScience.</p>
<p>We assessed 184 cognitively healthy people ranging in age from 85 to 99. Each participant reported their exercise habits and underwent a comprehensive battery of neuropsychological tests that were designed to evaluate various dimensions of cognitive function. </p>
<p>We found that those who incorporated both aerobic exercises, such as swimming and cycling, and strength exercises like weightlifting into their routines – regardless of intensity and duration – had better mental agility, quicker thinking and greater ability to shift or adapt their thinking.</p>
<p>Using a well-known cognitive screening tool called the <a href="https://mocacognition.com/">Montreal Cognitive Assessment</a> that provides a balanced view of many aspects of cognition, we found that people who didn’t engage in any physical exercise scored lower than those who did both cardio and strength training. This difference was slight but significant even when controlling for other factors like education and how much people exercised. In addition, the group that did both types of exercises did better in specific cognitive activities, like symbol coding, beyond just the screening results. </p>
<p>It’s important to note that while our study establishes a correlation between a mix of aerobic and strength training exercises and higher cognitive test scores, the design of the study did not enable us to determine a causal relationship.</p>
<p>Nonetheless, the results suggest that a varied exercise routine is associated with improved cognitive functioning in people who are in their late 80s and beyond. We conducted the study as part of a large, multisite collaboration with the <a href="https://mcknightbrain.org/">McKnight Brain Research Foundation</a>, which has institutes at the University of Florida, the University of Miami, the University of Arizona and the University of Alabama-Birmingham. </p>
<h2>Why it matters</h2>
<p>The aging of the global population makes cognitive health a pressing issue. The number of people diagnosed with Alzheimer’s disease in the U.S. is projected to reach <a href="https://www.statista.com/statistics/216624/projected-numbers-of-alzheimers-sufferers-aged-65-and-over-in-the-us/#statisticContainer">almost 14 million by 2060</a>, up from just over 6 million as of 2020. Our findings not only offer hope for healthier aging but also present a practical approach to maintaining or even enhancing cognitive health in the last decades of life.</p>
<p>These results are not just numbers; they represent real-world thinking abilities that can affect the quality of life for those entering their golden years.</p>
<p>The fact that nearly 70% of our study participants were already engaging in some physical exercise prior to signing up for our study challenges the stereotype that old age and physical inactivity must go hand in hand. </p>
<p>Our findings provide an evidence base for health care providers to consider recommending a mixed regimen of aerobic and strength exercises as part of their patients’ wellness plans. Studies show that when cognitive decline is slowed, people <a href="https://aspe.hhs.gov/reports/risk-costs-severe-cognitive-impairment-older-ages-key-findings-our-literature-review-projection-0">spend less on medical care</a> and experience a <a href="https://www.cdc.gov/aging/publications/chronic-diseases-brief.html">higher quality of life</a>. </p>
<figure>
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<figcaption><span class="caption">The aging body is like a machine that needs more upkeep and maintenance to stay intact.</span></figcaption>
</figure>
<h2>What’s next</h2>
<p>Some of the next questions we hope to answer include: What types of aerobic and strength exercises are most effective for cognitive health? Is walking as effective as jogging? Does lifting weights have the same impact as resistance band exercises? And how much exercise is needed to see noticeable cognitive benefits? </p>
<p>Another critical question is the potential of exercise as a treatment for neurocognitive disorders among older people. Our results suggest that physical activity is a preventive measure. But could it also be an active treatment for cognitive decline? This is an exciting development and one that is opening up all sorts of new possibilities for helping people live fully across their entire life span.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/212433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s long been known that exercise helps maintain strength and agility as we age. New research points to the importance of exercise type in supporting cognitive health in the latest decades of life.Brian Ho, PhD Candidate in Clinical & Health Psychology, University of FloridaRonald Cohen, Professor of Clinical and Health Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2126072023-09-22T01:25:31Z2023-09-22T01:25:31ZKids dressing up as older people is harmless fun, right? No, it’s ageist, whatever Bluey says<figure><img src="https://images.theconversation.com/files/548462/original/file-20230915-23-t7k9vt.jpg?ixlib=rb-1.1.0&rect=1%2C0%2C997%2C640&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-cute-little-baby-cosplaying-old-2161560119">Shutterstock</a></span></figcaption></figure><p>A child once approached me, hunched over, carrying a vacuum cleaner like a walking stick. In a wobbly voice, he asked:</p>
<blockquote>
<p>Do you want to play grannies?</p>
</blockquote>
<p>The idea came from the children’s TV show Bluey, which <a href="https://www.facebook.com/ABCKidsCommunity/videos/bluey-grannies/468144817266668/">has</a> <a href="https://www.facebook.com/ABCKidsCommunity/videos/new-bluey-episodes-the-grannies-are-back-abc-kids/371436135028190/">episodes</a>, <a href="https://www.bluey.tv/products/grannies-book/">a book</a>, <a href="https://www.discountmags.com/magazine/bluey-september-1-2023-digital">magazine</a> editions and an <a href="https://www.facebook.com/OfficialBlueyTV/videos/grannies-filter-bluey/5728362390510269/">image filter</a> about dressing up as “grannies”.</p>
<p>Children are also dressing up as 100-year-olds to mark their first “100 days of school”, an idea <a href="https://www.theage.com.au/national/victoria/old-people-s-home-for-five-year-olds-prep-students-don-senior-citizen-attire-20230801-p5dszb.html">gaining popularity</a> <a href="https://www.smh.com.au/education/cardigans-wigs-and-canes-why-kindy-students-are-dressing-up-as-100-year-olds-20230720-p5dpu8.html">in Australia</a>.</p>
<p>Is this all just harmless fun?</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1632154977664921600"}"></div></p>
<h2>How stereotypes take hold</h2>
<p>When I look at the older people in my life, or the patients I see as a geriatrician, I cannot imagine how to suck out the individual to formulate a “look”.</p>
<p>But Google “older person dress-ups” and you will find <a href="https://www.pinterest.com.au/pin/dress-up-like-youre-100-years-old-100thdayofschool--15199717464361356/">Pinterests</a> and <a href="https://www.wikihow.com/Dress-Up-Like-an-Old-Person#:%7E:text=Dress%20in%20comfortable%2C%20loose%2Dfitting,older%20people%20may%20wear%20include%3A&text=Oversized%20sweatshirts">Wikihow pages</a> doing just that.</p>
<p>Waistcoats, walking sticks, glasses and hunched backs are the key. If you’re a “granny”, don’t forget a <a href="https://www.facebook.com/OfficialBlueyTV/videos/games-you-can-play-at-home-grannies-bluey/645964056227345/">shawl and tinned beans</a>. You can buy “old lady” <a href="https://www.spotlightstores.com/party/costumes-and-accessories/costume-accessories/wigs-hair-accessories/wigs/spartys-kids-old-lady-wig-with-curlers/80578132?gclsrc=aw.ds&gclsrc=aw.ds&gclid=Cj0KCQjw0vWnBhC6ARIsAJpJM6emZHoNxO72pUa80Wc8ihYYiq3AohZ_w72jmuWBBDlficdCMy_rsK8aAj47EALw_wcB">wigs</a> or an “old man” <a href="https://www.bigw.com.au/product/facial-hair-set-old-man-3-pieces/p/305026">moustache and bushy eyebrows</a>.</p>
<p>This depiction of how older people look and behave is a stereotype. And if dressing up as an older person is an example, such stereotypes are all around us.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older stylish couple sitting on sofa" src="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548471/original/file-20230915-19-6zhh04.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">What do older people really look like? I can’t see a walking stick or shawl. Can you?</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/asian-elderly-couple-sitting-on-sofa-2204006701">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-dont-grown-ups-play-like-kids-199176">Curious Kids: why don't grown-ups play like kids?</a>
</strong>
</em>
</p>
<hr>
<h2>What’s the harm?</h2>
<p>There is <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/hypa.12170">some debate</a> about whether stereotyping is intrinsically wrong, and if it is, why. But there is plenty of research about the harms of <em>age</em> stereotypes or ageism. That’s harm to current older people and harm to future older people.</p>
<p>The World Health Organization <a href="https://www.who.int/health-topics/ageism#tab=tab_1">defines ageism</a> as:</p>
<blockquote>
<p>the stereotypes (how we think), prejudice (how we feel) and discrimination (how we act) towards others or ourselves based on age.</p>
</blockquote>
<p>Ageism <a href="https://www.who.int/health-topics/ageism#tab=tab_1">contributes to</a> social isolation, reduced health and life expectancy and costs economies <a href="https://academic.oup.com/gerontologist/article/60/1/174/5166947">billions of dollars</a> globally. </p>
<p>When it comes to health, the impact of negative stereotypes and beliefs about ageing may be even <a href="https://academic.oup.com/gerontologist/article/60/1/174/5166947">more harmful</a> than the discrimination itself. </p>
<p>In laboratory studies, older people perform <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4360754/">worse</a> than expected on tasks such as memory or thinking after being shown negative stereotypes about ageing. This may be due to a “<a href="https://www.simplypsychology.org/stereotype-threat.html">stereotype threat</a>”. This is when a person’s performance is impaired because they are worried about confirming a negative stereotype about the group they belong to. In other words, they perform less well because they’re worried about acting “old”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man doing a jigsaw puzzle" src="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548465/original/file-20230915-23-lvzcr4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Older people perform less well on some tasks after seeing negative stereotypes of ageing.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/senior-male-hands-working-on-puzzle-1957542670">Shutterstock</a></span>
</figcaption>
</figure>
<p>Another theory is “stereotype embodiment”. This is where people absorb negative stereotypes throughout their life and come to believe decline is an inevitable consequence of ageing. This leads to biological, psychological and physiological changes that <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2927354/">create</a> a self-fulfilling prophecy. </p>
<p>I have seen this in my clinic with people who do well, until they realise they’re an older person – a birthday, a fall, a revelation when they look in the mirror. Then, they stop going out, stop exercising, stop seeing their friends. </p>
<p>Evidence for “stereotype embodiment” comes from studies that show people with more negative views about ageing are more likely to have higher levels of stress hormones (such as cortisol and C-reactive protein) and are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182003/">less likely</a> to engage in health behaviours, such as exercising and eating healthy foods.</p>
<p>Younger adults with negative views about ageing are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2666386/">more likely</a> to have a heart attack up to about 40 years later. People with the most negative attitudes towards ageing have a lower life expectancy by as much as <a href="https://pubmed.ncbi.nlm.nih.gov/12150226/">7.5 years</a>. </p>
<p>Children are particularly susceptible to absorbing stereotypes, a process <a href="https://psycnet.apa.org/record/2007-09385-010">that starts</a> in early childhood. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman dressed in modern clothes enjoying herself making hand signals" src="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548464/original/file-20230915-25-k8hrpl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You don’t see many children dressing up like this older person. There’s a reason for that.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/funny-grandmother-portraits-senior-old-woman-1522642565">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-get-old-190142">Curious Kids: why do people get old?</a>
</strong>
</em>
</p>
<hr>
<h2>Ageism is all around us</h2>
<p><a href="https://www.who.int/health-topics/ageism#tab=tab_1">One in two people</a> have ageist views, so tackling ageism is complicated given it is socially acceptable and normalised. </p>
<p>Think of all the birthday cards and jokes about ageing or phrases like “geezer” and “old duck”. Assuming a person (including yourself) is “too old” for something. Older people say it is harder to <a href="https://www.abc.net.au/news/2023-07-06/senior-job-seekers-struggle-to-get-a-foot-in-the-door/102563144">find work</a> and they face discrimination in <a href="https://www.hcnsw.org.au/wp-content/uploads/2021/03/Ageism-in-Health-Care_final.pdf">health care</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/giving-out-flowers-on-tiktok-is-this-a-random-act-of-kindness-or-just-benevolent-ageism-187064">Giving out flowers on TikTok: is this a 'random act of kindness' or just benevolent ageism?</a>
</strong>
</em>
</p>
<hr>
<h2>How can we reduce ageism?</h2>
<p>We can reduce ageism through laws, policies and education. But we can also reduce it via <a href="https://www.who.int/health-topics/ageism#tab=tab_1">intergenerational contact</a>, where older people and younger people come together. This helps break down the segregation that allows stereotypes to fester. Think of the TV series <a href="https://iview.abc.net.au/show/old-people-s-home-for-4-year-olds">Old People’s Home for 4 Year Olds</a> or the follow-up <a href="https://iview.abc.net.au/show/old-people-s-home-for-teenagers">Old People’s Home for Teenagers</a>. More simply, children can hang out with their older relatives, neighbours and friends. </p>
<p>We can also challenge a negative view of ageing. What if we allowed kids to imagine their lives as grandparents and 100-year-olds as freely as they view their current selves? What would be the harm in that?</p><img src="https://counter.theconversation.com/content/212607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Mitchell is affiliated with the Australian Labor Party.
Opinions are my own and do not represent the views of my affilitated universities or health care employer. </span></em></p>Children absorb these stereotypes from a young age. And ageism is all around us.Lisa Mitchell, Geriatrician working in clinical practice. PhD Candidate at The University of Melbourne studying ethics and ageism in health care. Affiliate lecturer, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2092372023-08-10T02:20:28Z2023-08-10T02:20:28ZAgeing in a housing crisis: growing numbers of older Australians are facing a bleak future<figure><img src="https://images.theconversation.com/files/541828/original/file-20230808-30403-q9ved7.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4891&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Image courtesy of the Housing for the Aged Action Group</span></span></figcaption></figure><p>The collision between an ageing population and a housing crisis has left more older people in Australia enduring housing insecurity and homelessness. Our <a href="https://doi.org/10.26185/87bq-4190">research</a>, released today, explores how the scale of these problems among older people has grown over the past decade. </p>
<p><a href="https://doi.org/10.26185/87bq-4190">Our report</a>, Ageing in a Housing Crisis, shows safe, secure and affordable housing is increasingly beyond the reach of older people. This growing housing insecurity is system-wide. It’s affecting hundreds of thousands of people across all tenures, including home owners and renters. </p>
<p>The federal government released Australia’s first national wellbeing framework,
<a href="https://treasury.gov.au/policy-topics/measuring-what-matters">Measuring What Matters</a> last month. It recognises “financial security and access to housing” as essential for a secure, inclusive and fair society. However, urgent policy action is needed to reshape the Australian housing system so all older people have secure, affordable housing. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing increasing proportions of marginally housed and homeless older people" src="https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=496&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=496&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=496&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=623&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=623&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541664/original/file-20230808-29-p343gp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=623&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://doi.org/10.26185/87bq-4190">Authors & Housing for the Aged Action Group</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weve-all-done-the-right-things-in-under-cover-older-women-tell-their-stories-of-becoming-homeless-188356">'We've all done the right things': in Under Cover, older women tell their stories of becoming homeless</a>
</strong>
</em>
</p>
<hr>
<h2>Older people are increasingly at risk</h2>
<p>We analysed the most recent Australian Bureau of Statistics (ABS) <a href="https://www.abs.gov.au/tags/2021-census-articles">census data</a> and <a href="https://www.abs.gov.au/statistics/people/housing/estimating-homelessness-census/latest-release">homelessness estimates</a>. More older people lived in <a href="https://www.abs.gov.au/census/guide-census-data/census-dictionary/2021/variables-topic/housing/homelessness-operational-groups-opgp">marginal housing</a> – defined by the ABS as including crowding (less severe), improvised dwellings and caravans – and more were homeless in 2021 than a decade earlier. </p>
<h3>Older people experiencing homelessness by gender and category in 2011, 2016 and 2021</h3>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=757&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=757&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=757&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=951&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=951&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541594/original/file-20230808-17-p5ddl5.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=951&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing the decreasing proportion of older people living in social housing" src="https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=253&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=253&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=253&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=318&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=318&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541668/original/file-20230808-19-voz4jb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=318&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
</figcaption>
</figure>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing increasing proportion of older people living in private rental housing" src="https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=351&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=351&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541670/original/file-20230808-24-9qgvng.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=351&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://doi.org/10.26185/87bq-4190">Authors & Housing for the Aged Action Group. (Click on graphics to enlarge.)</a></span>
</figcaption>
</figure>
<p>The proportion of older people in private rental housing has also increased. This means more older people are exposed to the <a href="https://www.pc.gov.au/research/completed/renters">insecurity of renting</a> and <a href="https://news.anz.com/posts/2023/05/anz-news-corelogic-housing-affordability-report-2023?pid=bln-link-td-bln-03-23-tsk-corelogic-har23">rising rents</a>. Our work shows they are struggling to afford private rental housing.</p>
<p>The lowest-income households are the hardest hit. The private rental market is <a href="https://www.anglicare.asn.au/publications/2023-rental-affordability-snapshot/">failing to supply</a> housing they can afford. The shortfall in subsidised social housing is huge. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/its-soul-destroying-how-people-on-a-housing-wait-list-of-175-000-describe-their-years-of-waiting-210705">'It's soul-destroying': how people on a housing wait list of 175,000 describe their years of waiting</a>
</strong>
</em>
</p>
<hr>
<p>Older people who receive government benefits and allowances are at most risk because their incomes are not keeping up with housing costs. </p>
<p>In 2019-20 only 19% of older people on very low incomes (the lowest 20% of household incomes) lived in households whose rent was affordable. This means four out of five were spending more than 30% of their income on rent (the affordability benchmark for low-income households). Two in five were paying severely unaffordable rents – more than 50% of their income.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing 73% increase in the total number of older private renters in a decade" src="https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=626&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=626&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=626&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=787&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=787&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541659/original/file-20230808-23-rzkgxq.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=787&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://doi.org/10.26185/87bq-4190">Authors & Housing for the Aged Action Group</a></span>
</figcaption>
</figure>
<p>For older people who don’t own their homes, rising housing prices create <a href="https://www.ahuri.edu.au/research/final-reports/373">financial risk rather than windfall</a>. At the same time, more older people have mortgages. This increases their risk of housing insecurity or financial stress in retirement. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/fall-in-ageing-australians-home-ownership-rates-looms-as-seismic-shock-for-housing-policy-120651">Fall in ageing Australians' home-ownership rates looms as seismic shock for housing policy</a>
</strong>
</em>
</p>
<hr>
<h2>Ageing magnifies unaffordable housing impacts</h2>
<p>Rising housing costs, falling home ownership rates, mortgage debt carried into retirement, insecure private rental tenures and the worsening shortage of social housing are markers of system-wide housing insecurity. </p>
<p>Insecure or marginal housing affects all generations. However, for older people the risks are made worse by limited income-earning ability, increasing frailty, illness and/or caring responsibilities, growing need for at-home support, and age-based discrimination. These factors make it even harder to meet rising housing costs. </p>
<p>Housing insecurity widens the gap between the housing older people have and the housing they need to live safe, secure and dignified lives as they age. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Graphic showing breakdown of 270,000 older people who are homeless, marginally housed or renting a home they can't afford" src="https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=653&fit=crop&dpr=1 600w, https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=653&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=653&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=821&fit=crop&dpr=1 754w, https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=821&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/541665/original/file-20230808-21-l54cpd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=821&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"></span>
<span class="attribution"><a class="source" href="https://doi.org/10.26185/87bq-4190">Authors & Housing for the Aged Action Group</a></span>
</figcaption>
</figure>
<h2>System-wide risks demand system-wide action</h2>
<p>Growing housing insecurity among older people is a result of system-wide problems. This means system-wide solutions are needed. </p>
<p>We call for: </p>
<ul>
<li><p>adequate social housing supply that reflects population growth and ensures it’s available for older people across all states and territories, including by increasing aged-specific options and reducing the age at which social housing applicants are given priority to 45-55 </p></li>
<li><p>stronger national <a href="https://theconversation.com/how-5-key-tenancy-reforms-are-affecting-renters-and-landlords-around-australia-187779">tenancy regulations</a> that prioritise homes over profit </p></li>
<li><p>dedicated marginal and specialist homelessness services that are well designed with and for older people who have experienced housing insecurity and support systems </p></li>
<li><p>support for people to remain in their own homes, across all tenures. </p></li>
</ul>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1683318520061526017"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-5-key-tenancy-reforms-are-affecting-renters-and-landlords-around-australia-187779">How 5 key tenancy reforms are affecting renters and landlords around Australia</a>
</strong>
</em>
</p>
<hr>
<p>Responses and assistance models must allow for gender diversity, income difference, Aboriginal and/or Torres Strait Islander people’s cultural needs, as well as those of other culturally and linguistically diverse older people. Disability, caring responsibilities, history of trauma, and individuals’ unique housing pathways and experiences must all be considered. </p>
<p>Older people must have a say in reshaping the housing system. The Albanese government is developing a <a href="https://www.dss.gov.au/housing-support-programs-services-housing/developing-the-national-housing-and-homelessness-plan">National Housing and Homelessness Plan</a>. It’s essential that this plan, along with state, territory and local government implementation plans, consider the voices, experiences, concerns and aspirations of older people. </p>
<h2>Housing reform is good for everyone</h2>
<p>Older people are only one part of the population facing housing insecurity and homelessness. A comprehensive national housing plan must respond to all generational needs. Housing solutions for older people must not come at the expense of – or compete with – the needs of other generations. </p>
<p>Housing insecurity and homelessness in childhood, younger years and early adult life all warrant meaningful and urgent housing solutions. Making sure all people have lifelong access to secure housing will begin to reverse the growing problems identified by our report. Otherwise, Australia faces a future where more and more older people struggle with inadequate and unaffordable housing. </p>
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Read more:
<a href="https://theconversation.com/efforts-to-find-safe-housing-for-homeless-youth-have-gone-backwards-heres-what-the-new-national-plan-must-do-differently-210704">Efforts to find safe housing for homeless youth have gone backwards. Here's what the new national plan must do differently</a>
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<p>National reform that includes a focus on generational needs can deliver a housing system that provides affordable homes for everyone. This will ensure everyone is able to maintain community connections, which for older people means being able to age in safe, secure and affordable homes.</p><img src="https://counter.theconversation.com/content/209237/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emma Power receives funding from the Australian Research Council and the Housing for the Aged Action Group. </span></em></p><p class="fine-print"><em><span>Amity James receives funding from the Australian Housing and Urban Research Institute and the Housing for the Aged Action Group.</span></em></p><p class="fine-print"><em><span>Francesca Perugia receives funding from the Australian Housing and Urban Research Institute and the Housing for the Aged Action Group.</span></em></p><p class="fine-print"><em><span>Margaret Reynolds receives funding from the Australian Housing and Urban Research Institute and the Housing for the Aged Action Group</span></em></p><p class="fine-print"><em><span>Piret Veeroja receives funding from the Australian Research Council, the Australian Housing and Urban Research Institute, the Housing for the Aged Action Group and Kids Under Cover.</span></em></p><p class="fine-print"><em><span>Wendy Stone receives funding from the Australian Research Council, the Australian Housing and Urban Research Institute, the Housing for the Aged Action Group and Kids Under Cover. </span></em></p>An ageing population is caught in a perfect storm of rising house prices and rents, falling home ownership rates, mortgage debt carried into retirement, insecure rentals and a lack of social housing.Emma Power, Associate Professor, Geography and Urban Studies, Western Sydney UniversityAmity James, Associate Professor and Discipline Lead Property, Curtin UniversityFrancesca Perugia, Senior Lecturer, School of Design and the Built Environment, Curtin UniversityMargaret Reynolds, Research Fellow, Centre for Urban Transitions, Swinburne University of TechnologyPiret Veeroja, Research Fellow, Centre for Urban Transitions, Swinburne University of TechnologyWendy Stone, Professor of Housing & Social Policy, Centre for Urban Transitions, Swinburne University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101542023-08-08T12:29:52Z2023-08-08T12:29:52ZOlder ‘sandwich generation’ Californians spent more time with parents and less with grandkids after paid family leave law took effect<figure><img src="https://images.theconversation.com/files/541049/original/file-20230803-27-xpn12q.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4535%2C2841&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nearly a dozen states have enacted these policies so far.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-taking-care-of-old-woman-in-wheelchair-royalty-free-image/970176900?adppopup=true">Westend61 via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>A California law that mandates paid family leave has led to adults in their 50s, 60s and 70s spending more time taking care of their parents and less time being their grandkids’ caregivers.</p>
<p>The law requires all employers to allow eligible workers to <a href="https://edd.ca.gov/en/disability/Am_I_Eligible_for_PFL_Benefits/">take up to six weeks of paid leave</a> to care for newborns, newly adopted children or seriously ill family members.</p>
<p>From 2006, two years after the law went into effect, to 2016, <a href="https://ca.db101.org/ca/situations/workandbenefits/rights/program2c.htm">this policy led to older adults’ spending 19 fewer hours</a> per year caring for their grandchildren, a 17% decrease. They spent 20 additional hours on average helping their own parents, a 50% increase. </p>
<p>The effect was most striking for people with newborn grandchildren and parents in need of help, but the law also benefited Californians with older grandchildren and those who don’t have parents requiring their assistance.</p>
<p><a href="https://doi.org/10.1080/08959420.2023.2226283">These findings</a> are from research I conducted with <a href="https://scholar.google.com/citations?user=yWNlAzcAAAAJ">Marcus Dillender</a>, a fellow economist. They suggest the law had effects through two channels. It enabled older adults to take paid leave to care for relatives with medical needs and it reduced the need for older adults to care for their grandchildren by granting paid parental leave to these children’s parents.</p>
<p>To assess how older adults spend their time, we analyzed data for people between the ages of 50 and 79 from the Health and Retirement Study, a <a href="https://hrs.isr.umich.edu/">longitudinal study of approximately 20,000 Americans</a>.</p>
<p>The survey asks respondents in that age group how much time they spend taking care of their grandchildren and helping their aging parents with basic personal activities like dressing, eating and bathing. We compared outcomes for people who lived in California with what happened to Americans in other states before and the law’s enactment.</p>
<p>We also looked into what happened for people who had different combinations of caregiving obligations – grandchildren less than 2 years old or older grandkids, or parents who need help or no parents requiring assistance.</p>
<h2>Why it matters</h2>
<p>The U.S. is the only wealthy country that <a href="https://www.oecd.org/els/soc/PF2_1_Parental_leave_systems.pdf">doesn’t require employers to provide paid family leave</a>. California was the first state to implement its own policies; <a href="https://www.ncsl.org/labor-and-employment/state-family-and-medical-leave-laws">10 others and the District of Columbia</a> have followed suit so far.</p>
<p>These policies can significantly affect older adults, who spend substantial time caring for their relatives.</p>
<p>Caregiving has become a more urgent policy issue because of the growing number of Americans who feel that they belong to a “<a href="https://www.michiganmedicine.org/health-lab/sandwich-generation-study-shows-challenges-caring-both-kids-and-aging-parents">sandwich generation</a>” of people who have to take care of their children or grandchildren and their parents at the same time. </p>
<h2>What other research is being done</h2>
<p>Other research has found that California’s paid family leave policy doubled the overall length of maternity leave by new mothers, <a href="https://doi.org/10.1002/pam.21676">increasing it from an average of three weeks to six weeks</a>. It also upped the likelihood that <a href="https://doi.org/10.1002/pam.22030">fathers take parental leave</a> following the birth or adoption of a child by 46% – although <a href="https://doi.org/10.1002/pam.21894">fathers take less leave on average than mothers</a>.</p>
<p>According to some of the many other studies conducted so far, California’s paid family leave law helped workers with caregiving responsibilities stay employed by allowing them to take time off with reduced financial risk and increased job continuity, <a href="https://doi.org/10.1093/workar/waab022">including for those ages 45 to 64 with a disabled spouse</a> and <a href="https://doi.org/10.1093/geront/gny105">middle-aged female caregivers</a>. The law has, in addition, reduced the share of elderly people using nursing homes by <a href="https://doi.org/10.1002/pam.22038">facilitating more informal care</a>.</p><img src="https://counter.theconversation.com/content/210154/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joelle Abramowitz receives funding from the National Institute on Aging, the Social Security Administration and the National Science Foundation. </span></em></p>The law changed older adults’ caregiving behavior because their children became more able to take paid time off work to care for their own newborns.Joelle Abramowitz, Assistant Research Scientist at the Survey Research Center, University of MichiganLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2074052023-08-03T20:03:04Z2023-08-03T20:03:04ZLump sum, daily payments or a combination? What to consider when paying for nursing home accommodation<figure><img src="https://images.theconversation.com/files/540055/original/file-20230730-24-zd7sfx.jpg?ixlib=rb-1.1.0&rect=0%2C35%2C7951%2C5261&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Moving yourself or a loved one to a nursing home can be <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770">emotional and difficult</a>. While some have their nursing home accommodation costs fully covered by the government (based on a <a href="https://www.myagedcare.gov.au/how-much-will-i-pay">means test</a>), most will have to pay their own way.</p>
<p>The average lump sum room value is <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">A$334,000</a>. Choosing how to pay can make this time even more challenging, particularly for those with <a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">low financial literacy</a>.</p>
<p>This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide.</p>
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<a href="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540057/original/file-20230730-17770-ygyrj5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Not everyone can readily access the amount needed to pay a lump sum.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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Read more:
<a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">Would you pass this financial literacy quiz? Many won't – and it's affecting expensive aged care decisions</a>
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<h2>3 ways to pay</h2>
<p>You can <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs">pay</a> for a nursing home room in three ways.</p>
<p>You can pay the entire room price as a one-off, refundable lump sum (a “refundable accommodation deposit”, sometimes shortened to RAD). This lump sum is refunded to the resident or their estate when the person leaves the nursing home (if they move or pass away).</p>
<p>The refund is <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">guaranteed by the government</a>, even if a provider goes bankrupt.</p>
<p>People who don’t want to pay a lump sum can instead choose rent-style, “daily accommodation payments” (sometimes shortened to DAP).</p>
<p>These are fixed, daily interest-only payments calculated on the total room price. The rate at which they are calculated is known as the “maximum permissible interest rate” or MPIR. </p>
<p>The maximum permissible interest rate is set by the government and is currently <a href="https://www.health.gov.au/sites/default/files/2023-06/base-interest-rate-bir-and-maximum-permissible-interest-rate-mpir-for-residential-aged-care_0.pdf">7.9%</a> per annum. The <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">formula</a> for a daily accommodation payment is (RAD × MPIR) ÷ 365.</p>
<p>Unlike lump sums, daily accommodation payments are not refunded.</p>
<p>The third option is a <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">combination payment</a>. This means paying part of the room price as a lump sum, with daily payments calculated on the remaining room amount. On leaving the home, the part lump sum is refunded to the resident or their estate.</p>
<p>With a combination payment, the consumer can choose to pay whatever amount they like for the lump sum.</p>
<p>The table below shows three different ways someone could pay for a room priced at $400,000.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="attribution"><a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>So which is best? It’s impossible to say. It depends on a person’s circumstances, family situation, finances, preferences and expected length of stay.</p>
<h2>Why do some people choose a lump sum?</h2>
<p>One downside of a lump sum (or part lump sum) is that choosing this option means this money is not invested elsewhere.</p>
<p>By handing over the lump sum, for example, you forgo returns you could have made by investing this same money into property or stocks over the period of your nursing home stay.</p>
<p>On the other hand, paying lump sum means you get to avoid the daily interest payments (the 7.9% in the table above).</p>
<p>So you could potentially be better off paying a lump sum if you think there’s no way you could make investment returns on that money that are substantially higher than the interest you’d be charged through daily payments. </p>
<p>One advantage of choosing a lump sum is it’s considered an <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">exempt asset</a> for pension purposes; some people may get more <a href="https://www.afr.com/wealth/personal-finance/five-things-you-need-to-know-about-aged-care-deposits-20200302-p54606">pension</a> if they pay the lump sum.</p>
<p>The lump sum, however, does count as an asset in determining the <a href="https://www.health.gov.au/our-work/residential-aged-care/charging-for-residential-aged-care-services/residential-aged-care-fee-scenarios-for-people-entering-care-from-1-july-2014">means-tested care fee</a>.</p>
<p>And if you sell your house, remember any money leftover after you pay the lump sum will be counted as assets when you’re means-tested for the pension and means-tested care fee.</p>
<h2>Why might some people prefer daily payments?</h2>
<p>Not everyone can can afford a lump sum. Some may not want to <a href="https://theconversation.com/is-it-worth-selling-my-house-if-im-going-into-aged-care-161674">sell their home</a> to pay one. Some may want to hold onto their house if they think property prices may increase in the future.</p>
<p>Daily payments have recently overtaken lump sums as the most <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">popular payment option</a>, with 43% of people paying this way. However, recent <a href="https://amp-smh-com-au.cdn.ampproject.org/c/s/amp.smh.com.au/money/super-and-retirement/aged-care-interest-rate-increase-sees-daily-payments-almost-double-20230324-p5cuz2.html">interest rate rises</a> may slow or reverse this trend.</p>
<p>And if a spouse or “<a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/residential-aged-care/aged-care-costs">protected person</a>” – such as a dependant or relative that meets certain criteria – is still living in the house, it’s also exempt from assets tests for the pension and other aged care fees.</p>
<p>If the home is vacated by a protected person, its value is still excluded from the pension means test for <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">two years</a> (although rental income is still assessed).</p>
<p>If you do not anticipate a lengthy nursing home stay, daily payments may potentially be the easiest option. But it’s best to consult a financial adviser.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540058/original/file-20230730-105442-x8735z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some 60% of people we surveyed found the decision on payment options complex.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>What does the research say?</h2>
<p>My <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">research</a> with colleagues found many people choose the lump sum option simply because they can afford to.</p>
<p>Those <a href="https://ahes.org.au/portfolio-items/entering-aged-care/">owning residential property</a> are more likely to pay a lump sum, mostly because they can sell a house to get the money.</p>
<p>People who consult financial advisers are also more likely to choose lump sums. This may be due to <a href="https://www.afr.com/wealth/aged-care-costs-most-opt-for-pay-as-you-go-20181023-h170g4">financial advice</a> suggesting it’s tough to earn investment returns higher than what you’d save by avoiding the interest charged in the daily payment option.</p>
<p>Some aged care providers <a href="https://www.mq.edu.au/__data/assets/pdf_file/0003/1164243/the-role-of-refundable-accommodation-deposits-FINAL.pdf">prefer</a> lump sum payment since they <a href="https://www.agedcarequality.gov.au/providers/prudential-standards/permitted-use-refundable-deposits">use</a> these to renovate or refurbish their facilities. But providers are not allowed to influence or control your decision on how to pay.</p>
<p>The recent Royal Commission into Aged Care recommended <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">phasing out</a> lump sums as a payment option, leaving only daily payments. While that would reduce the complexity of the payment decision and remove the incentive for providers to sway decisions, it would also reduce consumer choice. </p>
<h2>Is there anything else I should know?</h2>
<p>Some 60% of people we <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">surveyed</a> found the decision complex, while 54% said it was stressful.</p>
<p>It is best to seek professional <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs#financial-advice">financial advice</a> before you decide.</p>
<p>Services Australia also runs a free <a href="https://www.servicesaustralia.gov.au/what-financial-information-service?context=21836">Financial Information Service</a> that can help you better understand your finances and the payment decision. But it does not give <a href="https://www.servicesaustralia.gov.au/financial-information-service-officers?context=21836#a2">financial advice or prepare plans</a>.</p>
<p>You have <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">28 days to choose a payment method</a> after admission, and six months to pay if you <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">choose a lump-sum payment</a>.</p>
<p>In the interim, you will be charged daily interest payments on the room price.</p>
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Read more:
<a href="https://theconversation.com/the-private-health-insurance-rebate-has-cost-taxpayers-100-billion-and-only-benefits-some-should-we-scrap-it-181264">The private health insurance rebate has cost taxpayers $100 billion and only benefits some. Should we scrap it?</a>
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<img src="https://counter.theconversation.com/content/207405/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anam Bilgrami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide.Anam Bilgrami, Research Fellow, Macquarie University Centre for the Health Economy, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085272023-07-26T12:18:41Z2023-07-26T12:18:41ZWhere the government draws the line for Medicaid coverage leaves out many older Americans who may need help paying for medical and long-term care bills – new research<figure><img src="https://images.theconversation.com/files/539037/original/file-20230724-23-hxz8n7.jpg?ixlib=rb-1.1.0&rect=0%2C738%2C3929%2C2144&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many older people with health insurance coverage through Medicare still can't afford the care they need.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-healthcare-assistance-in-a-home-royalty-free-image/1397246920?phrase=elder+care+drugs&adppopup=true">RichLegg/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Medicaid, which provides low-income Americans with health insurance coverage, currently excludes large numbers of adults over 65 with social, health and financial profiles similar to those of people the program does cover. Based on a <a href="https://doi.org/10.1080/08959420.2023.2195784">study we conducted</a>, we determined that if <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">strict eligibility rules for Medicaid</a> were changed to help cover such people, from 700,000 to 11.5 million people over 65 would be newly eligible for the program.</p>
<p>We analyzed data from the 2018 <a href="https://hrs.isr.umich.edu/about">Health and Retirement Study</a>, a large national survey of older adults conducted by the Institute for Social Research at the University of Michigan every two years, to determine how using five different financial eligibility criteria would increase the number of older adults who would qualify for Medicaid and what they would look like.</p>
<p>Depending on which rules were changed, we would expect to see one of the following scenarios:</p>
<ul>
<li><p>If the government switched from the <a href="https://healthcare.gov/glossary/federal-poverty-level-fpl/">official poverty measurement Medicaid uses</a> – currently an annual income of US$14,580 for one person – to its more accurate <a href="https://www.census.gov/topics/income-poverty/supplemental-poverty-measure.html">supplemental one</a>, which takes taxes, health care costs and certain other expenses into account, about 700,000 more older Americans would get Medicaid coverage.</p></li>
<li><p>If the <a href="https://www.verywellhealth.com/your-assets-magi-and-medicaid-eligibility-4144975">amount of assets that people can have</a> were in line with other programs, such as the <a href="https://www.medicare.gov/medicare-savings-programs">Medicare Savings Plan</a>, an additional 1.4 million people would qualify. Medicare Savings Programs help pay Medicare costs for older adults with limited income and savings.</p></li>
<li><p>If Medicaid stopped <a href="https://www.agingcare.com/articles/asset-limits-to-qualify-for-medicaid-141681.htm">considering assets</a> altogether, an additional 2 million would qualify. </p></li>
<li><p>If the income eligibility threshold were higher, equal to 138% of the <a href="https://www.healthinsurance.org/glossary/federal-poverty-level/">federal poverty level</a>, it would <a href="https://www.medicaid.gov/medicaid/eligibility/index.html">mirror how the government determines</a> whether adults under 65 can get Medicaid, and 4.7 million more older people could be covered by the program. </p></li>
<li><p>A measure that’s increasingly used to evaluate the vulnerability of older adults is the <a href="https://theconversation.com/turning-gray-and-into-the-red-the-true-cost-of-growing-old-in-america-127162">Elder Index</a>, which takes into account basic expenses like housing, health care and food. People over 65 with incomes that fall <a href="https://www.census.gov/library/visualizations/2021/demo/poverty_measure-how.html">above the official poverty line</a> but below the Elder Index are considered to be financially vulnerable. If the government used the Elder Index as a basis for Medicaid eligibility, 11.5 million additional older adults would qualify for the program.</p></li>
</ul>
<p>Unless the government adopted the Elder Index approach, most of the additional enrollees in these scenarios would have poor health and few financial assets.</p>
<h2>Why it matters</h2>
<p>The extra Medicaid enrollment would be in addition to the <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">7.2 million older people</a> already in the program.</p>
<p>All the people who would potentially qualify under these different eligibility standards are unable to shoulder even modest long-term care costs without <a href="https://www.aarp.org/aarp-foundation/our-work/income/public-benefits-guide-senior-assistance/">public assistance</a> aside from their <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">Social Security benefits</a> – one of the largest risks facing the over <a href="https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long-term-services-supports-0">70% of older adults</a> who will have such needs. This risk persists in part because Medicare does not cover such needs. </p>
<p>Low-income adults who are excluded from Medicaid under existing criteria also face high health care costs that contribute to their financial insecurity. Researchers found that <a href="https://doi.org/10.1001/jamanetworkopen.2023.14211">1 in 5 Americans over 65 skipped, delayed or used less</a> medical care or drugs because of financial constraints. </p>
<p>Increasing the number of low-income older people with both Medicaid and Medicare coverage would reduce their out-of-pocket health spending. That would make it <a href="https://doi.org/10.1016/j.jfineco.2019.10.008">easier for them to hang on to their modest savings</a> and also enable them to expand their own caregiving options should they have high medical or <a href="https://www.aplaceformom.com/caregiver-resources/articles/average-cost-long-term-care">long-term care expenses</a> as they age.</p>
<h2>What still isn’t known</h2>
<p>Increasing the number of older people with Medicaid coverage would require more government funding, although the degree of extra spending would depend on which rules the government would change.</p>
<p>Based on the average cost per Medicaid user, our rough estimates suggest that the cost of expanding Medicaid coverage for older people in the first four of the five scenarios we considered would range between about $8 billion and about $51 billion per year. We could not provide an estimate for the Elder Index scenario because the profile of individuals brought into the program would be substantially different from the current Medicaid users, so the per-person costs would be harder to predict.</p>
<p>Accurately estimating these costs and the potential benefits for families and communities that would come from these changes would require additional research.</p><img src="https://counter.theconversation.com/content/208527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging (NCOA).</span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging</span></em></p>Increasing the number of older people with both Medicaid and Medicare would mean fewer of them would be forced to skimp on the care and treatment they need.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center, UMass BostonJane Tavares, Senior Research Fellow and Lecturer of Gerontology, LeadingAge LTSS Center @UMass Boston, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2080052023-07-06T23:49:35Z2023-07-06T23:49:35ZWhat is ‘sundowning’ and why does it happen to many people with dementia?<figure><img src="https://images.theconversation.com/files/532536/original/file-20230619-134757-tunqcw.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4992%2C2612&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The term “<a href="https://www.nia.nih.gov/health/tips-coping-sundowning#:%7E:text=Late%20afternoon%20and%20early%20evening,tired%20caregivers%20need%20a%20break.">sundowning</a>” is sometimes used to describe a tendency for people living with dementia to become more confused in the late afternoon and into the night. </p>
<p>At the outset, I should emphasise the term “sundowning” is overly simplistic, as it’s a shorthand term that can encompass a vast number of behaviours in many different contexts. When assessing changed behaviours in dementia, it’s always better to hear a full and accurate description of what the person is actually doing at these times, rather than to just accept that “they’re sundowning.”</p>
<p>This set of behaviours commonly described as “sundowning” often includes (but is not limited to) confusion, anxiety, agitation, pacing and “shadowing” others. It may look different depending on the stage of dementia, the person’s personality and past behaviour patterns, and the presence of specific triggers.</p>
<p>Why then, do such altered behaviours tend to happen at specific times of the day? And what should you do when it happens to your loved one?</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/when-someone-living-with-dementia-is-distressed-or-violent-de-escalation-is-vital-205988">When someone living with dementia is distressed or violent, 'de-escalation' is vital</a>
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<a href="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=425&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=425&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533979/original/file-20230626-19-b3u3fq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=425&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living with dementia sometimes become more confused in the late afternoon and into the night.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<h2>Fading light</h2>
<p>We all interpret the world via the information that enters our brains through our five senses. Chief among these are sight and sound. </p>
<p>Imagine the difficulty you’d have if asked to perform a complex task while in a darkened room.</p>
<p>People living with dementia are just as dependent on sensory input to make sense of and correctly interpret their environment. </p>
<p>As <a href="https://www.medicalnewstoday.com/articles/314685#causes">light fades</a> towards the end of the day, so too does the amount of sensory input available to help a dementia patient interpret the world.</p>
<p>The <a href="https://www.medicalnewstoday.com/articles/314685#causes">impact</a> of this on a brain struggling to integrate sensory information at the best of times can be significant, resulting in increased confusion and unexpected behaviours.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/serving-up-choice-and-dignity-in-aged-care-how-meals-are-enjoyed-is-about-more-than-whats-on-the-plate-179669">Serving up choice and dignity in aged care – how meals are enjoyed is about more than what's on the plate</a>
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<h2>Cognitive exhaustion</h2>
<p>We have all heard it said that we only use a fraction our brain power, and it is true we all have far more brain power than we typically require for most of the day’s mundane tasks. </p>
<p>This “cognitive reserve” can be brought to bear when we are faced with complex or stressful tasks that require more mental effort. But what if you just don’t have much cognitive reserve?</p>
<p>The changes that ultimately lead to symptoms of Alzheimer’s disease can begin to develop for as many as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486209/">30 years</a> before the onset of symptoms.</p>
<p>During that time, in simple terms, the condition eats away at our cognitive reserve.</p>
<p>It is only when the damage done is so significant our brains can no longer compensate for it that we develop the first symptoms of Alzheimer’s disease and other dementias.</p>
<p>So by the time someone first presents with very early dementia symptoms, a lot of damage has already been done. Cognitive reserve has been lost, and the symptoms of memory loss finally become apparent.</p>
<p>As a result, people living with dementia are required to exert far more mental effort during the course of a routine day than most of us.</p>
<p>We have all felt cognitively exhausted, run down and perhaps somewhat irritable after a long day doing a difficult task that has consumed an extreme amount of mental effort and concentration. </p>
<p>Those living with dementia are required to exert similar amounts of mental effort just to get through their daytime routine.</p>
<p>So is it any surprise that after several hours of concerted mental effort just to get by (often in an unfamiliar place), people tend to get <a href="https://www.alz.org/help-support/caregiving/stages-behaviors/sleep-issues-sundowning">cognitively exhausted</a>?</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/532541/original/file-20230619-17-499g32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">People living with dementia exert a lot of mental effort just to get through their daytime routine.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/elderly-man-sitting-on-bed-8860212/">Pexels/cottonbro studio</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<h2>What should I do if it happens to my loved one?</h2>
<p>The homes of people living with dementia should be <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/gps.5712">well-lit</a> in the late afternoons and evenings when the sun is going down to help the person with dementia integrate and interpret sensory input.</p>
<p>A <a href="https://www.nia.nih.gov/health/tips-coping-sundowning">short nap</a> after lunch may help alleviate cognitive fatigue towards the end of the day. It gives the brain, and along with it a person’s resilience, an opportunity to “recharge”.</p>
<p>However, there is no substitute for a fuller assessment of the other causes that might contribute to altered behaviour. </p>
<p><a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/sundowning#:%7E:text=The%20reasons%20why%20sundowning%20happens,to%20sunlight%20during%20the%20day">Unmet needs</a> such as hunger or thirst, the presence of pain, depression, boredom or loneliness can all contribute, as can stimulants such as caffeine or sugar being given too late in the day.</p>
<p>The behaviours too often described by the overly simplistic term “sundowning” are complex and their causes are often highly individual and interrelated. As is often the case in medicine, a particular set of symptoms is often best managed by better understanding the root causes.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/these-12-things-can-reduce-your-dementia-risk-but-many-australians-dont-know-them-all-191504">These 12 things can reduce your dementia risk – but many Australians don't know them all</a>
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<img src="https://counter.theconversation.com/content/208005/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steve Macfarlane is affiliated with HammondCare and the RANZCP. </span></em></p>People living with dementia often become more confused in the late afternoon and into the night. Why, and what can we do about it?Steve Macfarlane, Head of Clinical Services, Dementia Support Australia, & Associate Professor of Psychiatry, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2064622023-06-01T12:31:37Z2023-06-01T12:31:37ZGetting Social Security on a more stable path is hard but essential – 2 experts suggest a way forward<figure><img src="https://images.theconversation.com/files/528714/original/file-20230528-19-7mz301.jpg?ixlib=rb-1.1.0&rect=54%2C39%2C5166%2C3475&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No big Social Security reforms have taken effect since the Reagan administration.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/president-reagan-speaks-before-signing-the-social-security-news-photo/568872063">David Hume Kennerly/Getty Images</a></span></figcaption></figure><p>Social Security is in trouble. </p>
<p>The retirement and disability program has been running a cash-flow deficit since 2010. Its trust fund, which holds US$2.7 trillion, is rapidly diminishing. Social Security’s trustees, a group that includes the secretaries of the departments of Treasury, Labor, and Health and Human Services, as well as the Social Security commissioner, project that the trust fund will be <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">completely drained by 2033</a>. </p>
<p>Under current law, when that trust fund is empty, Social Security can pay benefits only from dedicated tax revenues, which would by that point cover about <a href="https://www.ssa.gov/OACT/TRSUM/tr23summary.pdf">77% of promised benefits</a>. Another way to say this is that when the trust fund is depleted, under current law, Social Security beneficiaries would see a sudden 23% cut in their monthly checks in 2034. </p>
<p><a href="https://scholar.google.com/citations?hl=en&user=CwMgD5QAAAAJ">As economists</a> who <a href="https://scholar.google.com/citations?user=y0lrTOoAAAAJ&hl=en&oi=ao">study the Medicare and Social Security programs</a>, we view the above scenario as politically unacceptable. Such a sudden and dramatic benefit cut would anger a lot of voters. Unfortunately, the actions necessary now to avoid it – like raising taxes or cutting benefits – aren’t getting serious consideration today. But we believe there are strategies that could work.</p>
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<h2>Where the money for benefits comes from</h2>
<p>Roughly <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">67 million Americans, most of whom are 65 or older</a>, receive Social Security benefits. The agency <a href="https://www.ssa.gov/news/press/releases/2021/#8-2021-2">disburses more than $1 trillion annually</a>. It’s the government’s largest single expenditure, constituting nearly <a href="https://fiscaldata.treasury.gov/americas-finance-guide/federal-spending/">20% of the total federal budget</a>.</p>
<p><a href="https://www.ssa.gov/oact/progdata/taxRates.html">Social Security is funded</a> by a payroll tax of 12.4% on wages split equally between workers and employers. Self-employed people pay the entire 12.4%. This payroll tax applies to earnings up to $160,200 as of 2023. The government increases this cap annually based on increases in the <a href="https://www.investopedia.com/terms/n/national-average-wage-index-nawi.asp">National Average Wage Index</a> – a measure that combines wage growth and inflation. The program also receives about 4% of its revenue from a <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">tax on Social Security benefits</a>, though not everyone who receives them has to pay this tax.</p>
<p>Social Security tax revenue stayed relatively flat after 1990. But the costs of the program rose sharply in 2010, in part because of early <a href="https://doi.org/10.1177/0002716213499535">retirements in response to the Great Recession</a>.</p>
<p>Social Security spending has recently been growing more rapidly because of a <a href="https://www.pewresearch.org/short-reads/2020/11/09/the-pace-of-boomer-retirements-has-accelerated-in-the-past-year/">wave of baby boomer retirements</a>, which added to a decline in the <a href="https://retirementincomejournal.com/article/does-social-security-use-the-wrong-dependency-ratio">number of workers per retiree</a>.</p>
<p>Costs of the program are expected to further exceed the money that’s coming in, which will <a href="https://www.ssa.gov/OACT/TR/2023/tr2023.pdf">continue to drain the trust fund</a>, according to the program’s trustees. </p>
<p>Barring immediate action by the government, the trust fund’s exhaustion is only a little more than a decade away. And yet few members of Congress seem willing to do something about it. For example, <a href="https://thehill.com/homenews/sunday-talk-shows/3835082-mccarthy-social-security-medicare-cuts-off-the-table/">Social Security reform was not even</a> on the table during the 2023 negotiations over the debt ceiling and spending cuts.</p>
<h2>Trust fund</h2>
<p>Where did the trust fund, which helps cover the program’s costs, come from?</p>
<p>While the Social Security program was collecting surpluses from 1984 to 2009, that extra money funded other spending – keeping other taxes lower than they would have been otherwise and <a href="https://www.whitehouse.gov/omb/budget/historical-tables/">partially covering the budget deficit</a>.</p>
<p>During Social Security’s years of surplus, the excess revenues were credited to the trust fund in the form of <a href="https://www.ssa.gov/oact/progdata/specialissues.html">special-issue government bonds</a> that yielded the prevailing interest rates. When those bonds are needed to pay for Social Security expenses, the Treasury redeems them.</p>
<p>Those bonds are components of the <a href="https://www.crfb.org/papers/qa-gross-debt-versus-debt-held-public">government’s $31.4 trillion gross debt</a>. </p>
<h2>Last reformed during the Reagan administration</h2>
<p>Reducing the benefits current retirees receive would be extremely unpopular. Likewise, people now in the workforce who are nearing retirement would certainly object strongly if they were told to expect lower benefits in retirement than they have been promised throughout their careers.</p>
<p>The last time the government made big changes to Social Security was in 1983, during the Reagan administration, when the government enacted reforms that <a href="https://www.ssa.gov/history/1983amend.html">slowly reduced benefits over time</a>. These changes included raising the full retirement age, a change that is <a href="https://www.ssa.gov/benefits/retirement/planner/agereduction.html">still being phased in</a>. Because of those changes, workers born in 1960 or later cannot retire with full benefits until age 67 – two years later than the original retirement age.</p>
<p>The 1983 reforms also included increases in the Social Security payroll tax rate from 10.4% in 1983 to 12.4% by 1990, and for the first time levied federal income taxes on higher-income retirees’ benefits. Workers bore the burden of the payroll tax increases and <a href="https://faq.ssa.gov/en-us/Topic/article/KA-02471">higher-income retirees bore the burden of the tax on benefits</a>.</p>
<p>Those changes bolstered the program’s finances, but they no longer suffice.</p>
<p>The bipartisan <a href="https://www.ssa.gov/history/reports/pcsss/pcsss.html">2001 Commission to Strengthen Social Security</a> tried – and failed – during George W. Bush’s presidency to get Congress to enact reforms to shore up the program’s finances. There’s been no momentum toward resolving the problem since then.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man with gray hair sits at a table in front of a giant replica of a Social Security card." src="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=394&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=394&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=394&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=496&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=496&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529392/original/file-20230531-27-mc2adl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=496&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">George W. Bush sought to reform Social Security early in his presidency.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/george-bush-speaks-about-social-security-during-a-news-photo/525606778">Brooks Kraft LLC/Sygma via Getty Images</a></span>
</figcaption>
</figure>
<h2>4 principles</h2>
<p>We believe that policymakers and lawmakers need to follow four principles as they consider how to move forward.</p>
<ol>
<li><p>The program should be self-funded in the long run so that its annual revenues match its annual expenses. That way the many questions that arise related to trust fund accounting and whether Social Security tax revenues are being used for their intended purposes would be eliminated. </p></li>
<li><p>The reform burden should be shared across generations. Current retirees can share the burden through a reform that reduces the cost-of-living adjustment. Today’s workers can share the burden through an increase in the cap on income subjected to Social Security taxes so that 90% of total earnings are taxed. Continued gradual increases in the retirement age to keep pace with <a href="https://www.cbo.gov/system/files/2022-07/57975-demographic-outlook.pdf">anticipated longevity gains</a> would also be borne by current workers. </p></li>
<li><p>The government should make sure that Social Security benefits will be adequate for lower-income retirees for years to come. That means reforms that slow the benefit growth of future retirees would be designed to affect only higher-income retirees. </p></li>
<li><p>Any changes to Social Security should help constrain the future growth of federal spending, given the <a href="https://www.cbo.gov/publication/58946#_idTextAnchor004">current and projected growth in the budget deficit</a>.</p></li>
</ol>
<h2>Advantages of ending the delay</h2>
<p>It appears that the U.S. – citizens and elected officials included – are deferring serious debate on this urgent matter until the trust fund’s depletion is imminent. That’s unwise. Acting sooner rather than later would leave more options available to gradually resolve the program’s financial shortfalls. </p>
<p>Ending this procrastination would also give the millions of people who rely on Social Security benefits, taxpayers and businesses more time to prepare for any changes required by overdue reforms.</p><img src="https://counter.theconversation.com/content/206462/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Rettenmaier does not work for, consult, or own shares in or receive funding from any company or organization that would benefit from this article. He has received funding from the American Enterprise Institute, the Bradley Foundation, the Charles Koch Foundation, and the National Center for Policy Analysis. </span></em></p><p class="fine-print"><em><span>Dennis W. Jansen does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If Congress and the White House fail to take action, Social Security beneficiaries would see a sudden 23% cut in their monthly checks in 2034.Andrew Rettenmaier, Executive Associate Director of the Private Enterprise Research Center, Texas A&M UniversityDennis W. Jansen, Professor of Economics and Director of the Private Enterprise Research Center, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2048102023-05-31T20:07:11Z2023-05-31T20:07:11ZI’m over 65 and worried about the flu. Which vaccine should I have?<figure><img src="https://images.theconversation.com/files/529223/original/file-20230531-22-s5vazx.jpg?ixlib=rb-1.1.0&rect=8%2C516%2C2748%2C1322&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y5VBtBgswLQ">Philippe Leone/Unsplash</a></span></figcaption></figure><p>Influenza, or the flu, is a virus transmitted by respiratory droplets from coughing and sneezing. It can cause the sudden onset of a fever, cough, runny nose, sore throat, headache, muscle and joint pain. </p>
<p>In Australia, the flu is responsible for <a href="https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-cdi4004f.htm">more than 5,000 hospitalisation and 100 deaths</a> a year. The highest rates are among those over 65, whose immune systems aren’t as effective as they used to be, and children under five, whose immune systems are yet to mature. </p>
<p>To combat the decline in immunity as we age, specific vaccines are available for people aged 65 and over. So how do they work, and why exactly are they needed? </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/should-i-get-a-flu-vaccine-this-year-heres-what-you-need-to-know-203406">Should I get a flu vaccine this year? Here's what you need to know</a>
</strong>
</em>
</p>
<hr>
<h2>Remind me, how does the immune system work?</h2>
<p>The immune system uses multiple mechanisms to fight viral infections, which can be divided into two major arms of the immune system, called innate and adaptive immunity. </p>
<p>Innate immunity involves multiple inflammatory cells and chemicals that are triggered immediately, or within hours of encountering an infection. They activate the immune system to clear the infection. </p>
<p>Adaptive immunity takes a little longer (weeks) to work and involves memory T cells and antibody-producing B cells, which can be reactivated when the body encounters a virus or other pathogen.</p>
<p>The combined innate and adaptive immune response determines how well we respond to an invading virus like influenza. </p>
<h2>Why are older people more at risk from the flu?</h2>
<p>Generally, as we age past 65, the innate cells become less effective at their job of clearing infections. They also start <a href="https://www.annualreviews.org/doi/full/10.1146/annurev-cellbio-100616-060718">producing more inflammation</a>. </p>
<p>New T and B cell numbers also decrease with increasing age and hence the adaptive immune response is also not as effective as when we are younger. This immune system decline is called immunosenescence, which leads to increased susceptibility, hospitalisation and death from influenza. </p>
<figure class="align-center ">
<img alt="Older woman wearing a beanie sorts papers in her living room" src="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529224/original/file-20230531-19-2wea11.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">As we age, our immune system can’t clear infections as effectively.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/aODtyhXEAjg">Mariia Chalaya/Unsplash</a></span>
</figcaption>
</figure>
<p>Certain medical conditions, such as cancer and heart and lung conditions, increase susceptibility to severe influenza, with older people being more likely to have additional medical conditions than younger people.</p>
<h2>What flu vaccines are available?</h2>
<p><a href="https://www.health.gov.au/topics/immunisation/vaccines/influenza-flu-vaccine">Annual flu vaccines</a> are recommended to protect against the common circulating strains of influenza, which can differ from year to year. </p>
<p>The standard flu vaccines offered to adults aged under 65 consist of surface proteins of the virus or inactivated (killed) virus from four influenza strains: two A strains (H1N1 and H3N2) and two B strains. </p>
<p>When you’re vaccinated, your immune system makes antibodies from B cells which protect you if you become exposed to these strains of the virus. </p>
<p>However, the standard influenza vaccine is less effective in older people. </p>
<figure class="align-center ">
<img alt="Older people look out over an ocean" src="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529225/original/file-20230531-19-epmr1y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The standard flu vaccines aren’t as effective for older people.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/sRAWQyoUiVQ">Katarzyna Grabowska</a></span>
</figcaption>
</figure>
<p>Two stronger or augmented vaccines have been made targeting this age group. They contain the same components as the standard vaccine, but one vaccine – called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-01074-1&d=20230529172310101">Fluad</a> – uses a strong adjuvant (an agent used to increase the immune response to vaccination) called MF59 to stimulate better immunity. </p>
<p>The other augmented vaccine, called <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2020-CMI-02062-1">Fluzone</a>, uses a four-fold higher dose of each influenza strain to increase immunity. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-can-you-still-get-influenza-if-youve-had-a-flu-shot-184327">Why can you still get influenza if you've had a flu shot?</a>
</strong>
</em>
</p>
<hr>
<h2>How do they compare?</h2>
<p><a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Studies comparing Fluad and Fluzone</a> show both vaccines stimulate stronger immunity against influenza than the standard flu vaccine and are therefore likely to provide better protection. </p>
<p>Studies directly testing for improved clinical outcomes with vaccines for over-65s show a small benefit of receiving either of the vaccines over the standard vaccine, including a modest decrease in lab-confirmed influenza, <a href="https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(17)30235-7/fulltext">hospitalisations</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7563546/">emergency department visits</a> compared to the standard influenza vaccine. </p>
<p>They are however yet to show and impact on flu-related deaths.</p>
<figure class="align-right ">
<img alt="Woman pushes mother in a wheelchair" src="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=1067&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=1067&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=1067&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1341&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1341&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529226/original/file-20230531-29-ceaux9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1341&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Fluad and Fluzone provide better protection for older people against the flu than the regular vaccine.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/yk7F8bdD0eU">Raychan/Unsplash</a></span>
</figcaption>
</figure>
<p>In the few studies comparing <a href="https://academic.oup.com/cid/article/73/11/e4251/5992287?login=false">Fluad and Fluzone directly</a>, there is little evidence of a difference between them in reducing influenza and serious flu outcomes. <a href="https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-vaccines-in-2023">The Australian Technical Advisory Group on Immunisation therefore recommends</a> using either Fluad or Fluzone.</p>
<p>While both have been Therapeutic Goods Administration (TGA) approved since 2020, only Fluad is available for free on the National Immunisation Program for people aged 65 and over. </p>
<p>Fluzone is only available with a private prescription if you’re 60 years and over, at a cost of around A$65-70. </p>
<p>If neither augmented vaccine is available, a standard influenza vaccine is also acceptable for older people, since any influenza vaccine is preferable to receiving none. </p>
<p>Flu vaccines can also be given at the same time as COVID vaccines. </p>
<h2>How else can we protect against the flu?</h2>
<p>While influenza vaccination is the single most effective way of preventing influenza, other measures such as social distancing and wearing a mask or N95 respirator can also provide some <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">community protection</a>.</p>
<p>Wearing a mask or N95 respirator significantly <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5779801/">reduces the risk</a> of infecting others when infected.</p>
<p>The evidence for protecting oneself against infection is less conclusive, mainly because it’s linked to early, consistent and, importantly, the <a href="https://cdn.who.int/media/docs/default-source/influenza/advice-on-the-use-of-masks-in-the-community-setting-in-influenza-a-(h1n1)-outbreaks.pdf?sfvrsn=24a45a95_1&download=true">correct use of masks</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/over-half-of-eligible-aged-care-residents-are-yet-to-receive-their-covid-booster-and-winter-is-coming-205403">Over half of eligible aged care residents are yet to receive their COVID booster. And winter is coming</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/204810/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Magdalena Plebanski receives Grant funding from National Health and Medical Research Council (NHMRC) to conduct fundamental immunology research on Flu and DTP vaccines in older adults. She conducts research on ovarian cancer, including a Phase II human trial part funded by Astrazeneca and ANZGOG (Australia and New Zealand Gynecological and Oncological Group). </span></em></p><p class="fine-print"><em><span>Katie Louise Flanagan receives funding from NHMRC, MRFF, BMGF and Clifford Craig Foundation. She was previously on Vaccine Advisory Boards for Seqiris (2016-19) and Sanofi-Pasteur (2016-18). She is President of the Australasian Society for Infectious Diseases and a member of the Australian Technical Advisory Group on Immunisation. These are her own personal views. </span></em></p><p class="fine-print"><em><span>Jennifer Boer and Kirsty Wilson do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To combat the decline in immunity as we age, specific boosters are available for people aged over 65. Here’s how they work, and why they are needed.Magdalena Plebanski, Professor of Immunology, RMIT UniversityJennifer Boer, Postdoctoral Research Fellow, RMIT UniversityKatie Louise Flanagan, Infectious Diseases Specialist and Clinical Professor, University of TasmaniaKirsty Wilson, Postdoctoral Research Fellow, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2059602023-05-22T12:27:43Z2023-05-22T12:27:43ZGOP’s proposed expansion of SNAP work requirements targets many low-income people in their early 50s – but many of them already work<figure><img src="https://images.theconversation.com/files/527300/original/file-20230519-21-rnxqd4.jpg?ixlib=rb-1.1.0&rect=0%2C33%2C5488%2C3190&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many Americans in their early 50s take care of older loved ones.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caregiver-woman-helping-senior-man-with-shopping-royalty-free-image/587506108">FredFroese/E+ via Getty Imagres</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Roughly half of the people who would be affected by a proposed expansion of <a href="https://theconversation.com/extra-snap-benefits-are-ending-as-us-lawmakers-resume-battle-over-program-that-helps-low-income-americans-buy-food-199929">Supplemental Nutrition Assistance Program</a> work requirements already do what’s needed to meet those requirements. There’s also evidence suggesting that many of the rest have caregiving or health conditions that prevent them from working.</p>
<p>Formerly known as food stamps, SNAP helps low-income people buy groceries. </p>
<p>Republicans want the federal government to make SNAP benefits for <a href="https://www.cnn.com/2023/04/26/politics/work-requirements-food-stamps-medicaid-debt-ceiling/index.html">adults age 50 to 55</a> without dependents or disabilities contingent on spending <a href="https://www.fns.usda.gov/snap/work-requirements#:%7E:text=Work%20at%20least%2080%20hours,least%2080%20hours%20a%20month">80 hours per month on work activities</a>, which may include employment, short-term training and community service. This proposed change is in a package that the Republican-led <a href="https://www.cnn.com/2023/04/19/politics/mccarthy-debt-limit-bill/index.html">House of Representatives passed in April 2023</a> that seeks to cut spending on several social programs.</p>
<p>Currently, the requirements only apply to adults under 50 without dependents who aren’t disabled.</p>
<p>We’re basing these estimates on our analysis of nationally representative time-diary data from the Bureau of Labor Statistics’ <a href="https://www.bls.gov/tus/">American Time Use Survey</a>.</p>
<p>We analyzed the time that low-income Americans ages 50-55 who didn’t have a disability or child at home spent working, caring for others or dealing with their personal health and well-being from 2012 to 2021. </p>
<p>We found that in most years, more than half of them worked at least 20 hours per week. We estimated that, on average, those who met the work requirement actually worked about 41-51 hours per week – a full-time schedule. </p>
<p>We also determined that relative to their counterparts who met the work requirements, those who did not spent 10 times as much time managing their own health, five times as much time on child care, and more than five times as much time caring for an elderly or disabled adult.</p>
<p><iframe id="Lcj3Y" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Lcj3Y/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Why it matters</h2>
<p>The GOP bill is <a href="https://www.washingtonexaminer.com/restoring-america/faith-freedom-self-reliance/how-to-stop-the-lefts-dangerous-despicable-war-on-work">grounded in a belief</a> that people who get SNAP benefits and aid through other assistance programs are not employed but capable of working, and that enforcing work requirements can increase employment and earnings.</p>
<p>But <a href="https://www.census.gov/library/stories/2020/07/most-families-that-received-snap-benefits-in-2018-had-at-least-one-person-working.html">that’s a misconception</a>.</p>
<p>This measure and <a href="https://networklobby.org/devastating-debt-ceiling-bill/">several others like it</a> are part of a package that would raise the debt limit to avert a potential U.S. default and a global economic crisis.</p>
<p>Our findings <a href="https://www.cbpp.org/research/food-assistance/house-republicans-agriculture-appropriations-bill-would-cut-wic-benefits">support widespread concerns</a> that expanding SNAP work requirements would sever food assistance benefits for an estimated <a href="https://www.cbo.gov/publication/59102">275,000 low-income people</a> between the ages of 50 and 55, including many with health conditions and who care for others.</p>
<p>That’s troubling because the cost of <a href="https://blog.dol.gov/2023/01/24/new-childcare-data-shows-prices-are-untenable-for-families">professional child care</a> and <a href="https://www.cnn.com/2023/04/20/health/senior-care-cost/index.html">elder care</a>, as well as the <a href="https://www.nationaldisabilityinstitute.org/wp-content/uploads/2020/10/extra-costs-living-with-disability-brief.pdf">care for the disabled</a>, is very high in the U.S.</p>
<p>It’s reasonable to expect that the new work requirements would force many people to make hard choices between the caregiving arrangements for their loved ones and keeping their benefits. Also, since people who have poor health may not be able to work, they may find themselves unable to put food on the table if they lose SNAP benefits.</p>
<p><iframe id="Gpems" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/Gpems/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>What other research is being done</h2>
<p>SNAP is associated with many positive trends beyond getting enough to eat. These include <a href="https://doi.org/10.1001/jamainternmed.2017.4841">spending less on health care</a>, having <a href="https://doi.org/10.1017/s1368980021003815">better health</a> and <a href="https://www.federalreserve.gov/econres/feds/financial-repercussions-of-snap-work-requirements.htm">becoming more financially secure</a>.</p>
<p>Further, when Americans use SNAP to buy groceries, studies have shown that it <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/supplemental-nutrition-assistance-program-snap/economic-linkages/">stimulates the economy where they live</a>, supporting low-income communities. </p>
<p>Additional research has found that work requirements tied to aid programs <a href="https://theconversation.com/snap-work-requirements-dont-actually-get-more-people-working-but-they-do-drastically-limit-the-availability-of-food-aid-204257">don’t get more low-income people to enter the labor force</a>. Studies also have found that these policies cause many people who are eligible for assistance to <a href="https://theconversation.com/medicaid-work-requirements-would-leave-more-low-income-people-without-health-insurance-but-this-policy-is-unlikely-to-pass-this-time-around-204731">lose their benefits</a> due to paperwork hassles and unclear guidelines.</p><img src="https://counter.theconversation.com/content/205960/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Katherine Engel receives funding from the U.S. Department of Agriculture.</span></em></p><p class="fine-print"><em><span>Taryn Morrissey has received funding from the U.S. Department of Agriculture, the U.S. Department of Health and Human Services, the Robert Wood Johnson Foundation, the Bainum Family Foundation, DC Action for Children, and the Peter G. Peterson and Ford Foundations. Morrissey is a non-resident Fellow at the Urban Institute and previously a Senior Fellow at the Center for American Progress.</span></em></p>Republicans are pressing for policy changes based on a misconception that hardly anyone who gets help buying groceries with Supplemental Nutrition Assistance Program benefits is employed.Katherine Engel, PhD Student in Public Administration and Policy, American University School of Public AffairsTaryn Morrissey, Professor of Public Administration and Policy, American University School of Public AffairsLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2041742023-05-19T12:41:05Z2023-05-19T12:41:05ZBalance declines with age, but exercise can help stave off some of the risk of falling<figure><img src="https://images.theconversation.com/files/525481/original/file-20230510-25-jmyca.jpg?ixlib=rb-1.1.0&rect=0%2C53%2C5991%2C3817&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">About 1 in 4 adults ages 65 and up experience a fall every year.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caregiver-help-asian-or-elderly-old-woman-walk-with-royalty-free-image/1383512710?phrase=seniors+fall&adppopup=true">sasirin pamai/iStock via Getty Images Plus</a></span></figcaption></figure><p>My wife and I were in the grocery store recently when we noticed an older woman reaching above her head for some produce. As she stretched out her hand, she lost her balance and began falling forward. Fortunately, she leaned into her grocery cart, which prevented her from falling to the ground. </p>
<p>Each year, about <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm">1 in every 4 older adults experience a fall</a>. In fact, falls are the leading cause of injuries in adults ages 65 and older. Falls are the <a href="https://doi.org/10.1007/bf00298717">most common cause of hip fractures</a> and <a href="https://doi.org/10.1111/j.1553-2712.2000.tb00515.x">traumatic brain injuries</a>. </p>
<p>Injuries like those are also <a href="https://doi.org/10.1056/NEJM199710303371806">risk factors for placement in a nursing home</a>, where the fall risk is <a href="https://doi.org/10.7326/0003-4819-121-6-199409150-00009">nearly three times higher than for people living in the community</a>.</p>
<p>A number of physical changes with aging often go unseen preceding falls, including muscle weakness, decreased balance and changes in vision. </p>
<p>I am a <a href="https://facultyprofiles.tufts.edu/evan-papa">physical therapist</a> and <a href="https://scholar.google.com/citations?user=T9B_dHQAAAAJ&hl=en">clinical scientist focused on fall prevention</a> in older adults, commonly ages 65 and older. I’ve spent most of my career investigating why older adults fall and working with patients and their families to prevent falls. </p>
<h2>Why aging leads to increased risk of falls</h2>
<p>Aging is a process that affects the systems and tissues of every person. The rate and magnitude of aging may be different for each person, but overall physical decline is an inevitable part of life. Most people think aging starts in their 60s, but in fact we spend most of our life span <a href="https://doi.org/10.1093%2Fgeront%2Fgnv130">undergoing the process of decline</a>, typically beginning in our 30s. </p>
<p>Older adults are more prone to falling for various reasons, including age-related changes in their bodies and vision changes that leave them vulnerable to environmental factors such as curbs, stairs and carpet folds.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/ztPbKP68P2Q?wmode=transparent&start=24" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some straightforward measures to improve the safety of the home environment for older adults can significantly lower the risk of falls.</span></figcaption>
</figure>
<p>Based on my experience, here are some common reasons older adults may experience falls:</p>
<p>First, <a href="https://my.clevelandclinic.org/health/diseases/23167-sarcopenia#">aging leads to a natural loss of muscle strength</a> and flexibility, making it more challenging to maintain balance and stability. The loss of strength and poor balance are two of the most common causes of falls.</p>
<p>Second, older adults often have chronic conditions such as arthritis, Parkinson’s disease or diabetes that can affect their mobility, coordination and overall stability. </p>
<p>In addition, certain medications commonly taken by older adults, <a href="https://doi.org/10.4088/jcp.18f12340">such as sedatives</a> or <a href="https://doi.org/10.1001/jamainternmed.2013.14764">blood pressure drugs</a>, can cause dizziness, drowsiness or a drop in blood pressure, leading to an increased risk of falls.</p>
<p>Age-related vision changes, such as reduced depth perception and peripheral vision and difficulty in differentiating colors or contrasts, can make it harder to navigate and identify potential hazards. Hazards in the environment, such as uneven surfaces, slippery floors, inadequate lighting, loose rugs or carpets or cluttered pathways, can <a href="https://doi.org/10.1186/s12877-021-02499-x">significantly contribute to falls among older adults</a>.</p>
<p>Older adults who lead a sedentary lifestyle or have limited physical activity may also experience reduced strength, flexibility and balance.</p>
<p>And finally, such conditions as dementia or Alzheimer’s disease can affect judgment, attention and spatial awareness, leading to increased fall risk.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of an iceberg underwater and just partially showing above water, annotated with a few of the age-related changes that can increase fall risk." src="https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=827&fit=crop&dpr=1 600w, https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=827&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=827&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1039&fit=crop&dpr=1 754w, https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1039&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/524725/original/file-20230506-40482-sxlgnl.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1039&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Falls reflect age-related changes happening under the surface.</span>
<span class="attribution"><a class="source" href="https://www.istockphoto.com/photo/iceberg-with-underwater-view-gm486634864-73438575">Annotated by Evan Papa via iStock/Getty Images</a></span>
</figcaption>
</figure>
<h2>Theories of aging</h2>
<p>There are numerous theories about why we age but there is no one unifying notion that explains all the changes in our bodies. A large portion of aging-related decline is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295054/">caused by our genes</a>, which determine the structure and function of bones, muscle growth and repair and visual depth perception, among other things. But there are also numerous lifestyle-related factors that influence our rate of aging including diet, exercise, stress and exposure to environmental toxins. </p>
<p>A recent advance in scientific understanding of aging is that there is a difference between your <a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">chronological age and your biological age</a>. Chronological age is simply the number of years you’ve been on the Earth. Biological age, however, refers to how old your cells and tissues are. It is based on physiological evidence from a blood test and is related to your physical and functional ability. Thus, if you’re healthy and fit, your biological age may be lower than your chronological age. However, the reverse can also be true. </p>
<p>I encourage patients to focus on their biological age because it empowers them to take control over the aging process. We obviously have no control over when we are born. By focusing on the age of our cells, we can avoid long-held beliefs that our bodies are destined to develop cancer, diabetes or other conditions that <a href="https://doi.org/10.1016/j.cub.2012.07.024">have historically been tied to how long we live</a>. </p>
<p>And by taking control of diet, exercise, sleep and other lifestyle factors you can actually <a href="https://doi.org/10.1111%2Facel.13538">decrease your biological age</a> and improve your quality of life. As one example, our team’s research has shown that moderate amounts of aerobic exercise <a href="https://doi.org/10.1371/journal.pone.0188538">can slow down motor decline</a> even when a person begins exercise in the latter half of the life span.</p>
<h2>Fall prevention</h2>
<p>Adopting lifestyle changes such as regular, long-term exercise can <a href="https://doi.org/10.1001/jamainternmed.2018.5406">reduce the consequences of aging</a>, including falls and injuries. Following a healthy diet, managing chronic conditions, reviewing medications with health care professionals, maintaining a safe home environment and getting regular vision checkups can also help reduce the risk of falls in older adults. </p>
<p>There are several exercises that physical therapists use to improve balance for patients. It is important to note however, that before starting any exercise program, everyone should consult with a health care professional or a qualified physical therapist to determine the most appropriate exercises for their specific needs. Here are five forms of exercise I commonly recommend to my patients to improve balance:</p>
<ol>
<li><p>Balance training can help improve coordination and <a href="https://www.sciencedirect.com/topics/neuroscience/proprioception#">proprioception</a>, which is the body’s ability to sense where it is in space. By practicing movements that challenge the body’s balance, such as standing on one leg or walking heel-to-toe, the nervous system becomes better at coordinating movement and maintaining balance. A large research study analyzing nearly 8,000 older adults found that balance and functional exercises <a href="https://doi.org/10.1002/14651858.cd012424.pub2">reduce the rate of falls by 24%</a>. </p></li>
<li><p>Strength training exercises involve lifting weights or using resistance bands to increase muscle strength and power. By strengthening the muscles in the legs, hips and core, older adults can improve their ability to maintain balance and stability. Our research has shown that strength training can also lead to <a href="https://doi.org/10.2147/cia.s104674">improvements in walking speed and a reduction in fall risk</a>.</p></li>
<li><p>Tai chi is a gentle martial art that focuses on slow, controlled movements and shifting body weight. Research shows that it can improve balance, strength and flexibility in older adults. Several combined studies in tai chi have demonstrated a 20% reduction in the <a href="https://doi.org/10.1002/14651858.cd012424.pub2">number of people who experience falls</a>. </p></li>
<li><p>Certain yoga poses can enhance balance and stability. Tree pose, warrior pose and mountain pose are examples of poses that can help improve balance. It’s best to <a href="https://theconversation.com/yoga-modern-research-shows-a-variety-of-benefits-to-both-body-and-mind-from-the-ancient-practice-197662">practice yoga</a> under the guidance of a qualified instructor who can adapt the poses to individual abilities.</p></li>
<li><p>Flexibility training involves stretching the muscles and joints, which can improve range of motion and reduce stiffness. By improving range of motion, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990889/">older adults can improve their ability to move safely</a> and avoid falls caused by limitations in mobility. </p></li>
<li><p>Use of assistive devices can be helpful when strength or balance impairments are present. Research studies involving the evaluation of canes and walkers used by older adults confirm that <a href="https://doi.org/10.1016/j.apmr.2004.04.023">these devices can improve balance and mobility</a>. Training from a physical or occupational therapist in the proper use of assistive devices is an important part of improving safety.</p></li>
</ol>
<p>When I think back about the woman who nearly fell in the grocery store, I wish I could share everything we have learned about healthy aging with her. There’s no way to know if she was already putting these tips into practice, but I’m comforted by the thought that she may have avoided the fall by being in the right place at the right time. After all, she was standing in the produce aisle.</p><img src="https://counter.theconversation.com/content/204174/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evan Papa receives funding from the National Institutes of Health / National Institute of General Medical Sciences under the Mountain West Center for Translational Research Infrastructure grant #U54GM104944, and the Idaho Elks Rehab Society. </span></em></p>Lifestyle factors like physical activity, diet and sleep can lower the ‘biological age’ of your cells and tissues and reduce age-related physical decline.Evan Papa, Associate Professor of Physical Therapy and Rehabilitation Science, Tufts UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2035622023-05-17T01:27:55Z2023-05-17T01:27:55ZAm I too old to build muscle? What science says about sarcopenia and building strength later in life<figure><img src="https://images.theconversation.com/files/525760/original/file-20230512-41125-9ts1je.jpg?ixlib=rb-1.1.0&rect=0%2C44%2C7360%2C4858&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Sarcopenia is the progressive and accelerated loss of muscle mass and strength as we age. </p>
<p>The term was coined in the 1980s, and the condition has been recognised as a disease for less <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50432">than a decade</a>, but the concept is as old as time: use it or lose it.</p>
<p>But what if you’re in your 60s, 70s, 80s or 90s? Is it “too late” to build muscle and fight sarcopenia? Here’s what the research says.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525756/original/file-20230511-19-34yuj7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercise training during weight loss can also prevent bone loss.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-muscle-wasting-condition-sarcopenia-is-now-a-recognised-disease-but-we-can-all-protect-ourselves-119458">The muscle-wasting condition 'sarcopenia' is now a recognised disease. But we can all protect ourselves</a>
</strong>
</em>
</p>
<hr>
<h2>Sarcopenia isn’t just unfortunate. It’s dangerous</h2>
<p>All of us will start to gradually lose muscle from our mid-30s, but this loss accelerates in later years. For up to 30% of adults aged over 60, the declines are substantial enough to meet the <a href="https://onlinelibrary.wiley.com/doi/10.1002/jcsm.12783">definition for sarcopenia</a>.</p>
<p>Sarcopenia increases your risk of falls, fractures, hospitalisation, loss of independence and many other chronic diseases. </p>
<p>However, people who are active in early life and maintain this as they age can delay or prevent the <a href="https://onlinelibrary.wiley.com/doi/10.1002/jcsm.13218">onset of sarcopenia</a>.</p>
<p>The good news is it’s never too late to make a start, even if you are already experiencing the debilitating effects of sarcopenia. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=392&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=392&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=392&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525520/original/file-20230511-29-5201jv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s never too late to make a start.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What the science says</h2>
<p>Resistance training is the most effective way to build and strengthen muscle at all ages. That means things like:</p>
<ul>
<li><p>lifting free weights like dumbbells</p></li>
<li><p>using machine weights, like you find in a gym</p></li>
<li><p>using resistance bands</p></li>
<li><p>bodyweight exercises such as push-ups, squats, wall-sits or tricep dips.</p></li>
</ul>
<p>It’s OK to start with even very light weights, or do modified, easier versions of bodyweight exercises (for example, you might do a shallow squat rather than a deep one, or a push-up against a wall or windowsill instead of on the floor). Something is always better than nothing. </p>
<p>Aim to make the exercise harder over time. Lift progressively heavier weights or do increasingly harder versions of bodyweight or resistance band exercises. This is called progressive resistance training.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525565/original/file-20230511-27-1sxqpo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Aim to make the exercise harder over time.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p><a href="https://link.springer.com/article/10.1007/s40279-020-01331-7?fbclid=IwAR06PPIz8cf2xZExNvrnlueQp0-7SWQwT1x0bUdnZrgTOqcyiAdTrpufTjU">Clinical trials</a> have consistently shown all adults – even very frail people over the age of 75 – can make significant gains in muscle mass and strength by doing progressive resistance training at least twice a week. The improvements can be seen in as little as eight weeks. </p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/2342214/">One seminal study</a> included ten frail, institutionalised 86–96 year olds who did a high-intensity progressive resistance training program. </p>
<p>After just eight weeks, the average mid-thigh muscle area had increased by almost 10% (which is equivalent to the amount of muscle typically lost over a decade) and leg strength increased by about 180%. </p>
<p>In other words, these older people were almost three times stronger at the end of the short training program than before.</p>
<p>It really can be done. British-Swiss man <a href="https://www.youtube.com/watch?v=rGgoCm1hofM">Charles Eugster</a> (1919–2017), for example, took up progressive resistance training in his late 80s after noticing a decline in his muscle mass. He went on to become a <a href="https://www.bodybuilding.com/fun/lessons-from-a-95-year-old-bodybuilder.html">bodybuilder</a>, and in 2012 gave a TEDx <a href="https://www.youtube.com/watch?v=rGgoCm1hofM">talk</a> titled “Why bodybuilding at age 93 is a great idea”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6689%2C4466&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6689%2C4466&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525755/original/file-20230511-23-xwcq71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Resistance training is the most effective way to build and strengthen muscle at all ages.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What if my doctor has told me to lose weight?</h2>
<p>Many older adults have obesity, which increases the risk of cardiovascular disease and type 2 diabetes. </p>
<p>They’re often told to lose weight, but any dieting (or other strategy aimed at weight loss) also usually causes muscle loss.</p>
<p>Losing muscle mass in older age could increase the risk for many common chronic conditions. For example, muscle is crucial to keeping blood sugar levels under control, so excessive muscle loss could blunt the benefits of weight loss for people with type 2 diabetes.</p>
<p>If you’re losing weight, it’s important to try to minimise muscle mass loss at the same time. How? Progressive resistance training. </p>
<p>By combining progressive resistance training with weight loss, one study found the resulting muscle loss is <a href="https://pubmed.ncbi.nlm.nih.gov/29596307/">negligible</a>. (It’s also important that if you are dieting, you are still eating <a href="https://www.clinicalnutritionjournal.com/article/S0261-5614(14)00111-3/fulltext">enough protein</a>, so your body has the ingredients it needs to build new muscle).</p>
<p>Exercise training during weight loss can also prevent <a href="https://www.sciencedirect.com/science/article/pii/S2095254621000491">bone loss</a>, which reduces fracture risk in older people.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C4368%2C2877&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&rect=0%2C19%2C4368%2C2877&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/520175/original/file-20230411-26-v63lvh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">An accredited exercise professional can help design a program that suits you.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<h2>Aim for at least twice a week – more if you can</h2>
<p>Whether or not you’re trying to lose weight, and regardless of whether you think you have sarcopenia, all older adults can benefit from strengthening their muscles.</p>
<p>Even if getting to a gym or clinic is hard, there are plenty of resistance exercises you can do at home or outdoors that will help build strength.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/525783/original/file-20230512-35478-3o1th8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">All older adults can benefit from strengthening their muscles.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>Talk to a health professional before starting a moderate to high intensity progressive resistance training program. An accredited exercise professional can help design a program that suits you.</p>
<p>Generally, we should aim to do progressive resistance training at least <a href="https://link.springer.com/article/10.1007/s12603-021-1665-8">twice a week</a>.</p>
<p>Try to target 8–10 muscle groups, and start out at about 30–40% of your maximum effort before progressing over time to 70–80% of your maximum. </p>
<p>As the name suggests, it is key to progressively increase the effort or challenge of your program so you can feel the improvements and achieve your goals. </p>
<p>It’s never too late to start training for your fight against sarcopenia and loss of independence in older age. The health benefits will be worth it. As Socrates <a href="https://www.sacred-texts.com/cla/plato/theaetet.htm">said</a> in the 4th Century BC:</p>
<blockquote>
<p>is not the bodily habit spoiled by rest and idleness, but preserved for a long time by motion and exercise?</p>
</blockquote>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/use-it-or-rapidly-lose-it-how-to-keep-up-strength-training-in-lockdown-165810">Use it or rapidly lose it: how to keep up strength training in lockdown</a>
</strong>
</em>
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<img src="https://counter.theconversation.com/content/203562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Scott has been a consultant for Pfizer Consumer Healthcare and Abbott Nutrition. He has received competitive research funding from the National Health and Medical Research Council (NHMRC), Medical Research Future Fund (MRFF) and Amgen Australia. He is a Council member of the Australian and New Zealand Society for Sarcopenia and Frailty Research (ANZSSFR), and Chair of the ANZSSFR Sarcopenia Diagnosis and Management Taskforce.</span></em></p><p class="fine-print"><em><span>Robin Daly has received funding from the National Health and Medical Research Council (NHMRC), Medical Research Future Fund (MRFF), Eggs Australia, Meat and Livestock Australia, the Peanut Institute, Fonterra Co-operative Group Ltd as part of a Primary Growth Partnership grant via the Ministry of Primary Industries in New Zealand and Amgen Australia. He has previously received speaker honoraria from Abbott Nutrition, Fresenius Kabi, Nutricia Australia and Amgen. He is a member of the medical and scientific advisory committee of Healthy Bones Australia and a council member of the International Federation for Musculoskeletal Research Societies (IFMRS).
</span></em></p>It’s never too late to start.David Scott, Associate Professor (Research) and NHMRC Emerging Leadership Fellow, Deakin UniversityRobin M. Daly, Professor of Exercise and Ageing, Institute for Physical Activity and Nutrition, Deakin University, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1999292023-02-17T13:24:15Z2023-02-17T13:24:15ZExtra SNAP benefits are ending as US lawmakers resume battle over program that helps low-income Americans buy food<figure><img src="https://images.theconversation.com/files/510712/original/file-20230216-466-mfpujx.jpg?ixlib=rb-1.1.0&rect=43%2C359%2C3194%2C1796&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For some Americans, the decline will be quite sharp.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/clark-resident-jen-valencia-still-works-part-time-for-news-photo/1363541115">Michael Loccisano/Getty Images</a></span></figcaption></figure><p>Millions of Americans will find it harder to put enough food on the table starting in March 2023, after a <a href="https://www.fns.usda.gov/snap/covid-19-emergency-allotments-guidance">COVID-19 pandemic-era boost</a> to <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">Supplemental Nutrition Assistance Program</a> benefits comes to an end. Congress mandated this change in <a href="https://www.fns.usda.gov/snap/ea-provision-consolidated-appropriations-act-2023">budget legislation</a> it passed in late December 2022.</p>
<p><a href="https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap">Roughly 41 million Americans</a> are currently enrolled in this program, which the government has long used to ease hunger while <a href="https://theconversation.com/how-snap-can-help-people-during-hard-economic-times-like-these-133664">boosting the economy during downturns</a>.</p>
<p>Many families enrolled in the program, commonly known as SNAP but sometimes called food stamps, stand to <a href="https://www.cbpp.org/research/food-assistance/temporary-pandemic-snap-benefits-will-end-in-remaining-35-states-in-march#_ftn2">lose an average of roughly US$90 per person a month</a>.</p>
<p>While researching SNAP <a href="https://news.richmond.edu/releases/article/-/16856/ur-political-science-professor-awarded-funding-to-advance-book-project-on-history-of-americas-food-stamp-program.html">for an upcoming book</a>, I’ve observed that this program has provided critical assistance to struggling families over the last three years. The extra benefits, which Americans can use to purchase food at the <a href="https://ncoa.org/article/where-can-i-use-snap-benefit">roughly 250,000 stores that accept them</a>, have helped millions of people weather the pandemic’s economic fallout and high inflation rates.</p>
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<h2>SNAP benefits grew during the pandemic</h2>
<p>In the early days of the COVID-19 pandemic, <a href="https://www.nbcnews.com/news/us-news/covid-19-crisis-heaps-pressure-nation-s-food-banks-n1178731">lines at food banks grew</a> and <a href="https://www.bls.gov/opub/mlr/2021/article/unemployment-rises-in-2020-as-the-country-battles-the-covid-19-pandemic.htm">millions lost their jobs</a>. One way that <a href="https://www.congress.gov/bill/116th-congress/house-bill/6201/text">Congress responded was with legislation</a> that let the states, which administer this federally funded program, expand SNAP benefits during the public health emergency.</p>
<p>Under this temporary arrangement, all families who were eligible for SNAP could get the maximum allowable benefit amount for the size of their household. Otherwise, that maximum amount would only be available to people with no income at all. But starting in March 2023, SNAP benefits will once again be distributed everywhere on a sliding scale based on income levels.</p>
<p>Some states began to drop the extra benefits in the spring of 2021. <a href="https://www.fns.usda.gov/snap/2023-benefit-changes">But 32 states</a> and the District of Columbia were still offering the extra help in February 2023. </p>
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<p>A <a href="https://www.urban.org/research/publication/effect-reevaluated-thrifty-food-plan-and-emergency-allotments-supplemental">study from the Urban Institute</a>, a think tank, estimated that the extra benefits kept 4.2 million people out of poverty at the end of 2021 and had reduced overall poverty in states still offering the benefits by 9.6% and child poverty by 14%. </p>
<p>Although the unemployment rate has recently fallen to the <a href="https://www.cnbc.com/2023/02/03/jobs-report-january-2023-.html">lowest level since 1969</a>, the extra SNAP benefits have continued to help low-income families deal with soaring prices that <a href="https://www.bls.gov/news.release/cpi.nr0.htm">increased the cost of food consumed at home by 11.3%</a> in the 12 months ending in January 2023.</p>
<p>With more people enrolled in the program today than before the COVID-19 pandemic, and the distribution of extra benefits, SNAP spending reached a <a href="https://www.fns.usda.gov/pd/supplemental-nutrition-assistance-program-snap">record $114 billion</a> in the 12 months that ended in September 2022. </p>
<h2>Looming hunger cliff</h2>
<p>Many <a href="https://www.brookings.edu/blog/up-front/2021/08/19/a-healthy-reform-to-the-supplemental-nutrition-assistance-program-updating-the-thrifty-food-plan/">experts on food insecurity</a> have long argued that <a href="https://www.cbpp.org/research/food-assistance/more-adequate-snap-benefits-would-help-millions-of-participants-better">SNAP benefits have historically been too low</a>.</p>
<p>The Biden administration has already tried to boost them by adjusting the “<a href="https://theconversation.com/snap-benefits-are-rising-for-millions-of-americans-thanks-to-a-long-overdue-thrifty-food-plan-update-167876">Thrifty Food Plan</a>” – the standard the U.S. Department of Agriculture uses to set SNAP benefits based on the cost of a budget-conscious and nutritionally adequate diet.</p>
<p>As a result, benefits rose an average of $36 a month, a <a href="https://www.fns.usda.gov/news-item/usda-0179.21">21% increase</a>, in October 2021. That increase more than offset the expiration of a <a href="https://www.usda.gov/media/press-releases/2021/03/22/usda-increases-snap-benefits-15-funding-american-rescue-plan">temporary seven-month boost</a> in benefits that Congress had approved earlier that year.</p>
<p>SNAP benefits automatically adjust every October based on the increase in food prices in July as compared with the previous year. In 2022, they increased <a href="https://www.gobankingrates.com/saving-money/food/food-stamps-cola-update-increases-snap-ebt-benefits-starting-oct-1">12.5%</a>. But when prices are rising quickly, as is currently the case, SNAP benefits can lose a lot of ground in the months before the next adjustment.</p>
<p>Many <a href="https://frac.org/blog/close-snap-benefit-gaps">advocates for a stronger safety net</a> say that SNAP benefits are too low to meet the needs of low-income people. They are warning of a <a href="https://blog.ucsusa.org/alice-reznickova/a-hunger-cliff-is-looming-time-to-rethink-nutrition-assistance/">looming hunger cliff</a> – meaning a sharp increase in the number of people who don’t get enough nutritious food to eat – in March 2023, when the extra help ends.</p>
<p>At that point, the lowest-income families will lose <a href="https://www.fns.usda.gov/snap/changes-2023-benefit-amounts">$95 in benefits a month</a>. But some SNAP participants, such as <a href="https://www.washingtonpost.com/dc-md-va/2023/01/25/snap-emergency-allotments-seniors/">many elderly and disabled people</a> who live alone and on fixed incomes and who only qualify for the minimum amount of help, will see their benefits plummet from $281 to $23 a month.</p>
<p>Most people on SNAP who get Social Security benefits will see their <a href="https://www.fns.usda.gov/snap/changes-2023-benefit-amounts">SNAP benefits fall</a>. That’s because of the <a href="https://faq.ssa.gov/en-us/Topic/article/KA-01951#">8.7% cost of living increase</a> in Social Security benefits implemented in January 2023, which increases their income and lowers the amount of nutritional assistance they can receive. And some of these Americans may even have enough income that they no longer qualify for SNAP at all.</p>
<p>For an average family of four on SNAP, benefits will <a href="https://www.cbpp.org/research/food-assistance/a-quick-guide-to-snap-eligibility-and-benefits">fall from the maximum of $939</a> to $718, according to an estimate by the Center for Budget and Policy Priorities, an anti-poverty research group.</p>
<p><a href="https://www.usatoday.com/story/news/nation/2022/11/23/us-food-banks-pantries-struggle/10671432002/">Food banks, already under stress</a> because of higher food costs and falling donations, are <a href="https://www.cbsnews.com/news/food-stamps-snap-benefits-cut-in-32-states-emergency-allotments-march-2023/">bracing for higher demand</a>. Food banks in some states that ended the emergency boost in benefits early have seen a <a href="https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2022/07/19/more-states-are-forgoing-extra-federal-food-aid">30% increase</a> in need. </p>
<p>More people on SNAP also <a href="https://www.joinpropel.com/in-depth-pandemic-food-benefit-ending">reported skipping meals</a> in the states that dropped extra benefits than those that did not.</p>
<h2>Lawmakers poised to resume a longtime fight</h2>
<p>Several <a href="https://www.congress.gov/bill/117th-congress/house-bill/4077/text">Democrats have proposed legislation</a> to increase SNAP benefits over the long term. But many <a href="https://thefern.org/ag_insider/snap-costs-too-much-program-needs-revisions-say-house-republicans/">Republicans want to reduce spending on SNAP</a> and put more limits on who can get the program’s benefits. </p>
<p>Debate centers around whether unemployed adults deemed capable of working should be able to get SNAP. This argument, <a href="https://www.fns.usda.gov/snap/short-history-snap">almost as old as the program</a> itself, was largely set aside during the pandemic. </p>
<p>Legislation enacted in early 2020 suspended a requirement that limited benefits for adults under 50 who meet the government’s definition of able-bodied and have no dependents. They can receive no more than three months of SNAP <a href="https://www.cbpp.org/research/food-assistance/a-quick-guide-to-snap-eligibility-and-benefits">benefits every three years</a> – unless they work or participate in a work-training program at least 20 hours a week. </p>
<p>This time limit will come back when the <a href="https://www.usnews.com/news/national-news/articles/2023-02-09/biden-administration-releases-covid-19-public-health-emergency-transition-road-map">public health emergency ends</a> in May 2023. </p>
<p>But many critics of SNAP have argued the <a href="https://theconversation.com/scaling-back-snap-for-self-reliance-clashes-with-the-original-goals-of-food-stamps-128839">work requirements were never effectively enforced</a>. A <a href="https://www.agri-pulse.com/ext/resources/2023/02/08/Rep.-Gaetz-SNAP-BUDGET-LETTER-to-WH-2.7.23.pdf">few Republicans</a> want to make <a href="https://thefern.org/ag_insider/snap-costs-too-much-program-needs-revisions-say-house-republicans/">tightening restrictions on SNAP benefits</a> a condition for raising the debt ceiling. At this point, it isn’t clear if they will succeed.</p>
<p><a href="https://www.axios.com/2023/02/15/snap-food-benefits-end-covid">Debate over SNAP reforms</a> is likely to come up when Congress considers the program as part of broad food and agriculture <a href="https://theconversation.com/what-the-2018-farm-bill-means-for-urban-suburban-and-rural-america-89605">legislation known as the farm bill</a>. Congress must act to <a href="https://www.npr.org/2023/02/02/1151727273/congress-gears-up-for-another-farm-bill-heres-whats-on-the-menu">renew the program before October 2023</a>.</p>
<p>But with the <a href="https://pressgallery.house.gov/member-data/party-breakdown">House narrowly controlled by Republicans</a> and the <a href="https://ballotpedia.org/United_States_Senate_elections,_2022">Senate controlled by a slim Democratic majority</a>, I believe it will be hard to make big changes to the Supplemental Nutrition Assistance Program.</p><img src="https://counter.theconversation.com/content/199929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracy Roof does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More than 41 million people rely on the Supplemental Nutrition Assistance Program to buy their groceries. When the COVID-19 pandemic began, the program ramped up.Tracy Roof, Associate Professor of Political Science, University of RichmondLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1989522023-02-13T13:24:26Z2023-02-13T13:24:26ZCost of getting sick for older people of color is 25% higher than for white Americans – new research<figure><img src="https://images.theconversation.com/files/509317/original/file-20230209-20-w2n1zt.jpg?ixlib=rb-1.1.0&rect=62%2C107%2C5928%2C3628&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Racial and ethnic inequality extends to what researches call 'disease cost burdens.'</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/image-of-daughter-holding-the-mothers-hand-and-royalty-free-image/1314187202">sukanya sitthikongsak/Moment via Getty Images</a></span></figcaption></figure><p>As you age, you’re <a href="https://www.ncoa.org/article/the-top-10-most-common-chronic-conditions-in-older-adults">more likely to get sick</a>. And health problems can affect your financial well-being too.</p>
<p>People with health problems spend heavily on health care – the cumulative cost of chronic diseases in the U.S. is <a href="https://www.americanactionforum.org/research/chronic-disease-in-the-united-states-a-worsening-health-and-economic-crisis/">nearly $4 trillion a year</a>. And illnesses make it less likely that you can work as many hours as you might have put in otherwise. Getting sick may even mean you have to stop working altogether. </p>
<p><a href="https://www.umb.edu/faculty_staff/bio/marc_cohen">We are</a> <a href="https://www.umb.edu/jane_tavares_phd">gerontology researchers</a> who study financial vulnerability in later life. We wanted to see if it was possible to estimate the economic tolls of chronic health problems and whether race and ethnicity makes a difference. </p>
<p>To do this, we took advantage of a relatively <a href="https://milkeninstitute.org/sites/default/files/reports-pdf/ChronicDiseases-HighRes-FINAL.pdf">new way to figure out the approximate</a> costs of treating illnesses and the missed income among people who are employed but have to reduce their hours or stop working. This missed income also represents lost productivity to the economy. Experts often lump these two costs into a single “<a href="https://www.cdc.gov/policy/polaris/economics/cost-illness/index.html">disease cost burden</a>” estimate.</p>
<p>This measurement is expressed in total dollars and makes it possible to better understand the costs associated with different groups of people when they get sick. When <a href="https://ncoa.org/article/the-inequities-in-the-cost-of-chronic-disease-why-it-matters-for-older-adults">we analyzed and cross-referenced</a> a nationally representative <a href="https://hrs.isr.umich.edu/about">panel study</a> of 11,820 U.S. adults age 60 and older using this new metric, the results were disturbing.</p>
<p>We found that Black people and Latinos over age 60 – who are typically less able to afford to get sick than their non-Hispanic white counterparts – face bigger financial consequences when they get chronic illnesses. </p>
<h2>$22,734 a year</h2>
<p>Most older Americans will have <a href="https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm">at least one of these common</a> <a href="https://www.cdc.gov/nchs/fastats/older-american-health.htm">and often fatal chronic conditions</a> sooner or later: diabetes, cancer, lung disease, heart disease, stroke and some kind of dementia, according to the Centers for Disease Control and Prevention.</p>
<p>Three other illnesses are also very common late in life: <a href="https://www.cdc.gov/aging/pdf/mental_health.pdf">hypertension, arthritis and depression</a>. </p>
<p>We used that new measurement, created by the <a href="https://milkeninstitute.org/sites/default/files/reports-pdf/ChronicDiseases-HighRes-FINAL.pdf">Milken Institute</a>, a think tank, to obtain estimates for the costs of lost wages for adults age 60 and over, and total treatment costs for specific illnesses. </p>
<p>We adjusted these combined costs to <a href="https://fred.stlouisfed.org/series/CPIMEDSL">reflect 2022 prices</a>. For people with multiple conditions, we summed up all of those costs.</p>
<p>We found that the average yearly disease cost burden associated with older people who are Black or Hispanic, including those who have to stop working or reduce their employment hours, is $22,734. That’s about $4,500, or 25%, higher than the $18,145 average cost of getting sick for their white counterparts.</p>
<p>Our data relayed findings regarding non-Hispanic white, non-Hispanic Black and Hispanic people. Our analysis also included similar results for other people of color but with smaller sample sizes.</p>
<p><iframe id="jz0gl" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/jz0gl/4/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Major disparities</h2>
<p>One big reason for this disparity is that older people of color are more likely to have losses in earned income when they get sick. For example, we found that 39% of people of color lost wages due to common chronic diseases, versus 17% of non-Hispanic white older adults – a rate more than twice as high. </p>
<p>Most people of color are particularly vulnerable due to three factors: </p>
<ol>
<li><p>They usually have <a href="https://www.federalreserve.gov/econres/notes/feds-notes/disparities-in-wealth-by-race-and-ethnicity-in-the-2019-survey-of-consumer-finances-20200928.html">less wealth than white people</a>.</p></li>
<li><p>The illnesses they tend to get <a href="https://hbr.org/2015/10/the-costs-of-racial-disparities-in-health-care">are costlier overall</a> as compared with non-Hispanic white people – even though health insurance covers the majority of costs for individuals in all groups.</p></li>
<li><p>They are also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690237/">more likely to have to leave the labor force</a> once they become ill.</p></li>
</ol>
<h2>Diminishing wealth</h2>
<p>We also divided the population of all older people into four equal groups based on how much money they lost in wages due to illness. Those who lost the least missed out on about $8,000 a year. Those who lost the most had to make do without more than $30,000 of earned income they would otherwise have taken home.</p>
<p>We then looked at the relationship between mean <a href="https://missioninvestors.org/news/investing-financial-innovations-narrow-racial-wealth-gap">household net wealth</a> – a broad measure of wealth that includes the value of any housing someone owns – and lost wages due to illness among these four groups.</p>
<p>We found that older Americans who lost the most in wages due to chronic illnesses tend to have the least wealth to spend on dealing with getting sick. We also found that Black people and Latinos who get chronic diseases and lose out on the most earned income have only 15% to 22% of the net wealth of older white people.</p>
<p>Taken together, this means that older people of color, who generally have fewer assets that can cushion the blow from their lost economic productivity, face the highest costs for the common chronic diseases that people 60 and up tend to get.</p><img src="https://counter.theconversation.com/content/198952/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging</span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging. </span></em></p>A study of medical costs and income losses found that those who can least afford to pay for health care and miss out on their paychecks rack up the biggest bills.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center @UMass Boston, UMass BostonJane Tavares, Research Fellow, LeadingAge LTSS Center, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984812023-02-08T18:43:39Z2023-02-08T18:43:39ZThe pandemic played into ageist stereotypes, but intergenerational contact and co-operation can overcome them<figure><img src="https://images.theconversation.com/files/508476/original/file-20230206-13-t4itv6.jpg?ixlib=rb-1.1.0&rect=63%2C40%2C3810%2C2532&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Stereotypes about the elderly having more than their fair share can be heightened during times of crisis when resources are seen to be scarce.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>As the COVID-19 pandemic spread around the world, <a href="https://news.ontario.ca/en/statement/56348/enhanced-measures-to-protect-ontarians-from-covid-19">stringent public health regulations</a> were imposed to protect vulnerable individuals, with older people seen as a particularly vulnerable group.</p>
<p>In response, some argued the pandemic was just a problem for older people and that they should be <a href="https://doi.org/10.1093/geronb/gbaa102">locked away</a> so younger people could get on with their lives. Others showed <a href="https://doi.org/10.1037/amp0000699">increased concern</a> for older people, with dedicated shopping hours and food deliveries for seniors organized. </p>
<p>We are a team of researchers in psychology, sociology and political science with expertise in intergroup relations. Our research on ageism during the pandemic shows that the group-based beliefs and values people endorse have an impact on how older people are viewed. </p>
<p>This is important because it tells us what beliefs and values need to be targeted to create a more inclusive society, especially when facing a public health emergency like the COVID-19 pandemic.</p>
<p>In August 2020, we <a href="http://dx.doi.org/10.1111/josi.12554">conducted a survey</a> to gauge the attitudes and opinions of Canadians and Americans who were 18 to 65+ years old. The survey relied on nationally representative samples of 2,110 Canadians and 2,124 Americans. The goal was to assess how North Americans perceived older people during the pandemic and what factors explained these perceptions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A younger woman and an elderly man in a wheelchair place their hands on a glass barrier separating them." src="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508434/original/file-20230206-23-8gea8d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People talk through a plexiglass barrier at Lynn Valley Care Centre in North Vancouver in July 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<h2>Intergenerational tension and its basis</h2>
<p>The survey results showed that younger respondents were especially likely to say that older people were using more than their fair share of societal resources, such as those related to health care. This was the case for both Canadians and Americans, and demonstrates <a href="https://doi.org/10.1037/a0032367">ageist consumption stereotypes</a>. These stereotypes can be heightened when resources seem to be scarce.</p>
<p>The degree of concern younger North Americans felt in terms of their own health and finances did not predict ageist consumption stereotypes. Instead, their beliefs and values about group relations were key.</p>
<p>Younger North Americans who endorsed the statement that some groups of people are simply inferior to other groups were more likely to endorse ageist consumption stereotypes. The same was true for those who held values emphasizing competition. In contrast, younger North Americans who valued collective goals and believed in personal sacrifice for the collective good were less likely to hold ageist consumption stereotypes.</p>
<p>At the time of the survey, social distancing measures were in effect, so we also asked survey respondents about their opinions about social distancing. We found that younger North Americans who believed social distancing carries too many problems were also more likely to endorse ageist consumption stereotypes.</p>
<h2>What can we learn?</h2>
<p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good, while downplaying competition and group-based dominance. This benefits all of us. First, it promotes social cohesion in society. In addition, most of us will be old people someday and would prefer not to experience ageism at that time. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly black woman with grey hair looking out of a window." src="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508531/original/file-20230207-17-4dzrzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>In the context of the pandemic and similar health emergencies, one way to do this is through public health messaging that emphasizes how people of all ages share both the risk of diseases such as COVID-19 and the responsibility for co-operating to overcome it. This way, the emphasis is on society as a whole and less on broad age categories.</p>
<p><a href="https://doi.org/10.1093/geronb/gbaa051">Another strategy</a> to reduce ageism is to encourage intergenerational contact to promote solidarity and relatedness across age groups. This could, for example, include more frequent quality contact between family members of different generations, personal contact with older neighbours and participation in volunteering programs that bring people of different ages together. </p>
<p>There is also <a href="https://doi.org/10.1080/02701960.2020.1737047">evidence</a> that if intergenerational contact is coupled with education on aging, ageism can be successfully reduced. </p>
<p>A <a href="https://doi.org/10.1111/josi.12545">recent study</a> conducted during the pandemic found that exposure to online information that shows positive intergenerational contact and provides education that challenges ageist stereotypes effectively reduced ageism and perceived intergenerational conflict among young adults.</p>
<p>Intergenerational tension exists but it is not inevitable. To overcome it, we must understand where it comes from and implement a variety of strategies that bring together people of all ages in order to promote co-operation in solving common problems, rather than competition and dominance.</p><img src="https://counter.theconversation.com/content/198481/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Victoria Esses receives funding from Immigration, Refugees and Citizenship Canada. She has previously received funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p><p class="fine-print"><em><span>Kate Choi receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Patrick Denice receives funding from the Social Sciences and Humanities Research Council of Canada.</span></em></p><p class="fine-print"><em><span>Alina Sutter, Joanie Bouchard, and Mamta Vaswani do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To reduce ageist perceptions of older people, we should encourage collectivist norms and the importance of acting for the common good.Victoria Esses, Director, Network for Economic and Social Trends (NEST); Co-Chair, Pathways to Prosperity Partnership, Western UniversityAlina Sutter, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityJoanie Bouchard, Assistant Professor in Political Science, Université de Sherbrooke Kate Choi, Associate Professor, Sociology, Western UniversityMamta Vaswani, Postdoctoral Associate, Network for Economic and Social Trends (NEST), Western UniversityPatrick Denice, Assistant Professor of Sociology; Affiliate, Network for Economic and Social Trends (NEST), Western UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1965602023-01-31T13:48:24Z2023-01-31T13:48:24ZUltraprocessed foods – like cookies, chips, frozen meals and fast food – may contribute to cognitive decline<figure><img src="https://images.theconversation.com/files/507225/original/file-20230130-14099-bxhu8i.jpg?ixlib=rb-1.1.0&rect=20%2C104%2C4608%2C3588&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Surprisingly, even packaged foods that contain healthy components can qualify as ultra-processed.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/new-jersey-jersey-city-close-up-of-tv-dinner-on-royalty-free-image/114849031?phrase=processed%20foods&adppopup=true">Jamie Grill Photography/Tetra Images via Getty Images</a></span></figcaption></figure><p>Scientists have known for years that unhealthy diets – particularly those that are high in fat and sugar – may cause <a href="https://doi.org/10.1002/hipo.20470">detrimental changes to the brain</a> and <a href="https://doi.org/10.1111/j.1471-4159.2010.06865.x">lead to cognitive impairment</a>. </p>
<p>Many factors that contribute to cognitive decline are out of a person’s control, such as <a href="https://doi.org/10.1038/s41593-022-01042-4">genetics</a> and <a href="https://doi.org/10.1080/13607863.2022.2046694">socioeconomic factors</a>. But ongoing research increasingly indicates that a <a href="https://doi.org/10.1016/j.arr.2021.101395">poor diet is a risk factor</a> for memory impairments during normal aging and increases the risk of <a href="https://doi.org/10.1016/j.arr.2021.101397">developing Alzheimer’s disease</a>. </p>
<p>But when evaluating how some diets may erode brain health as we age, research on the effects of consuming minimally processed versus ultraprocessed foods has been scant – that is, until now. </p>
<p>Two recent large-scale studies suggest that eating ultraprocessed foods <a href="https://doi.org/10.1001/jamaneurol.2022.4397">may exacerbate age-related cognitive decline</a> and increase the <a href="https://doi.org/10.1212/WNL.0000000000200871">risk of developing dementia</a>. In contrast, another recent study reported that ultraprocessed food consumption was not associated <a href="https://doi.org/10.1007/s00394-022-02911-1">with worse cognition in people over 60</a>. </p>
<p>Although more research is needed, as a <a href="https://neuroscience.ufl.edu/profile/burke-sara/">neuroscientist</a> who researches how <a href="https://scholar.google.com/citations?user=EYPe4zQAAAAJ&hl=en">diet can influence cognition</a> later in life, I find that these early studies add a new layer for considering how fundamental nutrition is to brain health. </p>
<h2>Lots of ingredients, minimal nutrition</h2>
<p>Ultraprocessed foods tend to be lower in nutrients and fiber and higher in sugar, fat and salt compared to unprocessed or minimally processed foods. Some <a href="https://doi.org/10.1093/cdn/nzy077">examples of ultraprocessed foods</a> include soda, packaged cookies, chips, frozen meals, flavored nuts, flavored yogurt, distilled alcoholic beverages and fast foods. Even packaged breads, including those high in nutritious whole grains, qualify as ultraprocessed in many cases because of the additives and preservatives they contain. </p>
<p>Another way to look at it: You are not likely to find the ingredients that make up most of these foods in your home kitchen.</p>
<p>But don’t confuse ultraprocessed with processed foods, which still retain most of their natural characteristics, although they’ve undergone some form of processing – like canned vegetables, dried pasta or frozen fruit. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/7HeS6kG7NLQ?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A look at three categories of foods.</span></figcaption>
</figure>
<h2>Parsing the research</h2>
<p>In a December 2022 study, researchers compared the rate of cognitive decline over approximately eight years between groups of people that <a href="https://doi.org/10.1001/jamaneurol.2022.4397">consumed different amounts of ultraprocessed foods</a>. </p>
<p>At the beginning of the study, over 10,000 participants living in Brazil reported their dietary habits from the previous 12 months. Then, for the ensuing years, the researchers evaluated the cognitive performance of the participants with standard tests of memory and executive function. </p>
<p>Those who ate a diet containing more ultraprocessed foods at the start of the study showed slightly more cognitive decline compared with those that ate little to no ultraprocessed foods. This was a relatively modest difference in the rate of cognitive decline between experimental groups. It is not yet clear if the small difference in cognitive decline associated with higher consumption of ultraprocessed foods will have a meaningful effect at the level of an individual person. </p>
<p>The second study, with about 72,000 participants in the U.K., measured the association between <a href="https://doi.org/10.1212/WNL.0000000000200871">eating ultraprocessed foods and dementia</a>. For the group eating the highest amounts of ultraprocessed foods, approximately 1 out of 120 people were diagnosed with dementia over a 10-year period. For the group that consumed little to no ultraprocessed foods, this number was 1 out of 170. </p>
<p>Research examining the relationship between health and ultraprocessed foods uses the <a href="https://regulatory.mxns.com/en/ultra-processed-foods-nova-classification">NOVA classification</a>, which is a categorization system based on the type and extent of industrial food processing. Some nutritionists have <a href="https://doi.org/10.1093/ajcn/nqac123">criticized the NOVA classification</a> for not having clear definitions of food processing, which could <a href="https://doi.org/10.1038/s41430-022-01099-1">lead to misclassification</a>. They also argue that the potential health risks from consuming ultraprocessed foods could be explained by low levels of fiber and nutrients and high levels of fat, sugar and salt in the diet rather than the amount of processing. </p>
<p>Many ultraprocessed foods are high in additives, preservatives or coloring agents, while also having other features of an unhealthy diet, such as being low in fiber and nutrients. Thus, it is unclear if eating food that has undergone more processing has an additional negative impact on <a href="https://doi.org/10.1093/ajcn/nqac122">health beyond low diet quality</a>.</p>
<p>For example, you could eat a burger and fries from a fast food chain, which would be high in fat, sugar and salt as well as being ultraprocessed. You could make that same meal at home, which could also be high in fat, sugar and salt but would not be ultraprocessed. More research is needed to determine whether one is worse than the other. </p>
<h2>Brain-healthy diets</h2>
<p>Even when the processes that lead to dementia are not occurring, the aging brain undergoes biochemical and structural changes that are <a href="https://doi.org/10.1038/nrn1809">associated with worsening cognition</a>.</p>
<p>But for adults over the age of 55, a healthier diet could increase the likelihood of maintaining better brain function. In particular, <a href="https://doi.org/10.3390/nu13062067">the Mediterranean diet</a> and <a href="https://doi.org/10.1016/j.cmet.2017.08.004">ketogenic diet</a> are associated with better cognition in advanced age. </p>
<p>The Mediterranean diet emphasizes the consumption of plant-based foods and healthy fats, like olive oil, seeds and nuts. The ketogenic diet is high in fat and low in carbohydrates, with the primary fiber source being from vegetables. Both diets minimize or eliminate the consumption of sugar. </p>
<p>Our research and the work of others show that both diets can <a href="https://doi.org/10.1093/gerona/glx193">reverse some of these changes</a> and <a href="https://doi.org/10.3109/13697137.2015.1078106">improve cognitive function</a> – possibly by <a href="https://theconversation.com/what-is-inflammation-two-immunologists-explain-how-the-body-responds-to-everything-from-stings-to-vaccination-and-why-it-sometimes-goes-wrong-193503">reducing harmful inflammation</a>. </p>
<p>Although inflammation is a normal immune response to injury or infection, chronic inflammation can be detrimental to the brain. Studies have shown that excess sugar and fat <a href="https://doi.org/10.1096/fj.201700984RR">can contribute to chronic inflammation</a>, <a href="https://doi.org/10.3390/nu14163309">and ultraprocessed foods might</a> also exacerbate harmful inflammation.</p>
<p>Another way that diet and ultraprocessed foods may influence brain health is <a href="https://doi.org/10.1016/bs.irn.2022.07.006">through the gut-brain axis</a>, which is the communication that occurs between the brain and <a href="https://theconversation.com/which-microbes-live-in-your-gut-a-microbiologist-tries-at-home-test-kits-to-see-what-they-reveal-about-the-microbiome-181392">the gut microbiome</a>, or the community of microorganisms that live in the digestive tract.</p>
<p>Not only does the gut microbiome help with digestion, but it also influences the immune system, while producing hormones and <a href="https://doi.org/10.1038/mp.2016.50">neurotransmitters that are critical for brain function</a>.</p>
<p>Studies have shown that the <a href="https://doi.org/10.3390/nu14091758">ketogenic</a> and <a href="https://doi.org/10.1136/gutjnl-2019-319654">Mediterranean diets</a> change the composition of microorganisms in the gut in ways that benefit the person. Ultraprocessed food consumption is also associated with <a href="https://doi.org/10.3390/nu13082710">alterations in the type and abundance</a> of gut microorganisms that have more harmful effects.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/E479yto8pyk?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">There’s a war going on in your gut: good bacteria versus bad bacteria.</span></figcaption>
</figure>
<h2>The uncertainties</h2>
<p>Disentangling the specific effects of individual foods on the human body is difficult, in part because maintaining strict control over people’s diets to study them over long periods of time is problematic. Moreover, <a href="https://doi.org/10.1016/j.cmet.2019.05.008">randomized controlled trials</a>, the most reliable type of study for establishing causality, <a href="https://doi.org/10.3945/ajcn.116.136085">are expensive</a> to carry out. </p>
<p>So far, most nutritional studies, including these two, have only shown correlations between ultraprocessed food consumption and health. But they cannot rule out <a href="https://doi.org/10.1136/bmj.f6698">other lifestyle factors</a> such as exercise, education, socioeconomic status, social connections, stress and many more variables that may influence cognitive function. </p>
<p>This is where lab-based studies using animals are incredibly useful. Rats show <a href="https://doi.org/10.1111/ejn.12183">cognitive decline in old age that parallels humans</a>. It’s easy to control rodent diets and activity levels in a laboratory. And rats go from middle to old age within months, which shortens study times. </p>
<p>Lab-based studies in animals will make it possible to determine if ultraprocessed foods are playing a key role in the development of cognitive impairments and dementia in people. As the world’s population ages and the number of <a href="https://www.who.int/news-room/fact-sheets/detail/dementia#">older adults with dementia increases</a>, this knowledge cannot come soon enough.</p><img src="https://counter.theconversation.com/content/196560/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara N. Burke does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Researchers are trying to understand whether ultraprocessed foods erode brain health in the aging process.Sara N. Burke, Associate Professor of Neurobiology and Cognitive Aging, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1962182023-01-25T00:32:09Z2023-01-25T00:32:09Z5 reasons to check on your elderly neighbour during a heatwave<figure><img src="https://images.theconversation.com/files/500956/original/file-20221214-20-19j3u9.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/overheated-asian-senior-woman-sweatinghigh-temperature-1954041304">Shutterstock</a></span></figcaption></figure><p>We all know someone who insists on wearing a cardigan in summer or refuses to turn on the air conditioning because “it’s not that hot”. Chances are this is an older person, and there’s a good reason for that.</p>
<p>As we get older, we tend to not “feel” the heat <a href="https://www.sciencedirect.com/science/article/pii/S1568163710000450?casa_token=LxiONa0xZXQAAAAA:8IYLW0YquTHHUGkd2qiMgz6FNU3y2f4FIW96Lu9a-gjbAWw8iOgt7AOQ9C0UWMmDtXWOkqw#fig4">as much</a> even though our bodies are <a href="https://journals.physiology.org/doi/full/10.1152/japplphysiol.00202.2003">less able to handle the heat</a>. This contradiction can have <a href="https://www.sciencedirect.com/science/article/pii/S0160412017321980?casa_token=-nCG3M20MawAAAAA:VYwlO1kZIpibQnCLlm4LuSKMkK9nNvOgvdrXzUPHglOknNKp20UX0oty1DS2uWrlCZnoZhg">lethal consequences</a>, especially during periods of extreme heat.</p>
<p>So, why is extreme heat so dangerous for older people? And what can we do to help?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-can-extreme-heat-lead-to-death-91480">Health Check: how can extreme heat lead to death?</a>
</strong>
</em>
</p>
<hr>
<h2>Why are older people at risk?</h2>
<p><a href="https://www.sciencedirect.com/science/article/pii/S2212420921006324">Extreme heat kills</a> more Australians than <a href="https://www.sciencedirect.com/science/article/pii/S1462901114000999">all other natural hazards</a>, and people aged 60 or older account for 69% of those deaths.</p>
<p>There are five key reasons we’re more susceptible to heat as we get older.</p>
<p><strong>1. Bodily changes</strong></p>
<p>One of the main ways we lose excess heat, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228253/">blood flowing to our skin</a>, isn’t as effective as we get older. This is in part because the blood vessels in our skin don’t expand fast enough, and we may have less blood pumping with each beat of our heart.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S016041202031864X#f0010">Many other changes</a> in our bodies also lead us to gain and store more heat as we get older. These include how our bodies control sweat and how well our kidneys balance fluid, which are both important for staying cool.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-rising-temperatures-affect-our-health-123016">How rising temperatures affect our health</a>
</strong>
</em>
</p>
<hr>
<p><strong>2. Social isolation</strong></p>
<p>Loneliness and social isolation are <a href="https://www.sciencedirect.com/science/article/pii/S1064748120304425">health risks</a> on their own, but also <a href="https://www.sciencedirect.com/science/article/pii/S0160412020318237#b0065">multiply the risk</a> of heat-related illness. </p>
<p>A South Australian <a href="https://www.mdpi.com/1660-4601/10/12/6721">survey</a> of older people showed those who were socially isolated were less confident in asking for help during a heatwave. </p>
<p>This is concerning as many older Australians <a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/housing-and-living-arrangements">live alone</a>, and we are more likely to live alone as we get older.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/one-in-four-australians-are-lonely-which-affects-their-physical-and-mental-health-106231">One in four Australians are lonely, which affects their physical and mental health</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Beliefs and behaviour</strong></p>
<p>Older Australians may not respond to heat in ways that protect their own health and wellbeing. Australian culture tends to view heat tolerance as a matter of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3290974/">resilience</a> and <a href="https://www.tandfonline.com/doi/full/10.3402/gha.v5i0.19277">identity</a>, where there is a sense of generational pride in being able to cope with the heat. </p>
<p><a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/c67cf100436d8e7082a2dfc9302c1003/Adaptive+capabilities+in+elderly+people+during+extreme+heat+events+in+SA+-+Public+Health+Service+-+scientific+services+20140328.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-c67cf100436d8e7082a2dfc9302c1003-nKKgCmQ">Reports also suggest</a> many older people have concerns about the cost of air conditioning, may be hesitant to use it, or accidentally use reverse cycle units as heaters.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/high-energy-costs-make-vulnerable-households-reluctant-to-use-air-conditioning-study-86624">High energy costs make vulnerable households reluctant to use air conditioning: study</a>
</strong>
</em>
</p>
<hr>
<p><strong>4. Medical issues</strong></p>
<p>Many chronic illnesses that are more common with age are also associated with an increased risk for heat-related illness. Because blood flow is so important for regulating our body temperature, it’s not surprising that conditions such as <a href="https://www.sciencedirect.com/science/article/pii/S1071916417300969?casa_token=LEe23NWx7V0AAAAA:-cw7TgysaYdqXq0FTuTtIxxE3Oua1NImlwmmvWWSyt39guUUWbzOsevcsoBI8tw5hbbkwaI">heart failure</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4861190/">diabetes</a> are associated with increased heat risk.</p>
<p>Similarly, many medications commonly prescribed for chronic illnesses can <a href="https://www.health.vic.gov.au/environmental-health/extreme-heat-information-for-clinicians">interfere</a> with how our body regulates temperature. For instance, some blood pressure medicines reduce our ability to sweat and lose heat.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-time-of-day-should-i-take-my-medicine-125809">What time of day should I take my medicine?</a>
</strong>
</em>
</p>
<hr>
<p><strong>5. Home environment</strong></p>
<p>It is <a href="https://www.anglicare.asn.au/wp-content/uploads/2022/09/Australia-Fair-Ageing-in-Place.pdf">increasingly difficult</a> for older Australians to find affordable and appropriate housing, especially pensioners and renters. </p>
<p>Poor home design, lack of insulation, inability to pay their energy bills, and limited income <a href="https://cur.org.au/cms/wp-content/uploads/2016/12/heatwaveshomeshealth-briefing-paper_rmit-2.pdf">all contribute</a> to being vulnerable to heatwaves in Australia. This is particularly troubling as energy prices soar.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/to-keep-heatwaves-at-bay-aged-care-residents-deserve-better-quality-homes-85174">To keep heatwaves at bay, aged care residents deserve better quality homes</a>
</strong>
</em>
</p>
<hr>
<h2>What can we do?</h2>
<p><strong>Older Australians</strong></p>
<p>Knowing the risks of extreme heat is the first step. Don’t <a href="https://www.mdpi.com/1660-4601/10/1/1">underestimate</a> your own risk during a heatwave. </p>
<p>There are many practical ways we can all keep ourselves and our homes cool, both safely and efficiently. These include:</p>
<ul>
<li>using a fan, <a href="https://theconversation.com/how-humid-is-it-3-things-to-keep-you-cool-in-a-hot-and-sticky-summer-and-3-things-that-wont-176365">which is effective</a>, especially when it’s humid, but may <a href="https://www.sciencedirect.com/science/article/pii/S0003687014001355?casa_token=NoCMHlZZ_SUAAAAA:vu-Yk1WnHpy5RsumlwQ-5_SvvuMjJLeV5Cm087QTUYKI6kLUKwjnZ1-FuATlzGDC36WyCTI">not be enough</a> when it’s very hot and dry. If you have an air conditioner, consider using it</li>
</ul>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Know the signs of heat exhaustion and heat stroke" src="https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=846&fit=crop&dpr=1 600w, https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=846&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=846&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1063&fit=crop&dpr=1 754w, https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1063&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/500965/original/file-20221214-12-u73s9p.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1063&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Do you know the signs of heat-related illness?</span>
<span class="attribution"><a class="source" href="https://www.sahealth.sa.gov.au/wps/wcm/connect/6023f98b-bdcf-416b-9d3a-cfff9ea728c8/A4+Poster+-+Signs+and+symptoms+of+heat+illness.pdf?MOD=AJPERES&amp;CACHEID=ROOTWORKSPACE-6023f98b-bdcf-416b-9d3a-cfff9ea728c8-nwMnDGl">SA Health</a></span>
</figcaption>
</figure>
<ul>
<li><p>knowing the conditions inside your home by installing thermometers that ideally also <a href="https://theconversation.com/how-humid-is-it-3-things-to-keep-you-cool-in-a-hot-and-sticky-summer-and-3-things-that-wont-176365">measure humidity</a> so you know which ways will work best to cool down</p></li>
<li><p>opening windows facing away from the sun when it’s cooler outside; otherwise keep blinds closed in the heat of the day</p></li>
<li><p>taking cool showers or applying a damp cloth to the back of your neck can help cool the skin</p></li>
<li><p>taking regular, small drinks of water, even when you’re not thirsty (unless you have <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/heat-stress-and-older-people#how-to-help-an-older-relative-or-friend">heart or kidney problems</a> in which case you need to talk to your doctor first as too much water may be a problem for you)</p></li>
<li><p><a href="https://www.sahealth.sa.gov.au/wps/wcm/connect/6023f98b-bdcf-416b-9d3a-cfff9ea728c8/A4+Poster+-+Signs+and+symptoms+of+heat+illness.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-6023f98b-bdcf-416b-9d3a-cfff9ea728c8-nwMnDGl">knowing the signs</a> of heat exhaustion and heat stroke.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-cope-with-extreme-heat-days-without-racking-up-the-aircon-bills-128857">How to cope with extreme heat days without racking up the aircon bills</a>
</strong>
</em>
</p>
<hr>
<p><strong>Older relatives, friends and neighbours</strong></p>
<p>We can all keep an eye on our older relatives, friends and neighbours as:</p>
<ul>
<li><p>keeping in touch is <a href="https://link.springer.com/article/10.17269/s41997-020-00309-2">great protection</a> from heat-related illness; check in regularly</p></li>
<li><p>when an older person can’t keep the house cool, support a day trip to a cooler place such as a library, cinema, or shopping centre</p></li>
<li><p>encourage them to talk to their doctor about how medical conditions or medications might increase their risk to heat.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/australias-deadliest-natural-hazard-whats-your-heatwave-plan-90165">Australia's 'deadliest natural hazard': what's your heatwave plan?</a>
</strong>
</em>
</p>
<hr>
<h2>We need to raise awareness</h2>
<p>Australians are growing complacent about the health risks of extreme heat, see heatwaves as normal and public health messages <a href="https://widgets.figshare.com/articles/7618403/embed?show_title=1">aren’t cutting through</a> any more.</p>
<p>It’s also important to remember that older people aren’t all the same, so any public health approaches to extreme heat should be tailored to <a href="https://www.sciencedirect.com/science/article/pii/S0959378010001135?casa_token=e3YcjpeKWsgAAAAA:jzFlD6Wk7dvO05YEuoteZ0jUmMVc6eJczVhLxpDcw8qrLvCoTkvo2dz_wH_puWE-frzQNx4">communities and individuals</a>. </p>
<p>One way we’re trying to help is by working directly with older people. Together, we’re <a href="https://www.griffith.edu.au/research/climate-action/climate-transitions/health/ethos-project">researching and developing a smart device</a> that makes it easier to know when your house is getting warm, and customising strategies you can use to cool down safely.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-how-do-i-tell-if-im-dehydrated-107437">Health Check: how do I tell if I'm dehydrated?</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/196218/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sarah Cunningham receives an Australian Government Research Training Program scholarship. She is affiliated with the Extreme Heat and Older Persons research group which receives funding from Wellcome. </span></em></p><p class="fine-print"><em><span>Shannon Rutherford receives funding from Wellcome</span></em></p>Extreme heat kills more Australians than any other natural hazard. Here’s why it’s important to keep an eye on older family and friends this summer.Sarah Cunningham, Doctoral Candidate in Public Health, Griffith UniversityShannon Rutherford, Associate Professor, Public Health, Griffith UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1984862023-01-25T00:10:21Z2023-01-25T00:10:21ZTypical mass shooters are in their 20s and 30s – suspects in California’s latest killings are far from that average<figure><img src="https://images.theconversation.com/files/506204/original/file-20230124-16-st7p3u.jpg?ixlib=rb-1.1.0&rect=15%2C106%2C3531%2C2255&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two deadly mass shootings have California on edge.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/APTOPIXCaliforniaShooting/067f0d30edf4470ab167896ccb42161b/photo?Query=Monterey%20Park%20Jae%20C.%20Hong&mediaType=photo&sortBy=arrivaldatetime:desc&dateRange=Anytime&totalCount=99&currentItemNo=37">AP Photo/Jae C. Hon</a></span></figcaption></figure><p>The two men who <a href="https://www.reuters.com/world/us/california-staggered-by-deadly-back-to-back-mass-shootings-2023-01-24/">shot dead 18 people in separate incidents</a> just days apart in California are the latest perpetrators in America’s long history of mass gun violence. But something about these public shootings, and the men held responsible, stands out.</p>
<p>The <a href="https://www.theviolenceproject.org/key-findings/">median age of mass shooters in the United States is 32</a>. Yet the man who is alleged to have <a href="https://www.cnn.com/2023/01/24/us/monterey-park-california-mass-shooting-tuesday/index.html">shot dead 11 people in Monterey Park</a> on Jan. 21, 2023, before turning the gun on himself <a href="https://www.npr.org/2023/01/24/1150818507/the-suspected-monterey-park-attacker-was-72-heres-why-older-shooters-are-rare">was 72 years old</a> – the <a href="https://www.theviolenceproject.org/key-findings/">oldest mass shooter in modern American history</a>, our records show. Meanwhile, the gunman who <a href="https://www.cnn.com/2023/01/24/us/half-moon-bay-california-shootings-tuesday/index.html">took the lives of seven more in Half Moon Bay</a> two days later was also <a href="https://apnews.com/article/northern-california-shootings-3eb00c19a36ad129ca7f0063f4b2aaf9">older than most</a> — 66, the third-oldest in history. </p>
<p><a href="https://scholar.google.com/citations?user=iS4HAEMAAAAJ">We</a> are <a href="https://scholar.google.com/citations?user=hoHQX8MAAAAJ&hl=en">criminologists</a> who <a href="https://www.theviolenceproject.org">built a database</a> of 191 mass shooters using public data. The shooters in our records date back to 1966 and are coded on nearly 200 different variables, including age at the time of attack. Our research shows that mass shootings – <a href="https://www.theviolenceproject.org/methodology/">defined here</a> as events in which four or more people are killed in a public place with no underlying criminal activity – have become more frequent, and deadly, over time.</p>
<p><iframe id="dScJ5" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/dScJ5/5/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<p>Prior to the January 2023 Californian shootings, mass shooters were also <a href="https://www.axios.com/2022/06/02/mass-shooting-killers-young-teens">getting younger overall</a>. From 1980 to 1989, the median age of mass shooters was 39. Over the next two decades, it was 33. And from 2010 to 2019, it was 29. </p>
<p>Since 2020, the median age of mass shooters has come down to just 22 years old — mostly young men and boys who were born into or came of age in an <a href="https://www.pewresearch.org/politics/2014/06/12/political-polarization-in-the-american-public/">increasingly divided America</a> and carried out their attacks <a href="https://doi.org//10.1001/jamanetworkopen.2022.9393">amid the disruption of a global pandemic</a>.</p>
<h2>Older mass shooter behind deadliest assault</h2>
<p>Ages vary by shooting location, <a href="https://www.theviolenceproject.org/mass-shooter-database/">the data shows</a>. Though mass shooters at offices, warehouses and houses of worship skew older, shooters at K-12 schools, colleges and universities tend to be younger – in large part because many school shooters tend to be current or former students.</p>
<p>Prior to the tragic incidents in Monterey Park and Half Moon Bay, just six mass shooters in our study were over the age of 60. The oldest was a <a href="https://www.upi.com/Archives/1981/10/17/Mountain-town-shocked-by-shooting-outburst/9178372139200/">70-year-old who killed five people</a> at an auto parts store in Kentucky in 1981. The list also includes the perpetrator of the deadliest mass shooting in U.S. history – a 64-year-old who <a href="https://www.nbcnews.com/storyline/las-vegas-shooting/las-vegas-police-investigating-shooting-mandalay-bay-n806461">killed 60 people at a 2017 music festival</a> in Las Vegas.</p>
<p>The others were a 66-year-old who was supposed to turn himself in to serve a prison sentence but instead <a href="https://murderpedia.org/male.B/b/baker-william.htm">killed four people at the manufacturing plant</a> where he used to work in Illinois in 2001; a 64-year-old who <a href="https://www.usatoday.com/story/news/2013/03/14/upstate-new-york-herkimer-mohawk-suspect-surrounded/1986913/">killed four barbershop and oil change shop patrons</a> in rural New York in 2013; a 62-year-old who <a href="https://www.fosters.com/story/news/local/2017/02/22/author-to-speak-at-library-about-colebrook-shooting/22146250007/">killed four people</a> in 1997 in New Hampshire, including two state troopers and a judge; and a 60-year-old <a href="https://www.latimes.com/archives/la-xpm-1987-04-25-mn-990-story.html">who killed six at a shopping center</a> in Palm Bay, Florida, in 1987.</p>
<p>Nearly all of the over-60s perpetrators of mass shootings prior to the January 2023 Californian incidents were white men – just one was a nonwhite male. This differs in the Monterey Park and Half Moon Bay incidents, both of which are thought to have been carried out by Asian Americans.</p>
<h2>Less likely to leak details of attack</h2>
<p>Mass shooters over 60 also tend to have prior criminal records and to target their place of employment, or retail and outdoor locations in communities they knew well.</p>
<p>What separates the older mass shooters from their younger counterparts is that mass shooters in their 20s and 30s typically study previous mass shooters for inspiration and validation. Younger shooters also tend to <a href="https://doi.org//10.1001/jamanetworkopen.2021.33073">communicate intent to do harm</a> in advance. This practice, known as leakage, is often seen as a final cry for help. Younger shooters also tend to leave behind manifestos to communicate their anger and grievances to the world, the data shows. <a href="https://doi.org/10.1016/j.avb.2019.07.005">Analysis of their expressed motives</a> suggest they are seeking fame and notoriety for their actions. </p>
<p>None of the shooters aged 60 and above in our database did that – although investigations are ongoing in the back-to-back California cases. Instead, they tend to have experienced a recent stressor, such as a family conflict or debt. They are more likely to be motivated by legal, financial and interpersonal conflicts, not hate or fame-seeking like many of their younger counterparts.</p>
<p>But all perpetrators of mass shootings, young and old, have some things in common. Their mass shooting is intended to be their final act. Whether they die by suicide – as is <a href="https://www.latimes.com/california/story/2023-01-22/la-me-monterey-park-mass-shooting">seemingly the case with the alleged Monterey Park shooter</a>, are killed on scene, or <a href="https://www.latimes.com/california/story/2023-01-23/half-moon-bay-shooting-multiple-victims">sit and wait to be arrested like the Half Moon Bay suspect did</a>, mass shootings are a final act of hopelessness and anger. </p>
<p>They also have access to the firearms they need to commit these devastating crimes.</p><img src="https://counter.theconversation.com/content/198486/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jillian Peterson receives funding from the National Institute of Justice and the Joyce Foundation.</span></em></p><p class="fine-print"><em><span>James Densley has received funding from the National Institute of Justice and the Joyce Foundation. </span></em></p>Mass shooters over the age of 60 are rare, but often differ from younger gunmen in motives and actions prior to their attack.Jillian Peterson, Professor of Criminal Justice, Hamline University James Densley, Professor of Criminal Justice, Metropolitan State University Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1897702022-12-19T23:25:05Z2022-12-19T23:25:05ZShould we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision<figure><img src="https://images.theconversation.com/files/497130/original/file-20221123-24-ie9y4l.jpg?ixlib=rb-1.1.0&rect=36%2C0%2C4096%2C2728&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">cdc/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Almost <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary">400,000</a> Australians are living with dementia. A million or more family members and friends care for and support them. About two-thirds of people with dementia live in the community.</p>
<p>Deciding to move a loved one into a nursing home is an incredibly difficult one. I found it difficult and stressful considering this move for my own loved one, even with 20 years of experience in dementia and aged care. Sometimes the decision has to be made quickly, such as when the person is in hospital. Sometimes the decision takes much longer and is made over months, or even years. </p>
<p>There are some important things you should consider when trying to decide the best option for you and your loved one. I’ve outlined six here.</p>
<h2>1. Your loved ones’ views around going into care</h2>
<p>We don’t want to force our loved one to do something against their wishes. It’s unusual for someone to want to go into a nursing home. It may take many conversations and a decent amount of time before your loved one accepts they might need more care and that a nursing home is the right place to get that care.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-people-with-dementia-dont-all-behave-the-same-100960">Why people with dementia don't all behave the same</a>
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<h2>2. Your loved one’s current quality of life</h2>
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<a href="https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497136/original/file-20221124-18-o16mtr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">If your loved one currently has all their needs met at home, perhaps supporting them to stay there is a good option.</span>
<span class="attribution"><span class="source">micheile.com/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>If you think your loved one has an overall good quality of life, and that their quality of life may decrease when they go into a nursing home, this could be a sign you should keep trying to support the person to live at home. </p>
<p>However, if their quality of life is currently poor, particularly if this is due to not having enough day-to-day physical care, health care or emotional support, then moving into a nursing home might help meet their daily needs. </p>
<p>Spend some time observing to figure out <a href="https://theconversation.com/home-for-the-holidays-and-worried-about-an-older-relative-make-observations-not-assumptions-173782">how your loved one is doing at home</a>. </p>
<p>You could perhaps make a list of the things they need to lead a good life (company, three square meals, help taking medicines, going out into the community) and see if these are currently being met. </p>
<h2>3. Risks if your loved one stays at home</h2>
<p>People often <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-7-13">go into a nursing home</a> because we think they are no longer safe living at home. </p>
<p>It might be possible to reduce some of the risks of them being at home through <a href="https://www.enablingenvironments.com.au/home.html">modifying the home</a> and <a href="https://www.alzheimerswa.org.au/about-dementia/living-well-dementia/assistive-technology-help-sheets/">using technology</a> (personal emergency alarms, GPS trackers, stove timers) or services (meals on wheels, community care, physiotherapy for mobility). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/older-people-who-get-lost-sometimes-sadly-lose-their-lives-but-those-with-dementia-are-more-likely-to-survive-192938">Older people who get lost sometimes sadly lose their lives. But those with dementia are more likely to survive</a>
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<h2>4. Capacity of your loved one’s family and friends to keep supporting them</h2>
<p>The availability and capacity of family carers is probably the most crucial part in supporting someone with dementia to keep living well at home. Carers often have other responsibilities such as work and children, which means they can’t support their loved one as much as they would like. </p>
<p>Being a carer is physically and emotionally demanding, and over time caring can take its toll. Carers should seek help and support from other family and friends, learn more about <a href="https://forwardwithdementia.au/">dementia</a>, use services including <a href="https://theconversation.com/respite-care-can-give-carers-a-much-needed-break-but-many-find-accessing-it-difficult-183976">respite care</a> and <a href="https://www.dementia.org.au/support">Dementia Australia</a>.</p>
<p>Carers often face a difficult choice between their own health and wellbeing, and supporting their loved one to remain at home. If carers are caring as much as their time, energy and physical and mental wellbeing will allow, and that care is not enough for their loved one’s needs, then more help is needed – and residential care is one way of getting that help.</p>
<h2>5. Alternatives to nursing home care</h2>
<p>Community care services are government-subsidised services to support older people to keep living at home. You can get up to 14 hours of care a week depending on need, though there is an assessment process and often a waiting time for services. You can pay for community care privately as well, although this can be very expensive. </p>
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<a href="https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older person sitting on the bed" src="https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/497140/original/file-20221124-15750-ztb31l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Some families choose to move in with the person with dementia, but it’s not an option for all.</span>
<span class="attribution"><span class="source">jixiao huang/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>An <a href="https://www.cota.org.au/information/aged-care-navigators/who-can-use-aged-care-navigator-services/">Aged Care Navigator</a> (or from 2023 an “aged care finder”) can help you search for suitable available home care services.</p>
<p>Some families choose to move in with the person with dementia, or have them move in with family. This may be an option if there is suitable accommodation, and they are able to live together comfortably. </p>
<h2>6. Availability of quality nursing home care</h2>
<p>It’s emotionally easier to place a loved one in a nursing home if carers are confident the home will provide suitable care. Often, family want a nursing home that is geographically close so they can visit, has a suitable room (such as a single room with an ensuite), sufficient and kind staff with training in supporting people with dementia, a pleasant environment, nutritious appealing food, and quality clinical care. </p>
<p>It takes time to visit and pick a <a href="https://theconversation.com/when-choosing-a-nursing-home-check-the-clothing-and-laundry-100727">suitable nursing home</a>, check it’s appropriately <a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">accredited</a>, and understand how much it will <a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">cost</a>. You might have to wait for a bed in a quality home. You can often trial the nursing home by having your loved one stay for two weeks of respite care. </p>
<p>When your loved one enters nursing home care, you’ll still be caring for them. You want to ensure you can continue to support your loved one emotionally and practically in partnership with the nursing home. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-aged-care-residents-do-all-day-we-tracked-their-time-use-to-find-out-190147">What do aged care residents do all day? We tracked their time use to find out</a>
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<h2>Getting help</h2>
<p>Usually there is no “right” or “wrong” decision. You might struggle and there might be family conflict around what the “right” decision is. </p>
<p>Speaking to a counsellor at <a href="https://www.dementia.org.au/support/counselling">Dementia Australia</a> might help work through the options and your feelings, you can talk to them as an individual or attend as a family.</p><img src="https://counter.theconversation.com/content/189770/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lee-Fay Low works with Dementia Australia and the Forward with Dementia campaign. She has received research funding from the NHMRC, MRFF, Dementia Australia, Federal and NSW governments, and the Benevolent Society. She collaborates with many residential and community aged care providers including HammondCare, The Whiddon Group and Calvary Aged Care.</span></em></p>The decision to move a loved one with dementia into residential care is an incredibly difficult one. These considerations may help.Lee-Fay Low, Professor in Ageing and Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1944602022-11-24T13:52:35Z2022-11-24T13:52:35ZCheaper, tougher, less toxic: new alloys show promise in developing artificial limbs<figure><img src="https://images.theconversation.com/files/496106/original/file-20221118-26-19nxcy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Knee replacements can ease people's pain - but they are also often prohibitively expensive.</span> <span class="attribution"><span class="source">Dragana Gordic/Shutterstock</span></span></figcaption></figure><p>Titanium is a strong, resilient and relatively light metal. Its properties have also been well studied; scientists know a great deal about it. All of this makes it the ideal base for fashioning artificial limbs – particularly knees and hips – and teeth. It is less likely than other metals to rust and, as research <a href="https://www.sciencedirect.com/science/article/abs/pii/S1044580302003200">has shown</a>, it is more compatible with the human body than, for instance, stainless steels and cobalt based materials. </p>
<p>But there’s a major problem: titanium is not cheap. Precise data is hard to come by, but a <a href="https://hipknee.aahks.org/total-joint-replacement-a-breakdown-of-costs/">conservative average cost</a> of titanium-based prostheses is between US$3,000 and US$10,000. That’s expensive for most people, and prohibitively so for the majority of people in middle- and low-income countries like those in Africa.</p>
<p>Again, data is scarce, but a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535807/">recent study</a> about sub-Saharan Africa (excluding South Africa, which has better facilities for such procedures than most other countries on the continent) found that 606 hip and 763 knee replacements were performed between 2009 and 2018. Many more people in the region likely need replacements but will go without because they simply can’t afford the procedure. And, with the global population of those aged 65 and older <a href="https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Highlights.pdf">rising</a>, the demand for implants is set to increase; this age group <a href="https://josr-online.biomedcentral.com/articles/10.1186/s13018-021-02821-8">is prone</a> to diseases like osteoporosis and osteoarthritis.</p>
<p>That’s why we are working to produce cheaper titanium based materials that can be used to make affordable limbs. In our <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/maco.202213076">latest research</a> my colleagues and I experimented with metallic elements like titanium, aluminium, iron and vanadium to create new alloys. We tested each in a solution that mimics humans’ bodily fluids. </p>
<p>We found that the new alloys showed negligible rust in the solution. The new alloys, which are slightly cheaper than the commercial grade alloy, performed as well as it does – and one alloy even outperformed it. </p>
<h2>Pure titanium vs titanium alloys</h2>
<p>The biggest benefit of titanium for making artificial hips, knees and teeth is that it’s safe for use in the human body because it doesn’t degrade easily when exposed to body fluids. </p>
<p>However, when titanium is used in its pure form, it lacks the necessary strength and wear resistance required to cope with the rigours of human activity. </p>
<p>That’s why other metallic elements are added. Examples include aluminium, vanadium, zirconium, tantalum, niobium, molybdenum and iron. Scientists use these and other elements to create new alloys that are stronger and resistant to wear. </p>
<p>Currently the most utilised alloy in artificial hips and knees is Ti-6Al-4V: 90% titanium, 6% aluminium and 4% vanadium. Though it is effective, it has two major drawbacks. The first is the cost. Vanadium is nearly as expensive as titanium. The second is toxicity: aluminium and vanadium are toxic in large quantities. When the material degrades through corrosion, ions are released into the body and can cause chronic inflammation. These ions have also been <a href="https://www.sciencedirect.com/science/article/pii/S0022283619300270">linked</a> to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3986683/">Alzheimer’s disease</a>. </p>
<p>For this study we reduced the amount of aluminium and vanadium that are added to Ti-6Al-4V to make new titanium based materials. We also excluded aluminium and replaced vanadium fully with iron to make another, cheaper, titanium based material. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/south-africa-is-one-step-closer-to-processed-titanium-alloys-122428">South Africa is one step closer to processed titanium alloys</a>
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<p>Then we investigated whether these new implant materials would degrade quickly when immersed in the human body fluid. We used a solution called Hanks Balanced Salt Solution which contains the main ingredients in the human body fluid. We compared the new titanium materials with the commercial grade Ti-6Al-4V that is commonly used.</p>
<h2>The findings</h2>
<p>Almost all the new alloys performed better than Ti-6Al-4V in the salt solution. Those that fared worse in the solution were still on a par with Ti-6Al-4V. And none of the new alloys degraded more than 0.13 millimetres per year, the maximum permissible degradation rate allowed for implant material.</p>
<p>The alloys without vanadium and aluminium performed well, meaning they are potentially safer than Ti-6Al-4V because they have lower toxicity levels.</p>
<p>And, crucially, the new alloys are cheaper to produce than Ti-6Al-4V. We are not working on the actual manufacturing of artificial limbs – this research focuses on the chemical composition of the alloys. So we can’t say what the ultimate cost-saving would be if these alloys were to be used. But, merely by altering the starting materials as we did, replacing aluminium and vanadium fully or partially with iron, up to 10% cost savings can be achieved.</p>
<h2>A promising step</h2>
<p>From 2030 and beyond, <a href="https://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2015_Highlights.pdf">more older adults</a> will reside in developing countries such as those across the African continent. As this population increases, the demand for artificial limbs may also rise. That’s why identifying affordable, safe materials is so important. Our research is a promising step towards meeting that goal.</p><img src="https://counter.theconversation.com/content/194460/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Oluwatosin Bodunrin receives funding from the African Academy of Sciences under the AESA-RISE postdoctoral fellowship program, grant number ARPDF 18-03. </span></em></p>As the world’s population ages, cheap, durable and safe artificial limbs will become ever more important.Michael Oluwatosin Bodunrin, Senior lecturer, University of the WitwatersrandLicensed as Creative Commons – attribution, no derivatives.