tag:theconversation.com,2011:/global/topics/elderly-825/articlesElderly – The Conversation2024-03-14T12:46:04Ztag:theconversation.com,2011:article/2250532024-03-14T12:46:04Z2024-03-14T12:46:04ZHow for-profit nursing home regulators can use the powers they already have to fix growing problems with poor-quality care<figure><img src="https://images.theconversation.com/files/579738/original/file-20240304-22-wj7pxu.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5760%2C3837&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Nursing homes care for more than a million people in the U.S.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/NursingHomeHigh/7c838b5ffe0a4558bde70f78d42f123e/photo">AP Photo/Richard Drew</a></span></figcaption></figure><p>Governments at both state and federal levels have <a href="https://doi.org/10.1093/ppar/prad001">yet to fully wield their authority</a> to fight poor-quality care at for-profit nursing homes nationwide, leaving the pressing need for elder care accountability unmet.</p>
<p>Medicare has the <a href="https://doi.org/10.1093/ppar/prad001">power to improve financial accountability</a> at nursing facilities by capping profits while requiring that a percentage of revenues be spent on direct care expenditures. Already, four states – New Jersey, New York, Massachusetts and Pennsylvania – <a href="https://doi.org/10.1093/ppar/prad001">have shown this can be done</a>, passing laws requiring minimum percentages of expenditures on direct care while limiting profits.</p>
<p>I am a <a href="https://profiles.ucsf.edu/charlene.harrington">behavioral scientist</a> at the University of California, San Francisco who studies the economics of nursing homes and the implications for care. I am also the co-author of an <a href="https://theconversation.com/for-profit-nursing-homes-are-cutting-corners-on-safety-and-draining-resources-with-financial-shenanigans-especially-at-midsize-chains-that-dodge-public-scrutiny-225045">investigative piece in The Conversation</a> about for-profit nursing homes.</p>
<p>States also have the power to suspend and disqualify nursing home owners from the Medicaid program when they provide poor-quality care, commit fraud or harm residents. </p>
<p>For example, after the New Jersey comptroller <a href="https://www.cbsnews.com/newyork/news/princeton-care-center-abrupt-closure-law-violation/">concluded that the abrupt closure</a> of the Princeton Care Center nursing home in September 2023 jeopardized the health and safety of residents, the state took action. It <a href="https://nj.gov/comptroller/news/2024/20240116.shtml#:%7E:text=The%20Office%20of%20the%20State,other%20Medicaid%2Dfunded%20nursing%20homes.">moved in January 2024 to impose an eight-year ban</a> on the owners’ ability to receive Medicaid reimbursement at any nursing home and to require them to divest themselves from <a href="https://nj.gov/comptroller/news/2024/20240116.shtml#:%7E:text=The%20Office%20of%20the%20State,other%20Medicaid%2Dfunded%20nursing%20homes.">two other facilities they already ran</a>.</p>
<p>The federal government can also take aggressive actions to force the industry to shape up, even without new legislation. A 2023 <a href="https://scholarship.law.wm.edu/cgi/viewcontent.cgi?article=4001&context=wmlr">law review article</a> demonstrates that state and federal governments could use state licensure laws and federal nursing home certification requirements to prevent abuse. The article argues that governments could set clear nursing home ownership and operation criteria for individuals and companies, which can include experience, expertise, reputation, past performance and financial solvency standards.</p>
<p>Even federal prosecutors have largely unused powers to crack down on the industry. The Department of Justice <a href="https://www.justice.gov/opa/pr/department-justice-launches-national-nursing-home-initiative">has taken actions</a> against many nursing home owners and chains but rarely has moved to remove the certification of facilities despite having the authority to do so. Instead, nursing homes subject to legal action by the department generally are placed under what is known as a corporate integrity agreement and assigned a monitor to oversee regulatory compliance.</p>
<p>For example, <a href="https://oig.hhs.gov/fraud/cia/agreements/Saber_Healthcare_Holdings_LLC_et_al_03312020.pdf">Saber Healthcare Holdings</a>, which owned <a href="https://data.cms.gov/quality-of-care/nursing-home-affiliated-entity-performance-measures/data">126 nursing homes</a> in 2024, was placed under a <a href="https://oig.hhs.gov/faqs/corporate-integrity-agreement-faq/">corporate integrity agreement</a> in 2021. </p>
<p>The question remains: Why haven’t governments fully flexed their existing regulatory muscles to enforce vital reforms in nursing homes? With the welfare of vulnerable residents at stake, the urgency for decisive action has never been clearer.</p>
<p><em><a href="https://theconversation.com/for-profit-nursing-homes-are-cutting-corners-on-safety-and-draining-resources-with-financial-shenanigans-especially-at-midsize-chains-that-dodge-public-scrutiny-225045">Read The Conversation’s investigation</a> to learn more about the nation’s for-profit nursing homes and how they’re cutting corners on safety.</em></p><img src="https://counter.theconversation.com/content/225053/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Harrington is a advisory board member of the nonprofit Veteran's Health Policy Institute and a board member of the nonprofit Center for Health Information and Policy. Harrington served as an expert witness on nursing home litigation cases by residents against facilities owned or operated by Brius and Shlomo Rechnitz in the past and in 2022. She also served as an expert witness in a case against The Citadel Salisbury in North Carolina in 2021.
</span></em></p>Governments can do more to protect patients at for-profit nursing homes. A behavioral scientist who studies nursing homes weighs in.Charlene Harrington, Professor Emeritus of Social Behavioral Sciences, University of California, San FranciscoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2164022023-11-09T21:40:27Z2023-11-09T21:40:27ZThe experiences of older drivers can help design cleaner and safer cars<figure><img src="https://images.theconversation.com/files/557839/original/file-20231106-267473-frkprb.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Automobile technologies can be applied to allow older drivers continued mobility and independence.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/the-experiences-of-older-drivers-can-help-design-cleaner-and-safer-cars" width="100%" height="400"></iframe>
<p>The current pace of technological change in automobile technology rivals the period about a century ago when cars were moving from the exotic fringes of transportation into the lives of <a href="https://americanhistory.si.edu/america-on-the-move/americans-adopt-auto">ordinary people</a>. </p>
<p>The automobile has <a href="https://www.ushistory.org/us/46a.asp#:%7E:text=The%20social%20effects%20of%20the,shop%20in%20towns%20and%20cities">reshaped the world</a>, giving rise to new freedoms and greater access to distant places, creating jobs and wealth and changing the physical landscape with roads, service stations, dealerships and suburbs. </p>
<p>Cars have brought incredible convenience, but their proliferation has also resulted in traffic jams, oppressive freeways, pollution and high-speed <a href="https://www.thecanadianencyclopedia.ca/en/article/highway-disasters">crashes</a>. And, cars have played a <a href="https://www.fueleconomy.gov/feg/climate.shtml#:%7E:text=Highway%20vehicles%20release%20about%201.5,year%20for%20a%20typical%20vehicle">big part</a> in accelerating <a href="https://www.pwc.com/th/en/automotive/assets/co2.pdf">climate change</a>.</p>
<h2>Car transformations</h2>
<p>Automobile design is undergoing massive shifts. Cars are moving away from gasoline-powered internal combustion engines and toward electric vehicles that generate far less pollution and noise. Cars are getting safer, too, with sensors and cameras that can help drivers avoid collisions. </p>
<p>Self-driving cars don’t seem too far off either, but until then, automobile design should consider the changing needs of drivers.</p>
<p>For all drivers, but especially those who are older and more experienced, cars that can do more without involving the driver present both an opportunity and a threat. This presents an opportunity to support safe, independent driving for longer, in keeping with <a href="https://yourhealthsystem.cihi.ca/hsp/inbrief#!/indicators/011/life-expectancy-at-birth/;mapC1;mapLevel2;/">extended lifespans</a>, and address the social and practical needs of seniors to move around.</p>
<p>The threat is that a more autonomous car may lull drivers into feeling safer and make it harder to understand when drivers with health-related changes should no longer remain on the road. In fact, with added technology, <a href="https://doi.org/10.1177/0018720819900402">driving can require more advanced skills</a>.</p>
<h2>Safer for older drivers</h2>
<p>In my research, I work closely with older drivers, branches of government and automakers to ensure cars are as safe as can be.</p>
<p>I discussed these issues when I was invited to address <a href="https://sencanada.ca/en/Content/Sen/Committee/421/TRCM/53492-e">Canada’s Standing Senate Committee on Transport and Communications</a> in 2017. My colleagues and I continue to do research in partnership with older drivers and others, including <a href="https://doi.org/10.1016/j.aap.2020.105741">Transport Canada</a> and the <a href="https://www.flipsnack.com/caasco/caa-magazine-sco-winter-2020/full-view.html?p=20">Canadian Automobile Association</a>. </p>
<p>An important goal of my research and teaching is to help everyone — including seniors — understand that aging drivers are a growing yet varied group with a wide range of physical and cognitive abilities — and that, statistically speaking, <a href="https://www.iihs.org/topics/older-drivers">seniors are involved in fewer crashes than their middle-aged counterparts</a>. In other words, age alone does not determine who is safe or unsafe to be behind the wheel.</p>
<h2>Declining health</h2>
<p>We need to plan as humanely and responsibly as we can for the fact that, especially in the upper range of this demographic group, health-related declines and medical changes can happen <a href="https://publications.gc.ca/collections/Collection-R/LoPBdP/BP/bp351-e.htm">quickly</a> and are not always readily <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">apparent</a>. </p>
<p>For example, working with an advisory group of people with lived experience with dementia, my colleagues and I developed the <a href="https://drivinganddementia.ca/Acknowledgements">driving and dementia roadmap</a>. This is a free online resource to help health professionals, caregivers and individuals living with this disease be safer on the road.</p>
<p>As cars change, it is critical that manufacturers, engineers and regulators consider how drivers, particularly those in their later years, will respond to and engage with emerging technologies. It is also important to ensure new technology is created with older drivers in mind as much as anyone else, in keeping with the principles of <a href="https://universaldesign.ie/what-is-universal-design/">universal design</a>. </p>
<p>That includes making sure that getting in and out of a car, orienting oneself on the road and controlling all the systems of a vehicle are friendly to all drivers.</p>
<h2>Informed and transformed design</h2>
<p>My research team is embarking on a project in conjunction with our engineering colleagues and students at the <a href="https://electrification.mcmaster.ca">McMaster Automotive Resource Centre</a>, where we are inviting older drivers to volunteer and share their driving-related experiences. The aim is to inform the design of a 2023 Cadillac LYRIQ, an electric SUV, as part of the North American <a href="https://avtcseries.org/about-the-ecocar-ev-challenge/">EcoCar EV Challenge</a>. </p>
<p>The mandate of this contest is not just to make vehicles that are as efficient and as easy on the environment as possible, but also to optimize their safety and accessibility for drivers of different ages and abilities. </p>
<p>A modern car with fully loaded safety features and powered without gas will only be a great success if it’s designed for those who will use it. By involving older drivers — the most experienced on today’s roadways — in their research and development, the cars of tomorrow can be made clean, safe and accessible for all.</p><img src="https://counter.theconversation.com/content/216402/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Brenda Vrkljan has received research funding from the Canadian Institutes of Health Research, the Government of Canada, and the Ontario Ministry of Transportation (MTO). </span></em></p>Automobile technology provides opportunities for older drivers to maintain their independence and autonomy, but cars need to be designed with their needs in mind.Brenda Vrkljan, Professor of Occupational Therapy, School of Rehabilitation Science, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139542023-10-01T15:12:14Z2023-10-01T15:12:14ZEarly indicators of dementia: 5 behaviour changes to look for after age 50<figure><img src="https://images.theconversation.com/files/551222/original/file-20230929-24-as88uw.jpg?ixlib=rb-1.1.0&rect=146%2C251%2C6514%2C4290&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Behaviour changes like apathy, lack of impulse control or socially inappropriate behaviour may indicate a risk of dementia in people over age 50.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/early-indicators-of-dementia-5-behaviour-changes-to-look-for-after-age-50" width="100%" height="400"></iframe>
<p>Dementia is often thought of as a memory problem, like when an elderly person asks the same questions or misplaces things. In reality, individuals with dementia will not only experience issues in other areas of cognition like learning, thinking, comprehension and judgement, but they may also experience <a href="https://www.alzint.org/u/World-Alzheimer-Report-2021.pdf">changes in behaviour</a>. </p>
<p>It’s important to understand what dementia is and how it manifests. I didn’t imagine my grandmother’s strange behaviours were an early warning sign of a far more serious condition. </p>
<p>She would become easily agitated if she wasn’t successful at completing tasks such as cooking or baking. She would claim to see a woman around the house even though no woman was really there. She also became distrustful of others and hid things in odd places. </p>
<p>These behaviours persisted for some time before she eventually received a dementia diagnosis.</p>
<h2>Cognitive and behavioural impairment</h2>
<p>When cognitive and behavioural changes interfere with an individual’s functional independence, that person is considered to have dementia. However, when cognitive and behavioural changes don’t interfere with an individual’s independence, yet still negatively affect relationships and workplace performance, they are referred to as <a href="https://alzheimer.ca/sites/default/files/documents/other-dementias_mild-cognitive-impairment.pdf">mild cognitive impairment (MCI)</a> and <a href="https://doi.org/10.1186/s13195-021-00949-7">mild behavioural impairment (MBI)</a>, respectively. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9169943/">MCI and MBI can occur together</a>, but in one-third of people who develop Alzheimer’s dementia, the behavioural symptoms come <a href="http://dx.doi.org/10.1016/j.jagp.2019.01.215">before cognitive decline</a>. </p>
<p>Spotting these behavioural changes, which emerge in later life (ages 50 and over) and represent a persistent change from longstanding patterns, can be helpful for implementing preventive treatments before more severe symptoms arise. As a medical science PhD candidate, my research focuses on problem behaviours that arise later in life and indicate increased risk for dementia. </p>
<h2>Five behavioural signs to look for</h2>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Illustration of five behaviour changes that may indicate risk of dementia" src="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=525&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=525&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=525&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=659&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=659&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551071/original/file-20230928-17-jmy46j.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=659&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Spotting behavioural changes can be helpful for implementing preventive treatments before more severe symptoms arise.</span>
<span class="attribution"><span class="source">(Daniella Vellone)</span></span>
</figcaption>
</figure>
<p>There are <a href="https://doi.org/10.3233%2FJAD-160979">five primary behaviours</a> we can look for in friends and family who are over the age of 50 that <a href="https://doi.org/10.1186/s13024-023-00631-6">might warrant further attention</a>. </p>
<h2>1. Apathy</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12370">Apathy</a> is a decline in interest, motivation and drive.</p>
<p>An apathetic person might lose interest in friends, family or activities. They may lack curiosity in topics that normally would have interested them, lose the motivation to act on their obligations or become less spontaneous and active. They may also appear to lack emotions compared to their usual selves and seem like they no longer care about anything.</p>
<h2>2. Affective dysregulation</h2>
<p><a href="https://doi.org/10.1016/j.jad.2023.03.074">Affective dysregulation</a> includes mood or anxiety symptoms. Someone who shows affective dysregulation may develop sadness or mood instability or become more anxious or worried about routine things such as events or visits.</p>
<h2>3. Lack of impulse control</h2>
<p><a href="https://doi.org/10.1002%2Ftrc2.12016">Impulse dyscontrol</a> is the inability to delay gratification and control behaviour or impulses.</p>
<p>Someone who has impulse dyscontrol may become agitated, aggressive, irritable, temperamental, argumentative or easily frustrated. They may become more stubborn or rigid such that they are unwilling to see other views and are insistent on having their way. Sometimes they may develop sexually disinhibited or intrusive behaviours, exhibit repetitive behaviours or compulsions, start gambling or shoplifting, or experience difficulties regulating their consumption of substances like tobacco or alcohol.</p>
<h2>4. Social inappropriateness</h2>
<p><a href="http://dx.doi.org/10.1017/S1041610217001260">Social inappropriateness</a> includes difficulties adhering to societal norms in interactions with others.</p>
<p>Someone who is socially inappropriate may lose the social judgement they previously had about what to say or how to behave. They may become less concerned about how their words or actions affect others, discuss private matters openly, talk to strangers as if familiar, say rude things or lack empathy in interactions with others.</p>
<h2>5. Abnormal perceptions or thoughts</h2>
<p><a href="https://doi.org/10.1038/s44220-023-00043-x">Abnormal perception or thought content</a> refers to strongly held beliefs and sensory experiences.</p>
<p>Someone with abnormal perceptions or thoughts may become suspicious of other people’s intentions or think that others are planning to harm them or steal their belongings. They may also describe hearing voices or talk to imaginary people and/or act like they are seeing things that aren’t there.</p>
<p>Before considering any of these behaviours as a sign of a more serious problem, it’s important to rule out other potential causes of behavioural change such as drugs or medications, other medical conditions or infections, interpersonal conflict or stress, or a recurrence of psychiatric symptoms associated with a previous psychiatric diagnosis. If in doubt, it may be time for a doctor’s visit. </p>
<h2>The impact of dementia</h2>
<figure class="align-center ">
<img alt="A young man with his arms around an older man" src="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/551224/original/file-20230929-21-dz5kln.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">Some types of behaviour changes warrant further attention.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Many of us know someone who has either experienced dementia or cared for someone with dementia. This isn’t surprising, given that dementia is predicted to affect <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849#:">one million Canadians by 2030</a>.</p>
<p>While people between the ages of 20 and 40 may think that they have decades before dementia affects them, it’s important to realize that dementia isn’t an individual journey. In 2020, care partners — including family members, friends or neighbours — spent <a href="https://alzheimer.ca/sites/default/files/documents/Landmark-Study-1-Path-Forward-Alzheimer-Society-of-Canada-2022-wb.pdf">26 hours per week</a> assisting older Canadians living with dementia. This is equivalent to 235,000 full-time jobs or $7.3 billion annually. </p>
<p>These numbers are expected to triple by 2050, so it’s important to look for ways to offset these predicted trajectories by preventing or delaying the progression of dementia.</p>
<h2>Identifying those at risk</h2>
<p>While there is currently no cure for dementia, there has been progress towards <a href="https://alzheimer.ca/en/about-dementia/dementia-treatment-options-developments">developing effective treatments</a>, which <a href="https://alzheimer.ca/en/about-dementia/do-i-have-dementia/how-get-tested-dementia-tips-individuals-families-friends/10">may work better earlier in the disease course</a>. </p>
<p>More research is needed to understand dementia symptoms over time; for example, the online <a href="https://www.can-protect.ca/">CAN-PROTECT study</a> assesses many contributors to brain aging. </p>
<p>Identifying those at risk for dementia by recognizing later-life changes in cognition, function as well as behaviour is a step towards not only preventing consequences of those changes, but also potentially preventing the disease or its progression.</p><img src="https://counter.theconversation.com/content/213954/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Daniella Vellone 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>Dementia does not manifest solely as a memory problem. People with dementia can also experience issues with learning, comprehension and judgement, but they may also experience changes in behaviour.Daniella Vellone, Medical Science and Imaging PhD Candidate, University of CalgaryLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2139872023-09-28T01:55:39Z2023-09-28T01:55:39Z4 ways to support someone with dementia during extreme heat<figure><img src="https://images.theconversation.com/files/550476/original/file-20230927-21-7h3iw5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&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/elderly-woman-sitting-soffa-using-hand-2337887847">Shutterstock</a></span></figcaption></figure><p>Our ability to adapt our behaviour to changes in temperature takes a significant amount of thought and decision making. For example, we need to identify suitable clothing, increase our fluid intake, and understand how to best keep the house cool. </p>
<p>A person with dementia may find some or all these things challenging. These and other factors mean, for someone with dementia, extreme heat <a href="https://pubmed.ncbi.nlm.nih.gov/31520832/#:%7E:text=Conclusion%3A%20Heatwaves%20increased%20the%20risk,heat%2Drelated%20Alzheimer's%20disease%20burden.">can be deadly</a>.</p>
<p>But as the temperature rises, friends, relatives and carers can help.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/5-reasons-to-check-on-your-elderly-neighbour-during-a-heatwave-196218">5 reasons to check on your elderly neighbour during a heatwave</a>
</strong>
</em>
</p>
<hr>
<h2>El Niño means there are challenges ahead</h2>
<p>The recent declaration of <a href="https://www.abc.net.au/news/2023-09-19/bureau-of-meteorology-el-nino-blog/102875154">another El Niño</a> means we need to think about how we can best support those more vulnerable to be safe during the warmer months.</p>
<p>Extreme heat and bushfires bring unique challenges for someone with dementia.</p>
<p>Bushfires have a significant impact on older people’s mental health. But they generally <a href="https://www.health.act.gov.au/sites/default/files/2023-03/PATH_Impact%20of%202019-20%20Bushfires%20on%20a%20Cohort%20of%20Older%20Adults_REPORT_V3_0.pdf">bounce back</a> quickly. </p>
<p>However, for someone with dementia, extreme heat can lead to a <a href="https://www.sciencedirect.com/science/article/pii/S0013935119305110">significant deterioration</a> in their overall health and they may not recover. </p>
<p>Emergency evacuations can also be confusing and distressing for a person with dementia, so it is important to think ahead.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/worried-about-heat-and-fire-this-summer-heres-how-to-prepare-212443">Worried about heat and fire this summer? Here's how to prepare</a>
</strong>
</em>
</p>
<hr>
<h2>Why are people with dementia more at risk?</h2>
<p>Dementia can affect the parts of the brain that help <a href="https://academic.oup.com/brain/article/138/11/3360/332653?login=true">regulate</a> our body temperature. Some <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0243665">medications</a> can also increase someone’s sensitivity to heat. </p>
<p>Problems with memory and thinking associated with dementia <a href="https://www.alzheimers.org.uk/get-support/daily-living/drinking-hydration">means</a> remembering to drink or communicating you are thirsty can be challenging.</p>
<p>Heat can affect everyone’s mood. But if someone with dementia becomes dehydrated this can <a href="https://www.alzdiscovery.org/cognitive-vitality/blog/can-dehydration-impair-cognitive-function">increase</a> confusion and agitation, making it harder for them to know how to cool down.</p>
<p>A person with dementia can also wander and become lost, which can be dangerous in extreme heat.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1585508043772436480"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/is-my-medicine-making-me-feel-hotter-this-summer-5-reasons-why-199085">Is my medicine making me feel hotter this summer? 5 reasons why</a>
</strong>
</em>
</p>
<hr>
<h2>4 ways to support someone with dementia</h2>
<p><strong>1. Avoid dehydration and heatstroke</strong></p>
<p>Try to avoid dehydration by encouraging someone to drink throughout the day. It’s better to have <a href="https://pubmed.ncbi.nlm.nih.gov/31769256/">small amounts</a> of liquid regularly instead of a large amount all at once. Little and often will help maximise hydration while avoiding sudden trips to <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dementia-continence-issues#causes-of-incontinence-in-people-with-dementia">the bathroom</a>.</p>
<p>Try to offer different types of drinks, or ice blocks. Placing drinks in sight can help as a reminder to drink. Choose foods with a high liquid content, such as fruit, salads, cool broths and yoghurt. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older man eating icecream, sitting outside with walking stick" src="https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550474/original/file-20230927-15-4jij0o.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">Cooler foods, or ones containing lots of liquid, will help.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-senior-man-walking-cane-eating-2366409675">Shutterstock</a></span>
</figcaption>
</figure>
<p>Look out for <a href="https://www.nia.nih.gov/health/hot-weather-safety-older-adults#:%7E:text=Signs%20of%20heat%20stroke%20are,as%20under%20shade%20or%20indoors.">signs of heatstroke</a>, such as increased confusion beyond what the person would usually experience. Heatstroke may be more difficult to spot in someone living with dementia so it is important to check in when possible and to help them cool down if needed.</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>
<p><strong>2. Cool the home</strong></p>
<p>Try to modify their home to make it easier to stay cool. Some air-conditioners have complex settings so make sure the temperature is set appropriately and the person with dementia knows how to use the controls. </p>
<p>It is important to keep blinds and curtains shut where possible to reduce heat. However, ensure the <a href="https://www.scie.org.uk/dementia/supporting-people-with-dementia/dementia-friendly-environments/lighting.asp">lighting is adequate</a> to avoid falls.</p>
<p>Try to support the person to make suitable clothing choices for the season by having cool, lightweight options easily available.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-delirium-194631">What is delirium?</a>
</strong>
</em>
</p>
<hr>
<p><strong>3. Think about communications early</strong></p>
<p>If someone with dementia lives alone, consider how you will maintain contact in an emergency.</p>
<p>Some people may not realise many landlines don’t work in a power outage, and of course, mobile phones can’t be recharged. Ensure the person with dementia has access to an <a href="https://www.telstra.com.au/support/category/home-phone/uninterruptible-power-supply">uninterruptable power supply</a>. This can help maintain communication for a few hours in a blackout. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older woman using smartphone at home, next to window" src="https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550481/original/file-20230927-21-a77bl1.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 cannot always rely on phones in an emergency.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/old-woman-uses-smart-phone-623448185">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<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>
</strong>
</em>
</p>
<hr>
<p><strong>4. Have an evacuation plan</strong></p>
<p>In case of fire, flash flooding or severe storm, <a href="https://dementiaresearch.org.au/wp-content/uploads/2017/10/2447_DCRC_Prep_natural_disaster_EBook_5.pdf">have an evacuation plan</a>. If the person with dementia attends a day or respite centre, know their plan too.</p>
<p>The situation can change quickly in an emergency, and this can be particularly overwhelming for people with cognitive issues. </p>
<p>Understand that someone with dementia may become distressed when their routine is disrupted. So be prepared with some simple activities or comfort items, current medications, and any specific medical information. </p>
<p>Stay up-to-date with <a href="http://www.bom.gov.au/">current warnings</a> and act early whenever possible.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/floods-and-other-emergencies-can-be-extra-tough-for-people-with-dementia-and-their-carers-heres-how-to-help-193096">Floods and other emergencies can be extra tough for people with dementia and their carers. Here's how to help</a>
</strong>
</em>
</p>
<hr>
<h2>We can all help</h2>
<p>It’s not just carers of people with dementia who can help. We can all ensure people with dementia stay safe and cool this spring and summer. </p>
<p>So remember to check in on your relatives, friends and neighbours or arrange for someone to do so on your behalf.</p><img src="https://counter.theconversation.com/content/213987/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nikki-Anne Wilson receives funding from the Australian Association of Gerontology and the UNSW Ageing Futures Institute. </span></em></p>Extreme heat and bushfires bring unique challenges for someone with dementia. Here’s how we can all play a part in helping them stay safe and cool this spring and summer.Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2128672023-09-26T21:10:43Z2023-09-26T21:10:43ZAre seniors being pressured into retirement homes by lack of community services?<figure><img src="https://images.theconversation.com/files/549798/original/file-20230922-29-uw9xz2.jpg?ixlib=rb-1.1.0&rect=715%2C169%2C7881%2C5254&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Retirement homes might seem like less of a lifestyle choice and more like relocation imposed upon older adults by fragmented and under-resourced primary and community care services.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/are-seniors-being-pressured-into-retirement-homes-by-lack-of-community-services" width="100%" height="400"></iframe>
<p>Ads for retirement homes often feature an older couple relaxing in comfortable surroundings, playing a board game or enjoying a meal with friends. They look well — and young for their age — with broad smiles and perfect silver hair. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Collage of three photo of healthy, smiling older adults." src="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=488&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=488&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=488&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=613&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=613&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550125/original/file-20230925-26-eb6i3b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=613&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Ads for retirement homes seem to offer a worry-free lifestyle choice. Above: stock images seen in marketing materials for retirement homes in Canada.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>These ads offer worry-free, active retirement living at its fullest, complete with delicious and nutritious food. It looks like a wonderful lifestyle choice. </p>
<p>But is it really a lifestyle choice? Or, is it imposed upon older adults by fragmented and under-resourced primary and community care services?</p>
<h2>Assisted living</h2>
<p>In Canada, retirement homes (also known by other names like assisted living) are increasingly for-profit living facilities for older adults. They offer a variable range of services paid for by residents. Across Canada, <a href="https://www.comfortlife.ca/retirement-community-resources/retirement-cost">monthly fees range from $1,600 to over $6,000 for spaces ranging from 300 to 600 square feet</a>. </p>
<p>In Ontario, <a href="https://www.cmhc-schl.gc.ca/blog/2021/2021-seniors-housing-survey-learn-more-insights">where monthly fees for retirement homes average almost $4,000</a>, at least two services must be provided, such as meals and medication administration, with additional services often available at extra cost. </p>
<figure class="align-center ">
<img alt="Two older women sitting at a table while a young man wearing an ID badge talks to them" src="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549801/original/file-20230922-24-ripe1o.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">In Ontario, retirement homes must provide at least two services, such as meals and medication administration.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Some homes (for extra fees) offer services geared towards people with cognitive impairment, and others provide nursing and personal care to those who require physical support. Yet, these privately paid services are often not enough. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344365/">A 2017 study</a> in the Hamilton Niagara Haldimand Brant region of Ontario showed that up to 40 per cent of retirement home residents receive publicly funded home care services, in addition to those purchased from the home. In almost one-third of these cases, retirement home residents or their caregivers said they would be better off living elsewhere, such as in long-term care (LTC) homes, where they can receive 24-hour access to nursing and personal support services. </p>
<p>In Ontario, <a href="https://www.closingthegap.ca/long-term-care-homes-vs-retirement-homes-vs-home-care-in-ontario/">retirement homes are almost exclusively private facilities</a> offering accommodations and some paid care services for less frail seniors, and they operate under less stringent regulations by the <a href="https://www.ontario.ca/page/ministry-seniors-accessibility">Ministry for Seniors and Accessibility</a>. </p>
<p>In contrast, LTC homes provide 24/7 nursing care for more dependent individuals and are regulated and subsidized by the <a href="https://www.ontario.ca/page/ministry-long-term-care">Ministry of Long-Term Care</a>. Retirement homes typically feature private suites or apartments, whereas LTC homes have more institutional and less private accommodations.</p>
<p><a href="https://doi.org/10.1017/S0714980820000045">A recent review of research</a> showed that the opportunity for greater social interaction in retirement homes is an important consideration for some, and consistent anecdotal reports suggest that many residents have a boost in health and well-being after moving into a retirement home. </p>
<p>However, the primary drivers of relocation are concerns over age-associated decline in health, coupled with uncertainty over being able to access services — such as assistance with property upkeep, medications or personal care — in their current home.</p>
<h2>Unmet health-care needs</h2>
<p>We still have a limited picture about <a href="https://doi.org/10.1017/s0714980813000159">what happens when someone moves into a retirement home</a>. In contrast to the LTC sector, for which we have relatively rich information sources at the national level, there is almost no information on retirement home residents. </p>
<figure class="align-center ">
<img alt="A woman in a white coat with a stethoscope and clipboard stands and talks to an older woman in a chair" src="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549799/original/file-20230922-17-vel5bj.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 role of primary care medical providers is not regulated in retirement homes in Ontario.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>What we do know paints a mixed picture. For example, retirement home residents living with dementia, and who can afford specialized memory care services, <a href="https://doi.org/10.1016/j.jamda.2021.07.002">are less likely to move to a LTC home</a>. In contrast, retirement home residents <a href="https://doi.org/10.1503/cmaj.211883">receive far fewer primary care visits</a> than those in LTC homes, and are more likely to visit the <a href="https://doi.org/10.1016/j.jamda.2023.06.024">emergency department</a>, <a href="https://doi.org/10.1016/j.jamda.2015.01.079">be hospitalized</a> and experience prolonged hospital stays.</p>
<p>Clearly, the service and health-care needs of retirement home residents are not being met, nor were these being met in the community, compelling the move to a retirement home in the first place. </p>
<p>In Canada, under-resourcing of home- and community-care sectors imposes limits on where an older person can reside as their health declines, though more choices are available to those living in larger cities and able to pay for expensive private home care. Canada spends <a href="https://www.oecd.org/health/long-term-care.htm">substantially less per capita on home and community-care than the OECD average</a>. </p>
<p>Despite evidence that the medical needs of retirement home residents have been growing more complex, the role of primary care medical providers is <a href="https://doi.org/10.1016/j.jamda.2021.12.012">not regulated</a>, nor is there much incentive to practice in these settings. Retirement homes look like <a href="https://doi.org/10.1503/cmaj.211883">primary care deserts</a>, with residents often having no meaningful access to their previous primary care provider due to mobility limitations in transportation to off-site clinic locations. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/preventing-delirium-protects-seniors-in-hospital-but-could-also-ease-overcrowding-and-emergency-room-backlogs-189220">Preventing delirium protects seniors in hospital, but could also ease overcrowding and emergency room backlogs</a>
</strong>
</em>
</p>
<hr>
<p>Retirement home residents are more likely to be hospitalized and experience accelerated functional and cognitive decline without access to co-ordinated, senior-friendly primary care. Reliance on the limited access to community-based primary care clinics is inadequate because outside primary care providers often can’t know the environment or staff in the retirement home. </p>
<p>Common issues, like falls, can go unaddressed given that there is no one on site to do a sufficiently thorough medical falls risk assessment. Dehydration related delirium (confusion) that could be addressed on site can instead lead to hospital admission and premature institutional care. </p>
<h2>Designed for institutionalization</h2>
<p>Our health-care system <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">seems designed to foster premature institutionalization</a>. The retirement home sector attempts to fill a care and service gap in the community, but is progressively less able to do so as resident care needs become more complex and exceed what they can afford out of pocket.</p>
<figure class="align-center ">
<img alt="A nurse taking a man's blood pressure on a sofa" src="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549800/original/file-20230922-21-pyv5pf.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 solution requires that publicly funded and integrated home and community services be made more accessible to older people regardless of where they choose to live.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>The solution requires that publicly funded and integrated home and community services be <a href="http://nationalseniorsstrategy.ca/wp-content/uploads/2020/09/NSS_2020_Third_Edition.pdf">made accessible to older people regardless of where they chose to live</a>, whether in a retirement home or in the private residence where they have lived for years. </p>
<p>Specific attention is required for community dwelling older people with cognitive difficulties, many of whom could continue aging in place with minimal assistance for nutrition, medication management and surveillance of chronic medical conditions. </p>
<p>Interprofessional primary care (teams that include multiple health professionals such as doctors, nurse practitioners, dietitians and social workers) <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10198684/">would have greater capacity to support older people with complex health issues</a>. Such teams must be made available to prevent hospitalization and its often disabling consequences. </p>
<p>Since many residents have limited capacity to travel to office visits, providing on-site access to primary care in retirement homes is simply fulfilling the promise of the Canada Health Act that reasonable access to insured health services is provided to all Canadians. </p>
<p>More home care and better access to robust primary care services will better meet the needs of older adults in the community, optimize their health and independence, and reduce the huge <a href="https://doi.org/10.1503/cmaj.230719">strain on our hospitals</a> and caregivers. They will also allow older people greater choice over — and ability to afford — whatever lifestyle they prefer.</p><img src="https://counter.theconversation.com/content/212867/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>George A Heckman receives funding from the Schlegel Research Chair in Geriatric Medicine. The Schlegel Chair endowment was a charitable donation to the University of Waterloo, and there is no personal obligation to the donor. </span></em></p><p class="fine-print"><em><span>Andrew Costa receives funding from the Canadian Institutes of Health Research and the Public Health Agency of Canada for related research. He is the Schlegel Chair in Clinical Epidemiology & Aging and Canada Research Chair in Integrated Care for Seniors at McMaster University. The Schlegel Chair endowment was a charitable donation to McMaster, and there is no personal obligation to the donor. He is Research Director of St. Joseph’s Health System's Centre for Integrated Care (Hamilton).</span></em></p>Publicly funded primary and home care should be accessible to all older adults, regardless of where they live.George A Heckman, Schlegel Research Chair in Geriatric Medicine, Associate Professor, University of WaterlooAndrew Costa, Associate Professor | Schlegel Chair in Clinical Epidemiology & Aging | Canada Research Chair in Integrated Care for Seniors, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2109732023-09-24T12:10:16Z2023-09-24T12:10:16ZHow long will a loved one live? It’s difficult to hear, but harder not to know<figure><img src="https://images.theconversation.com/files/549786/original/file-20230922-27-gg4746.jpg?ixlib=rb-1.1.0&rect=201%2C70%2C6508%2C4054&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even for an experienced health-care professional, estimating the life expectancy of a patient with a serious illness is challenging.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/how-long-will-a-loved-one-live-its-difficult-to-hear-but-harder-not-to-know" width="100%" height="400"></iframe>
<p>Planning for the future is difficult for people living with a life-limiting illness. Clinicians, based on their experience, can offer broad estimates of survival — in days to weeks, weeks to months, or months to years. However, patients and their care partners often want greater precision when arranging or making decisions about their care. </p>
<p>An accurate prediction of survival can enable earlier conversations about preferences and wishes at the end of life, and earlier introduction of palliative care. </p>
<p>However, even for an experienced clinician, <a href="https://doi.org/10.1371/journal.pone.0161407">estimating the life expectancy</a> of a patient with a serious illness <a href="https://doi.org/10.1136/bmj.320.7233.469">is challenging</a>. It requires large amounts of data and an understanding of the relationship between the patient’s baseline health, the complexity of their medical condition and how they respond to or progress with treatment. This is where predictive algorithms could help. </p>
<h2>A tool for timely conversations and planning</h2>
<p><a href="https://www.projectbiglife.ca/respect-elder-life">RESPECT (Risk Evaluation for Support: Predictions for Elder life in their Communities Tool) is a risk communication tool</a> powered by prediction algorithms that estimate individuals’ survival — that is, how long someone will live. It was developed by the Project Big Life Research Team and validated <a href="https://doi.org/10.1503/cmaj.200022">using health-care data collected on nearly one million older adults who received home and community care</a> or nursing home care in Ontario. </p>
<figure>
<iframe src="https://player.vimeo.com/video/539710931" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">RESPECT is intended to help people plan for palliative and end-of-life care.</span></figcaption>
</figure>
<p>RESPECT was designed with patients’ information needs in mind, and with the intention of empowering patients and their care partners. By providing patients with data on the survival and experiences of other individuals who had similar disease journeys, the tool can help patients understand their own illness trajectory, have earlier conversations about their preferences and wishes, and advocate for the support they need. </p>
<h2>A tool for patients, care partners and clinicians</h2>
<p><a href="https://www.projectbiglife.ca/respect-elder-life">RESPECT</a> launched publicly on ProjectBigLife.ca in July 2021. <a href="https://www.projectbiglife.ca/">ProjectBigLife.ca</a> is home to several health calculators developed by the research team as a means of translating data and evidence into tools that can help Canadians think about their health and plan for their care. </p>
<p>Using the responses to 17 questions about their health and ability to care for themselves, RESPECT provides an estimate of a person’s survival based on information gathered on people who have similar characteristics. Older adults, their care partners and health care professionals who are uncertain about the life expectancy of someone living with a critical illness can use the calculator to gain a better understanding of their decline. </p>
<p>Beyond life expectancy, RESPECT reports measures of functional decline — for example, whether the patient is able to get around their house and engage in activities of daily living, like bathing and cooking, without any assistance. </p>
<p>A patient can use this information to discuss their care needs with their care partners and health-care providers. Similarly, health-care providers can use this tool to discuss with their patient what can be expected as the patient approaches the end of life, and plan for the supports that their patient may need.</p>
<p>RESPECT is also actively used in Ontario’s retirement homes and nursing homes. Many residents in these settings have a life expectancy of less than two years. Earlier conversations about the older person’s goals and wishes for their remaining life can enable the care team to provide the best quality of life and care for the individuals under their care.</p>
<h2>Sustainable infrastructure</h2>
<p>One of the goals of RESPECT is to provide sustainable infrastructure to study, learn and improve how we use predictive algorithms for end-of-life care.</p>
<p>Despite the benefits that are emerging from the early uses of RESPECT, many questions remain about when and how it can be most appropriately used. For example, poor numerical literacy — that is, a person’s understanding of numbers, mathematics and statistics — could lead to misinterpreting the estimate provided by RESPECT. While the resources supporting RESPECT were co-developed with patients and their care partners, more research is still needed to reduce such potential harms.</p>
<p>To ensure we optimize the benefits that can be gained from prediction algorithms like RESPECT, clinical epidemiologists Douglas Manuel and Justin Presseau, along with the co-authors of this article, have created the RESPECT Learning Health System — a network of care partners, researchers and health-care professionals collaborating to address these challenges. We combine research and practice to sustainably study, learn and improve end-of-life care and experience through predictive algorithms.</p>
<h2>Identification is just the first step</h2>
<p>Only <a href="https://www.cihi.ca/sites/default/files/document/access-to-palliative-care-in-canada-2023-report-en.pdf">58 per cent of people who die in Canada</a> receive some form of palliative care prior to death. Few (13 per cent) are able to die at home with the support of palliative home care. </p>
<p>In deepening our understanding of frailty and decline, RESPECT may help clinicians, patients and their care partners be prepared for a poor prognosis and help develop a personalized plan for their care. </p>
<p>However, to improve end-of-life care delivery in Canada and enable Canadians to die with dignity, more investment is still needed within our formal health-care system to meet the need of individuals at the end of life.</p><img src="https://counter.theconversation.com/content/210973/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span> Lysanne Lessard receives funding from Canadian Institutes of Health Research for research related to the RESPECT Learning Health System.
Lessard is a member of the University of Ottawa's LIFE Research Institute.</span></em></p><p class="fine-print"><em><span>Amy T. Hsu receives funding from the Canadian Institutes of Health Research for research related to the RESPECT Calculator. </span></em></p><p class="fine-print"><em><span>Peter Tanuseputro receives funding from the Canadian Institutes of Health Research for research related to the RESPECT calculator. </span></em></p><p class="fine-print"><em><span>Sampath Bemgal 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>An accurate prediction of survival can enable earlier conversations about preferences and wishes at the end of life, and earlier introduction of palliative care.Lysanne Lessard, Associate Professor, Telfer School of Management, L’Université d’Ottawa/University of OttawaAmy T. Hsu, Brain and Mind-Bruyère Research Institute Chair in Primary Health Care in Dementia, L’Université d’Ottawa/University of OttawaPeter Tanuseputro, Associate Professor, Division of Palliative Care, Department of Medicine, L’Université d’Ottawa/University of OttawaSampath Bemgal, Assistant Professor, Management Information Systems, University of New BrunswickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2134552023-09-20T18:00:02Z2023-09-20T18:00:02ZWildfire risk is soaring for low-income, elderly and other vulnerable populations in California, Washington and Oregon<figure><img src="https://images.theconversation.com/files/548882/original/file-20230918-25-4fjeir.jpg?ixlib=rb-1.1.0&rect=0%2C17%2C3000%2C1976&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many of the people caught in the wildfire that swept through Paradise, Calif., in 2018 were older adults.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nancy-clements-stands-in-front-of-her-home-that-survived-news-photo/1060370226?adppopup=true">Justin Sullivan/Getty Images</a></span></figcaption></figure><p>As wildfires <a href="https://www.nifc.gov/fire-information/nfn">burn across the Western U.S.</a>, the people in harm’s way are increasingly those least able to protect their homes from fire risks, evacuate safely or recover after a fire.</p>
<p>In a <a href="https://www.science.org/doi/10.1126/sciadv.adh4615">new study</a>, we and a team of fellow <a href="https://scholar.google.com/citations?user=tGGNDyUAAAAJ&hl=en">wildfire</a> <a href="https://scholar.google.com/citations?user=S1J4kAoAAAAJ&hl=en">scientists</a> examined who lived within the perimeters of wildfires over the past two decades in Washington, Oregon and California – home to about 90% of Americans in the U.S. West exposed to wildfires over that period.</p>
<p>Overall, nearly half a million people in California, Oregon and Washington were exposed to wildfires at some point during the past 22 years. Alarmingly, about half the people exposed to wildfires in Washington and Oregon were considered socially vulnerable.</p>
<p>While the number of people exposed to fire rose overall, the number of socially vulnerable people exposed more than tripled between the first and second decades.</p>
<h2>How social vulnerability affects fire risk</h2>
<p>A variety of factors shape <a href="http://ece.uprm.edu/%7Epol/pdf/cutter1.pdf">social vulnerability</a>, including wealth, race, age, disability and fluency in the local language.</p>
<p>These factors can make it harder to take steps to protect homes from wildfire damage, evacuate safely and recover after a disaster. For example, low-income residents often can’t afford adequate insurance coverage that could help them rebuild their homes after a fire. And residents who don’t speak English may not hear about evacuation orders or know how to get assistance after a disaster.</p>
<figure class="align-center ">
<img alt="A main points off camera as sprinklers run, leaving wet ground in front of a row of mobile homes. The neighborhood is up against thick pine forest." src="https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/548869/original/file-20230918-36057-7ybnl0.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">Residents at a mobile home community in South Lake Tahoe, Calif., set up sprinklers to try to defend their homes against the Caldor Fire in 2021.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/1b8cc92909294173a05adb7e5602ffae?ext=true">AP Photo/Sam Metz</a></span>
</figcaption>
</figure>
<h2>Older adults face rising fire exposure</h2>
<p>We found that older adults in particular were disproportionately exposed to wildfires in all three states.</p>
<p>Physical difficulties and cognitive decline can hamper older adults’ ability to keep their properties clear of flammable materials, such as dry shrubs and grasses, and can slow their ability to evacuate in an emergency. The fire that destroyed the town of Paradise, California, in 2018 was a tragic example. Of the 85 victims, 68 were 65 years of age or older.</p>
<p>Poverty was another important factor in the exposure of people with high vulnerability to wildfires in Oregon and Washington. </p>
<p>The reasons that socially vulnerable people were increasingly exposed to wildfires varied by state.</p>
<p>In California, the rise was in large part due to socially vulnerable people moving into wildfire-affected areas, possibly in search of more affordable housing, among other factors.</p>
<p>In Oregon and Washington, however, wildfires have increasingly encroached on existing vulnerable communities over the past decade, mainly in rural areas. This is predominantly due to <a href="https://theconversation.com/human-exposure-to-wildfires-has-more-than-doubled-in-two-decades-who-is-at-risk-might-surprise-you-207903">increasing trends of intense, destructive fires</a>.</p>
<p>Nearly 17,000 people living within the perimeter of wildfires in Oregon and Washington over the past decade had high social vulnerability, based on <a href="https://www.atsdr.cdc.gov/placeandhealth/svi/index.html">data from the Centers for Disease Control and Prevention</a>. A smaller percentage of California’s exposed population from 2011-2021 was considered to have high social vulnerability, 11%, but that was still 26,100 people.</p>
<h2>Secondary impacts of wildfires</h2>
<p>Our definition of exposure to wildfire considered only those people who directly lived within a wildfire perimeter.</p>
<p>If you take into account secondary exposures – those living close to wildfire perimeters and likely experiencing evacuation, trauma and poor air quality – the number of people affected is many times larger.</p>
<p>Importantly, other hazards related to wildfires reach still more high-vulnerability communities. <a href="https://theconversation.com/north-americas-summer-of-wildfire-smoke-2023-was-only-the-beginning-210246">Wildfire smoke</a>, for example, has frequently filled large metropolitan areas with unhealthy air in recent years, disproportionately affecting people who work outdoors and other vulnerable populations.</p>
<h2>Policy changes that can help</h2>
<p>To prepare and respond as wildfire <a href="https://doi.org/10.1038/s41893-023-01163-z">risk rises in a warming world</a>, knowledge of the local population’s social vulnerabilities is necessary, along with targeted community-based strategies.</p>
<p>For example, the exposure of populations with limited English-language skills highlights the need for disaster warnings and response resources in multiple languages. </p>
<p>While the <a href="https://www.fs.usda.gov/managing-land/fire/grants">federal government increased its investment</a> for reducing wildfire threats to at-risk communities, including tribes, funding availability does not currently meet the demand.</p>
<p>Increasing exposure of certain populations, such as those living in nursing homes, requires significant investment to plan for and ensure proper and timely responses. When a wildfire in August 2023 burned more than 200 homes <a href="https://www.spokesman.com/stories/2023/aug/28/we-lost-everything-we-owned-gray-fire-destroys-loc/">near Medical Lake, Washington</a>, southwest of Spokane, it <a href="https://www.dshs.wa.gov/ffa/gray-fire-emergency-updates-august-2023">came close to</a> a state-operated psychiatric hospital and a residential home for people with intellectual disabilities.</p>
<figure class="align-center ">
<img alt="Hospital workers push patients in wheelchairs outside the hospital during the evacuation. A dog sits on one woman's lap." src="https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=511&fit=crop&dpr=1 754w, https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=511&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/549241/original/file-20230920-21-q6lyos.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=511&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Feather River Hospital in Paradise, Calif., evacuated its patients ahead of the 2018 wildfire. The building was damaged by the fire and never reopened.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/hospital-workers-and-first-responders-evacuate-patients-news-photo/1059463210">Justin Sullivan/Getty Images</a></span>
</figcaption>
</figure>
<p>Finally, including social vulnerability when studying future wildfire trends is important to shape community responses and policies. </p>
<p>Many national disaster prevention programs skew funding toward wealthier communities because they use cost-benefit analyses to direct <a href="https://www.npr.org/2019/03/05/688786177/how-federal-disaster-money-favors-the-rich#">resources to areas with the greatest potential losses</a>. But while wealthy residents may lose more in dollar value, low-income residents typically lose a larger percentage of their assets and <a href="https://doi.org/10.2202/1547-7355.1792">have a harder time recovering</a>. With the rising percentage of people with high social vulnerability at risk of wildfires, governments may need to rethink those methods and <a href="https://www.americanprogress.org/article/how-fema-can-prioritize-equity-in-disaster-recovery-assistance/">lower the barriers for aid</a>.</p><img src="https://counter.theconversation.com/content/213455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mojtaba Sadegh receives funding from the Joint Fire Science Program and National Science Foundation. </span></em></p><p class="fine-print"><em><span>John Abatzoglou receives funding from the National Science Foundation, US Department of Food and Agriculture, the National Atmospheric and Oceanic Administration and the Joint Fire Science Program. </span></em></p>Alarmingly, about half the people exposed to wildfires in Washington and Oregon were those least able to afford to protect their homes, evacuate safely and recover.Mojtaba Sadegh, Associate Professor of Civil Engineering, Boise State UniversityJohn Abatzoglou, Professor of Engineering, University of California, MercedLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2101052023-09-17T12:07:27Z2023-09-17T12:07:27ZOlder Canadians’ savings are shaped by their long-term care preferences<figure><img src="https://images.theconversation.com/files/547630/original/file-20230911-8406-rbs70z.jpg?ixlib=rb-1.1.0&rect=15%2C38%2C5160%2C3406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A recent study has found that Canadians are highly motivated to save money in preparation of long-term care.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/older-canadians-savings-are-shaped-by-their-long-term-care-preferences" width="100%" height="400"></iframe>
<p>Canada’s aging population is growing. According to the Organization for Economic Co-operation and Development, the proportion of Canadians aged 80 and older <a href="https://www.oecd.org/health/health-at-a-glance/">will surpass nine per cent by 2050</a>, up from 4.3 per cent in 2021. </p>
<p>This demographic shift is happening in most developed nations, and will result in a greater demand for long-term care. Québec, for instance, anticipates that <a href="https://creei.ca/wp-content/uploads/2021/02/cahier_21_01_financement_soutien_autonomie_personnes_agees_croisee_chemins.pdf">600,000 people will need long-term care by 2050</a> — nearly double the current number.</p>
<p>Meanwhile, escalated care expenses in recent years, <a href="https://www.statcan.gc.ca/o1/en/plus/4165-nurses-working-harder-more-hours-amid-increased-labour-shortage">attributed to labour shortages and exacerbated by COVID-19</a>, are a pressing concern.</p>
<h2>The costs of long-term care</h2>
<p>In Québec, <a href="https://bonjourresidences.com/blogue/couts-hebergement-chsld/">the rates (before any income-based subsidy) for public nursing home accommodations are around $2,000 a month</a>. But since public nursing homes have such long waiting lists, some choose private nursing homes instead. The costs of private nursing homes are estimated to be between $5,000 and $8,000 a month.</p>
<p>Home care — <a href="https://theconversation.com/canadians-want-home-care-not-long-term-care-facilities-after-covid-19-170620">a preferred option for many</a> — costs around $5,550 a month, excluding additional expenses like maintenance and food. Consequently, long-term care expenses present a substantial financial risk in old age, potentially motivating people to save for it ahead of time.</p>
<p>While both nursing homes and home care impose financial burdens, their distinct cost structures can influence precautionary savings in different ways. </p>
<p>Nursing homes bundle accommodation and food, offering limited additional services. In contrast, home care recipients can allocate savings for quality-of-life improvements like better food, home maintenance, etc. Additionally, people may inherently value spending more while at home.</p>
<h2>Long-term care and savings</h2>
<p>Our <a href="https://economie.esg.uqam.ca/wp-content/uploads/sites/54/2023/05/2023_02_docdt_eco.pdf">recent research project</a> aimed to understand how preferences for home-based care versus nursing homes affect people’s savings, using both survey responses and a simulation study.</p>
<p>Our research is crucial for two reasons. First, even before the pandemic, a reluctance to be institutionalized — known as <a href="https://doi.org/10.1016/j.jhe.2017.10.001">institutionalization aversion</a> — was documented. Second, COVID-19 has further <a href="https://doi.org/10.1016/j.jebo.2022.06.034">discouraged nursing home entry</a>, possibly due to excess mortality in nursing homes, as has been <a href="https://doi.org/10.1002/hec.4613">documented in many countries</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/inquiry-into-coronavirus-nursing-home-deaths-needs-to-include-discussion-of-workers-and-race-139017">Inquiry into coronavirus nursing home deaths needs to include discussion of workers and race</a>
</strong>
</em>
</p>
<hr>
<p>To model savings in different care settings effectively, we needed to understand how individuals allocated their resources in those settings. To accomplish this, we developed a set of survey questions aimed at uncovering these preferences.</p>
<p>These survey questions were designed to prompt respondents to consider how they would allocate their resources depending on the long-term care setting in a well-defined, hypothetical scenario.</p>
<p>Survey respondents were randomly assigned to different long-term care settings (home care, semi-private room in a nursing home or a private room in a nursing home). Their resource allocation choices allowed us to examine how their preferences for savings varied based on the type of long-term care setting.</p>
<p>Our analysis of 3,000 survey responses shows that Canadians are highly motivated to save money to be better prepared for long-term care. This willingness to save was much larger when respondents expected to use home care; respondents anticipating home care allocated 38 per cent more resources to savings. This reflects the greater financial needs associated with home care.</p>
<h2>Long-term care insurance</h2>
<p>We used the results from our survey to calibrate a simulation study — a computer-based experiment using a combination of economic theories and survey evidence — to simulate how households and individuals make financial decisions.</p>
<p>Our simulation study examined two scenarios: one based on the Canadian system, which includes a universal subsidy that lowers nursing home costs, and one based on the U.S. Medicaid system, which features a purely means-tested subsidy that provides free long-term care and ensures a minimum standard of living for those without sufficient income.</p>
<p>Differences in individual preferences for various care settings largely explain the savings disparities. In the Canada-like system, the prospect of receiving long-term care at home substantially boosts savings. On average, individuals planning to use home care saved $25,000 (8.3 per cent) more by the age of 66, compared to those planning to use private nursing home rooms, and $29,000 (9.8 per cent) more compared to those opting for semi-private rooms. </p>
<p>Under the U.S.-like system, the impacts on savings of different care settings were much smaller. This is because, in the absence of public subsidies, the minimum costs of a room in a nursing home are much higher than those of home care. When comparing the savings of individuals opting for home care versus a private room in a nursing home, the difference in savings was almost null. </p>
<p>However, when comparing savings between those opting for home care versus a semi-private room in a nursing home, we found that the former saved 3.7 per cent more.</p>
<h2>Policy implications</h2>
<p>Assessing how individuals value additional public subsidies for each type of long-term care setting can provide policymakers with valuable insights about how to expand public long-term care insurance effectively. </p>
<p>Our research found that all subsidies are valued well beyond costs, with home care subsidies being more valued than nursing home subsidies. Under the Canada-like system, the average valuation for a home care subsidy was $2.98 per $1 spent, surpassing private ($2.72) and semi-private ($2.35) nursing home subsidies.</p>
<p>Middle-income individuals who aren’t eligible for means-tested programs, but who have limited savings, placed the highest value on these subsidies. This shows that expanding subsidies for home care can be an effective way to protect Canadians from long-term care risks.</p><img src="https://counter.theconversation.com/content/210105/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marie-Louise Leroux receives funding from FRQSC and SSHRC-CRSH. She is affiliated with CIRANO (Montreal) and CESifo (Munich). </span></em></p><p class="fine-print"><em><span>Franca Glenzer receives funding from SSHRC-CRSH. </span></em></p><p class="fine-print"><em><span>Bertrand Achou, Minjoon Lee, and Philippe De Donder 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>While both nursing homes and home care impose financial burdens, their differing structures can influence how older Canadians save money.Marie-Louise Leroux, Professeure titulaire en Sciences Economiques, Université du Québec à Montréal (UQAM)Bertrand Achou, Assistant Professor, Economics, University of GroningenFranca Glenzer, Assistant Professor, Department of Finance, HEC MontréalMinjoon Lee, Assistant Professor, Economics, Carleton UniversityPhilippe De Donder, Research director (CNRS), Toulouse School of Economics – École d'Économie de ToulouseLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124262023-09-14T19:48:11Z2023-09-14T19:48:11ZNavigating the complexities of caregiving for dementia in South Asian communities<figure><img src="https://images.theconversation.com/files/547295/original/file-20230908-43950-v2nuih.jpg?ixlib=rb-1.1.0&rect=103%2C60%2C5647%2C3768&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Caregiving in South Asian communities is characterized by close family bonds that emphasize respect for elders.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/navigating-the-complexities-of-caregiving-for-dementia-in-south-asian-communities" width="100%" height="400"></iframe>
<p>In 2020, an estimated <a href="https://alzheimer.ca/en/research/reports-dementia/landmark-study-report-1-path-forward">597,000</a> individuals were living with dementia in Canada. By 2030, that number is expected to increase to almost one million, and by 2050, almost 1.7 million. </p>
<p>Dementia is a global struggle affecting many around the world. In South Asian communities, an intricate tapestry of cultures, languages and traditions engenders a caregiving dynamic for those living with dementia.
Dementia care in South Asian households is nuanced and complex and is shaped by cultural, familial and societal forces. </p>
<p>Strong familial bonds and respect for elders provide a foundation for support. However, stigma, language barriers and gendered caregiving roles can create formidable challenges.</p>
<p>By understanding these diverse dynamics, experts and medical practitioners can provide better and more tailored support to South Asians with dementia and the people who care for them.</p>
<h2>Caregiving in South Asian communities</h2>
<p><strong>Strong family bonds:</strong> The South Asian community is characterized by its close-knit family structures, where family members often share caregiving responsibilities. This communal caregiving approach fosters unity and support, allowing individuals with dementia to remain within their familial environment. </p>
<p><strong>Respect for elders</strong>: South Asian cultures traditionally hold elders in high regard. This fosters a sense of duty and responsibility toward caring for aging family members and can translate into a heightened commitment to caregiving for individuals with <a href="https://brill.com/display/title/37884">dementia</a>. </p>
<p>These values are also informed by religious beliefs and cultural practices. In Hinduism, the concept of <a href="https://timesofindia.indiatimes.com/astrology/kundali-dasha-remedies/lal-kitab-remedies-for-pitru-rin/articleshow/68206686.cms">Pitru Rin (debt to ancestors)</a> emphasizes the obligation of children to <a href="https://doi.org/10.1177/1084822312439466">repay their parents for their nurturing and care</a>. Similarly, Islam strongly emphasizes <a href="https://doi.org/10.1007/s11562-020-00458-8">respecting and caring for one’s parents</a> and elderly relatives, as prescribed in the Qur’an and Hadith. In Sikhism, the concept of <a href="https://www.bbc.co.uk/bitesize/guides/zmcf3k7/revision/3">seva (selfless service)</a> extends to caring for elders in the community. Cultural norms and expectations shape the roles and responsibilities of care partners.</p>
<p><strong>Multi-generational households:</strong> Many South Asian households often have multiple generations living under one roof. This arrangement can benefit dementia caregiving, allowing continuous care, emotional support and companionship. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A young Indian women places her arms around an older woman wearing a sari and holding a book." src="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547888/original/file-20230912-28-ew1qvu.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">Living in multi-generational households can provide people with dementia continuous care, emotional support and companionship.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Challenges to caregiving</h2>
<p><strong>Stigma and a lack of awareness</strong>: Stigma surrounding dementia is prevalent and can often mean people delay getting medical help and <a href="https://doi.org/10.1177/1471301212444806">lack awareness about available support</a>. This can lead to isolation and a lack of care for people with dementia.</p>
<p><strong>Collectivism:</strong> South Asian cultures emphasize collectivism, where the needs of the family or community take precedence over individual needs. This can influence the decision-making process regarding caregiving arrangements.</p>
<p>While collectivism can provide a robust support network, it can also lead to care partners neglecting their well-being in favour of the needs of the person living with dementia. </p>
<p><strong>Language and cultural barriers:</strong> Language and cultural differences can pose significant challenges in accessing appropriate care and information about dementia. People with dementia and their caregivers may not be fluent in the language of their host country. That can make it especially challenging to communicate effectively with doctors and navigate <a href="https://doi.org/10.1017/S1041610211000214">health-care systems</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/navigating-dementia-care-in-the-south-asian-community-overcoming-barriers-and-stigma-171788">Navigating dementia care in the South Asian community: Overcoming barriers and stigma</a>
</strong>
</em>
</p>
<hr>
<p><strong>Emotional and financial stress:</strong> Caregiving for a loved one with dementia can be emotional and stressful for anyone. The constant demands of caregiving, coupled with the progressive nature of dementia, can lead to caregiver burnout and mental health issues. </p>
<p>In South Asian communities, caregiving responsibilities often fall on daughters or other female relatives due to <a href="https://doi.org/10.1159/000506363">gendered expectations</a> of their role in the family. Women often have to juggle caregiving with their other household and family duties. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Close up of an elderly woman's hands being held by a younger woman." src="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547293/original/file-20230908-27-9nesjy.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">Stigma surrounding dementia and language barriers can often lead to isolation or delayed treatment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Living in multi-generational households can also bring additional stress for family members tasked with caregiving. Long-term care homes are often viewed negatively due to cultural values that prioritize family unity and the belief that it’s the responsibility of younger generations to care for their elders at home. That can be compounded by financial stress if caregivers have to quit jobs to provide care full-time. </p>
<h2>Supporting caregivers</h2>
<p>Acknowledging and supporting caregivers is crucial for a more equitable future. This support entails recognizing and valuing their unpaid care work.</p>
<p>Employers should promote flexibility and provide workplace resources to ease caregiving burdens. These could include offering flexible work arrangements, adjusted hours and remote working options. They can provide paid family leave to accommodate caregiving needs and consider providing childcare support. </p>
<p>Financial support and legal protections further empower caregivers. These concerted efforts from governments, employers and communities collectively contribute to a more equitable and inclusive society.</p>
<p>By acknowledging the positive aspects of caregiving and addressing the negatives, society can work toward enhancing the well-being of South Asian care partners and individuals with dementia. </p>
<p>It is imperative to address the unique challenges faced by South Asian care partners and individuals with dementia. This includes promoting awareness about dementia, overcoming language barriers in health care and fostering culturally sensitive support networks.</p><img src="https://counter.theconversation.com/content/212426/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Navjot Gill 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>Dementia care in South Asian households is shaped by cultural, familial and societal forces that bring benefits and challenges.Navjot Gill, Doctoral Candidate, Aging, Health and Well-being, University of WaterlooLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2068522023-06-25T13:35:00Z2023-06-25T13:35:00ZFinding joy at age 100: Talking to centenarians about living their best life at any age<figure><img src="https://images.theconversation.com/files/530460/original/file-20230606-27-okg1ov.png?ixlib=rb-1.1.0&rect=143%2C0%2C1657%2C1003&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Centenarian Clementina Ripplinger with researcher Heather Nelson. Researchers spoke to very elderly people about what brings them joy and how they plan for the future.</span> <span class="attribution"><span class="source">(Shane Luhning)</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Aging is seen as a period of loss, and there are unhelpful <a href="https://www.nia.nih.gov/health/10-myths-about-aging">myths about older adults</a>. Myths lead to treatable conditions being considered normal parts of aging, including cognitive decline, dementia, depression and loneliness. Some even consider exercise dangerous in older adults.</p>
<p>At the same time, mainstream media promotes the message that <a href="https://doi.org/10.4236/jss.2017.58015">being young is central to a person’s value</a>. These ideas lead to ageism and older adults being seen as lesser.</p>
<p>After spending time with six female centenarians in assisted living facilities, our research team — which included four nursing researchers and a documentary filmmaker — learned there is plenty still worth living for. </p>
<p>Centenarians are a small but growing segment of the population with <a href="https://www150.statcan.gc.ca/n1/en/daily-quotidien/220928/dq220928c-eng.pdf?st=LrkfjZE_">13,844 centenarians in Canada</a>, and our findings debunk myths about the experience of aging.</p>
<figure>
<iframe src="https://player.vimeo.com/video/800973319" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trailer for documentary film about talking to centenarians.</span></figcaption>
</figure>
<p>We asked the centenarians questions about what brings them joy and how they plan for the future because we wanted to learn how the very elderly plan for and find ways to live their best lives. The results of this study were <a href="https://vimeo.com/showcase/looking-forward-at-100">turned into a 32-minute documentary</a> that captures participants’ long and interesting lives and offers insight into continued meaning experienced by centenarians in their daily lives. Three of the centenarians died shortly after the interviews took place.</p>
<h2>Long and interesting lives</h2>
<p>The participants were born between the years 1919 and 1922. They were children during the Great Depression and young adults during the Second World War. </p>
<p>One of the women helped build bullet casings and worked on the <a href="https://www.britannica.com/technology/Lancaster-airplane">Lancaster bomber</a>. Another woman helped her husband protect the blueprints of the ill-fated <a href="https://www.thecanadianencyclopedia.ca/en/article/avro-arrow">Avro Arrow aircraft</a> when he brought them home from work. Two women lost their husbands when their children were small and had to go to work to support their families. They all experienced love and adventure. </p>
<p>Our team was fascinated by their stories and wanted to further explore what their lives look like today. </p>
<p>Betty, 101, saw happiness as a choice. “I don’t know what’s really to complain about. I went through life staying happy,” she said.</p>
<h2>Joy and challenges</h2>
<p>This study used a research method called <a href="https://www.scribd.com/doc/151684840/Braun-Clarke-2006-Using-Thematic-Analysis">thematic analysis</a> to find four themes: Finding Joy, Act your Age, Looking Forward and Putting Challenges into Perspective.</p>
<p>The centenarians found joy each day and enjoyed the little things such as activities, visits and treats. Betty enjoyed cheating at solitaire and Jean, 100, played the piano. Clementina, 101, had fun gambling and Joyce, 100, continued to write stories and watch her grandchildren in music concerts.</p>
<p>Family was central to their lives and they enjoyed spending time with their children, grandchildren and great-grandchildren. Two of the women stated that raising their children was the biggest accomplishment in their lives.</p>
<p>The centenarians also found great joy in reminiscing about their interesting lives. However, one of the challenges was that there was no one left alive who had the same shared experiences.</p>
<h2>Limitations</h2>
<p>The centenarians were constrained by the limitations of society, their bodies and their self-perceptions. “You have to act your age,” said Clementina. She physically described this phenomenon by clasping her hands together in her lap and sitting still. </p>
<p>Some participants found life to be boring at 100 compared to their lives as younger adults. They had limited opportunities to do what they would like. “We had homes,” said Joyce, 100, describing how they had known better lives, which made it hard to accept the constraints of their current existence. </p>
<p>In spite of these feelings, many of the participants continued to be busy and live life fully despite limitations. Jean, despite needing a wheelchair for mobility, continues to do people’s taxes for a volunteer organization, plays piano for church services and leads choirs within her facility. </p>
<p>“I am constantly rebelling against my situation physically,” she said.</p>
<figure>
<iframe src="https://player.vimeo.com/video/791224058" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
</figure>
<p>The other women in this study also continued to challenge norms of what their age and disabilities meant. Joyce writes and submits short stories for publication, and has a poem in the war archives in Ottawa.</p>
<p>Assisted living facilities often prioritize resident safety, but this can come at a cost to personal freedom. Some residents only leave their facility accompanied by a facility employee or a family member. Clementina rebelled against this restriction and at the age of 97, snuck out of her assisted living facility in a cab to go to the casino, pretending that she was going to meet her son.</p>
<p>All of the participants put their life challenges into perspective. They all had lost spouses, friends and some had lost their children. “I was broken,” Clementina said about losing her husband. </p>
<p>Christine, 102, was asked how she managed after losing her husband when her children were still small. “I am still here,” she said.</p>
<h2>The future</h2>
<p>Most of the centenarians had few plans for themselves for the future and were more interested in leading their day-to-day lives. Betty jokingly described the inevitability of her death and that she was “looking for the bucket.” Most described being prepared to die except for Jean, who laughed and said she didn’t have time to die. “I have too many plans.”</p>
<p>The centenarians looked to the future of their families and the larger community and entrusted the next generation to make good choices.</p>
<p>Participants in this study had long and interesting lives and continued to find meaning each day. This study supports the idea that older adults continue to lead engaging lives and that we need to support older adults to live their best lives at any age.</p>
<p><em>This article was also co-authored by journalist and filmmaker Kelly-Anne Riess and retired nursing instructor Susan Page.</em></p><img src="https://counter.theconversation.com/content/206852/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heather Joyce Nelson receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council.</span></em></p><p class="fine-print"><em><span>Beverlee Ziefflie receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Paula Mayer receives funding from the Saskatchewan Health Research Foundation and the Social Sciences and Humanities Research Council. </span></em></p>What is life like at 100? Centenarians shared their joys and future hopes with a team of Saskatchewan researchers.Heather Joyce Nelson, Assistant Professor of Nursing, University of ReginaBeverlee Ziefflie, Instructor, Nursing, Saskatchewan PolytechnicPaula Mayer, Associate Research Scientist, Nursing, Saskatchewan PolytechnicLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2067482023-06-01T20:46:39Z2023-06-01T20:46:39ZIntergenerational Day: How bringing different generations together can support our mental well-being<figure><img src="https://images.theconversation.com/files/529458/original/file-20230531-25420-dofez7.jpg?ixlib=rb-1.1.0&rect=22%2C128%2C5017%2C3234&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Programs that bring young and old together help foster meaningful relationships across generational divides.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>“You old bag!” </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man in wheelchair receives birthday cards from young children." src="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529480/original/file-20230601-25420-992d5s.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Herb receiving birthday cards from students in the iGen program.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>To many, this phrase might spark confusion or concern. But, for Herb, a long-term care resident of Saskatoon’s <a href="https://www.sherbrookecommunitycentre.ca/">Sherbrooke Community Centre</a>, it is his favourite phrase for teasing friends. </p>
<p>So, when he was gifted a t-shirt with those words on his 69th birthday, you couldn’t have seen a bigger smile on his face, nor heard more laughter from the friends who gave it to him — a class of 11- and 12-year-olds.</p>
<p>Herb’s connection with these young students is sincere and an important one to celebrate. Especially on June 1, which marks <a href="https://nationaltoday.com/intergenerational-day/#:%7E:text=Now%20more%20than%20ever%20we,on%20June%201%20was%20created">Intergenerational Day</a>.</p>
<p>Established in 2010, Intergenerational Day was created to shrink the <a href="https://www.pewresearch.org/social-trends/2009/08/12/ii-generations-apart-and-together/">widening gap</a> between the old and young, two generations that people believe differ wildly on a broad range of topics, from core moral values and political views to tastes in music. </p>
<p>Intergenerational Day serves as a reminder of what the old and young can learn from one another, as well as the benefits that come from connecting with others.</p>
<h2>Intergenerational classroom</h2>
<p>For the past three years, we have been researching the benefits of intergenerational connections. We have found that, just like Herb, most people not only feel a great deal of meaning in connecting with someone of a different age than themselves, but that these connections are associated with greater well-being.</p>
<p><a href="https://www.mdpi.com/1660-4601/20/5/4403">In our research</a>, we have focused our attention on a program called <a href="https://www.cbc.ca/news/canada/saskatchewan/community/long-term-care-eden-alternative-saskatoon-1.6692053">iGen</a>: an <a href="https://www.saskatoonpublicschools.ca/program/igen/Pages/default.aspx">intergenerational classroom</a> in Saskatoon housed at the Sherbrooke Community Centre and created in partnership with educator <a href="https://www.spsd.sk.ca/school/collegepark/Announcements/DispForm.aspx?ID=39&ContentTypeId=0x010400A523F8B49A40D74B94D75356FE80B353#/=">Keri Albert</a>.</p>
<p>Each year, 25 Grade 6 students complete the standard curriculum at Sherbrooke while interacting with the long-term care residents called Elders. The term “Elders” is used within the <a href="https://www.sherbrookecommunitycentre.ca/sherbrooke-difference/the-eden-alternative-philosophy/#:%7E:text=The%20Eden%20Alternative%20%C2%AE%20focuses,care%20of%20the%20human%20body.">Eden Alternative Philosophy</a> of long-term care to honour residents and the wisdom of their life experiences.</p>
<p>Every day, students connect with and support the Elders through various activities like reading, painting, playing games or simply chatting. These repeated interactions provide a comfortable opportunity for conversations and true friendships to grow.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/sp3r8PsQjDc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">The iGen program brings young students together with older adults living in long-term care to foster intergenerational connections.</span></figcaption>
</figure>
<h2>Improving well-being</h2>
<p>In our recently published study, we worked with Albert and Sherbrooke’s Communications leader, Eric Anderson, to survey 24 students in the iGen class of 2020. Students told us about their experiences and rated how it had impacted several aspects of their well-being, such as their energy, self-esteem, optimism and life satisfaction.</p>
<p>What did we find? First, students’ ratings were off the charts: Students said that their conversations, activities and experiences with the Elders were incredibly meaningful and rated their well-being at the top of our scales. In other words, these students were enjoying their experience in iGen and feeling happy about themselves.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A girl and an elderly man in a wheelchair pose for a photo together." src="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=800&fit=crop&dpr=1 600w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=800&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=800&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1005&fit=crop&dpr=1 754w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1005&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/529479/original/file-20230601-21632-tjxide.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1005&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Frequent intergenerational interactions provide an opportunity for meaningful connections and friendships to grow.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Second, we found that forming meaningful connections with care home residents in the program was associated with greater happiness. Students who reported having more meaningful intergenerational experiences also reported greater well-being on every single measure included in our surveys, such as greater life satisfaction and self-esteem. </p>
<p>These findings align with <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2F0033-2909.117.3.497">hundreds of studies</a> indicating that social relationships are a key source of happiness.</p>
<p>How were students and Elders able to form meaningful relationships? Responses to our survey offer one insight: spending time together. In fact, the more time that students spent with the Elders, the more meaningful they reported their intergenerational experiences to be. This suggests that when generations interact through programs like iGen, they can reap the potential benefits of these relationships.</p>
<p>Building intergenerational connections may be especially timely now given widespread worries of <a href="https://www.nytimes.com/2023/04/30/opinion/loneliness-epidemic-america.html">loneliness</a> for people of all ages, which may contribute to the young and elderly’s declining mental health. </p>
<p>One-in-five youth in Canada <a href="https://www.unicef.ca/en/blog/mental-health-top-concern-canadas-youth?ea.tracking.id=20DIAQ01OTE&19DIAQ02OTE=&gad=1&gclid=Cj0KCQjw4NujBhC5ARIsAF4Iv6epKZpNm_bqWnbwj9VKg7ElWEpj1Tq_-0zBa1OnMUttHPWBi7fqdAkaAkAkEALw_wcB">struggle with mental illness</a>. While in the U.S. the number of youth reporting feelings of <a href="https://www.apa.org/monitor/2023/01/trends-improving-youth-mental-health?utm_source=twitter&utm_medium=social&utm_campaign=apa-monitor-trends&utm_content=2023-trends-youth-mental-health">sadness and hopelessness</a> has grown by 40 per cent in the last 10 years. </p>
<p>At the other end of the lifespan, many older adults struggle with their well-being, with roughly seven per cent of the world’s older population <a href="https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults">suffering from depression</a>.</p>
<p>Yet, <a href="https://worldhappiness.report/ed/2023/world-happiness-trust-and-social-connections-in-times-of-crisis/">new data</a> shows that even in 2022, after years of separation due to the pandemic, people reported greater feelings of social connection than loneliness. This is promising, because feeling socially connected is one of the strongest predictors of greater well-being. And it provides us with yet more reasons to create and celebrate social connections across generations.</p>
<p>At a time when the young and old are <a href="https://hbr.org/2018/06/the-u-s-isnt-just-getting-older-its-getting-more-segregated-by-age">growing further apart</a>, we show that programs like iGen may help youth form valuable relationships that can bridge social divides like age and ability, and possibly, leave us all happier for it.</p><img src="https://counter.theconversation.com/content/206748/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 organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Intergenerational Day serves as a reminder of what the old and young can learn from one another, as well as the benefits that come from connecting with others.Jason Proulx, PhD Student, Social Psychology, Simon Fraser UniversityJohn Helliwell, Professor Emeritus, Vancouver School of Economics, University of British ColumbiaLara Aknin, Distinguished Associate Professor of Psychology, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2054032023-05-28T20:06:18Z2023-05-28T20:06:18ZOver half of eligible aged care residents are yet to receive their COVID booster. And winter is coming<figure><img src="https://images.theconversation.com/files/527921/original/file-20230524-27-shh5r9.jpg?ixlib=rb-1.1.0&rect=0%2C2%2C1000%2C663&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/large-group-happy-enthusiastic-elderly-ladies-367740026">Shutterstock</a></span></figcaption></figure><p>As Australia heads towards the fourth winter of the pandemic, we have once again started seeing an increase in the level of <a href="https://www.health.gov.au/health-alerts/covid-19/case-numbers-and-statistics?language=und#covid19-case-notifications">COVID circulating</a>. With this comes an increased risk of infection and serious illness.</p>
<p>Elderly people living in aged care are <a href="https://www.health.gov.au/health-alerts/covid-19/advice-for-groups-at-risk/risk-factors-for-more-serious-illness">one of the groups</a> facing the greatest risk.</p>
<p>But the <a href="https://www.health.gov.au/sites/default/files/2023-05/covid-19-outbreaks-in-australian-residential-aged-care-facilities-26-may-2023_0.pdf">latest figures</a> from the federal health department show that to May 24 just over 40% (42.9%) of aged care residents estimated eligible for a booster vaccination have had their latest shot and are fully vaccinated.</p>
<p>If we also take into account immunity gained through recent infection in the past six months, just over half (50.4%) of aged care residents are estimated to have adequate levels of immunity.</p>
<p>Although numbers have increased considerably in the past few weeks, this is plainly far from ideal.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1575083469553926149"}"></div></p>
<h2>It’s been heartbreaking</h2>
<p>Earlier in the pandemic, I was briefly part of the <a href="https://www.theguardian.com/australia-news/2020/jul/25/australian-government-sets-up-aged-care-response-centre-to-deal-with-covid-19-surge-in-victorian-facilities">Victorian Aged Care Response Centre</a>, set up to coordinate the response to the COVID surge in residential facilities. I was part of the team that collected, collated and interpreted COVID data used to inform the public health response.</p>
<p>What we witnessed in aged care then, and since, has been nothing short of heartbreaking. </p>
<p>Our inability to adequately protect aged care residents in the early part of the pandemic was undoubtedly one of our <a href="https://www1.racgp.org.au/newsgp/clinical/covid-represents-aged-care-s-greatest-challenge-ro">biggest pandemic failures</a>. </p>
<p>I saw firsthand that this was not due to a lack of effort. The reality was there were just <a href="https://www.theguardian.com/australia-news/2020/jul/29/a-foreseeable-catastrophe-how-covid-19-swept-through-victorias-nursing-homes">too many factors</a> thwarting our ability to bring outbreaks under control in this <a href="https://theconversation.com/4-in-10-nursing-homes-have-a-covid-outbreak-and-the-death-rate-is-high-whats-going-wrong-187775">uniquely challenging setting</a>.</p>
<p>Since then, aged care residents have continued to die from COVID during the Omicron era. Since January 2022 COVID has accounted for <a href="https://www.health.gov.au/sites/default/files/2023-05/covid-19-outbreaks-in-australian-residential-aged-care-facilities-26-may-2023_0.pdf">about 5%</a> of all deaths in residential aged care.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/4-in-10-nursing-homes-have-a-covid-outbreak-and-the-death-rate-is-high-whats-going-wrong-187775">4 in 10 nursing homes have a COVID outbreak and the death rate is high. What's going wrong?</a>
</strong>
</em>
</p>
<hr>
<h2>Why booster shots are so critical</h2>
<p>Maintaining <a href="https://www.health.gov.au/our-work/covid-19-vaccines/getting-your-vaccination/booster-doses#booster-doses">high levels of immunity</a> by being up to date with COVID boosters is vital for protecting this vulnerable cohort from serious outcomes this winter.</p>
<p>Age, existing chronic illnesses and weaker immune systems are just some of the reasons why this group is most vulnerable.</p>
<p>Not only do vaccines protect against severe illness, they reduce the likelihood of <a href="https://www.health.gov.au/our-work/covid-19-vaccines/advice-for-providers/clinical-guidance/product-information#vaccine-effectiveness-against-sarscov2-transmission">passing COVID</a> on to others in this high-risk environment.</p>
<p>And with higher rates of COVID transmission in the community, we’ll likely see more active outbreaks in residential aged care facilities. This highlights how important it is to see more residents receive their booster shots.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health worker vaccinating an elderly woman wearing mask" src="https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528446/original/file-20230526-29-ovvvur.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">Age, existing chronic illnesses and weaker immune systems are just some of the reasons why elderly people need to have their COVID booster shots.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/general-practitioner-vaccinating-old-patient-clinic-1850607544">Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/havent-had-covid-or-a-vaccine-dose-in-the-past-six-months-consider-getting-a-booster-199096">Haven't had COVID or a vaccine dose in the past six months? Consider getting a booster</a>
</strong>
</em>
</p>
<hr>
<h2>COVID fatigue, vaccine distribution</h2>
<p>It’s not entirely clear why COVID booster rates in aged care are so low.</p>
<p>There may be some <a href="https://www.smh.com.au/national/nsw/a-matter-of-urgency-two-thirds-of-aged-care-residents-not-fully-boosted-20230417-p5d0zr.html">COVID vaccine fatigue</a>. Residents and their families may have tuned out to public health messages about the importance of vaccination and keeping up to date with booster shots. But how much of an issue this is in aged care is hard to measure.</p>
<p>Changes in the way COVID vaccines are delivered to aged care may have also played a role. Early in the pandemic, vaccine delivery was coordinated federally. However, now aged care centres <a href="https://www.health.gov.au/our-work/covid-19-vaccines/information-for-aged-care-providers-workers-and-residents-about-covid-19-vaccines/residential-aged-care-service-providers">are responsible</a> for ensuring residents have access to the recommended COVID vaccine, with primary health-care providers, such as GPs and pharmacists, administering the shots.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1552979471367413761"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/covid-vaccine-consent-for-aged-care-residents-its-ethically-tricky-but-there-are-ways-to-get-it-right-155380">COVID vaccine consent for aged-care residents: it's ethically tricky, but there are ways to get it right</a>
</strong>
</em>
</p>
<hr>
<h2>We’ve tried incentives</h2>
<p>Health departments and health workers are well aware of the need to adequately protect aged care residents as we head towards winter.</p>
<p>In February 2023, <a href="http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/026D05484FA1F70DCA2589390004DE31/$File/PDF%20Version%20Factsheet-Medicare%20Support%20for%20COVID-19%20Vaccinations-20.01.2023.pdf">incentive payments</a> for eligible health workers to go into residential aged care facilities to administer COVID vaccines were streamlined and increased.</p>
<p>In April 2023, the federal health department’s chief medical officer, and the aged care quality and safety commissioner <a href="https://www.agedcarequality.gov.au/sites/default/files/media/joint-letter-to-providers-on-covid-19-preparedness.pdf">issued a joint letter</a> to aged care providers with advice on preparing for winter, including a reminder about COVID vaccination.</p>
<p>The federal government has also <a href="https://www.health.gov.au/resources/webinars/covid-19-response-update-for-primary-care-11-may-2023">called on</a> <a href="https://www.health.gov.au/our-work/phn/what-PHNs-are">Primary Health Networks</a> – bodies responsible for coordinating delivery of primary health care in their regions – to encourage them to support residential aged care homes across Australia to arrange COVID vaccination clinics.</p>
<p>This is all positive and sensible. Yet, we still haven’t seen a huge spike in COVID booster rates as we reach the end of May. That is concerning.</p>
<h2>We mustn’t forget flu vaccines</h2>
<p>As we enter the colder months, influenza also poses a <a href="https://www.vicniss.org.au/media/2056/influenza-rfq04061-pdi-agedcarefactsheet_a4_c-final.pdf">significant threat</a> for aged care residents. </p>
<p>So promoting COVID and influenza vaccination in aged care should go hand-in-hand this year, and for the foreseeable future.</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>
<img src="https://counter.theconversation.com/content/205403/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hassan Vally 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>Elderly people living in aged care are among those most at risk. But not enough are getting vaccinated as we approach winter.Hassan Vally, Associate Professor, Epidemiology, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047662023-05-17T13:23:14Z2023-05-17T13:23:14Z91% of sub-Saharan African workers don’t save for old age: why that’s a problem and how to fix it<figure><img src="https://images.theconversation.com/files/523614/original/file-20230501-28-ys3s45.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sub-Saharan Africa has the lowest level of pension savings in the world</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/nigerian-naira-notes-pension-jar-elderly-759556243">Shutterstock</a></span></figcaption></figure><p><em>Less than 10% of the workers in sub-Saharan Africa save for old age, <a href="https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@soc_sec/documents/publication/wcms_849597.pdf#page=32">the lowest</a> rate for any region in the world. That implies most of the breadwinners today won’t be able to afford basic items after retirement. A pension plan is meant to commit employers to make regular savings so that employees will continue to earn after retirement. The Conversation Africa asked Owen Nyang'oro, a financial economist, about Africa’s pensions and why they need to be fixed.</em> </p>
<hr>
<h2>What’s the state of sub-Saharan Africa’s pension savings?</h2>
<p>In a <a href="https://www.wider.unu.edu/sites/default/files/Publications/Working-paper/PDF/wp2022-95-pension-funds-in-sub-saharan-africa.pdf">recent study</a> of retirement savings in sub-Saharan Africa (other than the francophone countries), we established that the continent’s pension funds are diverse in architecture, coverage and performance. But they mostly lag behind in reforms compared to other regions. Pension savings are also low compared to other regions. Only 19.8% of people above statutory retirement age receive a pension in sub-Saharan Africa, and just 8.9% of the labour force <a href="https://www.ilo.org/wcmsp5/groups/public/@ed_protect/@soc_sec/documents/publication/wcms_849597.pdf#page=32">is covered by pension schemes</a>. This is much lower than the global average where 77.5% of people above statutory age and 53.7% of workers have pension coverage. </p>
<p>Pension schemes in sub-Saharan African countries are characterised by low contributions due to low earnings, high informality, high financial illiteracy levels and lack of proper information about the benefits of adequate contributions for future pension withdrawals.</p>
<p><a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-2022-FINAL.pdf">Market data</a> shows that South Africa, with pension fund assets valued at about US$330.3 billion in 2019 (latest country update), is the continent’s top performer in absolute terms. Nigeria, which had assets worth US$32.6 billion, Kenya with US$13.7 billion and Namibia with US$13.3 billion were the <a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-Preliminary-2021-Data-on-Pension-Funds.pdf#page=2">other top pension savers</a> in 2021. </p>
<p>Countries with low pension savings at the end of 2021 included Mozambique with US$224 million, Zambia (US$745 million) and Angola (US$861 million). </p>
<p>But in proportion to the <a href="https://www.oecd.org/daf/fin/private-pensions/Pension-Markets-in-Focus-2022-FINAL.pdf#page=11">size of the economy</a>, the best performers in 2019 included Namibia (95.4%), South Africa (82.6%) and Botswana (51.9%). Angola, Mozambique, Zambia, Nigeria and Ghana trailed with pension assets below 10% of their gross domestic product.</p>
<p>Generally, Africa’s pension assets are very small compared to the 2021 retirement funds of say, the United States (US$40.0 trillion) or the United Kingdom (US$3.8 trillion). </p>
<h2>What’s peculiar about Africa’s population?</h2>
<p>The majority of the population is young and <a href="https://data.worldbank.org/indicator/SP.DYN.TFRT.IN?locations=ZG">fertility rates</a> are high. The old-age dependency ratio (the number of elderly people for every economically active person) is low compared to other regions, averaging <a href="https://population.un.org/wpp/Download/SpecialAggregates/EconomicTrading/">5.5 in 2022</a>, and the ageing population is small but increasing. The annual population growth rate in sub-Saharan Africa was 2.5% in 2022, which is more <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf">than three times the global annual average of 0.8%</a>.</p>
<p>With much <a href="https://www.un.org/ohrlls/news/young-people%E2%80%99s-potential-key-africa%E2%80%99s-sustainable-development#:%7E:text=Africa%20has%20the%20youngest%20population,to%20realise%20their%20best%20potential.">younger populations</a> and relatively <a href="https://data.worldbank.org/indicator/SP.POP.GROW?locations=ZG">high population growth rates</a>, the number of dependants in sub-Saharan African countries is increasing at a slightly faster rate, and over time the numbers of elderly people needing social support will also rise. It is projected that the number of elderly persons in the region will grow at <a href="https://www.un.org/development/desa/pd/sites/www.un.org.development.desa.pd/files/wpp2022_summary_of_results.pdf#page=20">annual rates above 3% between 2022 and 2050</a>. </p>
<p>The concern is that <a href="https://www.ilo.org/global/research/global-reports/world-social-security-report/2020-22/lang--en/index.htm">only one in five</a> people of pensionable age receives an old-age pension compared to over three in four people globally. </p>
<p>High levels of unemployment and the large <a href="https://theconversation.com/yes-africas-informal-sector-has-problems-but-the-answer-isnt-to-marginalise-it-188234">size of the informal sector</a> – which <a href="https://www.ilo.org/global/publications/books/WCMS_626831/lang--en/index.htm">accounts</a> for over 89.2% of the labour work force – mean that the elderly will continue to face income challenges. Households are also becoming smaller and changing from multi-generational (made up of grandparents, parents, children and grandchildren) which offer social support to the elderly, to skipped-generation (where grandparents live with grandchildren in the absence of parents) or one-generation (where the elderly live by themselves). </p>
<h2>What are the benefits of a good pension system?</h2>
<p>The primary goal of pension savings is to provide income and livelihood in old age. However, pension savings can also be mobilised to finance productive activities and improve living standards.</p>
<p>The continent’s annual infrastructure funding gap (the difference between resources required and what’s available) is <a href="https://www.afdb.org/fileadmin/uploads/afdb/Documents/Publications/African_Economic_Outlook_2018_-_EN.pdf#page=16">estimated</a> at between US$68 billion and US$108 billion. Resources to meet the infrastructure gap could be mobilised from pension funds. This requires good governance and removal of any regulatory obstacles. Pension funds can also support development of capital markets and improve ease of trade in the capital market through their investment activities.</p>
<p>Pension funds can also reduce public borrowing, and improve efficiency of the labour market by creating incentives for formalisation of businesses.</p>
<h2>How should countries improve pension savings?</h2>
<p>African governments can boost pension savings in four ways:</p>
<ul>
<li><p>Increase pension participation and coverage by including the unemployed and those in the informal sector. This could be achieved through a targeted universal pension scheme and greater financial literacy. The countries should have a mix of universal schemes and schemes with payroll deductions and employer contributions.</p></li>
<li><p>Bundling pensions with other products. Bundling pensions with other products such as life insurance cover, and even matching contributions to encourage greater participation and long-term savings in pension funds. Favourable tax considerations can also enhance the growth of contributions and assets of pension funds.</p></li>
<li><p>Use of technology. Leverage innovations in digital technology to increase pension savings. The region <a href="https://www.gsma.com/sotir/wp-content/uploads/2022/03/GSMA_State_of_the_Industry_2022_English.pdf">accounts for 53% of active mobile money accounts in 2021</a>. Use of digital technology could increase coverage, especially in the informal sector. It can make enrolment and contribution to pension funds easier.</p></li>
<li><p>Review regulatory frameworks of the pension sector to open it up to the unserved population. There is also a need to streamline management of pensions and minimise costs of administration, especially for private pensions. This will allow pension funds to extend investments to other assets, including foreign ones, to improve returns.</p></li>
</ul>
<p>Sub-Saharan African countries are likely to gain from a well-developed pension system that provides adequate income to the elderly. This will in turn reduce the need for social protection, provide financing for infrastructure development, and support the development of capital markets. </p>
<p>All this calls for deliberate reforms to facilitate growth of pension savings. Countries should prioritise pensions within their development plans, address informality in the labour market and take advantage of technological advancements and the youthful population.</p>
<p>A well-developed pension system will improve the region’s financial stability through reduced budgetary strain as funds become available for development. It could also open up capital markets and improve the labour market, thus leading to growth.</p><img src="https://counter.theconversation.com/content/204766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The article is based on a study prepared within the United Nations University World Institute for Development Economics Research (UNU-WIDER) project: "The domestic savings shortfall in developing countries - what can be done about it?" which is part of the Domestic Revenue Mobilisation programme financed through specific contributions by the Norwegian Agency for Development Cooperation (Norad).</span></em></p>The number of elderly people in need of support in Africa is projected to grow at annual rates above 3% up to 2050.Owen Nyang'oro, Lecturer, University of NairobiLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2016302023-04-02T11:46:49Z2023-04-02T11:46:49ZAgeism and the pandemic: How Canada continues to let older adults suffer and die from COVID-19<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/ageism-and-the-pandemic--how-canada-continues-to-let-older-adults-suffer-and-die-from-covid-19" width="100%" height="400"></iframe>
<p>Three years into this pandemic, most Canadians have taken off their masks and many have stopped getting booster shots. However, COVID-19 is rising among the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401">leading causes of death</a> in Canada, <a href="https://www.finder.com/ca/what-are-the-top-10-causes-of-death-in-canada">reaching the No. 3 spot</a>.</p>
<p>This is the first time an infectious disease has pushed its way into the top five causes of death during the <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/articles/causesofdeathover100years/2017-09-18">last 80 years or so of the antibiotic era</a>.</p>
<p>Older adults account for most of those deaths, and we are letting it happen.</p>
<h2>COVID-19, aging and ageism</h2>
<p>COVID is a <a href="https://www.cdc.gov/globalhealth/immunization/diseases/index.html">vaccine-preventable disease</a>, but we are not using vaccines as well as we could. Most Canadians don’t understand the importance of booster shots in <a href="https://www.bmj.com/content/380/bmj-2022-072529">protecting them from long-term health issues that may follow infection</a>, such as long COVID. Even fewer recognize that getting vaccinated <a href="https://immunize.ca/">helps protect their entire community</a>, including older adults. </p>
<figure class="align-center ">
<img alt="A man and his grandson wearing face masks touching elbows greeting social" src="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518590/original/file-20230330-27-pzod8w.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">Healthy seniors are assets to their communities. They are caregivers, volunteers and keepers of cultural knowledge.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Most COVID deaths are in older people. That’s not just a problem for them. It’s a problem for everyone. When older adults are healthy they are an incredible asset to our communities — they are <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2020001/article/00007-eng.htm">caregivers</a>, <a href="https://www150.statcan.gc.ca/n1/pub/75-006-x/2021001/article/00002-eng.htm">volunteers</a> and <a href="https://www.bayshore.ca/resources/respect-your-elders-how-seniors-contribute-to-a-better-world/">repositories of knowledge and culture</a>. When they are unwell it is a <a href="https://www.canada.ca/en/public-health/services/publications/science-research-data/economic-burden-illness-canada-2010.html">tremendous strain</a> on them, their caregivers and <a href="https://www.cambridge.org/core/journals/canadian-journal-on-aging-la-revue-canadienne-du-vieillissement/article/abs/chronic-health-conditions-changing-prevalence-in-an-aging-population-and-some-implications-for-the-delivery-of-health-care-services/0FFB314D39504F95027340EBD7534DCB">our health-care system</a>.</p>
<p><a href="https://www.cihi.ca/en/hospital-stays-in-canada">COVID has become the second-leading cause of hospitalization in Canada</a>, after childbirth. Among those over 50, it is the single leading cause of hospitalization. </p>
<p>We had <a href="https://www.publichealthontario.ca/en/data-and-analysis/infectious-disease/covid-19-data-surveillance/covid-19-data-tool?tab=outbreaks">more outbreaks in long-term care facilities in 2022</a> than we had in <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">2020 and 2021 combined, and more deaths and more hospitalizations than the first two years of the pandemic combined</a>. </p>
<p>COVID is not over, but we are acting like it is. Many COVID research programs are <a href="https://www.covid19immunitytaskforce.ca/citf-leadership/">winding down</a>. Can you imagine winding down research into any other condition on the top five mortality list? </p>
<p>The reason for not doing more to prevent COVID-19 appears to be ageism, plain and simple. There is no logical explanation for accepting an unnatural degree of hospitalization and premature deaths in elders except that we value the lives of younger people more. </p>
<h2>The toll of COVID-19 in older people</h2>
<p>Unfortunately, dying isn’t even necessarily the worst of it. </p>
<p>It’s just the part that’s easier to count and that makes the most headlines. There is still a sea of suffering out there, as older people — who are more likely to have other health issues — get sick with COVID and take a long time to recover, if they do recover. </p>
<figure class="align-center ">
<img alt="Rows of small white crosses on a lawn with a building in the background" src="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=425&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=425&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=425&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=534&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=534&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518114/original/file-20230329-16-glion1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=534&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canada had the highest proportion of COVID deaths in long-term care of any country in the Organisation for Economic Co-operation.
and Development. Crosses outside a Mississauga, Ont. long-term care centre during the first wave of the pandemic.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nathan Denette</span></span>
</figcaption>
</figure>
<p>For older adults, respiratory illness is often a <a href="https://doi.org/10.1007/978-3-030-22009-9_550">catalyst for other health problems</a>, triggering a spiral that ends in premature death. Illness also causes many people to <a href="https://www.nber.org/books-and-chapters/women-working-longer-increased-employment-older-ages/women-working-longer-labor-market-implications-providing-family-care">retire early because they or the people they care for are chronically ill</a>.</p>
<p>Canada had the <a href="https://www.cihi.ca/sites/default/files/document/covid-19-rapid-response-long-term-care-snapshot-en.pdf">highest proportion of COVID deaths in long-term care</a> of any country in the Organisation for Economic Co-operation and Development, because we did not prioritize preventing infectious disease. Now, because of the demographic bulge of the Baby Boom, the <a href="https://toronto.ctvnews.ca/wait-list-for-long-term-care-beds-in-ontario-nearly-doubled-in-10-years-oltca-says-1.6229216">demand for long-term care for older adults is rising</a>, even as COVID outbreaks continue in such facilities.</p>
<p>It’s hard to believe that after the <a href="https://www.cbc.ca/news/canada/montreal/quebec-herron-inquest-day-3-1.6170046">horror show</a> in so many Canadian long-term care homes during early months of COVID that we have slipped back into complacency, allowing Canadians’ parents, grandparents, neighbours and friends to become infected because the rest of us won’t take simple actions.</p>
<p>It doesn’t have to be this way, and it shouldn’t. </p>
<h2>Excess COVID-19 deaths in older adults are not inevitable</h2>
<p>Typically, people under 50 are likely to have much more social contact through school, social events and work, making them the most likely to be exposed to the virus. However, they are also the least likely to protect themselves — and others — by keeping up with their <a href="https://health-infobase.canada.ca/covid-19/vaccination-coverage/#a5">booster shots</a> and <a href="https://angusreid.org/covid-unmasked-unwilling/">wearing masks</a>. </p>
<figure class="align-center ">
<img alt="An older woman walking outdoors with a younger woman who has her arm through the older woman's. Both are wearing face masks." src="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/518589/original/file-20230330-1159-b3w2ko.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">If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>It may be easier for them to believe and behave as if the threat of COVID has passed, because they are far <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">more likely to make a quick and complete recovery</a> from COVID. But they are also the ones <a href="https://health-infobase.canada.ca/covid-19/current-situation.html">most likely to spread it to those who have far less immune protection</a> and far less choice. </p>
<p>We shouldn’t treat COVID-19 in older adults as inevitable. With better testing, policy makers could have better information to make decisions about how to reduce the number of infections. If more Canadians kept up with their vaccines, there could be less COVID-19 in the community and vulnerable populations would be better protected.</p>
<p>Older adults have inherent value and dignity, and are an asset to their communities. They are people who have already contributed to society in family, professional and social capacities, and who continue to do so. They deserve to live as long and as well as possible.</p><img src="https://counter.theconversation.com/content/201630/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dawn ME Bowdish receives funding from the COVID-19 Immunity Task Force (Public Health Agency of Canada) for her research on COVID-19 infections and vaccinations in older adults. She is on the Board of Directors of the Lung Health Foundation. </span></em></p>COVID-19 is the third-leading cause of death in Canada, but it’s older people who are dying. That we accept this and carry on as if the pandemic is over reveals our ageism: We don’t value older people.Dawn ME Bowdish, Canada Research Chair in Aging & Immunity, McMaster UniversityLicensed 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/1977662023-01-18T20:28:32Z2023-01-18T20:28:32ZStorytelling allows elders to transfer values and meaning to younger generations<figure><img src="https://images.theconversation.com/files/504829/original/file-20230117-22-olpvhe.jpg?ixlib=rb-1.1.0&rect=58%2C67%2C6416%2C4241&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People don’t necessarily tell the same stories over and over again because they’re losing cognitive function, but because the stories are important, and they feel we need to know them.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>If you spent time over the holidays with elderly relatives or friends, you may have heard many of the same stories repeated — perhaps stories you’d heard over the years, or even over the past few hours.</p>
<p>Repeated storytelling can sometimes be unnerving for friends and families, raising concerns about a loved one’s potential cognitive decline, memory loss or perhaps even the onset of dementia.</p>
<p><a href="https://tenstories.ca/">Our research</a> at Queen’s University suggests there is another way to think about repeated storytelling that makes it easier to listen and engage with the stories. We interviewed 20 middle-aged adults who felt they had heard the same stories over and over from their aging parent. We asked them to tell us those stories and we recorded and transcribed them. </p>
<p>We used a <a href="https://doi.org/10.1108/14439881211248356">narrative inquiry approach</a> to discover that repeated storytelling is a key method for elders to communicate what they believe to be important to their children and loved ones. Narrative inquiry uses the text of stories as research data to explore how people create meaning in their lives.</p>
<figure class="align-center ">
<img alt="An elderly couple and a young man sit around a table chatting." src="https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=357&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=357&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=357&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=449&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=449&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504951/original/file-20230117-21-mowxh5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=449&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Storytelling is an essential human process and an effort to share what’s important.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Transmitting values</h2>
<p>Based on nearly 200 collected stories, we found that there are approximately <a href="https://doi.org/10.1111/scs.13121">10 stories</a> that older parents repeatedly tell to their adult children. </p>
<p>The hypothesis was that repeated storytelling was about inter-generational transmission of values. By exploring the themes of those repeated stories, we could uncover the meaning and messages elders were communicating to their loved ones. </p>
<p>The ultimate purpose was to offer a new and more constructive way of thinking about stories that we’ve heard many times before, and that can be otherwise perceived as alarming.</p>
<h2>Here’s what we have learned:</h2>
<ol>
<li><p>There are typically just 10 stories that people tell repeatedly. While 10 is not a magic number, it does seem to be about the right number to capture the stories that are told over and over. Interviewees felt that a set of approximately 10 allowed them to do justice to their parent’s stories.</p></li>
<li><p>Among our interviewees, a significant number of their parents’ stories – 87 per cent — took place when they were in their teens or twenties. A person’s second and third decades are a time when they make many of the decisions that shape the rest of their lives; a time when values are consolidated and the <a href="https://doi.org/10.1080/09658211.2013.863358">adult identity is formed</a></p></li>
<li><p>What’s important about the 10 stories is not the factual details, but the lesson that was learned, or the value that was reinforced — values like loyalty toward friends, putting family first, maintaining a sense of humour even in hard times, getting an education, speaking up against injustice, and doing what’s right.</p></li>
<li><p>Key themes in the stories reflected the significant events and prevailing values of the early to mid-20th century. Many of the stories revolved around the war, and both domestic and overseas experiences that were formative. Many of our interviewees heard stories about immigrating to Canada, starting out with very little, seeking a better life and working hard. Stories often reflected a more formal time when it was important to uphold standards, make a good impression, know one’s place and adhere to the rules.</p></li>
<li><p>The stories elders tell appear to be curated for the individual receiving them. They would be different if told to another child, a spouse or a friend.</p></li>
</ol>
<h2>Tips for listening</h2>
<p>Our research offers some tips for listening to stories from elders:</p>
<ul>
<li><p>Focus on just 10 stories. It can make the listening seem less overwhelming.</p></li>
<li><p>Write them down. Writing challenges us to get the story straight.</p></li>
<li><p>Notice your loved one’s role in the story, as the message is often contained in that role.</p></li>
<li><p>Be attentive to feelings, sensations, tension and discomfort. These can be signals or clues to the meaning of a story.</p></li>
<li><p>Finally, remember these stories are for you — selected and told in the context of your relationship with your loved one. As such, they are a gift from a loved one who is running out of time.</p></li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An elderly Asian man speaking to a younger boy who is sitting in a woman's arms." src="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/505211/original/file-20230118-7914-mgq0ar.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">Many of the stories elderly people told their family and friends revolved around experiences that were formative.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>The importance of receiving stories</h2>
<p>Storytelling is an <a href="https://doi.org/10.1002/cad.20067">essential human process</a> and a universal experience associated with aging. Neuroscientists suggest that storytelling has practical survival value for individuals and communities, <a href="https://www.jonathangottschall.com/storytelling-animal">as well as social and psychological benefits</a>. </p>
<p>It may be as powerful as medication or therapy for <a href="https://doi.org/10.1002/gps.1018">overcoming depression among elders</a>. Storytelling becomes especially important <a href="https://doi.org/10.1080/13607863.2017.1396581">when people become aware of their mortality</a> — when they are ill, suffering or facing death.</p>
<p>People don’t necessarily tell the same stories over and over again because they’re losing cognitive function, but because the stories are important, and they feel we need to know them. Telling stories repeatedly isn’t about forgetfulness or dementia. It’s an effort to share what’s important.</p>
<p>Our hope is that by better understanding elderly storytelling, caregivers may be able to listen in a different way to those repeated stories and understand the messages they contain. Those 10 stories can help us to know our loved one at a deeper level and assist our parent or grandparent with an important developmental task of old age. </p>
<p>This research offers a constructive way for caregivers to hear the repeated stories told by their aging parents, and to offer their loved one the gift of knowing they have been seen and heard.</p><img src="https://counter.theconversation.com/content/197766/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Mary Ann McColl received funding for this work from the Government of Canada's New Horizons for Seniors program.</span></em></p>Repeated storytelling from elderly relatives doesn’t necessarily always signal age or cognitive decline. It’s about conveying memories and values to a new generation.Mary Ann McColl, Professor, School of Rehabilitation Therapy, Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1949692023-01-03T13:27:22Z2023-01-03T13:27:22ZKick up your heels – ballroom dancing offers benefits to the aging brain and could help stave off dementia<figure><img src="https://images.theconversation.com/files/500091/original/file-20221209-19531-psjcx1.jpg?ixlib=rb-1.1.0&rect=16%2C0%2C5450%2C3663&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not only is it good aerobic exercise, but dancing may help the elderly with reasoning skills and memory.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-couple-dancing-together-in-community-center-royalty-free-image/858729852?phrase=ballroom%20dancing%20elderly&adppopup=true">Thomas Barwick/Stone 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>Social ballroom dancing can improve cognitive functions and reduce brain atrophy in older adults who are at increased risk for Alzheimer’s disease and other forms of dementia. That’s the key finding of my team’s <a href="https://doi.org/10.1123/japa.2022-0176">recently published study</a> in the Journal of Aging and Physical Activity.</p>
<p>In our study, we enrolled 25 adults over 65 years of age in either six months of twice-weekly ballroom dancing classes or six months of twice-weekly treadmill walking classes. None of them were engaged in formal dancing or other exercise programs.</p>
<p>The overall goal was to see how each experience affected cognitive function and brain health. </p>
<p>While none of the study volunteers had a dementia diagnosis, all performed a bit lower than expected on at least one of our dementia screening tests. We found that older adults that completed six months of social dancing and those that completed six months of treadmill walking improved their executive functioning – an umbrella term for planning, reasoning and processing tasks that require attention.</p>
<p>Dancing, however, generated significantly greater improvements than treadmill walking on one measure of executive function and on processing speed, which is the time it takes to respond to or process information. Compared with walking, dancing was also associated with reduced brain atrophy in the hippocampus – a brain region that is key to memory functioning and is particularly affected by Alzheimer’s disease. Researchers also know that this part of our brain can undergo neurogenesis – or grow new neurons – <a href="https://doi.org/10.1073/pnas.0611721104">in response to aerobic exercise</a>. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/unmbhUvnGow?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Research shows those who regularly dance with a partner have a more positive outlook on life.</span></figcaption>
</figure>
<p>While several previous studies suggest that dancing has beneficial effects <a href="https://doi.org/10.1093/ageing/afaa270">on cognitive function in older adults</a>, only a few studies have compared it directly with traditional exercises. Our study is the first to observe both better cognitive function and improved brain health following dancing than walking in older adults at risk for dementia. We think that social dancing may be more beneficial than walking because it is physically, socially and cognitively demanding – and therefore strengthens a wide network of brain regions. </p>
<p>While dancing, you’re not only using brain regions that are important for physical movement. You’re also relying on brain regions that are important for interacting and adapting to the movements of your dancing partner, as well as those necessary for learning new dance steps or remembering those you’ve learned already. </p>
<h2>Why it matters</h2>
<p>Nearly 6 million older adults in the U.S. and 55 million worldwide <a href="https://doi.org/10.1016/j.jalz.2019.01.010">have Alzheimer’s disease</a> or a <a href="https://www.who.int/news-room/fact-sheets/detail/dementia">related dementia</a>, yet there is no cure. Sadly, the efficacy and ethics surrounding recently developed drug treatments <a href="https://doi.org/10.1080/21507740.2022.2129858">are still under debate</a>. </p>
<p>The good news is that older adults can potentially <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">lower their risk for dementia</a> through lifestyle interventions, even later in life. These include reducing social isolation and physical inactivity. </p>
<p>Social ballroom dancing targets both isolation and inactivity. In these later stages of the COVID-19 pandemic, a better understanding of the <a href="https://doi.org/10.1177/23337214211005223">indirect effects of COVID-19</a> – particularly those that increase dementia risk, such as social isolation – is urgently needed. In my view, early intervention is critical to prevent dementia from becoming the next pandemic.
Social dancing could be a particularly timely way to overcome the adverse cognitive and brain effects associated with isolation and fewer social interactions during the pandemic.</p>
<h2>What still isn’t known</h2>
<p>Traditional aerobic exercise interventions such as treadmill-walking or running have been shown to lead to modest but reliable improvements in cognition – <a href="https://doi.org/10.1177/1745691617707316">particularly in executive function</a>. </p>
<p>My team’s study builds on that research and provides preliminary evidence that not all exercise is equal when it comes to brain health. Yet our sample size was quite small, and larger studies are needed to confirm these initial findings. Additional studies are also needed to determine the optimal length, frequency and intensity of dancing classes that may result in positive changes. </p>
<p>Lifestyle interventions like social ballroom dancing are a promising, noninvasive and cost-effective path toward staving off dementia as we – eventually – leave the COVID-19 pandemic behind.</p><img src="https://counter.theconversation.com/content/194969/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Helena Blumen receives funding from National Institute on Aging</span></em></p>Dancing requires physical, social and cognitive engagement and, as a result, it may bolster a wide network of brain regions.Helena Blumen, Associate Professor of Medicine and Neurology, Albert Einstein College of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1940982022-11-09T16:46:34Z2022-11-09T16:46:34Z70-plus seems the new 50 for male politicians, but they’re threatening the world order<figure><img src="https://images.theconversation.com/files/494270/original/file-20221108-4292-14x072.jpg?ixlib=rb-1.1.0&rect=0%2C68%2C5760%2C3578&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Former president Donald Trump arrives for the Bedminster Invitational LIV Golf tournament in Bedminster, NJ., in July 2022. </span> <span class="attribution"><span class="source">(AP Photo/Seth Wenig)</span></span></figcaption></figure><p><a href="https://www.politico.com/news/2022/10/11/bidens-about-to-turn-80-dont-expect-a-blowout-birthday-bash-00061090">Joe Biden is turning 80</a> soon. Russia’s <a href="https://www.reuters.com/world/europe/amid-war-crisis-putin-turns-70-with-prayer-his-health-2022-10-07/">Vladimir Putin is 70</a>; India’s <a href="https://timesofindia.indiatimes.com/india/pm-modi-turns-72-how-he-celebrated-his-birthday-in-the-last-10-years/articleshow/94264591.cms">Narendra Modi is 72</a>, while China’s <a href="https://asia.nikkei.com/Politics/Xi-marks-69th-birthday-as-media-praise-grows">Xi Jinping at 69</a> is the youngest of the rulers of the major world powers.</p>
<p>None are planning to retire.</p>
<p>Brazil just elected a 77-year-old as its new president, while Israel’s incoming prime minister is 73. As younger men, both Luiz Inácio Lula da Silva and Benjamin Netanyahu <a href="https://www.cnn.com/2022/11/02/politics/trump-lula-da-silva-netanyahu-second-political-acts/index.html">held power previously</a>. <a href="https://people.com/politics/donald-trump-plans-to-celebrate-his-76th-birthday-in-new-jersey-bedminster/">Donald Trump, at age 76</a>, is reportedly about to announce that <a href="https://www.abc.net.au/news/2022-11-08/trump-to-make-big-announcement-next-week/101629732">he will seek the American presidency a second time</a> in 2024.</p>
<p>One reason for the gerontocracy is that those who assumed power at younger ages in non-democratic countries have amended constitutions and rules to allow unlimited terms of office. In Russia, Putin has ruled uninterrupted for 23 years, while in China, Xi has ensured unlimited years of rule for himself.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black-and-white photo of a man with thinning dark hair wearing a suit and tie." src="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494176/original/file-20221108-18-7zleo2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Newly elected Sen. Joe Biden is seen in this 1972 photo.</span>
<span class="attribution"><span class="source">(AP Photo/Henry Griffin)</span></span>
</figcaption>
</figure>
<p>In democratic countries, older politicians draw on decades of political capital and alliances. Biden’s success in running for president was partly due to the fact that he convinced voters that his 36 years as senator and eight years as vice-president would benefit America. <a href="https://www.cbc.ca/news/world/midterm-morning-after-analysis-1.6645292">The surprisingly strong performance of Democrats</a> in the mid-term elections may suggest he has a point.</p>
<p>Like Biden, older leaders often promise continuity and stability. In a world beset with daunting problems — from climate change to pandemics and inflation — a capable leader, particularly of a major power, is often seen by citizens as someone who has a track record. Those with many years of political experience argue they are best placed to deal with what lies ahead.</p>
<h2>Challenges faced by novices</h2>
<p>The sorry tale of Liz Truss, Britain’s prime minister for 44 days earlier this year, shows how quickly and furiously the <a href="https://www.bbc.com/news/world-63333462">business and political establishment can turn on a novice leader</a>.</p>
<p>Curiously, western Europe, the region with the largest proportion of older citizens <a href="https://ec.europa.eu/eurostat/web/products-eurostat-news/-/ddn-20210316-1">(more than a fifth of western Europeans are over age 65</a>), has the youngest leaders. France’s Emmanuel Macron, in his second term, <a href="https://gettotext.com/emmanuel-macron-celebrates-his-44-years-why-he-lived-very-badly-his-last-birthday-femme-actuelle-the-mag/">is 44</a>, while the United Kingdom’s <a href="https://economictimes.indiatimes.com/news/international/world-news/at-42-rishi-sunak-youngest-to-take-uk-pm-office-in-over-200-years/articleshow/95067616.cms">Rishi Sunak is 42</a>. German Chancellor <a href="https://www.britannica.com/biography/Olaf-Scholz">Olaf Scholz at 64</a> is the oldest leader of a major European country.</p>
<p>The phenomenon of younger leaders but a greying population in Europe is due to some extent to the unique politics of many countries in the region. Nearly all European nations have a multitude of political parties, meaning coalition governments are the norm. </p>
<p>Other countries, like the U.K., have party rules that make it relatively easy to replace leaders. Under such conditions, outcomes in political leadership races are less predictable, and there’s more turnover. Britain has had <a href="https://www.npr.org/2022/10/20/1130184234/liz-truss-prime-minister-resigns-uk-turmoil%5D">five prime ministers in the past six years</a>, while <a href="https://www.euronews.com/my-europe/2022/10/21/italy-is-set-for-its-68th-government-in-76-years-why-such-a-high-turnover">Italy has had four</a>.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman with long dark hair and wearing a white blouse adjusts her earphone." src="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494178/original/file-20221108-18-z8f3a6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Finnish Prime Minister Sanna Marin adjusts her earphone during a media conference at the European Parliament in France in September 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Jean-Francois Badias)</span></span>
</figcaption>
</figure>
<p>Women are largely absent among world leaders. The few women who have recently reached the pinnacle of political power have done so early in their careers. <a href="https://www.aljazeera.com/news/2022/10/22/italy-sworns-in-first-female-prime-minister-giorgia-meloni">Giorgia Meloni, the new prime minister of Italy, is 45</a> while <a href="https://www.britannica.com/biography/Jacinda-Ardern">Jacinda Ardern of New Zealand is 42</a>. <a href="https://www.britannica.com/biography/Sanna-Marin">Sanna Marin, the prime minister of Finland, turns 37 soon</a>.</p>
<h2>Working longer</h2>
<p>Around the world people are living longer and healthier lives than ever before in human history, <a href="https://www.theatlantic.com/newsletters/archive/2022/08/older-aging-politicians-athletes-culture/671027/">and in many cases working longer</a>. This is good news, but there are concerns about elderly and long-serving leaders.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/antiquated-thinking-about-old-age-hinders-canadas-economic-and-social-development-182367">Antiquated thinking about old age hinders Canada’s economic and social development</a>
</strong>
</em>
</p>
<hr>
<p>They may be out of touch with the younger generations they need to represent. Solutions to policy conundrums that worked for them decades ago might no longer apply now or in the future. </p>
<p>Their attitudes and perspectives may become conservative or inflexible. <a href="https://abtc.ng/meet-sanna-marins-adorable-daughter-emma-amalia-marin/">Unlike Finland’s Marin</a>, they probably don’t have children in kindergarten and so don’t see how policy plays out in real life.</p>
<figure class="align-right ">
<img alt="An ageing man poses for a photo with a young child." src="https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/494174/original/file-20221108-14-7adp6l.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">
<figcaption>
<span class="caption">Supporters take photos of Luiz Inacio Lula da Silva on election day in São Paulo, Brazil, on Oct. 30, 2022.</span>
<span class="attribution"><span class="source">(AP Photo/Marcelo Chello)</span></span>
</figcaption>
</figure>
<p>Transitions from one leader to another are among <a href="https://hbswk.hbs.edu/item/transitions-of-power-are-difficult-what-joe-biden-and-other-incoming-leaders-need-to-know">the most dangerous times</a> in the political life of a nation, whether they’re democracies or authoritarian regimes. The Capitol Hill riots in the United States during the <a href="https://thegroundtruthproject.org/capitol-breach-demonstrated-u-s-democracys-vulnerability-how-does-that-affect-americas-global-influence-president-trump-impeachment/">last days of Trump’s infamous presidency</a> are a reminder of how even in the “world’s greatest democracy,” long-established rules about the transfer of power can quickly be undermined.</p>
<p>But when the same person dominates public life in a nation for a long time, transitions are bound to be even more difficult. This is especially worrying in a large and powerful country since internal volatility can quickly have dramatic, and unpredictable, international repercussions.</p>
<p>Long-term rulers rarely prepare a succession plan, if only because doing so jeopardizes their grip on power. </p>
<p>But without a succession strategy and strong institutions that support a peaceful transition to the next leader, the aging leaders of the world’s superpowers can represent a serious threat to the global order.</p><img src="https://counter.theconversation.com/content/194098/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Thomas Klassen 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>Many of the world’s most powerful and aspiring leaders are aging or elderly men. That’s a big problem.Thomas Klassen, Professor, School of Public Policy and Administration, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1758792022-06-27T12:25:53Z2022-06-27T12:25:53ZSocial Security benefits play key role in preventing older Americans from lacking enough quality food<figure><img src="https://images.theconversation.com/files/468321/original/file-20220610-39156-lh3vlo.jpg?ixlib=rb-1.1.0&rect=241%2C60%2C6468%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social Security makes it more likely the elderly have enough food.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/cheerful-mature-couple-having-fun-while-eating-royalty-free-image/1164678611">skynesher/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>Social Security benefits make it easier for older Americans to afford the food they need to live a healthy, active life, according to <a href="http://www.doi.org/10.1002/aepp.13218">our recently published research</a>. </p>
<p>Although this finding may seem obvious, to our knowledge this is the first study to directly examine the link between income from Social Security in old age and <a href="https://theconversation.com/what-is-food-insecurity-152746">food insecurity</a>, whereby a household can’t get adequate food because it has insufficient money and other resources.</p>
<p>We used data from a unique national household survey, the <a href="https://psidonline.isr.umich.edu">Panel Study of Income Dynamics</a>, to examine changes in the ability of a household to purchase food from year to year. We focused on how just under 1,000 households receiving Social Security benefits for the first time or experiencing an increase in Social Security benefits affected their food insecurity. </p>
<p>We found that becoming a Social Security beneficiary for the first time lowers the odds of food insecurity by 54%. After that, an increase in benefits by 10% reduced the probability of someone’s being food insecure by over half a percentage point, we found.</p>
<p>Another way to put this: We estimate that if overall benefits were increased by 10%, about half a million senior citizens would no longer be food insecure. </p>
<h2>Why it matters</h2>
<p>Unfortunately, in our view, the debate over Security Security isn’t whether or how much to increase benefits <a href="https://www.cnn.com/2022/06/02/politics/social-security-medicare-report/index.html">but how much to cut them</a>. </p>
<p>That’s because the Old-Age and Survivors Insurance Trust Fund, which funds benefits, <a href="https://www.ssa.gov/oact/TRSUM/">is expected to be depleted</a> by 2034, at which point Social Security taxes alone will cover just 77% of scheduled benefits.</p>
<p>Social Security <a href="https://www.ssa.gov/history/briefhistory3.html">was originally conceived</a> in 1934 as a way to cut poverty among older Americans. Researchers have <a href="https://www.nber.org/papers/w10466">previously shown</a> that receiving Social Security income indeed reduces overall levels of poverty among older Americans, but they didn’t explicitly look at the impact on food security.</p>
<p>Since aging is often associated with increased medical expenses, these additional costs may offset any income gains seen from Social Security. Older adults with limited incomes may need to make difficult choices about what expenses to cover and may choose to prioritize health care expenses over food expenses.</p>
<p>Currently, <a href="https://hungerandhealth.feedingamerica.org/wp-content/uploads/2020/05/2020-The-State-of-Senior-Hunger-in-2018.pdf">11% of adults age 60 or older</a> are food insecure, which is a little higher than the <a href="https://www.ers.usda.gov/topics/food-nutrition-assistance/food-security-in-the-u-s/key-statistics-graphics/">10.5% for all U.S. households</a>. Seniors can begin receiving Social Security benefits as soon as age 62.</p>
<p>Our study suggests that cutting Social Security benefits would be likely to cause more retirees to struggle to access the food they need and push more retirees to enroll in government-sponsored programs such as SNAP, which provide funds to purchase food. </p>
<h2>What still isn’t known</h2>
<p>The impact of receiving Social Security benefits varies from group to group. </p>
<p>The small sample size of the data set we used limited our ability to fully explore this. Continuing this research using a larger nationally representative data set such as the <a href="https://www.census.gov/programs-surveys/cps.html">Current Population Survey</a> could make it possible to explore this issue in more detail across different groups of people. </p>
<p>In addition, we did not explore exactly how Social Security benefits reduce food insecurity. Social Security benefits may have direct impacts by boosting income overall or by reducing fluctuations in income from month to month, allowing people to consistently acquire more healthy food. Social Security benefits may also affect food insecurity through indirect channels by improving physical or mental health. Future research that captures more detailed information about health and getting Social Security benefits could explore these impacts more closely.</p><img src="https://counter.theconversation.com/content/175879/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophie Mitra receives funding from the U.S. Department of Agriculture, Food and
Nutrition Service. She is currently a visiting research scholar at the Center for Health and Wellbeing at Princeton University. </span></em></p><p class="fine-print"><em><span>Debra Brucker receives funding from the U.S. Department of Agriculture and the U.S. Social Security Administration.</span></em></p><p class="fine-print"><em><span>Katie Jajtner receives funding from the U.S. Department of Agriculture and the U.S. Social Security Administration. </span></em></p>Higher Social Security benefits can significantly reduce the odds of an older person’s being food insecure.Sophie Mitra, Professor of economics, Fordham UniversityDebra Brucker, Research Associate Professor at Institute on Disability, University of New HampshireKatie Jajtner, Assistant Scientist, Center for Demography of Health and Aging, University of Wisconsin-MadisonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1840952022-06-06T12:26:26Z2022-06-06T12:26:26ZTechnology is alienating people – and it’s not just those who are older<figure><img src="https://images.theconversation.com/files/466388/original/file-20220531-26-1dgfp7.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5744%2C3809&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many types of people feel disengaged with technology</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-attractive-latin-woman-lying-home-1147331624">Shutterstock</a></span></figcaption></figure><p>We take it for granted that technology brings people closer together and improves our access to essential products and services. If you can’t imagine life without your smartphone, it’s easy to forget that people who can’t or don’t want to engage with the latest technology are being left behind. </p>
<p>For example, there have recently been reports that <a href="https://www.express.co.uk/life-style/cars/1618497/parking-poll-results-cashless-car-parks-card-smartphone-app-only-elderly-drivers-spt">cashless payment systems</a> for car parking in the UK are seeing older drivers unfairly hit with fines. This has led to calls for the <a href="https://www.dailymail.co.uk/news/article-10851103/Esther-Rantzen-tells-ministers-pensioners-not-use-apps-pay-parking.html">government to intervene</a>.</p>
<p>Age is one of the biggest predictors of <a href="https://ageing-better.org.uk/sites/default/files/2020-08/landscape-covid-19-digital.pdf">digital exclusion</a>. Only 47% of those aged <a href="https://www.ons.gov.uk/businessindustryandtrade/itandinternetindustry/bulletins/internetusers/2019">75 and over</a> use the internet regularly. And out of the 4 million who have never used the internet in the UK, only 300,000 people are <a href="https://ageing-better.org.uk/sites/default/files/2020-08/landscape-covid-19-digital.pdf">under 55</a>.</p>
<p>But older people are not the only ones who feel shut out by new technology. For example, research shows vulnerable people, such as those with disabilities, are also disengaging with e-services and being <a href="https://www.tandfonline.com/doi/full/10.1080/0267257X.2012.691526">“locked out” of society</a>. </p>
<h2>The digital transition</h2>
<p>From train tickets to vaccine passports, there is a growing expectation that consumers should embrace technology to participate in everyday life. This is a global phenomenon. Out in front, Sweden predicts its economy will be <a href="https://sweden.se/life/society/a-cashless-society">fully cashless</a> by March 2023.</p>
<p>Shops increasingly use QR codes, virtual reality window displays and self-service checkouts. Many of these systems require a smart device, and momentum is building for QR codes to be integrated into <a href="https://www.thegrocer.co.uk/technology-and-supply-chain/the-time-has-finally-arrived-for-electronic-shelf-labels-heres-why/661068.article">digital price tags</a> as they can give customers extra information such as nutritional content of food. Changing paper labels is a labour intensive process. </p>
<p>Technology pervades all aspects of consumer life. Going on holiday, enjoying the cinema or theatre, and joining sport and social clubs all make people feel part of society. But many popular artists now use online queues to sell tickets to their shows. Social groups use WhatsApp and Facebook to keep their members updated. </p>
<p>When it comes to booking a holiday, there is a <a href="https://www.statista.com/statistics/919811/number-of-travel-agents-united-kingdom-uk/#:%7E:text=Overall%2C%20there%20were%203%2C710%20retail,as%20TUI%20and%20Hays%20Travel.">decreasing number</a> of in-person travel agents. This limits the social support to make the best choice, which is particularly important for those with specific needs such as people with health issues. And once travelling, aircrew expect flight boarding passes and COVID passports to be available on smartphones. </p>
<p>Essential services such as healthcare, which can already <a href="https://www.tandfonline.com/doi/full/10.1080/0267257X.2022.2078861">be difficult</a> for older and other people to navigate, are also moving online. Patients are increasingly expected to use the GP website or email to request to see a doctor. Ordering prescriptions online is encouraged. </p>
<figure class="align-center ">
<img alt="Older man sits alone in a green chair at a park, autumn leaves on the ground" src="https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/466389/original/file-20220531-26-ycjd7m.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">Most of the people who have never used the internet are over 55.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-sitting-alone-on-park-bench-1669176061">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Not just older people</h2>
<p><a href="https://www.gov.uk/government/publications/digital-lifeline-a-qualitative-evaluation/digital-lifeline-a-qualitative-evaluation">Not everyone can afford</a> an internet connection or smart technology. Some regions, particularly rural ones, struggle for phone signal. The UK phone network’s plans for a <a href="https://www.bbc.co.uk/news/uk-england-shropshire-61377944">digital switchover</a> by 2025, which would render traditional landlines redundant, could cut off people who rely on their landlines. </p>
<p>Concerns about privacy can also stop people using technology. Data collection and security breaches impact people’s confidence in organisations. A 2020 survey into <a href="https://www.mckinsey.com/business-functions/risk-and-resilience/our-insights/the-consumer-data-opportunity-and-the-privacy-imperative">consumers’ trust</a> in businesses showed no industry reached a trust rating of 50% for data protection. The majority of respondents (87%) said they would not do business with a company if they had concerns about its security practices. </p>
<p>Some people view “forced” digitisation as a symbol of consumer culture and will limit their technology use. Followers of the <a href="https://www.researchgate.net/publication/228310981_The_Voluntary_Simplicity_Movement_Reimagining_the_Good_Life_Beyond_Consumer_Culture">simple living movement</a>, which gained momentum in the 1980s, try to minimise their use of technology. Many people take a “less is more” <a href="https://www.emerald.com/insight/content/doi/10.1108/JCM-04-2020-3749/full/html">approach to technology</a> simply because they feel it offers a more meaningful existence. </p>
<p>One of the most common reasons for digital exclusion, however, <a href="https://www.iriss.org.uk/resources/esss-outlines/digital-inclusion-exclusion-and-participation">is poverty</a>. When the <a href="https://www.local.gov.uk/parliament/briefings-and-responses/tackling-digital-divide-house-commons-4-november-2021">pandemic hit in March 2020</a>, 51% of households earning between £6,000 to £10,000 had home internet access, compared with 99% of households with an income over £40,000.</p>
<p>Limited access to tablets, smartphones and laptops can result in feelings of isolation. Many older consumers have developed strategies to manage and overcome the <a href="https://www.tandfonline.com/doi/full/10.1080/0267257X.2021.1945662">digital challenges</a> presented by these devices. But those unable to <a href="https://theconversation.com/how-older-people-are-mastering-technology-to-stay-connected-after-lockdown-165562">engage with technology</a> remain excluded if their family and friends don’t live close by. </p>
<h2>Smart change</h2>
<p>The solution is not simply to give devices to those without smart technology. While there is a need to provide affordable internet access and technology, and offer support in learning new skills, we need to recognise diversity in society. </p>
<p>Services should provide non-digital options that embrace equality. For example, cash systems should not be abolished. There might be a demand for services to become digital, but service providers need to be aware of the people who will be isolated by this transition. </p>
<p>Retailers, local councils, health providers and businesses in tourism, entertainment and leisure should try to understand more about the diversity of their consumers. They need to develop services that cater for the needs of all people, especially those without access to technology.</p>
<p>We live in a diverse world and diverse consumers need choice. After all, access to and inclusion in society is a human right.</p><img src="https://counter.theconversation.com/content/184095/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 organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Think again if you assume only older people are isolated by technology.Carolyn Wilson-Nash, Lecturer, Marketing and Retail, Stirling Management School, University of StirlingJulie Tinson, Professor of Marketing, University of StirlingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1838932022-05-30T15:12:44Z2022-05-30T15:12:44ZMore long-term care beds in Ontario won’t help without well-paid, well-trained staff<figure><img src="https://images.theconversation.com/files/465394/original/file-20220525-18-6c6gst.JPG?ixlib=rb-1.1.0&rect=0%2C0%2C5138%2C3671&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A resident chats with workers at Orchard Villa Long-Term Care in Pickering, Ont., in June 2020.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span></figcaption></figure><p>Days away from the Ontario election, with health care a <a href="https://www.cp24.com/news/healthcare-number-one-issue-for-ontario-voters-new-poll-suggests-1.5888145">top issue</a>, what are the three major parties’ proposals for fixing Ontario’s chronic long-term care problems?</p>
<p>The governing Conservatives are planning <a href="https://toronto.ctvnews.ca/ontario-plans-to-spend-933m-on-increasing-improving-long-term-care-spaces-1.5353011?cache=ipijopopjosws%3FclipId%3D89531">to open 30,000 more beds and upgrade existing facilities</a>. </p>
<p><a href="https://ontarioliberal.ca/elder-care-plan/">The Liberals</a> plan to end for-profit long-term care and increase the proportion of at-home care, increasing spending by 10 per cent annually. </p>
<p>The <a href="https://www.ontariondp.ca/platform">New Democrats</a> would add long-term care spaces, help seniors live at home longer and upgrade the pay of the personal support workers who provide most of the physical care in nursing homes and home-care settings.</p>
<p>I wouldn’t believe any of their promises.</p>
<p>Their plans gloss over what is really going on — we haven’t been training nearly enough health-care workers necessary to care for our elderly. The promised new beds and money for services require people to actually work at long-term care facilities and provide care, which we don’t have.</p>
<p>Let’s not blame the politicians completely though. All of this was predicted years ago, yet it took a pandemic for many of us to wake up to the reality. Our elder-care system is in trouble and Ontario’s <a href="https://www12.statcan.gc.ca/census-recensement/2021/as-sa/98-200-X/2021003/98-200-X2021003-eng.cfm">fastest growing demographic</a> faces a grim future. Many of us may shortly find ourselves or our loved ones without care.</p>
<h2>COVID-19 devastation</h2>
<p>We were all saddened, often angered, by what we saw happening in Ontario’s long-term care homes in the early months of the pandemic. COVID-19 swept into facilities filled with vulnerable residents but severely lacking in well-trained, adequately paid, experienced professional care workers. </p>
<p>The results were tragic — <a href="https://covid19-sciencetable.ca/sciencebrief/covid-19-and-ontarios-long-term-care-homes-2/">many COVID-19 deaths in Ontario</a> <a href="https://doi.org/10.1371/journal.pone.0262807">occurred in long-term care homes</a> while many more residents were sickened, forced into quarantine and separated from their families.</p>
<figure class="align-center ">
<img alt="A sea of ornamental poppies in front of a long-term care home" src="https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/465392/original/file-20220525-16-38henl.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">A sea of ornamental poppies in front of the Main Street Terrace long-term care home in Toronto in November 2020. The home experienced a COVID-19 outbreak among residents and staff.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Frank Gunn</span></span>
</figcaption>
</figure>
<p>The pandemic exposed problems that had long festered. Many of them boiled down to not having enough staff, or staff who weren’t trained sufficiently and who lacked experience. That’s because there is simply not enough money being spent on people to look after us as we age.</p>
<p>Many of us, at some point, will cease to be able to live independently. <a href="https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long-term-services-supports-0">Research suggests we’ll likely need care in a residential home</a> or, if fortunate, in our own home. Many of us will be dependent on others at some point … but who will we depend on?</p>
<p>Long-term care is, at its root, straightforward. Vulnerable people, many of them older, need skilled, trustworthy caregivers to help them move around, bathe and dress.</p>
<p>While technology and automation have made many other sectors much more efficient, their use is <a href="https://www.mcmasteroptimalaging.org/blog/detail/blog/2021/08/11/harnessing-the-potential-of-technology-to-strengthen-the-long-term-care-sector-(part-1)">naturally limited</a> in long-term care or home-based care, since almost all the work is one-to-one skilled personal care. Health care, consequently, requires paying people to help other people.</p>
<h2>The backbone of elder care</h2>
<p>Whether care happens at home or in a facility, most care is provided by personal support workers, who are the unregulated backbone of elder care. Their jobs are stressful and laborious, and they don’t get <a href="https://www.cbc.ca/news/canada/ottawa/home-care-workers-poorly-paid-shortage-gender-race-issue-1.5953597">paid enough</a>. As a result, there is <a href="https://www.ontario.ca/page/long-term-care-staffing-study">high staff turnover</a>, which makes it difficult to develop an experienced, professional and committed workforce. </p>
<p>Important care is also provided by nurses, therapists, physicians and others who are also not incentivized to care for our elders.</p>
<p>More beds will not help unless those beds come with real staff. This has been made plain during the pandemic, when anecdotal reports circulate that much of the COVID-19 emergency care funds were returned because <a href="https://toronto.ctvnews.ca/ontario-long-term-care-homes-see-staff-absences-of-20-to-30-per-cent-amid-outbreaks-1.5730144">there wasn’t enough staff available</a> to pay to expand care.</p>
<p>The number of personal care workers, nurses and others <a href="https://www.oecd.org/publications/who-cares-attracting-and-retaining-elderly-care-workers-92c0ef68-en.htm">has declined per capita in Canada, and is well below comparable countries</a>. </p>
<p>It’s no surprise that burnout among care workers is at <a href="https://covid19-sciencetable.ca/sciencebrief/burnout-in-hospital-based-healthcare-workers-during-covid-19/">an all-time high</a>, and many are working reduced hours or leaving health care altogether. It’s also no surprise that as society ages, so do care workers, <a href="https://www.conferenceboard.ca/e-library/abstract.aspx?did=11445">compounding the issue</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1527622123002404864"}"></div></p>
<p>What Ontario most needs is far more people caring for our elders and other vulnerable populations, and for those caregivers to be better trained and better paid.</p>
<p>So when political candidates talk about their long-term care proposals, let’s remember there isn’t much point unless we train and adequately compensate enough workers to care for our loved ones.</p><img src="https://counter.theconversation.com/content/183893/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Costa receives funding from: Canadian Institutes for Health Research, Public Health Agency of Canada, Health Canada, Retirement Homes Regulatory Authority. I do not accept private funding, gifts, or fees.
I hold the position of Schlegel Chair at McMaster University, which was established by a gift by the Schlegel family - who own and operate Schlegel Villages; a chain of long-term care and retirement homes. Schlegel Chair endowment was a charitable donation to McMaster. I was appointed to Chair by institution and have no obligation to the donor. </span></em></p>When political candidates talk about their long-term care proposals, let’s remember there isn’t much point unless we recruit and adequately compensate enough workers to care for our loved ones.Andrew Costa, Associate Professor | Schlegel Chair in Clinical Epidemiology & Aging, McMaster UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1791772022-04-14T12:14:29Z2022-04-14T12:14:29ZThe FDA approved a new drug to treat Alzheimer’s, but Medicare won’t always pay for it – a doctor explains what researchers know about Biogen’s Aduhelm<figure><img src="https://images.theconversation.com/files/456237/original/file-20220404-17-spt0ki.jpg?ixlib=rb-1.1.0&rect=0%2C10%2C7178%2C4031&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An illustration of amyloid plaques within the human brain, characteristic features of Alzheimer's. By 2060, approximately 14 million Americans are expected to have the disease.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/illustration/nerve-cells-affected-by-alzheimers-disease-royalty-free-illustration/1328334584?adppopup=true">Kateryna Kon/Science Photo Library via Getty Images</a></span></figcaption></figure><p><a href="https://www.statnews.com/2022/04/07/medicare-final-decision-alzheimers-coverage-biogen-aduhelm/?utm_source=STAT+Newsletters&utm_campaign=954f9558f2-MR_COPY_01&utm_medium=email&utm_term=0_8cab1d7961-954f9558f2-153726530">Medicare finalized its decision</a> to restrict its coverage of Aduhelm, Biogen’s new Alzheimer’s disease drug, on April 8, 2022.</p>
<p>The decision means only patients who have enrolled in clinical trials <a href="https://www.commonwealthfund.org/blog/2022/medicares-decision-cover-alzheimers-drug-aduhelm-what-will-it-mean-patients-and-program">will receive Medicare coverage for Aduhelm</a>, which goes by the generic drug name of Aducanumab. </p>
<p>Because of the restrictions, many Alzheimer’s patients may be unable to use the drug. Without Medicare coverage, Aduhelm’s annual cost is US$28,200, or $2,350 a month, a price that’s prohibitively expensive for most Americans. </p>
<p>What’s more, not everyone with mild Alzheimer’s will be able to enroll in a clinical trial due to location or other logistical issues. And some of those in the trial may be randomized to only receive a placebo. </p>
<p>Medicare’s ruling clashes dramatically with the Food and Drug Administration’s <a href="https://www.fda.gov/news-events/press-announcements/fda-grants-accelerated-approval-alzheimers-drug">decision in June 2021</a> to approve Aduhelm for all Alzheimer’s patients without restrictions. </p>
<p>This is a departure for Medicare, which <a href="https://doi.org/10.18553/jmcp.2018.24.12.1230">almost always pays for drugs the FDA approves</a>, at least for authorized uses.</p>
<p><a href="https://khn.org/morning-breakout/biogen-pushes-back-against-medicare-decision-over-alzheimers-drug/">Biogen has criticized Medicare’s decision</a>, saying the added requirements “<a href="https://investors.biogen.com/news-releases/news-release-details/biogens-statement-draft-national-coverage-determination-ncd">would significantly restrict</a> and delay patient access to an FDA-approved therapy for a progressive disease.”</p>
<p>But the <a href="https://www.politico.com/news/2022/04/09/alzheimer-drug-aduhelm-medicare-coverage-00024222">core of the issue</a> surrounding this drug is simple: Does it actually work? </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/swvqh1N-MoA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">An explainer on Aduhelm, the new drug to treat Alzheimer’s.</span></figcaption>
</figure>
<h2>Mixed trial results</h2>
<p><a href="https://einstein.pure.elsevier.com/en/persons/andrew-r-williams">As a physician and researcher</a> who investigates the efficacy of medicines, I have been watching this story unfold over the past year. As of right now, I am certain of one thing: With 6 million people in the United States suffering from Alzheimer’s, and current treatments only marginally effective, there is a desperate need for medications that can slow the disease. </p>
<p>But the evidence on Aduhelm so far is contradictory. Two <a href="https://clinicaltrials.gov/ct2/show/study/NCT02477800">Phase III</a> <a href="https://clinicaltrials.gov/ct2/show/study/NCT02484547">clinical trials</a> were stopped early after an independent committee, appointed by Biogen, analyzed the data and reported the studies were unlikely to show Aduhelm would demonstrate a benefit. This is not unusual; clinical trials are often stopped when early data suggests a drug will not work.</p>
<p>After that analysis, Biogen announced <a href="https://doi.org/10.1016/S1474-4422(19)30480-6">it did find benefits</a> that were statistically significant in one of the trials. This came after evaluating results for 318 participants whose data was not available in time for the initial committee review. That <a href="https://doi.org/10.1002/alz.12286">new data</a> showed the cognitive function of participants in the high-dose group declined 23% more slowly than those in the placebo group. The low-dose group showed no benefit. </p>
<p>While the effects on cognitive decline may seem ambiguous, Aduhelm indisputably <a href="https://doi.org/10.1038/nature19323">reduces patients’ amyloid plaques</a>. It was on this basis that Biogen sought approval for Aduhelm through FDA’s <a href="https://www.fda.gov/drugs/information-health-care-professionals-drugs/accelerated-approval-program">accelerated approval pathway</a>, where drugs treating a serious illness may receive expedited approval if they are reasonably likely to provide a clinical benefit based on some other marker, such as amyloid plaque burden.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/DtbMkAEOan4?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">From the CBS Evening News: The challenge to caregivers.</span></figcaption>
</figure>
<h2>Background on Aduhelm</h2>
<p>Aduhelm is a monoclonal antibody treatment delivered as an infusion. The drug targets amyloid, a protein that clumps in the brains of Alzheimer’s patients. </p>
<p>While Aduhelm does reduce amyloid plaques in patients’ brains, so do many other medications that haven’t been shown <a href="https://doi.org/10.1136/bmj.n156">to slow cognitive decline</a>. It may be that reducing amyloid plaques does not necessarily improve cognitive function in Alzheimer’s patients. </p>
<p>At the core of the question is the amyloid hypothesis, which has been a central concept of Alzheimer’s research for decades. Simply put, the hypothesis assumes that accumulation of <a href="https://www.alz.org/documents/national/topicsheet_betaamyloid.pdf">the peptide amyloid-B</a> is the primary cause of Alzheimer’s. Many researchers believe that it initiates <a href="https://doi.org/10.1038/d41586-018-05719-4">a cascade of processes</a> that include inflammation and the <a href="https://doi.org/10.1016/j.bbadis.2004.08.014">formation of neurofibrillary tangles</a>, made up of the protein tau, within brain cells. This is thought to lead to dysfunction of the communication points between brain cells known as synapses, which ultimately leads to cell death.</p>
<p>But amyloid plaques are often found in the brains of individuals who <a href="https://dx.doi.org/10.1097%2FNEN.0b013e31822e8ae9">do not have Alzheimer’s</a>. The reduced cognitive function seen in Alzheimer’s is more closely correlated with the number and location of <a href="https://doi.org/10.1097/NEN.0b013e31825018f7">intracellular tau-tangles</a>. It may be that those with <a href="https://www.statnews.com/2020/02/27/alzheimers-brains-but-no-symptoms/">plaques but no symptoms</a> have an early stage of Alzheimer’s.</p>
<h2>Risks and ripple effects</h2>
<p>While the benefits of Aduhelm remain murky, some risks are clear. The same Phase III trials showed that 41% of patients who received the high dose of Aduhelm – the dose that may have led to cognitive benefits – <a href="https://doi.org/doi:10.1001/jamaneurol.2021.4161">experienced cerebral swelling or hemorrhage</a>. Although the majority of these were minor and asymptomatic, a <a href="https://www.nytimes.com/2021/11/22/health/aduhelm-death-safety.html">75-year-old woman in the trial died</a> after experiencing brain swelling and seizures. The risk was considered high enough for the FDA to require the company <a href="https://www.accessdata.fda.gov/drugsatfda_docs/label/2021/761178s003lbl.pdf">to place a warning on Aduhelm’s label</a>, advising physicians to monitor patients and obtain two MRI brain scans during the first year of treatment. </p>
<p>Patients selected for the Phase III studies were excluded if they had any of the many medical complications common for older people. This includes cardiac problems, the use of blood thinners or impaired liver or kidney function. These selected patients, who may be healthier than those in the general public who would receive the medication, underwent not two but seven MRIs for monitoring. MRIs are expensive procedures; they <a href="https://doi.org/10.1001/jamahealthforum.2021.4495">raise the real cost</a> of Aduhelm by about 20%. </p>
<p><a href="https://doi.org/10.1038/d41586-022-00651-0">Other anti-amyloid immunotherapy medications</a> are in the pharmaceutical pipeline. More data may emerge to suggest these drugs delay progression of Alzheimer’s, but so far, the relatively minor cognitive benefits seen <a href="https://www.fda.gov/drugs/news-events-human-drugs/fdas-decision-approve-new-treatment-alzheimers-disease">do not seem to match</a> the robust reduction in amyloid plaques. While it’s indisputable that Aduhelm can consistently and convincingly reduce the level of amyloid plaques in the brain, the cognitive benefit it provides to patients remains in doubt. This discrepancy speaks to the complexities of Alzheimer’s – and the holes that remain to be filled in the understanding of this terrible disease.</p>
<p>[<em>Get the best of The Conversation, every weekend.</em> <a href="https://memberservices.theconversation.com/newsletters/?nl=weekly&source=inline-weeklybest">Sign up for our weekly newsletter</a>.]</p><img src="https://counter.theconversation.com/content/179177/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Williams 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>Although Medicare has agreed to pay for Aduhelm, its coverage comes with restrictions.Andrew Williams, Assistant Professor of Emergency Medicine, Albert Einstein College of MedicineLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1754972022-01-28T13:27:30Z2022-01-28T13:27:30ZOmicron makes booster shots more critical for medically vulnerable seniors<figure><img src="https://images.theconversation.com/files/442781/original/file-20220126-23-bjda9k.jpg?ixlib=rb-1.1.0&rect=74%2C0%2C8256%2C5388&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">With a COVID-19 booster shot, vaccine effectiveness against hospitalization goes up to 90%. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-gets-a-booster-vaccine-royalty-free-image/1362422474?adppopup=true">FatCamera/E+ via Getty Images</a></span></figcaption></figure><p>People are understandably worn out, tired of thinking about COVID-19 and wanting to get back to a true normal. </p>
<p>This so-called “<a href="https://www.scientificamerican.com/article/how-we-can-deal-with-pandemic-fatigue/">pandemic fatigue</a>” is real. But it’s also <a href="https://www.ama-assn.org/delivering-care/public-health/what-doctors-wish-patients-knew-about-pandemic-fatigue">contributing to lapses in COVID-19</a> precautions and to more people getting infected with the <a href="https://theconversation.com/alpha-then-delta-and-now-omicron-6-questions-answered-as-covid-19-cases-once-again-surge-across-the-globe-174703">omicron variant of SARS-CoV-2</a>. </p>
<p>It is become starkly clear that this pandemic is not behind us yet. Since late December 2021, COVID-19 infections have been surging, <a href="https://www.npr.org/2021/12/30/1069027394/omicron-causes-record-breaking-covid-cases-in-the-u-s-and-globally#">exceeding the rates seen</a> at any other point in the pandemic. The people who are becoming most sick – needing hospitalization or even dying from infection – <a href="https://www.npr.org/2021/12/14/1064011230/as-unvaccinated-covid-19-patients-pack-colorado-hospitals-anger-grows">are the unvaccinated</a>. </p>
<p>But new data suggests that older adults who have received two shots of the COVID-19 vaccine but who have not yet received a booster shot are also getting sick and <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e2.htm?s_cid=mm7104e2_w">having poor outcomes</a>. The omicron variant, which spreads very easily, is putting a spotlight on how critical it is for <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e3.htm?s_cid=mm7104e3_w">these seniors to get a booster shot</a> – especially older adults living in close quarters with others.</p>
<p>As <a href="https://uvahealth.com/findadoctor/profile/laurie-r-archbald-pannone">a geriatrician</a> at the University of Virginia, I see patients who are over 65 years old. Many of them have experienced someone close to them becoming ill or even dying from COVID-19 infection in the past two years. </p>
<p>Having witnessed this directly, most of my patients continue to practice safety measures to minimize risk of infection, like wearing masks, limiting their exposure to large crowds and practicing social distancing. They want to be able to safely visit with their families and friends. A booster shot has now become an important part of protecting them against infection and poor outcomes. </p>
<h2>The case for boosters</h2>
<p>In September 2021, the Centers for Disease Control and Prevention <a href="https://theconversation.com/tense-decision-making-as-cdc-joins-fda-in-recommending-pfizer-booster-shot-for-65-and-up-people-at-high-risk-and-those-with-occupational-exposure-to-covid-19-168703">endorsed booster shots</a> for people 65 years old and up, as well as some other high-risk groups. But since that time, <a href="https://doi.org/10.1016/S0140-6736(21)02388-6">the need for booster shots</a> for all vaccine-eligible people has become more clear. </p>
<p>The CDC recently reported that vaccine effectiveness against hospitalizations from COVID-19 goes <a href="https://www.cdc.gov/mmwr/volumes/71/wr/mm7104e3.htm?s_cid=mm7104e3_w">from 38% up to 90%</a> with a third booster dose. The CDC is now calling having received a booster shot as being <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html">“up to date”</a> on COVID-19 vaccination.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/qXdjt8ZBQbE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Big questions about the COVID-19 booster shot, answered.</span></figcaption>
</figure>
<h2>A need for renewed focus on boosters</h2>
<p>Some of my patients live independently and have full access to schedule an appointment for their booster and drive themselves to a pharmacy to receive it. Others are not as mobile. Some are homebound or live in a long-term care facility, assisted-living facility or memory care unit. In these cases, my patients can only get vaccinated if the vaccine comes to them. </p>
<p>In December 2020 and January 2021, when the first COVID-19 vaccines were becoming available, there was a massive push to get vulnerable elderly people living in long-term care vaccinated. They were considered “<a href="https://www.kff.org/other/state-indicator/state-covid-19-vaccine-priority-populations/">Phase 1 priority</a>.” Teams of public health officials and pharmacy staff came to vaccinate these residents as quickly as possible. And the efforts were successful. Nearly 90% of the people <a href="https://data.cms.gov/covid-19/covid-19-nursing-home-data">living in these types of congregate settings</a> received a COVID-19 vaccine.</p>
<p>But the recent numbers show that those herculean efforts may need to be replicated in order to <a href="https://acl.gov/covid19/covid-19-vaccine-access-long-term-care-settings">reach these community members</a> for booster shots. As of late January 2022, nearly 90% of people ages 65 and up have received two COVID-19 shots – but <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations_vacc-total-admin-rate-total">about a third of those</a>, or more than 15 million older adults, haven’t received their COVID-19 booster. </p>
<p>In many cases, booster shots will need to be taken to those who are unable to access them. The CDC’s website emphasizes the need for continuing to protect people who are “disproportionately affected by COVID-19,” particularly those living in long-term care, or LTC, settings. “All LTC settings that request assistance accessing COVID-19 vaccines for their residents and staff will receive the support they need.”</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>If you or someone you care for is living in a care facility, you can <a href="https://www.cdc.gov/vaccines/covid-19/retail-pharmacy-program/pharmacies-contact.html">find out how to request</a> on-site vaccination or access to a pharmacy location. Local health departments, pharmacies and hospitals may have teams established to vaccinate facility residents and staff on-site. </p>
<p>If health care providers can get the vast majority of vulnerable people up to date on vaccinations, perhaps it can help turn a corner in the pandemic so that we don’t have to do it all over again in 2023.</p><img src="https://counter.theconversation.com/content/175497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone 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>Studies suggest seniors without the booster shot run a higher risk of infection and hospitalization from the omicron variant.Laurie Archbald-Pannone, Associate Professor of Medicine and Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1751412022-01-23T19:09:49Z2022-01-23T19:09:49Z1,100 Australian aged care homes are locked down due to COVID. What have we learnt from deaths in care?<figure><img src="https://images.theconversation.com/files/441889/original/file-20220121-9056-1nksr7b.jpg?ixlib=rb-1.1.0&rect=15%2C23%2C5160%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://image.shutterstock.com/image-photo/adult-woman-old-person-has-600w-1617269392.jpg">Shutterstock</a></span></figcaption></figure><p>Australia’s aged care homes are being devastated by the current wave of COVID infections, with more than <a href="https://www.sbs.com.au/news/fears-aged-care-homes-are-at-breaking-point-as-covid-19-outbreaks-rise/59d0dd8c-b3b9-41c6-97b9-0d80402b20a0">1,100 outbreaks</a> affecting over 7,000 residents and staff. Fear of outbreaks has prompted other homes to lock down and their residents are suffering the serious physical and psychological effects of isolation and, sometimes, inadequate care, due to major staff shortages. </p>
<p>Government responses to last May’s Aged Care Royal Commission’s <a href="https://agedcare.royalcommission.gov.au/publications/final-report">recommendations</a> have only begun to scratch the surface of longstanding problems in the aged care sector. Major workforce issues remain and responses of aged care providers to the threat of COVID in their facilities are highly variable. </p>
<p>Government decisions about broader community public health can have significant and damaging impacts on the health and well-being of aged care residents and staff.</p>
<h2>A high risk group</h2>
<p>Early in the COVID pandemic it became clear that residents of aged care homes were at high risk of serious illness and death. During 2020, Australia had a relatively low rate of COVID deaths at 3.6 per 100,000 population. However, three quarters of all deaths (685 of 910) were <a href="https://www.health.gov.au/sites/default/files/documents/2021/11/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities-independent-review-of-covid-19-outbreaks-in-australian-residential-aged-care-facilities_0.docx">aged care residents</a>, at a rate of around 309 per 100,000 residents.</p>
<p>Infections and deaths are not the whole story. Independent <a href="https://www.google.com/url?q=https://www.health.gov.au/sites/default/files/documents/2020/08/coronavirus-covid-19-review-of-dorothy-henderson-lodge-covid-19-outbreak-review-of-dorothy-henderson-lodge-covid-19-outbreak.pdf&sa=D&source=docs&ust=1642725612623670&usg=AOvVaw2dMHv2NUZkG7PZRcZcD_vI">reviews</a> of COVID outbreaks in agedcare <a href="https://www.google.com/url?q=https://www.health.gov.au/sites/default/files/documents/2020/08/coronavirus-covid-19-newmarch-house-covid-19-outbreak-independent-review-newmarch-house-covid-19-outbreak-independent-review-final-report.pdf&sa=D&source=docs&ust=1642725612623910&usg=AOvVaw27_cKGL6F9d3C-hRObQNjC">identified</a> other serious adverse effects of lockdowns. </p>
<p>Residents were <a href="https://www.health.gov.au/sites/default/files/documents/2020/12/coronavirus-covid-19-independent-review-of-covid-19-outbreaks-at-st-basil-s-and-epping-gardens-aged-care-facilities.pdf">confined</a> to their rooms and visitors excluded. Family members were often unable to communicate with loved ones for weeks. Staff who were infected or close contacts were replaced by “surge” workers, many of whom had no experience in aged care or infection control. Many residents became depressed, confused, or deconditioned from lack of exercise. </p>
<p>In some homes, remaining staff were overwhelmed by excessive workloads and could <a href="https://www.smh.com.au/politics/federal/malnourished-aged-care-residents-left-to-fend-for-themselves-during-covid-outbreaks-20211102-p59592.html">not provide adequate care</a>. Some were abused by angry relatives or vilified by the media. </p>
<p>A <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2020-10/aged-care-and-covid-19-a-special-report.pdf">special report</a> into COVID by the Aged Care Royal Commission, in September 2020, concluded </p>
<blockquote>
<p>The COVID-19 pandemic has been the greatest challenge Australia’s aged care sector has faced […] Thousands of residents […] have endured months of isolation which has had a terrible effect on their physical, mental and emotional wellbeing.</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/older-australians-are-already-bamboozled-by-a-complex-home-care-system-so-why-give-them-more-of-the-same-173326">Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?</a>
</strong>
</em>
</p>
<hr>
<h2>What went wrong?</h2>
<p>The reviews identified leadership and communication failures, shortages of properly trained staff and poor infection control as major problems – but there was wide variation between homes. </p>
<p>Support from commonwealth and state government agencies was essential during outbreaks – for public health and infection control advice, laboratory testing and staff replacements. But many homes were let down by poor communication and coordination, inadequate planning and preparation and contradictory advice. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="elderly woman's hand" src="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441904/original/file-20220121-9089-1kjssru.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">Although the special report into what went wrong in aged care during 2020 was damning, conditions have only changed marginally.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hand-old-woman-patient-hold-bed-1048637588">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Not much has changed</h2>
<p>In response to the Royal Commission’s recommendations, the federal government promised <a href="https://www.abc.net.au/news/2021-05-11/federal-budget-2021-aged-care-funding/13339356">nearly $18 billion</a> in additional funding over five years – a fraction of what was recommended, and most of it yet to be allocated. </p>
<p>Aged care homes must now employ a nurse with approved infection control training, but their responsibilities and ongoing support and training remain undefined. There have been no moves to improve pay, working conditions or training of aged care workers, whose <a href="https://anmj.org.au/government-must-do-more-to-stop-the-nations-escalating-covid-19-aged-care-crisis-anmf-says/">numbers have fallen</a> since 2020. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/budget-package-doesnt-guarantee-aged-care-residents-will-get-better-care-160611">Budget package doesn't guarantee aged-care residents will get better care</a>
</strong>
</em>
</p>
<hr>
<p>There is a plethora of advice from expert committees and government agencies but little information about how effectively or consistently it is being implemented. To date, about 90% of aged care residents and almost all aged care staff have received two vaccine doses but earlier delays in the vaccine rollout mean many are <a href="https://www.theage.com.au/politics/victoria/hundreds-of-aged-care-homes-around-country-yet-to-get-vaccine-boosters-20220109-p59mw7.html">yet to receive boosters</a>.</p>
<p>Despite improvements, the aged care sector is currently under extreme pressure. The number of homes with COVID outbreaks more than <a href="https://www.smh.com.au/national/more-than-7000-covid-19-cases-in-aged-care-as-hundreds-of-homes-locked-down-20220114-p59oer.html">doubled</a> between January 7 and 14.</p>
<p>There have been relatively few deaths, so far, but government assurances that Omicron is not significantly impacting residents’ health, contradicts reports from the <a href="https://www.theguardian.com/australia-news/2022/jan/13/genuinely-diabolical-in-home-aged-care-struggling-to-meet-critical-needs-under-omicron-surge">frontline</a>. Many facilities are in lockdown, whether or not there is an outbreak and staff shortages are critical. </p>
<p>The serious adverse effects of isolation and neglect are potentially as severe and more widespread than in 2020 and likely to contribute to premature deaths. Unlike cases and deaths from Omicron, they will not be documented as COVID-related but likely attributed to old age or other underlying conditions. </p>
<p>It is not clear whether political leaders who advocated lifting restrictions and “<a href="https://theconversation.com/grattan-on-friday-scott-morrisons-ministerial-team-looks-far-from-match-fit-175343">pushing through</a>” the Omicron wave considered the human rights of aged care residents. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1484243952471805953"}"></div></p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/grattan-on-friday-scott-morrisons-ministerial-team-looks-far-from-match-fit-175343">Grattan on Friday: Scott Morrison's ministerial team looks far from match-fit</a>
</strong>
</em>
</p>
<hr>
<h2>An urgent need for reform and future planning</h2>
<p>Measures introduced to protect the community from Omicron have been widely criticised as too little, too late and easing of restrictions too premature. Aged-care residents and other vulnerable groups have been disproportionately affected by the massive surge in community transmission. They will be again, in future waves, unless their needs are considered through more nuanced, proactive strategies than either “let it rip” or lockout/lockdown. </p>
<p>There is an urgent need for the Royal Commission’s recommendations to be fully implemented as soon as possible and for aged care reform to be coordinated with reform of the whole care system: hospitals, aged, disability and primary care, and public health. </p>
<p>The Royal Commission highlighted longstanding deficiencies in the aged care sector, but they can’t be fixed during a crisis. Aged care providers need support to build resilience and ensure service continuity. This will require significant financial commitment from government. </p>
<p>Addressing the aged care staff crisis will require an effective campaign – planned in consultation with frontline workers, managers and clients – to attract workers by offering better pay, conditions, training and career structures.</p><img src="https://counter.theconversation.com/content/175141/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lyn Gilbert (and Adj/Professor Alan Lilly) received funding from the Department of Health to undertake independent reviews of COVID-19 outbreaks in residential aged care facilities. The Department had no input into the selection of participants, interviews, survey or workshops conducted during the reviews or analysis and reporting of findings.
</span></em></p>Despite improvements, the aged care sector is currently under extreme pressure. The serious effects of isolation and neglect are potentially as severe now and more widespread than in 2020.Lyn Gilbert, Honorary Professor Faculty of Health and Medical Science, Univeristy of Sydney; Senior Researcher Sydney Institue for Infectious Disease, University of Sydney., University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1745352022-01-19T18:59:21Z2022-01-19T18:59:21ZConfusion, financial pressure, discomfort: older people can struggle with sustainable living, despite its obvious benefits<figure><img src="https://images.theconversation.com/files/441439/original/file-20220119-27-1mu2wkd.jpg?ixlib=rb-1.1.0&rect=250%2C571%2C4967%2C2902&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>Improving the sustainability of Australia’s housing stock is <a href="https://www.google.com/search?client=safari&rls=en&q=building+sector+australia+emissions+the+conversation&ie=UTF-8&oe=UTF-8">crucial</a> to meeting national emissions reduction goals. But for older adults, such changes can bring both benefits and challenges.</p>
<p>My <a href="https://www.sciencedirect.com/science/article/abs/pii/S0360132321007344">recent research</a> examined the literature on environmental sustainability measures at residences for older adults. These included private homes, retirement villages and nursing homes.</p>
<p>I found that while sustainability measures can bring multiple benefits to older people, they also bring challenges. For example, people living in sustainable dwellings may use less energy and water which leads to lower bills. But older people may suffer cognitive decline and struggle to use sustainable technology devices. </p>
<p>The full effects of environmentally sustainable features must be better understood if we’re to provide seniors with high-quality residential environments.</p>
<figure class="align-center ">
<img alt="Older man walks down corridor" src="https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=393&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=393&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=393&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=493&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=493&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441440/original/file-20220119-15-60lcsc.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=493&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Sustainability measures can bring benefits and challenges to older people.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Sustainability and ageing: a complex mix</h2>
<p>Forecasts suggest that by 2056, <a href="https://www.aihw.gov.au/reports-data/population-groups/older-people/overview">22% of Australians</a> – or 8.7 million people – will be aged 65 or older. High-quality residential environments are important to maintaining the welfare of these people as they age. </p>
<p>Environmental sustainability is playing an ever greater role in residential development across the board, including retirement villages. And <a href="https://www.hindawi.com/journals/jar/2014/919054/">previous research</a> suggests most retirement village residents want to lead more sustainable lifestyles.</p>
<p>As climate change worsens, the dwellings of older adults should allow them to adapt to these changing conditions. The reduced ability of elderly people to regulate their body temperature means global warming is a profound threat to this group.</p>
<p>Improving the sustainability of a residential environment may include:</p>
<ul>
<li>reducing waste</li>
<li>using low carbon or recycled building materials</li>
<li>solar passive design</li>
<li>efficient heating and cooling</li>
<li>using renewable energy such as rooftop solar.</li>
</ul>
<p><a href="https://new.gbca.org.au/case-studies/building/stockland-takes-sustainability-retirement-living/">Some residential projects</a> for the elderly already include environmental sustainability. A <a href="https://www.emerald.com/insight/content/doi/10.1108/F-08-2011-0060/full/html">case study</a> of a not-for-profit retirement village in South Australia revealed practices such as innovative floor plans, thermally efficient building materials, good window orientation and a water harvesting system.</p>
<p>And my previous research <a href="https://www.sciencedirect.com/science/article/abs/pii/S0959652619341605">found</a> a range of sustainability features at eight private and not-for-profit retirement villages in Queensland.</p>
<p>However, while many retirement village developers prioritise “social sustainability” features such as care provision and social interaction, environmental sustainability is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0959652617313963">largely ignored</a>.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/intergenerational-report-to-show-australia-older-smaller-in-debt-163474">Intergenerational report to show Australia older, smaller, in debt</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="elderly woman holds hands of carer" src="https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441450/original/file-20220119-25-1qtv5d.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">Forecasts suggest that by 2056, 22% of Australians will be aged 65 or older.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>On the plus side</h2>
<p>The benefits of environmentally sustainable features in in older adults’ residential environment include:</p>
<p><strong>- reduced resource consumption:</strong> sustainable dwellings usually require less water and energy use, which lowers living costs. This is especially important for older adults who often have reduced financial capacity after retirement. Older people also use energy <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301421597000402">more intensively</a> than other groups because they have fewer household members, greater heating requirements and spend more time at home. </p>
<p><strong>- reduced health risks:</strong> environmentally sustainable measures can lead to healthier indoor environments. For example, good ventilation and high-quality air conditioning often lead to improved indoor air quality and more comfortable ambient temperatures.</p>
<p><strong>- alleviated environmental challenges:</strong> many older people want their homes to be more environmentally friendly. Doing their bit to alleviate global problems such as greenhouse gas emissions can provide them with peace of mind.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-great-australian-dream-new-homes-in-planned-estates-may-not-be-built-to-withstand-heatwaves-166266">The Great Australian Dream? New homes in planned estates may not be built to withstand heatwaves</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="elderly person's hands on heater" src="https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441438/original/file-20220119-15-124namg.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">Sustainable dwellings usually require less water and energy use,</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The potential downsides</h2>
<p>The challenges of environmentally sustainable home features for older adults include:</p>
<p><strong>- financial pressure:</strong> the income of many older adults is substantially reduced after retirement. This <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301421511005222">can conflict</a> with the high initial investment of developing an sustainable housing and the cost of replacing existing systems with sustainable ones.</p>
<p><strong>- reducing energy consumption:</strong> in some cases, sustainability measures can involve tolerating slightly higher or cooler temperatures. For example, moving from a gas-heating system to a more sustainable type may <a href="https://www.sciencedirect.com/science/article/pii/S0301421515001172">delay</a> the arrival of heat in a room and leave older people uncomfortable for a short time. This may conflict with older people’s <a href="https://ideas.repec.org/a/eee/enepol/v84y2015icp250-256.html">increased sensitivity</a> to ambient temperatures.</p>
<p><strong>- confusion and complexity:</strong> Older adults can have <a href="https://academic.oup.com/bmb/article/92/1/135/332828">reduced cognitive capabilities</a> affecting memory and information processing speed. As a result they may struggle to use sustainable technologies such as smart thermostats. Research has <a href="https://www.sciencedirect.com/science/article/abs/pii/S0301421514006259">suggested</a> ways of overcoming this, such as better recognising the diversity of older adults to achieve a better “person-technology fit”.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/buildings-produce-25-of-australias-emissions-what-will-it-take-to-make-them-green-and-wholl-pay-105652">Buildings produce 25% of Australia's emissions. What will it take to make them 'green' – and who'll pay?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center ">
<img alt="Four older women shelter from the sun under umbrella" src="https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=407&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=407&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=407&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=512&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=512&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441437/original/file-20220119-25-fkfanl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=512&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Older people may have increased sensitivity to hot or cold temperatures.</span>
<span class="attribution"><span class="source">Paul Miller/AAP</span></span>
</figcaption>
</figure>
<h2>Next steps</h2>
<p>Older adults have unique needs which their homes <a href="https://www.sciencedirect.com/science/article/abs/pii/S0360132321007344">must satisfy</a>, even when sustainability features are being adopted. </p>
<p>Ageing should be seen as a dynamic process with physical, psychological and social dimensions. And the complex interrelationships of ageing, environmental sustainability and the residential environment also need to be recognised.</p>
<p>Best practices and lessons learned in creating sustainable living environments for older adults should be <a href="https://www.sciencedirect.com/science/article/abs/pii/S0959652618325241">shared</a>. </p>
<p>Finally, developers making sustainability decisions should consult other stakeholders. These include contractors, occupational therapists, researchers and most importantly, older adults themselves.</p><img src="https://counter.theconversation.com/content/174535/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Xin Hu 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>People living in sustainable dwellings may use less energy and water which leads to lower bills. But older people may suffer cognitive decline and struggle to use sustainable technology devices.Xin Hu, Lecturer, School of Architecture and Built Environment, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.