tag:theconversation.com,2011:/us/topics/aging-2802/articlesAging – The Conversation2024-03-20T12:20:42Ztag:theconversation.com,2011:article/2150432024-03-20T12:20:42Z2024-03-20T12:20:42ZAre you one of the millions about to have cataract surgery? Here’s what ophthalmologists say you need to know<figure><img src="https://images.theconversation.com/files/557920/original/file-20231107-25-sofdb9.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4406&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Cataract surgery removes the clouded lens of the eye and replaces it with a new, clear lens.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/laser-correction-vision-concept-royalty-free-image/1279156312?phrase=cataract%2Bsurgery">Ivan-balvan/iStock via Getty Images Plus</a></span></figcaption></figure><p>Cataract surgery is one of the most popular and commonly performed procedures in the world. The vast majority of patients have excellent outcomes with few complications.</p>
<p>Here are the numbers: </p>
<ul>
<li><p>By age 80, <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts">over half of all Americans have cataracts</a>.</p></li>
<li><p>Close to 4 million cataract surgeries are <a href="https://doi.org/10.1136/bmjophth-2020-000464">performed in the U.S. every year</a>.</p></li>
<li><p>Over 90% of patients have <a href="https://doi.org/10.4103/ijo.IJO_1073_22">20/20 vision with glasses after surgery</a>, although those with other eye conditions may not do as well, including those with <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma">glaucoma</a>, a progressive disease typically associated with elevated pressure within the eye; <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/diabetic-retinopathy">diabetic retinopathy</a>, which ultimately can cause leakage in the retinal tissues; and <a href="https://www.hopkinsmedicine.org/health/conditions-and-diseases/agerelated-macular-degeneration-amd#">macular degeneration</a>, a disease that is typically related to age.</p></li>
<li><p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK559079/#">rate of post-surgery infection from endophthalmitis</a> is less than 0.1%.</p></li>
</ul>
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<p><a href="https://eye.ufl.edu/profile/steigleman-walter/">As ophthalmologists who have</a> <a href="https://integrity-eye.com/elizabeth-hofmeister/">performed thousands of these procedures</a>, we know that many patients have misconceptions about both cataracts and the surgery. For example, some think a cataract is a growth on the eye’s surface. </p>
<p>We like to compare a cataract with the frosted glass of a bathroom window, where light can be transmitted but details cannot. Or when turbulence from a storm causes normally clear water in the ocean to become murky. In much the same way, the eye’s once transparent lens becomes cloudy. </p>
<figure>
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<figcaption><span class="caption">After surgery, there’s no bending, inversions, lifting or straining, high-impact activities or eye makeup for one to two weeks or until the doctor says it’s OK.</span></figcaption>
</figure>
<h2>About the surgery</h2>
<p>Cataract surgery removes the clouded lens of the eye and replaces it with a new, clear lens to restore your vision. Most patients report the procedure is painless. </p>
<p>It’s <a href="https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/cataracts/cataract-surgery#">typically an elective surgery</a> that is performed on an outpatient basis. The patient is often awake, under local anesthesia, with sedation similar to that used for dental procedures. We like to say patients receive the equivalent of three margaritas in their IV. </p>
<p>Numbing drops are then applied to the eye’s surface, along with an anesthetic inside the eye. Patients with claustrophobia, or movement disorders such as Parkinson’s disease, may not be suitable candidates for awake surgeries and require general anesthesia.</p>
<p>Before surgery, patients receive dilating drops to make the pupil as large as possible. The surgeon makes a tiny incision, usually with a small pointed scalpel, between the clear and white part of the eye to gain access to the <a href="https://www.aao.org/eye-health/anatomy/lens-capsule-definition">lens capsule</a>, a thin membrane similar in thickness to a plastic produce bag at the grocery store. </p>
<p>This capsule is <a href="https://webvision.med.utah.edu/2020/09/ciliary-zonules/#">suspended by small fibers called zonules</a>, which are arranged like the springs that suspend a trampoline from a frame. The surgeon then creates a small opening in the capsule, called a capsulotomy, to gain access to the cataract. The cataract is then broken into smaller parts so they are removable through the small incision. </p>
<p>This is similar to a tiny jackhammer, breaking the large lens into smaller pieces for removal. That sounds scary, but it’s painless. Ultrasound emulsifies the lens and vacuum power then aspirates it from the eye. </p>
<p>Laser-assisted cataract surgery <a href="https://doi.org/10.3310/hta25060">has been found to have similar outcomes</a> to traditional cataract surgery. </p>
<h2>Complications are rare</h2>
<p>Serious complications, such as postoperative infection, bleeding in the eye or a postoperative retinal detachment are rare; they occur in approximately 1 in 1,000 cases. But even in many of these situations, appropriate management <a href="https://doi.org/10.1038/eye.2015.3">can salvage useful vision</a>. </p>
<p>Capsular complications deserve additional discussion. According to some studies, they occur <a href="https://doi.org/10.1159/000528657">in up to 2% of cases</a>. If a hole or tear of the posterior capsule is encountered during cataract surgery, the clear gel in <a href="https://www.aao.org/eye-health/anatomy/vitreous">the vitreous</a> – the back chamber of the eye – may be displaced into the front chamber of the eye. </p>
<p>If that happens, the gel must be removed at the time of the cataract surgery. This will reduce the likelihood of additional postoperative complications, but those who have the procedure, <a href="https://www.aao.org/eye-health/treatments/what-is-vitrectomy">known as a vitrectomy</a>, have an increased risk for additional complications, including postoperative infections and postoperative swelling. </p>
<h2>After the surgery</h2>
<p>Patients usually go home right after the procedure. Most surgery centers require that the patient have someone drive them home, more for the anesthesia rather than the surgery. Patients begin applying postoperative drops that same day and must wear an eye shield at bedtime for a few weeks after surgery. </p>
<p>Patients should keep the eye clean and avoid exposure to dust, debris and water. They should try not to bend over and should avoid heavy lifting or straining in the first week or so after surgery. Lifting or straining can cause a surge of blood pressure to the face and eye. <a href="https://doi.org/10.1159/000533937">Known as a choroidal hemorrhage</a>, it can lead to bleeding into the wall of the eye and be devastating to vision. </p>
<p>Things that cause only moderate increases in heart rate such as walking are OK. Routine postoperative examinations are usually completed the day after surgery, about a week after surgery and about a month after surgery. </p>
<figure>
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<figcaption><span class="caption">Light and UV exposure, coupled with time, causes the lens of the eye to become increasingly cloudy.</span></figcaption>
</figure>
<h2>A choice of lens</h2>
<p>The plastic lens used to replace the cataract, or <a href="https://www.aao.org/eye-health/diseases/cataracts-iol-implants">intraocular lens</a>, requires careful sizing for optimal results and a nuanced discussion between patient and surgeon. </p>
<p>Early intraocular lens technologies <a href="https://www.ncbi.nlm.nih.gov/books/NBK580484/">were monofocal</a>, and most patients with these lenses chose distance correction and used reading glasses for near tasks. This is <a href="https://www.aao.org/eye-health/diseases/cataracts-iol-implants#">still the preferred approach</a> for approximately 90% of patients having cataract surgery today. </p>
<p>Recent advances have led to <a href="https://www.verywellhealth.com/intraocular-contact-lenses-3421653">intraocular lenses that offer multifocality</a> – the opportunity to have near as well as distance vision, without glasses. Some multifocal lenses are even in the trifocal category, which includes distance, near, and intermediate vision, the latter of which in recent years has become very important for computer and phone use. </p>
<p>Most patients with these advanced technology multifocal lenses <a href="https://doi.org/10.2147/OPTH.S347382">are happy with them</a>. However, a small percentage of patients with multifocal lenses can be so bothered by visual disturbances – notably night glare and halos around light sources in the dark – that they request removal of the multifocal lens to exchange it for a standard intraocular lens. These exchanges are a reasonable option for such situations and offer relief for most affected patients. </p>
<p>Determining who’s an ideal candidate for a multifocal intraocular lens is an area of active research. Most clinicians would recommend against such a lens for a patient with a detail-oriented personality. Such patients tend to <a href="https://doi.org/10.1177/11206721231176313">fixate on the shortcomings of these lenses</a> despite their potential advantages.</p>
<p>As with many technologies, current generation advanced technology intraocular lenses are much better than their predecessors. Future offerings are likely to offer improved vision and fewer side effects than those available today.</p>
<p>But these newer lenses are often not reimbursed by insurance companies and often entail <a href="https://www.bettervisionguide.com/multifocal-iols/">substantial out-of-pocket costs</a> for patients. </p>
<p>Deciding on what type of lens is best for you can be complicated. Fortunately, except in unusual circumstances, such as when a cataract develops after trauma to the eye, there is seldom a hurry for adult cataract surgery.</p><img src="https://counter.theconversation.com/content/215043/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Typically, cataract surgeries are painless and significantly restore vision.Allan Steigleman, Associate Professor of Ophthalmology, University of FloridaElizabeth M. Hofmeister, Associate Professor of Surgery, Uniformed Services University of the Health SciencesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2251532024-03-18T12:23:59Z2024-03-18T12:23:59ZBiden and Trump, though old, are both likely to survive to the end of the next president’s term, demographers explain<figure><img src="https://images.theconversation.com/files/581396/original/file-20240312-16-ug5e1v.jpg?ixlib=rb-1.1.0&rect=6%2C6%2C4247%2C2965&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Both Joe Biden and Donald Trump are nearly twice the median age of the U.S. population.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Election2024ChinaUnitedStates/46152c599dd14340abc0595fca447682/photo">AP Photo</a></span></figcaption></figure><p><a href="https://poll.qu.edu/poll-release?releaseid=3890">In a recent poll</a>, 67% of Americans surveyed believe that President Joe Biden, 81, is too old to serve another term as president. But only 41% of respondents said they feel that way about former President Donald Trump, who is 77. Both men have stumbled around and have forgotten or mixed up names and events, <a href="https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging">which are behaviors that characterize some older people</a>.</p>
<p><a href="https://scholar.google.com/citations?user=jAfhO2YAAAAJ&hl=en">We</a> are <a href="https://scholar.google.com/citations?user=OBIxsGQAAAAJ&hl=en">demographers</a> – not <a href="https://www.salon.com/2024/02/23/dr-john-gartner-on-a-tale-of-two-brains-bidens-brain-is-aging-brain-is-dementing/">scholars of brain function</a> considering people’s cognitive abilities. But there is a question we can answer, one that speaks to concerns about both men’s ages: their life expectancy.</p>
<p>And it turns out that the four-year age difference between Biden and Trump isn’t really much of a difference when it comes to their respective odds of surviving. The statistical odds are good that both would complete a four-year term as president.</p>
<p>We know this because of one of the most versatile <a href="https://www.cambridge.org/core/books/population-and-society/5D47EB8139ED72FD59F7379F7D41B4FB">tools of demography</a>, which is called a life table. It’s a table of age groups, usually from 0 to 100 years, showing the <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=14">percentages of the population at any age</a> surviving to a later age. It is based on the age-specific death rates of the population.</p>
<h2>Early record-keeping</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table of figures representing births and deaths." src="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=716&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=716&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=716&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=899&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=899&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581391/original/file-20240312-28-kj30q1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=899&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A bill of mortality for 1605 and 1606, by John Graunt, an early version of what is now known as a life table.</span>
<span class="attribution"><a class="source" href="https://en.wikipedia.org/wiki/File:Bill_of_Mortality_1606.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The life table dates back to <a href="https://www.britannica.com/biography/John-Graunt">John Graunt, a self-educated citizen of London</a> in the 17th century who is known by many as the <a href="https://www.cambridge.org/core/books/abs/population-and-society/references/35C31BCEC27E2B0448B160414E1893BF">founder of demography</a>. <a href="https://www.jstor.org/stable/41138862">In 1662, Graunt produced and distributed the first life table</a>, showing the probabilities of London’s population surviving from one age to the next.</p>
<p>There are two kinds of life tables. The first is a cohort life table, which represents the death rates and ages for a specific group of people. A cohort table could, for example, document the deaths of all males born in the U.S. in 1940. That table would be very precise, but it wouldn’t be complete until every member of the group had died – so it’s not especially useful for examining the prospects of the living.</p>
<p>As a result, demographers more often use life tables for a current time period, such as the year 2021, which is the date of the most <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf">current period life table for the U.S.</a></p>
<p>It shows the probabilities of surviving from one age to another age based on the death rates in 2021. </p>
<h2>Statistical documentation</h2>
<p><a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf">A period life table for 2021</a> indicates that almost 99% of all people born in the U.S. survive from age 0 to age 20; just over 95% of them survive to age 40, and over 85% to age 60. More than 51% of them live to age 80.</p>
<p>But life tables get much more specific. It’s important to examine life tables’ data for each age, race and gender combination. This is because males don’t live as long as females, Black people don’t live as long as white people, and non-Hispanic people don’t live as long as Hispanic people. There are more specialized life tables that focus on education level and income, but they are not as current and complete as the broader tables.</p>
<p>Biden and Trump are both non-Hispanic white men. Biden is 81 and Trump is 77.</p>
<p>Based on the age-specific death rates of non-Hispanic white men in the U.S. in 2021, Biden has a 92.9% probability of surviving at least to age 82. Trump has a 95.1% probability of surviving to at least age 78. These odds are nearly identical, so each man is very likely to be alive on Inauguration Day 2025, regardless of which of them is being sworn in as president.</p>
<p>What about finishing out that four-year term? <a href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=47">Our calculations from the life tables</a> reveal that there is a 63.3% probability that Biden will survive another five years – to at least 86. And there is a 73.6% probability for Trump to survive that period – to at least age 82. Of course, it’s possible either or both will die, but their odds of death are much lower than their odds of survival.</p>
<p>In general, the chances are a bit more favorable for Trump, because he is slightly younger.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A table of figures showing how many people of one age survive to a future age." src="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=297&fit=crop&dpr=1 600w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=297&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=297&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=373&fit=crop&dpr=1 754w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=373&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/581097/original/file-20240311-20-hc2ous.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=373&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The 2021 life table for the U.S. is the most recent available.</span>
<span class="attribution"><a class="source" href="https://www.cdc.gov/nchs/data/nvsr/nvsr72/nvsr72-12.pdf#page=10">U.S. Centers for Disease Control and Prevention</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<h2>Precise calculations</h2>
<p>There are two factors that let us demographers get even more specific. </p>
<p>First, we measure age as exact years. Their age gap is not four years, but 3.5: <a href="https://www.whitehousehistory.org/bios/joseph-r-biden-jr">Biden was born on Nov. 20, 1942</a>, and <a href="https://www.whitehousehistory.org/bios/donald-j-trump">Trump on June 14, 1946</a>. That 10 percentage-point survival advantage for Trump over Biden was based on a four-year age difference. The real difference drops one or two points because they’re not quite so far apart in age.</p>
<p>Second, demographers have shown that <a href="https://doi.org/10.2307/2648114">people who attend church regularly live longer</a> than those who don’t. This is not because of some divine favor but because churchgoers tend to have more optimistic attitudes, clearer senses of purpose and more regular social interactions and connections. All of these factors extend people’s lives. Biden is a Catholic and <a href="https://www.reuters.com/article/idUSKBN2AC1X6/">attends Mass weekly, in general</a>. Trump was raised as a Presbyterian but now considers himself to be a “<a href="https://www.deseret.com/2023/10/22/23922731/biden-trump-faith-and-presidential-candidates/">nondenominational Christian</a>,” and he attends religious services very irregularly. So, Biden gets the survival advantage associated with churchgoing. </p>
<p>Other factors come into play with longevity as well, such as marital status, <a href="https://doi.org/10.1007/978-3-031-10936-2">body mass index scores</a>, diets and levels of physical fitness and exercise. </p>
<h2>A comparison with the American people</h2>
<p>Biden and Trump are <a href="https://theconversation.com/candidates-aging-brains-are-factors-in-the-presidential-race-4-essential-reads-223419">two of the three oldest people</a> ever to serve as president. The population they are seeking to lead is also older than ever before.</p>
<p>The median age of the nation’s population was <a href="https://www.census.gov/newsroom/press-releases/2023/population-estimates-characteristics.html">38.9 in 2022</a> compared with <a href="https://www.census.gov/library/publications/1972/dec/pc-s1-10.html">28.1 in 1970</a> and just <a href="https://www2.census.gov/programs-surveys/decennial/2000/phc/phc-t-09/tab07.pdf">16.7 in 1820</a>. </p>
<p>“<a href="https://www.nytimes.com/2024/03/06/opinion/biden-aging-america-population.html">Relative to the age of the population</a>, President Biden is no older than the country’s first presidents,” including Thomas Jefferson, wrote James Chappel, a scholar of aging and history at Duke University, in The New York Times. More recently, Reagan was older than the median American of his time than Biden and Trump are today.</p>
<p>At their second inaugurations, Jefferson was roughly 45 years older than the median age of the U.S. population then, and Reagan 43 years older. If Biden wins a second term, he will be 42 years older than today’s median. If Trump wins in 2024, he will be 38 years older than the current median. </p>
<p>As demographers, we can say it is likely that both Biden and Trump will be alive when the presidential term that begins in 2025 comes to an end in 2029. But as the U.S. population gets older too, the age factor may become less important to voters. This is not an immediate change, however, but one that will likely occur over the next decade or so.</p><img src="https://counter.theconversation.com/content/225153/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Detailed data on the ages at which people die can give good indications of a person’s remaining life span.Dudley L. Poston Jr., Professor of Sociology, Texas A&M UniversityRogelio Sáenz, Professor of Demography, The University of Texas at San AntonioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2172592024-03-05T14:00:43Z2024-03-05T14:00:43ZHow age-friendly universities can improve the second half of life<figure><img src="https://images.theconversation.com/files/578357/original/file-20240227-22-jb0bay.jpg?ixlib=rb-1.1.0&rect=38%2C23%2C5137%2C3422&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Opportunities to learn alongside people of different ages can benefit the entire community.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/group-of-mature-students-collaborating-on-project-royalty-free-image/511846363?phrase=older+college+students&adppopup=true">monkeybusinessimages via Getty Images</a></span></figcaption></figure><p>By 2030, more than 1.4 billion people across the globe will be at least 60 years old. This number will shoot up to <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">2.1 billion by 2050</a>. At this point, there will be more people age 60 or older <a href="https://www.who.int/docs/default-source/documents/decade-of-health-ageing/decade-ageing-proposal-en.pdf">than people between 10 and 24</a>. </p>
<p>These dramatic demographic shifts prompted the United Nations and World Health Organization to declare the 2020s the <a href="https://www.who.int/initiatives/decade-of-healthy-ageing">decade of healthy aging</a>. </p>
<p>The creation of a more age-friendly world includes basic things like improving health care access. But one critical component is often overlooked: taking college courses in your 50s, 60s or beyond. These opportunities to learn later in life have been associated with a host of positive health outcomes. These include <a href="https://doi.org/10.1080/26883597.2020.1794757">being less socially isolated</a> and <a href="https://www.nbcnews.com/health/aging/want-keep-your-brain-sharp-old-age-go-back-school-n1030326">staying sharp mentally</a>.</p>
<p>Many older adults know as much. According to the National Center for Education Statistics, <a href="https://nces.ed.gov/ipeds/TrendGenerator/app/trend-table/2/8?trending=column&rid=89">more than 550,000 U.S. adults 50 and older</a> were enrolled in college undergraduate and graduate programs in 2021. Their reasons for going back to school range from <a href="https://www.pbs.org/newshour/show/older-adults-are-heading-to-college-in-pursuit-of-new-opportunities">learning new skills</a> to wanting to get ahead in their careers to achieving long-held goals.</p>
<p>Institutions of higher education play a unique role in shaping an aging world. In 2012, a group of interdisciplinary scholars met to establish the <a href="https://www.afugn.org/principles">10 principles of an age-friendly university</a>. These include things such as career development for older adults pursuing second careers, increased access to health and wellness programs at universities and opportunities to learn alongside younger students. </p>
<p>In 2014, these efforts expanded to become the <a href="https://www.afugn.org/">Age-Friendly University Global Network</a>, a collective of more than 120 colleges and universities across the world. These institutions promote positive and healthy aging through innovative educational programs, research agendas, civic engagement opportunities and more. </p>
<h2>What are age-friendly universities?</h2>
<p>An age-friendly university is one that commits to including and supporting learners of all ages. What this means may vary from university to university. Some focus on increasing the presence of older adults – considered age 55 and older – on campus. Others lead the development of health and research initiatives to improve the lives of older adults. </p>
<p>At Mississippi State University, where one of us works, the focus on learners at all stages of life is growing. The new <a href="https://www.cpcs.msstate.edu/">College of Professional and Continuing Studies</a> develops and supports both credit and noncredit programs for nontraditional students.</p>
<p>We are also working with the city of Starkville, Mississippi, where one of us is located, to ensure it is an attractive destination for retirees. And we offer extension programs across the state that are of interest to many older adults, such as the <a href="https://extension.msstate.edu/community/leadership/master-gardener">master gardener program</a>, which involves 40 hours of educational training in consumer horticulture.</p>
<p>Other schools, such as the <a href="https://www.sarasotamanatee.usf.edu/news/2023/usf-receives-international-designation-as-age-friendly.aspx">University of South Florida</a>, emphasize the importance of engaging older adults in research. This includes conducting research at their <a href="https://www.usf.edu/cbcs/aging-studies/eol-center/index.aspx">Center for Hospice, Palliative Care and End-of-Life Studies</a>. The center works to ensure better quality of life for older adults in the future. Similarly, the Center for Social and Demographic Research on Aging at UMass Boston works with communities throughout the commonwealth to research what older adults need and <a href="https://www.umb.edu/demographyofaging/communities/archive/">how the community can provide for them</a>.</p>
<p>All of these examples are from universities that are part of the Age-Friendly University Global Network. But this designation just builds on what many universities have long been doing. For example, the <a href="https://www.osherfoundation.org/olli.html">Osher Lifelong Learning Institutes</a> have helped universities design programs to reach older adults for decades. These include offerings such as <a href="https://olli.fullerton.edu/classes/the_arts/Linedancing.php">dance classes</a>, <a href="https://www.depts.ttu.edu/olli/catalog/2022S1/0330EuropeanCheeseWestTexasWine.php">wine tastings</a> and <a href="https://web.uri.edu/olli/programs/travel/">educational trips</a>. </p>
<h2>How age-friendly universities improve life for older students</h2>
<p>Whether older adults go to college to earn academic credits toward a degree or just for personal development, their presence on campus <a href="https://doi.org/10.1007/s10755-016-9371-x">benefits the entire community</a>. </p>
<p>Older adults benefit from <a href="https://doi.org/10.1080/02601370.2020.1819905">social opportunities, intellectual stimulation and personal growth</a>. This even extends to their health. Older adults involved in social activities are <a href="https://www.nia.nih.gov/health/healthy-aging/participating-activities-you-enjoy-you-age">less likely to develop certain diseases</a>, including heart disease and some cancers. Continued learning is also associated with <a href="https://doi.org/10.1080/02601370802408332">positive health outcomes</a>, such as improved general well-being and mental health. </p>
<p>Research also shows that intergenerational relationships on campus can reduce younger students’ <a href="https://doi.org/10.1080/02701960.2019.1638257">negative perceptions of older adults</a>. Young students may associate older people less with physical decline and death and more with smiling and learning, for example. Shared classes promote more positive experiences between them, including deep and meaningful conversations.</p>
<p>The best programs at age-friendly universities make sure that older adults experience a greater sense of <a href="https://doi.org/10.1080/02701960.2020.1726744">inclusivity, respect and opportunities for learning</a>. At some universities, older adults can also find friendship in university-based retirement communities and shortened courses that meet their needs for flexibility. And at these institutions, professors are committed to integrating older adults in their college classrooms.</p>
<p>While older adults can engage in learning opportunities at almost any school, universities with the age-friendly designation may be their best bet when it comes to inclusion.</p><img src="https://counter.theconversation.com/content/217259/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As the share of adults age 60 and older grows globally, age-friendly universities offer social connection, continued learning and better health.David R. Buys, Associate Professor of Health, Mississippi State UniversityAaron Guest, Assistant Professor of Aging, Arizona State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2228542024-02-29T21:48:23Z2024-02-29T21:48:23ZBetter sleep is a protective factor against dementia<figure><img src="https://images.theconversation.com/files/573581/original/file-20240117-23-vqzz7m.jpg?ixlib=rb-1.1.0&rect=60%2C0%2C6720%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Lack of sleep, or poor quality sleep, is one of the risk factors for developing Alzheimer's disease. Fortunately, there are ways to improve sleep.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Dementia is a progressive loss of cognitive abilities, such as memory, that is significant enough to have an impact on a person’s daily activities. </p>
<p>It can be caused by a number of different diseases, including <a href="https://alzheimer.ca/en/about-dementia/what-alzheimers-disease">Alzheimer’s</a>, which is the most common form. Dementia is caused by a loss of neurons over a long period of time. Since, by the time symptoms appear, many changes in the brain have already occurred, many scientists are focusing on studying the risk and protective factors for dementia. </p>
<p>A risk factor, or conversely, a protective factor, is a condition or behaviour that increases or reduces the risk of developing a disease, but does not guarantee either outcome. Some risk factors for Alzheimer’s disease and dementia, such as age or genetics, are not modifiable, but there are several other factors we can influence, <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">specifically lifestyle habits and their impact on our overall health</a>.</p>
<p>These risk factors include depression, lack of physical activity, social isolation, high blood pressure, obesity, diabetes, excessive alcohol consumption and smoking, as well as poor sleep.</p>
<p>We have been focusing our research on the question of sleep for over 10 years, particularly in the context of the <a href="https://www.nhlbi.nih.gov/science/framingham-heart-study-fhs">Framingham Heart Study</a>. In this large community-based cohort study, ongoing since the 1940s, the health of surviving participants has been monitored to the present day. As researchers in sleep medicine and epidemiology, we have expertise in researching the role of sleep and sleep disorders in cognitive and psychiatric brain aging. </p>
<p>As part of our research, we monitored and analyzed the sleep of people aged 60 and over to see who did — or did not — develop dementia. </p>
<h2>Sleep as a risk or protective factor against dementia</h2>
<p>Sleep appears to play an essential role in a number of brain functions, such as memory. Good quality sleep <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2793873">could therefore play a vital role in preventing dementia</a>.</p>
<p>Sleep is important for maintaining <a href="https://www.science.org/doi/10.1126/science.1241224">good connections in the brain</a>. Recently, research has revealed that sleep seems to have a function similar to that of a garbage truck for the brain: <a href="https://doi.org/10.1016/j.mad.2023.111899">deep sleep could be crucial for eliminating metabolic waste from the brain</a>, including clearing certain proteins, such as those known to accumulate in the brains of people with Alzheimer’s disease. </p>
<p>However, the links between deep sleep and dementia still have to be clarified.</p>
<h2>What is deep sleep?</h2>
<p>During a night’s sleep, we go through several <a href="http://ceams-carsm.ca/en/a-propos-du-sommeil/">sleep stages</a> that succeed one another and are repeated. </p>
<p>NREM sleep (non-rapid eye movement sleep) is divided into light NREM sleep (NREM1 stage), NREM sleep (NREM2 stage) and deep NREM sleep, also called slow-wave sleep (NREM3 stage). The latter is associated with several restorative functions. Next, REM sleep (rapid eye movement sleep) is the stage generally associated with the most vivid dreams. An adult generally spends around 15 to 20 per cent of each night in deep sleep, if we add up all the periods of NREM3 sleep. </p>
<p>Several sleep changes are common in adults, such as going to bed and waking up earlier, sleeping for shorter periods of time and less deeply, and waking up more frequently during the night.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=279&fit=crop&dpr=1 600w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=279&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=279&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=350&fit=crop&dpr=1 754w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=350&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/579041/original/file-20240229-16-efo9mx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=350&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sleep stages, and the role of deep sleep for brain health.</span>
<span class="attribution"><span class="source">(Andrée-Ann Baril)</span></span>
</figcaption>
</figure>
<h2>Loss of deep sleep linked to dementia</h2>
<p>Participants in the <a href="https://jamanetwork.com/journals/jamaneurology/fullarticle/2810957">Framingham Heart Study</a> were assessed using a sleep recording — known as polysomnography — on two occasions, approximately five years apart, in 1995-1998 and again in 2001-2003. </p>
<p>Many people showed a reduction in their deep slow-wave sleep over the years, as is to be expected with aging. Conversely, the amount of deep sleep in some people remained stable or even increased. </p>
<p>Our team of researchers from the Framingham Heart Study followed 346 participants aged 60 and over for a further 17 years to observe who developed dementia and who did not. </p>
<p>Progressive loss of deep sleep over time was associated with an increased risk of dementia, whatever the cause, and particularly Alzheimer’s type dementia. These results were independent of many other risk factors for dementia.</p>
<p>Although our results do not prove that loss of deep sleep causes dementia, they do suggest that it could be a risk factor in the elderly. Other aspects of sleep may also be important, such as its duration and quality. </p>
<h2>Strategies to improve deep sleep</h2>
<p>Knowing the impact of a lack of deep sleep on cognitive health, what strategies can be used to improve it? </p>
<p>First and foremost, if you’re experiencing sleep problems, it’s worth talking to your doctor. Many sleep disorders are underdiagnosed and treatable, particularly through behavioural (i.e. non-medicinal) approaches. </p>
<p>Adopting good sleep habits can help, such as going to bed and getting up at consistent times or avoiding bright or blue light in bed, like that of screens. </p>
<p>You can also avoid caffeine, limit your alcohol intake, maintain a healthy weight, be physically active during the day, and sleep in a comfortable, dark and quiet environment.</p>
<p>The role of deep sleep in preventing dementia remains to be explored and studied. Encouraging sleep with good lifestyle habits could have the potential to help us age in a healthier way.</p><img src="https://counter.theconversation.com/content/222854/count.gif" alt="La Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrée-Ann Baril received funding from the Sleep Research Society Foundation, the Alzheimer Society of Canada, the Canadian Institutes of Health Research, Banting Postdoctoral Fellowships, the Fondation de l'Hôpital du Sacré-Coeur de Montréal, the Université de Montréal and speaking fees from Eisai.</span></em></p><p class="fine-print"><em><span>Matthew Pase received funding from the National Health and Medical Research Council of Australia, National Institute on Aging, Dementia Australia, Alzheimer's Association, National Heart Foundation of Australia, Australian Research Council, Stroke Foundation, Brain Foundation, Alzheimer's Drug Discovery Foundation, Rebecca L Cooper Medical Research Foundation, and Bethlehem Griffiths Research Foundation.</span></em></p>Sleep appears to play an essential role in a number of brain functions, such as memory. So good quality sleep could play a vital role in preventing dementia.Andrée-Ann Baril, Professeure-chercheure adjointe au Département de médecine, Université de MontréalMatthew Pase, Associate Professor of Neurology and Epidemiology, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2234192024-02-16T13:18:39Z2024-02-16T13:18:39ZCandidates’ aging brains are factors in the presidential race − 4 essential reads<figure><img src="https://images.theconversation.com/files/575373/original/file-20240213-24-9ifh6w.jpg?ixlib=rb-1.1.0&rect=6%2C0%2C4247%2C2971&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Joe Biden and Donald Trump are two of the three oldest people ever to serve as president.</span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Election2024ChinaUnitedStates/46152c599dd14340abc0595fca447682/photo">AP Photo</a></span></figcaption></figure><p>The leading contenders in the 2024 presidential election are two of the three oldest people ever to serve as president. President <a href="https://www.usatoday.com/story/news/politics/2023/11/27/how-old-is-joe-biden/71479875007/">Joe Biden is 81</a>. Former President <a href="https://www.usatoday.com/story/news/politics/2023/11/27/how-old-is-joe-biden/71479875007/">Donald Trump is 77</a>. Ronald <a href="https://thehill.com/changing-america/enrichment/arts-culture/3744771-here-are-the-oldest-us-presidents-to-ever-hold-office/">Reagan took office at 69</a> and left it at age 77.</p>
<p>Both Biden and Trump have faced criticism about what can appear to be obvious signs of aging, including <a href="https://www.washingtonpost.com/wellness/2024/02/10/memory-lapses-brain-biden-trump/">questions about their memory</a> and <a href="https://www.reuters.com/world/us/age-mental-capacity-dominates-presidential-campaign-trail-after-report-questions-2024-02-10/">cognitive abilities</a>.</p>
<p>Scholars writing for The Conversation U.S. have discussed various aspects of how aging affects people’s brains. Here we spotlight four articles that collectively explain why there is cause for concern, why there is no clear statement to be made about any specific person’s cognitive power as they age, and ways people can preserve their brain power into their golden years. </p>
<h2>1. Decline in thinking can come with age</h2>
<p>Brandeis psychology professor <a href="https://scholar.google.com/citations?user=KL6sulQAAAAJ&hl=en&oi=ao">Angela Gutchess</a>, who studies brain activity to understand human thought, said there is a body of work documenting a cognitive decline in aging people:</p>
<blockquote>
<p>“<a href="https://theconversation.com/aging-brains-arent-necessarily-declining-brains-33574">Past behavioral data</a> largely pointed to loss in cognitive – that is, thinking – abilities with age, including poorer memory and greater distractibility.”</p>
</blockquote>
<p>But her work has also found that “aging brains can reorganize and change, and not necessarily for the worse.”</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aging-brains-arent-necessarily-declining-brains-33574">Aging brains aren't necessarily declining brains</a>
</strong>
</em>
</p>
<hr>
<h2>2. Some people age faster than others</h2>
<p>Aging is an individual experience, explained <a href="https://scholar.google.com/citations?user=tqI8C_UAAAAJ&hl=en">Aditi Gurkar</a>, a geriatric medicine scholar at the University of Pittsburgh:</p>
<blockquote>
<p>“<a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">Although age is the principal risk factor</a> for several chronic diseases, it is an unreliable indicator of how quickly your body will decline or how susceptible you are to age-related disease. This is because there is a difference between your chronological age, or the number of years you’ve been alive, and your biological age – your physical and functional ability.”</p>
</blockquote>
<p>Gurkar’s work has been focused on the latter, noting that some people with the same chronological ages can have very different cognitive and physical abilities. Key factors include the strength of a person’s social connections, as well as their sleeping habits, water consumption, exercise and diet.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">Are you a rapid ager? Biological age is a better health indicator than the number of years you've lived, but it's tricky to measure</a>
</strong>
</em>
</p>
<hr>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9eOofp64IYI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">As University of Pittsburgh geriatric scholar Aditi Gurkar notes in her TED Talk, aging is not just a number.</span></figcaption>
</figure>
<h2>3. Even cells age differently inside the body</h2>
<p><a href="https://scholar.google.com/citations?user=DDc-okgAAAAJ&hl=en">Ellen Quarles</a>, who teaches cellular and molecular biology of aging at the University of Michigan, explained that aging is so individualized that it varies even at the cellular level:</p>
<blockquote>
<p>“<a href="https://theconversation.com/aging-is-complicated-a-biologist-explains-why-no-two-people-or-cells-age-the-same-way-and-what-this-means-for-anti-aging-interventions-202096">There is no single cause of aging</a>. No two people age the same way, and indeed, neither do any two cells. There are countless ways for your basic biology to go wrong over time, and these add up to create a unique network of aging-related factors for each person that make finding a one-size-fits-all anti-aging treatment extremely challenging.”</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aging-is-complicated-a-biologist-explains-why-no-two-people-or-cells-age-the-same-way-and-what-this-means-for-anti-aging-interventions-202096">Aging is complicated – a biologist explains why no two people or cells age the same way, and what this means for anti-aging interventions</a>
</strong>
</em>
</p>
<hr>
<h2>4. There is a way to preserve abilities</h2>
<p><a href="https://theconversation.com/profiles/brian-ho-1466332">Brian Ho</a> and
<a href="https://scholar.google.com/citations?user=kFenpZ4AAAAJ&hl=en&oi=ao">Ronald Cohen</a>, University of Florida scholars who study brain health in aging people, have found that physical activity makes a real difference in cognition:</p>
<blockquote>
<p>“<a href="https://theconversation.com/aerobic-and-strength-training-exercise-combined-can-be-an-elixir-for-better-brain-health-in-your-80s-and-90s-new-study-finds-212433">People in the oldest stage of life</a> who regularly engage in aerobic activities and strength training exercises perform better on cognitive tests than those who are either sedentary or participate only in aerobic exercise.”</p>
</blockquote>
<p>Specifically, they found:</p>
<blockquote>
<p>“(T)hose who incorporated both aerobic exercises, such as swimming and cycling, and strength exercises like weightlifting into their routines – regardless of intensity and duration – had better mental agility, quicker thinking and greater ability to shift or adapt their thinking.”</p>
</blockquote>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/aerobic-and-strength-training-exercise-combined-can-be-an-elixir-for-better-brain-health-in-your-80s-and-90s-new-study-finds-212433">Aerobic and strength training exercise combined can be an elixir for better brain health in your 80s and 90s, new study finds</a>
</strong>
</em>
</p>
<hr>
<p>Whether it’s for Biden and Trump or anyone else, these scholars advise staying active, deepening connections with family and friends and recognizing that not everyone ages the same way.</p>
<p><em>This story is a roundup of articles from The Conversation’s archives.</em></p><img src="https://counter.theconversation.com/content/223419/count.gif" alt="The Conversation" width="1" height="1" />
Both men have faced criticism about what can appear to be obvious signs of aging, including questions about their memory and cognitive abilities.Jeff Inglis, Politics + Society Editor, The Conversation USLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2213802024-02-13T16:08:44Z2024-02-13T16:08:44ZMillions of older people don’t get enough nutrients – how to spot it and what to do about it<figure><img src="https://images.theconversation.com/files/574978/original/file-20240212-16-xw8sc6.jpg?ixlib=rb-1.1.0&rect=29%2C9%2C6581%2C4390&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/photo/osteoporosis-good-food-for-our-good-health-royalty-free-image/1475431573?phrase=healthy+older+adults+eating+dairy&adppopup=true">Erdark</a></span></figcaption></figure><p>By 2050, approximately a quarter of the UK population is <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/january2021">expected to be over the age of 65</a>. With this in mind, the World Health Organization (WHO) has put “<a href="https://cdn.who.int/media/docs/default-source/decade-of-healthy-ageing/decade-proposal-final-apr2020-en.pdf?sfvrsn=b4b75ebc_28">healthy ageing</a>” on its agenda. This means finding ways to maintain health, wellbeing and functional ability in order to have a good quality of life and enjoy the later years. </p>
<p>Everyone ages at a different rate – but there are some things that can influence how well we age, such as by making changes to the types of activity we do and the foods we eat. </p>
<p>Older adults are <a href="https://www.ageuk.org.uk/globalassets/age-uk/documents/reports-and-publications/research-report-2019--one-step-at-a-time.pdf">generally less physically active</a> than they were when they were younger and because of this, their energy intake requirement may decrease. However, there is a difference between energy requirements and nutrient requirements, and nutrient requirements actually remain the same, if not increase, as we get older. </p>
<p>This means we need to get more nutrients into less energy which can be tricky as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4589891/#:%7E:text=The%20physiological%20changes%20that%20occur,can%20contribute%20to%20declining%20appetite.">older adults often have lower appetites</a>. This is why <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6971894/">scientists suggest</a> that it may be necessary to enrich the food of older people to maintain the nutrient intake. </p>
<h2>How to spot when someone isn’t eating enough?</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8399049/">Several studies have shown</a> that undernutrition affects one in ten older people living independently at home. However, it affects five in ten older people living in nursing homes, and seven in ten older people in hospital. </p>
<p>Being overweight, even obese, <a href="https://link.springer.com/article/10.1007/s40520-023-02650-1">does not protect</a> against undernutrition. And when older adults lose weight, they lose muscle, meaning that they are more likely to lose their <a href="https://www.frontiersin.org/articles/10.3389/fnut.2022.892675/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Nutrition&id=892675">abilities to do daily tasks</a>.</p>
<p>Weight loss in older adults is a key sign of malnutrition that needs to be addressed – but it can be easily missed, especially when many older adults associate the idea of thinness <a href="https://www.sciencedirect.com/science/article/pii/S0195666319307603?casa_token=iU5UIdNwGDgAAAAA:I81EKDJ2T0oBsOsZunpPBk6uI-TcgiCr-5gPJE1tz4-Tq3w8pK4Yi_mv22AhVHHpRpiv1Bvz0RI">with good health</a>. But clothing that’s too loose or a watchstrap that floats on the wrist are all warning signs of undernourishment.</p>
<p>Similarly, if someone you care for has started to say things like, “Oh, I don’t want much food today, I’m not hungry”, “I’m not hungry, it’s natural, I’m getting older”, or “I’d rather just have a biscuit to be honest,” then these could be warning signs. An effective way to keep on top of this is regular weighing at least once per month which enables a quick response to potential indicators of malnutrition.</p>
<h2>Getting more nutrients into less food</h2>
<p>If people are eating small amounts of food, it is important to think about how to add more nutrients into it. A very effective technique, “fortification” is commonly done with pre-made products such as breakfast cereals, plant-based milk and bread in the UK. </p>
<p>Fortification (adding foods, ingredients or nutrients into to existing foods or meals) is easy to do at home as well and can provide a flexible approach for older adults as it allows them to continue eating the foods that they most enjoy.</p>
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<p>For older adults in particular, protein is a very important nutrient, because of muscle loss (<a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4066461/#:%7E:text=Sarcopenia%20has%20been%20defined%20as,decade%20of%20life%20%5B1%5D.">sarcopenia)</a> which is a natural part of ageing. This could be slowed down or even reversed by <a href="https://www.medicalnewstoday.com/articles/could-a-higher-protein-intake-lead-to-healthier-eating">eating enough protein</a> at regular intervals throughout the day. A few ways to increase protein include: </p>
<p>• Adding dairy ingredients such as milk, high-protein yoghurt, Quark (soft cheese), milk powders, eggs and cheese into meals – even into simple foods like mashed potato.</p>
<p>• Nuts are a great source of protein, try adding ground almonds to savoury or sweet meals (beware of nut allergies).</p>
<p>• Soy protein can be a convenient and cost-effective option, either for vegetarians or to further fortify minced-meat meals.</p>
<p>• Look in the sports section of supermarkets to find <a href="https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/whey-powder#:%7E:text=Whey%20powders%20are%20characterized%20as,of%20products%20obtained%20from%20milk.">whey protein</a> powders. These are marketed to gym enthusiasts, but actually whey is one of the <a href="https://www.mdpi.com/2072-6643/15/15/3424">best proteins to stimulate muscle growth</a>. This versatile ingredient can be mixed into porridge before cooking or used it as a substitute for other powdered ingredients in baking.</p>
<h2>Importance of physical activity and strength exercises</h2>
<p>Physical activity and nutrition go hand-in-hand – both are equally important. As we age, being physically active becomes <a href="https://link.springer.com/article/10.1007/s12603-021-1665-8?fbclid=IwAR3dJkeHjgcSrR9Xq5kBfN-HLrbpli8WcAnz7AeY5Nu9XcGCHEB07Sd2z1w">even more essential</a> as it helps to prevent disease, maintains independence, decreases risk of falls, improves cognitive function, mental health and sleep. </p>
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<img alt="" src="https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/574972/original/file-20240212-30-g71g12.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">
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<span class="caption">Balance and strength training are more important than ever in later life.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.co.uk/detail/photo/senior-women-taking-a-yoga-class-in-beautiful-royalty-free-image/1487712999">MoMo Productions</a></span>
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<p>Exercise can also <a href="https://academic.oup.com/ageing/article/48/4/476/5423796?login=false">combat isolation and loneliness</a> which has also been <a href="https://www.bda.uk.com/resource/loneliness-and-malnutrition.html">linked to decreased appetite</a> in older adults. Often strength training gets ignored when we think of being active but to keep independence and prevent falls, older adults should do varied physical activity that emphasises balance and strength training at moderate or greater intensity on three or more days a week.</p>
<p>Ultimately, it’s essential to contact a doctor or dietician with any worries or concerns about malnutrition or unintentional weight loss. There are, however, <a href="https://www.futurelearn.com/courses/ageing-well-nutrition-and-exercise-for-older-adults">some excellent resources</a> to learn more about ageing healthily and maintaining a good quality of life in later years.</p><img src="https://counter.theconversation.com/content/221380/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Miriam Clegg receives funding from the Medical Research Council, Biotechnology and Biological Sciences Research Council, EIT Food, Horizon 2020, Apetito, and Tanita Healthy Weight Community Trust. She is affiliated with Association for Nutrition.</span></em></p><p class="fine-print"><em><span>Rachel Smith 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>Want to stay active and healthy in later life? Food fortification and strength and balance training could help improve quality of life for older adultsMiriam Clegg, Senior Lecturer in Human Nutrition, University College CorkRachel Smith, Sensory and Consumer Scientist, University of ReadingLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199532024-02-12T13:26:57Z2024-02-12T13:26:57ZFamily caregivers face financial burdens, isolation and limited resources − a social worker explains how to improve quality of life for this growing population<figure><img src="https://images.theconversation.com/files/574183/original/file-20240207-27-pcczxx.jpg?ixlib=rb-1.1.0&rect=30%2C30%2C5061%2C3359&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Family caregivers may be less likely to turn to others when they need their own support. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/african-american-woman-pushing-father-in-wheelchair-royalty-free-image/494327497?phrase=caring+for+the+elderly&adppopup=true">Terry Vine/DigitalVision via Getty Images</a></span></figcaption></figure><p>Millions of Americans have <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">become informal family caregivers</a>: people who provide family members or friends with unpaid assistance in accomplishing daily tasks such as bathing, eating, transportation and managing medications. </p>
<p>Driven in part by a <a href="https://www.aarp.org/home-family/your-home/info-2021/home-and-community-preferences-survey.html">preference for home-based care</a> rather than long-term care options such as assisted living facilities, and the <a href="https://doi.org/10.1155/2012/680265">limited availability and high cost</a> of formal care services, family caregivers play a pivotal role in the safety and well-being of their loved ones.</p>
<p>Approximately 34.2 million people in the United States <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">provide unpaid assistance</a> to adults age 50 or above, according to the Family Caregiver Alliance. Among them, about 15.7 million adult family caregivers care for someone with dementia.</p>
<p>I am a licensed clinical social worker and an assistant professor of social work <a href="https://scholar.google.com/citations?user=AikbrQ4AAAAJ&hl=en">studying disparities in health and health care systems</a>. I focus on underrepresented populations in the field of aging. </p>
<h2>Challenges for family caregivers</h2>
<p>In my research focusing on <a href="https://doi.org/10.1093/geront/gnad086">East Asian family caregivers</a> for people with Alzheimer’s and related dementia, I discovered that <a href="https://doi.org/10.1177/07334648221142600">Chinese American</a> and <a href="https://doi.org/10.1080/13607863.2022.2122932">Korean American caregivers</a> often encounter challenging situations. These include discrimination from health care facilities or providers, feelings of loneliness and financial issues. Some of these caregivers even find themselves <a href="https://doi.org/10.1080/13607863.2022.2122932">having to retire early</a> because they struggle to balance both work and caregiving responsibilities. </p>
<p>My findings join a growing body of research showing that <a href="https://doi.org/10.1111/scs.12463">family caregivers</a> commonly <a href="https://doi.org/10.1177/0733464818813466">encounter five specific challenges</a>: financial burdens, limited use of home- and community-based services, difficulties accessing resources, a lack of knowledge about existing educational programs, and physical and emotional challenges, such as feelings of helplessness and caregiver burnout. </p>
<p>However, researchers are also finding that family caregivers feel more capable of managing these challenges when they can tap into formal services that offer practical guidance and insights for their situations, as well as assistance with some unique challenges involved with family caregiving.</p>
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<h2>The demographics of informal caregivers</h2>
<p>More than 6 in 10 family caregivers are women. </p>
<p>Society has always expected <a href="https://doi.org/10.1093/geront/32.5.607">women to take on caregiving responsibilities</a>. Women also usually earn less money or rely on other family members for financial support. This is because equal pay in the workplace <a href="https://iwpr.org/wp-content/uploads/2020/09/C455.pdf">has been slow to happen</a>, and women often take on roles like becoming the primary caregiver for their own children as well as their aging relatives, which can drastically affect their earnings. </p>
<p>While nearly half of care recipients live in their own homes, 1 in 3 live <a href="https://www.caregiver.org/resource/caregiver-statistics-demographics/">with their caregivers</a>.</p>
<p>Sometimes termed “resident caregivers,” these individuals are less likely to turn to others outside the family for caregiving support, often because they feel that it’s important to keep caregiving within the family. These caregivers <a href="https://doi.org/10.1080/13607863.2021.1935460">are typically older, retired or unemployed</a> and have lower income than caregivers who live separately.</p>
<p>According to a 2020 report from the AARP Public Policy Institute, about 1 in 3 family caregivers <a href="https://www.aarp.org/ppi/info-2020/caregiving-in-the-united-states.html">provide more than 21 hours of care a week</a> to a loved one. </p>
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<h2>Juggling caregiving with everyday life</h2>
<p>Caregiving often creates financial burdens because it <a href="https://doi.org/10.1093/geronb/gbv095">makes it harder to hold a full-time or part-time job</a>, or to <a href="https://doi.org/10.1093/geronb/gbv095">return to work</a> after taking time off, particularly for spouses who are caregivers.</p>
<p>Often, community-based organizations such as nonprofits that serve older adults offer a variety of in-home services and educational programs. These can help family caregivers <a href="https://www.cdc.gov/aging/caregiving/caregiver-brief.html">manage or reduce</a> the physical and emotional strains of their responsibilities. However, these demands also can make it difficult for some caregivers to even learn that these resources exist, or take advantage of them, particularly as the care recipient’s condition progresses. </p>
<p>These challenges <a href="https://doi.org/10.23750/abm.v93iS2.12979">worsened at the height of the COVID-19 pandemic</a>. Many support programs were canceled, and it was hard to access health care, which made things even more stressful and tiring for caregivers. </p>
<p>Research shows that those who are new to family caregiving often take care of their loved ones <a href="https://www.ncbi.nlm.nih.gov/books/NBK2665/">without any formal support initially</a>. As a result, they may face increased emotional burdens. And caregivers age 70 and above face particular challenges, since they may be navigating their own health issues at the same time. These individuals are less likely to receive informal support, which can lead to social isolation and burnout.</p>
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<a href="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=1000&fit=clip"><img alt="Mature woman places a cardigan on an elderly adult." src="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6699%2C4456&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572934/original/file-20240201-23-2arn8b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Caregivers age 70 and above may be navigating their own health challenges with little support.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-caring-for-her-elderly-mother-royalty-free-image/1390975112?phrase=family+caregivers&adppopup=true">Alistair Berg/DigitalVision via Getty Images</a></span>
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<h2>Support for family caregivers</h2>
<p>There are numerous programs and services available for family caregivers and their loved ones, whether they reside at home or in a residential facility. These resources include government health and disability programs, legal assistance and disease-specific organizations, some of which are <a href="https://www.caregiver.org/connecting-caregivers/services-by-state/">specific to certain states</a>.</p>
<p>In addition, research has found that providing appropriate <a href="https://doi.org/10.1046/j.1532-5415.2001.49090.x">education and training</a> to people in the early stages of caregiving enables them to better balance their own health and well-being with successfully fulfilling their responsibilities. Many community-based organizations, such as local nonprofits focused on aging, as well as government programs or senior centers, <a href="https://doi.org/10.1111/jgs.14259">may offer case management services</a> for older adults, which can be beneficial for learning about existing resources and services. </p>
<p>For family caregivers of people with dementia, formal support services are particularly crucial to their <a href="https://doi.org/10.1590/1809-98232016019.150117">ability to cope and navigate the challenges</a> they face.</p>
<h2>The role of Medicaid</h2>
<p>Formal support may also be helpful in finding affordable home-based and community resources that can help compensate for a lack of informal support. These include <a href="https://www.medicare.gov/coverage/home-health-services">home health services</a> funded by Medicare and <a href="https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html">Medicaid-funded providers</a> of medical and nonmedical services, including transportation.</p>
<p>Medicaid, which targets low-income Americans, seniors, people with disabilities and a few select other groups, has certain income requirements. Determine the eligibility requirements first to find out whether your loved one qualifies for Medicaid.</p>
<p>The <a href="http://www.thescanfoundation.org/sites/default/files/the-need-to-include-family-caregiver-assessment-medicaid-hcbs-waiver-programs-report-aarp-ppi-ltc.pdf">services and support covered by Medicaid may vary</a> <a href="https://www.payingforseniorcare.com/medicaid-waivers/home-care">based on a number of factors</a>, such as timing of care, the specific needs of caregivers and their loved ones, the care plan in place for the loved one and the location or state in which the caregiver and their loved one reside. </p>
<p>Each state also has its own Medicaid program with unique rules, regulations and eligibility criteria. This can result in variations in the types of services covered, the extent of coverage and the specific requirements for <a href="https://www.medicaidplanningassistance.org/getting-paid-as-caregiver/">accessing Medicaid-funded support</a>.</p>
<p>If so, <a href="https://www.medicaid.gov/about-us/contact-us/index.html">contact your state’s Medicaid office</a> to get more information about self-directed services and whether you can become a paid family caregiver.</p>
<h2>Medicare might help</h2>
<p>Medicare may <a href="https://www.medicare.gov/coverage/home-health-services">help pay for certain home health services</a> if an older adult needs skilled services part time and is considered homebound.</p>
<p>This assistance can alleviate some of the caregiving responsibilities and financial burdens on the family caregiver, allowing them to focus on providing care and support to their loved ones without worrying about the cost of essential medical services. </p>
<p>Peer-to-peer support is also crucial. Family caregivers who join support groups tend to <a href="https://doi.org/10.1080/13607863.2016.1231169">manage their stress more effectively</a> and <a href="https://doi.org/10.3389/fpubh.2019.00122">experience an overall better</a> <a href="https://doi.org/10.1111/j.1532-5415.1990.tb03544.x">quality of life</a>.</p><img src="https://counter.theconversation.com/content/219953/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kathy Lee has received funding from the Alzheimer's Association - New to the Field (AARG-NTF-20-678171). </span></em></p>Family caregivers who have stronger support networks and positive communication with loved ones tend to be more resilient.Kathy L. Lee, Assistant Professor of Gerontological Social Work, University of Texas at ArlingtonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2202342024-02-07T15:41:14Z2024-02-07T15:41:14ZCould protecting our proteins help us prevent ageing?<figure><img src="https://images.theconversation.com/files/566856/original/file-20231102-21-co328v.jpg?ixlib=rb-1.1.0&rect=41%2C236%2C4643%2C2641&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What if protecting our proteins helped us to age well?</span> <span class="attribution"><a class="source" href="https://unsplash.com/fr/photos/donna-sorridente-VMGAbeeJTKo">Ravi Patel/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Existing theories on the chemistry of ageing are being turned on their head, thanks in particular to a small ultra-resistant bacterium capable of “coming back to life” after extremely harmful attacks.</p>
<p>This is <a href="https://presse.inserm.fr/wp-content/uploads/2017/01/2006_09_27_CP_Deinococcus_Resurrec.pdf"><em>Deinococcus radiodurans</em></a>, one of the most resistant bacteria known to date, which lives in arid environments such as desert sand. It survives in canned meat after the “shock” treatment of gamma radiation sterilisation. It can also overcome an irradiation dose 5,000 times greater than the lethal dose for humans.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Transmission electron microscopy of an extremophilic bacterium" src="https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=690&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=690&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=690&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=867&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=867&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553213/original/file-20231011-25-suiwlh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=867&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption"><em>Deinococcus radiodurans</em> is an extremophilic bacterium and one of the most radiation-resistant organisms known. Here it is seen by transmission electron microscopy.</span>
<span class="attribution"><a class="source" href="https://fr.wikipedia.org/wiki/Deinococcus_radiodurans#/media/Fichier:Deinococcus_radiodurans.jpg">Michael Daly, Uniformed Services University, US Department of Energy</a></span>
</figcaption>
</figure>
<p>Studies have shown that <a href="https://pubmed.ncbi.nlm.nih.gov/26871429/">this bacterium survives even if its DNA is damaged and broken into several hundred fragments</a> as a result of violent stress. In just a few hours, it reconstitutes its entire genetic make-up and returns to life. Its DNA isn’t resistant, it’s simply repaired immediately by proteins that are indestructible in the face of this extreme radiation.</p>
<p>Hence the secret of the robustness of this extremophilic bacterium depends on the robustness of its “proteome” – the sum of all its proteins – and in particular its DNA repair proteins.</p>
<p>This suggests a new paradigm: to increase longevity, particularly in humans, it is the proteome – rather than DNA – that we need to protect.</p>
<p>An organism’s survival depends on the activity of its proteins. If we act against the alteration of the proteome, which is at the root of ageing, we are simultaneously acting on all its consequences: for example, cell survival and function; and we are avoiding mutations induced by radiation.</p>
<h2>The keys to ageing</h2>
<p><a href="https://www.medecinesciences.org/en/articles/medsci/full_html/2020/11/msc200258/msc200258.html">Ageing</a> is characterised by the accumulation of events that deteriorate the functions of our organs and, as a consequence, there’s an <a href="https://pubmed.ncbi.nlm.nih.gov/30914006/">exponential increase in the risk of death and disease over time</a>.</p>
<p>Numerous models have been proposed to explain the molecular basis of ageing, such as the theory of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8344376/">cellular senescence</a>, the reduction in DNA repair capacity, <a href="https://www.inserm.fr/c-est-quoi/ca-use-ca-use-c-est-quoi-telomeres/">telomere shortening</a>, mitochondrial dysfunction and <a href="https://www.medecinesciences.org/en/articles/medsci/full_html/2006/04/medsci2006223p266/medsci2006223p266.html">oxidative stress</a> or <a href="https://www.medecinesciences.org/en/articles/medsci/full_html/2020/11/msc200019/msc200019.html">chronic inflammation</a>.</p>
<p>These different models all attempt to understand the consequences of ageing, not the causes. The scientific dogma “DNA -> RNA -> proteins,” which refers to the relationships between DNA, RNA and proteins and asserts that this relationship is unidirectional (that is, from DNA to proteins via RNA), now deserves to be reconsidered.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553215/original/file-20231011-24-r1aap0.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Triple helix of collagen, a structural protein that contributes to skin resistance.</span>
<span class="attribution"><span class="source">Naos</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>Indeed, rather than focusing on our DNA and trying to protect it to slow down our ageing, what if <a href="https://pubmed.ncbi.nlm.nih.gov/36660191/">we protected our proteome</a>?</p>
<h2>What is the proteome?</h2>
<p>The term <a href="https://www.inserm.fr/actualite/proteomique-code-vie-traduit-plus-90/"><em>proteome</em></a> refers to all the proteins present in a cell or organism. Proteins – from the Greek <em>protos</em> meaning “first” – are only exceeded as a constituent of the human body by water, and account for <a href="https://legacy.foresight.org/Nanomedicine/Ch03_1.html">around 20%</a> of its mass.</p>
<p>The term was coined by analogy with the genome: the proteome being to proteins what the genome is to genes, i.e. the set of genes/proteins of an individual – this protein set varying according to the activity of the genes.</p>
<p>The proteome is a dynamic entity, constantly adapting to the needs of the cell and its environment. Proteins are essential molecules in the construction and functioning of all living organisms. <a href="https://www.aquaportail.com/definition-15276-interactome.html">Around 650,000 interactive protein-protein networks</a> have been identified in various organisms, including around 250,000 in humans.</p>
<p>Proteins perform a <a href="https://www.futura-sciences.com/sante/definitions/biologie-proteine-237/">wide variety of functions</a>:</p>
<ul>
<li><p>A structural role: many proteins are central to the maintenance and cohesion of our tissues. For example, actin and tubulin are involved in cell architecture. Keratin is involved in the architecture of our epidermis, hair and nails. Collagen is a protein that plays an important role in the structure of bones, cartilage and skin.</p></li>
<li><p>A functional role: enzymatic (for example, proteases are involved in cleaning up dysfunctional proteins and in desquamation), hormonal (for example, insulin regulates glycaemia), transport (for example, aquaporins transport water in the different layers of the skin) or defence (for example, immunoglobulins are involved in the immune response). All vital functions are thus ensured by the activity of proteins.</p></li>
</ul>
<h2>Carbonylation, the leading cause of irreparable damage to our proteome</h2>
<p>The balance between the synthesis of new proteins and their breakdown is called <a href="https://cordis.europa.eu/article/id/435462-maintaining-proteostasis-may-slow-ageing-and-related-diseases/fr"><em>proteostasis</em></a>. It’s necessary for our body to function, but this state of equilibrium is sensitive. It is under constant threat, because protein synthesis and degradation also depend on proteins. Over time and as a result of external aggression, the proteome is subjected to <a href="https://www.medecinesciences.org/en/articles/medsci/full_html/2017/02/medsci20173302p176/medsci20173302p176.html">various alterations</a>, the most formidable of which is <em>carbonylation</em>, irreversible damage linked to the oxidation of proteins.</p>
<p>Carbonylated proteins are permanently modified and can no longer perform their biological functions properly. When they are irreparably damaged, proteins must be recycled or eliminated by the body. With age, this elimination becomes more difficult, and they can accumulate in the form of toxic aggregates that interfere with cellular physiology and accelerate ageing. Above a certain threshold, these aggregates are harmful to the body: a state of <a href="https://www.sciencedirect.com/topics/biochemistry-genetics-and-molecular-biology/proteotoxicity">proteotoxicity</a> sets in.</p>
<p>The <a href="https://www.nature.com/articles/s41580-019-0101-y">loss of proteostasis</a>, i.e. the balance between the synthesis of new proteins and their degradation, due to the accumulation of protein aggregates, is the central cause of ageing and degenerative diseases. These carbonylated protein aggregates are found in most age-related diseases, as well as in the main signs of skin ageing.</p>
<p>Until now <a href="https://pubmed.ncbi.nlm.nih.gov/26871429/">our view of ageing has been centred on the genome</a>, but recent research on the proteome introduces the importance of the accumulation of damaged proteins as a key factor in the ageing process as a whole.</p>
<h2>Antioxidant chaperone molecules to act on the causes of ageing</h2>
<p>To correctly perform their many jobs, <a href="https://sitn.hms.harvard.edu/flash/2010/issue65/">proteins need to fold into a range of shapes</a> and are helped out by specialised proteins called “chaperones”. These help out the proteins after their synthesis by ribosomes, or their correct folding after stress, such as heat.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=365&fit=crop&dpr=1 600w, https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=365&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=365&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=459&fit=crop&dpr=1 754w, https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=459&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/553218/original/file-20231011-23-at0nwd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=459&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Illustration of the extraction of bacterioruberins from the bacterium <em>Arthrobacter agilis</em>. Bacterioruberins are antioxidant biological pigments with a chaperone effect, protecting the proteome (NAOS).</span>
<span class="attribution"><span class="source">Naos</span>, <span class="license">Fourni par l'auteur</span></span>
</figcaption>
</figure>
<p>The term <em>chaperone molecule</em> – of French origin although proposed by <a href="https://pubmed.ncbi.nlm.nih.gov/2695089/">John Ellis and Sean Hemmingsen</a> – has been adopted because their role is to prevent undesirable interactions and to break any incorrect bonds that may form, like a human chaperone. In short, chaperones (protein or chemical) are the doctors of malformed proteins.</p>
<p>Returning to the bacterium <em>Deinococcus radiodurans</em>, chaperones play a key role in protecting proteins against carbonylation, by preventing their amino acids from being exposed to free radicals or reactive oxygen species (ROS). In this way, they reduce their susceptibility to damage. At the same time, their antioxidant effectiveness neutralises the causes of carbonylation.</p>
<p>In collaboration with the NAOS laboratories, it was established that these antioxidant chaperone proteins therefore constitute an effective means of protecting the proteome, by providing both physical protection for the functional structure of proteins and an antioxidant shield linked to proteins that protects against damage such as carbonylation.</p>
<p>In <em>Deinococcus radiodurans</em>, because its proteome is protected against oxidative damage by <a href="https://pubmed.ncbi.nlm.nih.gov/23818498/">chaperone molecules</a>, it remains intact and can then able to repair damage to its genome. <em>In fine</em>, within a few hours it can be resuscitated.</p>
<p>Beyond the genome, protection of our proteome – that is to say, our proteins – can now be seen as the key to our health and longevity.</p><img src="https://counter.theconversation.com/content/220234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Miroslav Radman is founder and scientific director of the Mediterranean Institute for Life Sciences (MedILS). The MedILS has received funding from the NAOS company for several research collaborations. He is a consultant and member of the NAOS Scientific Committee.</span></em></p>Bacteria that are resistant to phenomenal amounts of radiation are prompting us to rethink our understanding of the mechanisms underlying ageing.Miroslav Radman, Professeur, InsermLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2019272024-01-22T13:27:25Z2024-01-22T13:27:25ZBreaking down fat byproducts could lead to healthier aging − researchers identify a key enzyme that does just that<figure><img src="https://images.theconversation.com/files/569661/original/file-20240116-25-w3uhfy.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2121%2C1412&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A buildup of fat byproducts like glycerol may contribute to accelerated aging.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/oily-water-royalty-free-image/492968264">MagicColors/iStock via Getty Images Plus</a></span></figcaption></figure><p>The journey of aging brings with it an unavoidable reality for many: an increased accumulation of body fat. Though much of society seems mostly focused on the aesthetics of being overweight, doctors look past any cosmetic concerns to focus on the health implications of fat byproducts in the body.</p>
<p><a href="https://www.britannica.com/science/fatty-acid">Fatty acids</a> are one of the molecular building blocks that make up fats. Though essential for various bodily functions, excessive amounts of fatty acids in the body <a href="https://doi.org/10.1111/acel.13048">can be harmful</a>, shortening a person’s <a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">health span and life span</a> by increasing their risk of chronic disease, disrupting metabolic processes and promoting inflammation. </p>
<p>Fatty acids are <a href="https://medlineplus.gov/lab-tests/triglycerides-test/">routinely checked</a> during medical examinations, such as blood tests measuring your lipid profile. But clinicians and researchers often overlook the other key component of fat despite its potentially harmful effects: <a href="https://doi.org/10.1016/j.cmet.2009.10.003">glycerol</a>, a compound that links fatty acids to make a fat molecule. </p>
<p>Both of these fat byproducts disrupt cellular and organ function, mirroring the effects of aging. In fact, researchers are increasingly seeing obesity as a <a href="https://doi.org/10.3389%2Ffendo.2019.00266">catalyst for accelerated aging</a>.</p>
<p>The role that fats play in aging is one of the focuses of my work as a <a href="https://scholar.google.com/citations?user=O3qOkKsAAAAJ&hl=en">genomicist and biochemist</a>. My <a href="https://www.agingobesitylab.org">research team</a> and I wondered whether reducing harmful fat byproducts might help slow the aging process and consequently stave off common diseases. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/QhUrc4BnPgg?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Fats perform essential functions in your cells, but not all of them are good for you.</span></figcaption>
</figure>
<h2>Breaking down fat byproducts</h2>
<p>In studying ways to extend the life span and improving the health at late age of lab animals, my colleagues and I saw a <a href="https://doi.org/10.1016/j.cub.2023.01.059">consistent pattern</a>: All the anti-aging interventions we tested led to reduced glycerol levels.</p>
<p>For instance, when placed on a calorie-restricted diet, the nematode <em>Caenorhabditis elegans</em> <a href="https://doi.org/10.1073/pnas.95.22.13091">lives about 40% longer</a>. We found that the glycerol levels in the body of these long-lived worms were lower than in shorter-lived worms that were not food restricted. Calorie restriction also <a href="https://doi.org/10.1016/j.cub.2023.01.059">heightened the activity of an enzyme</a> responsible for breaking down glycerol, ADH-1, in their intestine and muscles.</p>
<p>We saw similar <a href="https://doi.org/10.1016/j.cub.2023.01.059">high ADH-1 activity levels in people</a> undergoing dietary restriction or treated with an anti-aging drug called rapamycin. This finding suggests there may be a common mechanism underlying healthy aging across species, with ADH-1 at its core.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Figure showing the chemical structure of glycerol, a fatty acid, and a triglycerol" src="https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=792&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=792&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=792&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=995&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=995&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569663/original/file-20240116-20-gctpab.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=995&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Triacylglycerols, also known as triglycerides, are composed of a glycerol linked to three fatty acids.</span>
<span class="attribution"><a class="source" href="https://bio.libretexts.org/Bookshelves/Microbiology/Microbiology_(Boundless)/02%3A_Chemistry/2.05%3A_Organic_Compounds/2.5.02%3A_Lipid_Molecules">Lumen Learning (formerly Boundless) via LibreTexts</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>We hypothesized that elevated ADH-1 activity promotes health in old age by decreasing harmful levels of glycerol. Supporting this hypothesis were <a href="https://doi.org/10.1016/j.cub.2023.01.059">two critical observations</a>. First, we found that adding glycerol to the diet of worms <a href="https://doi.org/10.1016/j.cmet.2009.10.003">shortened their life span by 30%</a>. By contrast, animals genetically modified to boost levels of the glycerol-busting enzyme ADH-1 had low glycerol levels and remained lean and healthy with longer lives, even on unrestricted diets. </p>
<p>The simple molecular structure and wealth of research on ADH-1 make it an attractive target for developing drugs that boost its activity. My lab’s long-term goal is to explore how compounds that activate ADH-1 affect the health and longevity of both mice and people.</p>
<h2>A long-lived society</h2>
<p>Anti-aging research generates both excitement and debate. On the one hand, the benefits of <a href="https://theconversation.com/aging-is-complicated-a-biologist-explains-why-no-two-people-or-cells-age-the-same-way-and-what-this-means-for-anti-aging-interventions-202096">healthy aging</a> are clear. On the other hand, extending life span through healthier aging will likely introduce new societal challenges. </p>
<p>If life spans extending to 120 years become the norm, <a href="https://doi.org/10.1016/S2666-7568(21)00250-6">social structures</a>, including retirement ages and economic models, will need to evolve to accommodate an aging population. Legal and social frameworks regarding the elderly and family care may need revision. The <a href="https://www.washingtonpost.com/parenting/2023/03/22/caregivers-sandwich-generation/">sandwich generation</a>, those with children and living parents and grandparents, might find themselves caring for even more generations simultaneously. Longer lives will require society to rethink and reshape how we integrate and support an increasingly older population in our communities.</p>
<p>Whether through ADH-1 or dietary adjustments, the quest for the solution to healthy aging is not just a medical journey but a societal one.</p><img src="https://counter.theconversation.com/content/201927/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eyleen Jorgelina O'Rourke does not receive funding from any organization that would benefit from this article. </span></em></p>Although you get your fatty acid levels routinely checked at the doctor’s, rarely do clinicians and researchers consider the effects of their potentially harmful byproducts.Eyleen Jorgelina O'Rourke, Associate Professor of Biology and Cell Biology, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2208172024-01-17T13:36:23Z2024-01-17T13:36:23ZChef Bill Granger dies and leaves behind an inadvertent legacy – the avocado toast meme<figure><img src="https://images.theconversation.com/files/569130/original/file-20240112-25-mrzqwn.jpg?ixlib=rb-1.1.0&rect=12%2C25%2C4268%2C2818&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Is it avocado toast or high interest rates that have prevented so many young people from buying homes?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/avocado-butter-royalty-free-image/185328444?phrase=avocado+toast+illustration&searchscope=image%2Cfilm&adppopup=true">Josef Mohyla/E+ via Getty Images</a></span></figcaption></figure><p>On Christmas Day 2023, world-renowned Australian chef and restaurateur <a href="https://www.theguardian.com/food/2023/dec/27/bill-granger-renowned-australian-cook-dies-aged-54">Bill Granger died at 54</a>. </p>
<p>Granger owned and operated 19 restaurants across Australia, the U.K., Japan and South Korea. He authored 14 cookbooks, produced several TV shows and was awarded <a href="https://www.afr.com/life-and-luxury/food-and-wine/how-bill-granger-conquered-the-world-s-breakfast-tables-20230307-p5cq7g">the Medal of the Order of Australia</a>.</p>
<p>But his lasting legacy may be his role in making avocado toast <a href="https://www.nytimes.com/2023/12/28/dining/bill-granger-dead.html">a Western culinary staple</a> – and, inadvertently, the viral meme that transformed the open sandwich into a symbol of generational tension.</p>
<figure class="align-right ">
<img alt="Man uses a spatula to flip pancakes in a frying pan." src="https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=795&fit=crop&dpr=1 600w, https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=795&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=795&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=999&fit=crop&dpr=1 754w, https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=999&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/569577/original/file-20240116-17-asgem0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=999&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Bill Granger was renowned for adding a bougie twist to breakfast.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/australian-chef-bill-granger-cooks-pancakes-for-tasting-of-news-photo/72864230?adppopup=true">Yoshikazu Tsuno/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>The practice of spreading avocado on bread has existed for centuries, particularly in Central and South America. Some speculate it dates as far back as the 1500s, <a href="https://tastecooking.com/really-invented-avocado-toast/">when the Spanish settlers brought Western breads to Mexico</a>. But a <a href="https://www.washingtonpost.com/news/wonk/wp/2016/05/06/how-the-internet-became-ridiculously-obsessed-with-avocado-toast/">2016 Washington Post article</a> pointed to Granger as the first person to put avocado toast on a menu, when he did so at his Sydney café, Bills, in 1993.</p>
<p>I love ordering the occasional avocado toast. But as a sociologist of the internet and social media, I’m most interested in the meme – its origins, how it became a point of contention and how it has ultimately muddied the waters of inequality. </p>
<h2>Avocado toast and the American dream</h2>
<p>On May 15, 2017, Australian real estate tycoon <a href="https://fortune.com/2023/09/13/australia-real-estate-ceo-tim-gurner-pain-in-economy-avocado-toast/">Tim Gurner</a> said <a href="https://www.theguardian.com/lifeandstyle/2017/may/15/australian-millionaire-millennials-avocado-toast-house">in an interview</a>, “When I was trying to buy my first home, I wasn’t buying smashed avocado for $19 and four coffees at $4 each.”</p>
<p>Gurner’s comments implied that young people were not buying homes at the same rate as older generations due to their poor money management skills – unlike Gurner and his cohort, who understood the value of a buck and the importance of an honest day’s work. </p>
<p>No matter that minimal research revealed that Gurner’s nearly billion-dollar empire <a href="https://thiswastv.com/tim-gurner-parents/">began with financial assistance from his wealthy family</a>. The backlash on the internet was swift and searing, as Gurner became a stand-in for an entire out-of-touch generation who didn’t know how easy they had it.</p>
<p>Memes emphasized the fact that baby boomers, in general, <a href="https://doi.org/10.1016/j.jhe.2019.01.004">had an easier time becoming homeowners</a> compared to millennials, who largely came of age during the post-2008 economic downturn, which forced them to reckon with the crumbling remains of the American dream.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"910207147861983232"}"></div></p>
<h2>Generational tensions or class tensions?</h2>
<p>In their article “<a href="https://doi.org/10.1177/08969205211025724">A Sociological Analysis of ‘OK Boomer</a>,’” sociologists Jason Mueller and John McCollum describe how we’re in a period rife with confusions exacerbated by the internet. </p>
<p>They conclude that meme trends like “<a href="https://knowyourmeme.com/memes/ok-boomer">OK Boomer</a>” – a phrase that Gen Z popularized as an online retort to politicians and reporters who dismissed young people – reflect a world in which generational wars online coexist with class wars offline. The avocado toast meme works in a similar way.</p>
<p>In offline reality, <a href="https://www.nber.org/system/files/working_papers/w27123/w27123.pdf">there is some correlation between generations and wealth</a>. But generations are not what ultimately explain class inequality. </p>
<p>Instead, economic sociologists largely agree that a political emphasis on market “freedoms” and the concurrent paring back of programs that distribute resources have led to soaring economic inequality. These include laws that deregulated markets and privatized public spaces, as well as those that scaled back funding for health care, welfare, education and other government services. The policies first emerged under the umbrella of “<a href="https://www.annualreviews.org/doi/abs/10.1146/annurev-soc-090220-025543">The Washington Consensus</a>” in the late 20th century. </p>
<p>For example, the <a href="https://www.fcc.gov/general/telecommunications-act-1996">Telecommunications Act of 1996</a>, rather than treating emerging internet technology as a public good, <a href="https://ijoc.org/index.php/ijoc/article/view/14707">ensured the privatization of the internet</a>, paving the way for an online economy that profits off the attention and data of users.</p>
<p>Deregulation has created the conditions for today’s economic reality, in which many millennials and Gen Zers must work <a href="https://www.emerald.com/insight/content/doi/10.1108/REGE-08-2021-0153/full/html">precarious jobs in the gig economy</a>. They continue to struggle to buy homes and afford rent.</p>
<p>But importantly, many baby boomers face the same economic reality. Millions of them have been forced <a href="https://doi.org/10.1002/ajim.22694">to delay retirement</a>, particularly <a href="https://doi.org/10.1002/ajim.22694">if they’re from marginalized races and genders</a>. </p>
<p>In other words, the adverse impacts of class inequality leave no generation untouched.</p>
<h2>Illusions of separation</h2>
<p>So why does it feel like most baby boomers have it so easy?</p>
<p>Cultural theorist Mark Fisher, in his 2009 book “<a href="https://files.libcom.org/files/Capitalist%20Realism_%20Is%20There%20No%20Alternat%20-%20Mark%20Fisher.pdf">Capitalist Realism</a>,” describes this moment in history as one in which “hyperreality” prevails. </p>
<p>The term, coined by <a href="https://revistia.org/files/articles/ejis_v3_i3_17/Ryszard.pdf">French post-modernist Jean Baudrillard</a> in 1981, essentially describes a state in which simulations of reality appear more “real” than reality. </p>
<p>In his book “<a href="https://www.amazon.com/Simulacra-Simulation-Body-Theory-Materialism/dp/0472065211">Simulacra and Simulation</a>,” Baudrillard uses the example of Disneyland to describe hyperreality. Many people would rather pay to go to Disneyland – a park built to mimic imaginary places – <a href="https://www.discovermagazine.com/planet-earth/destination-science-the-natural-world-outside-disney-world">than travel to national parks</a>, where they can experience nature for free or on the cheap.</p>
<p>The virtual world of the internet – with its own sets of cultural norms, language and memes – is the epitome of hyperreality.</p>
<p>And in the hyperreal world of the internet, as Mueller and McCollum discuss in their article about the “OK Boomer” meme, generational tensions take form.</p>
<p>Memes like avocado toast construct a state of generational conflict in the online world that is real, quite simply, because it feels real.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1011175349055623169"}"></div></p>
<p>Algorithms have every incentive to stoke this conflict. </p>
<p>That’s because online generational conflicts, along with most social media battles, <a href="https://theconversation.com/hate-cancel-culture-blame-algorithms-129402">are immensely profitable</a>. In “<a href="https://www.upress.umn.edu/book-division/books/virality">Virality: Contagion Theory in the Age of Networks</a>,” sociologist Tony Sampson concludes that viral content usually elicits strong emotional reactions.</p>
<p>When users, old and young, are angry with one another, and express that anger in the language of memes, social media platforms like X, formerly known as Twitter, get more engagement and make more money.</p>
<h2>Reframing avocado toast</h2>
<p>What Sampson finds, though, is that positive feelings also lead to virality.</p>
<p>So perhaps one way to honor Granger is to reclaim the avocado toast meme as an in-joke that nonmillionaires and nonbillionaires of all generations can relate to. </p>
<p>It’s about one billionaire’s absurd proposition that millennials eating a fleshy fruit on a piece of toast is preventing them from buying homes. It’s the billionaire divorced from the struggles of everyday people who’s out of touch – not an entire generation of boomers. </p>
<p>The avocado toast meme serves as a reminder that the hyperreal space of the internet distorts an offline reality in which generations share struggles, whether through housing insecurity or delayed retirements – a reality perpetuated by billionaires like Tim Gurner and the economic systems that serve their interests.</p><img src="https://counter.theconversation.com/content/220817/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aarushi Bhandari 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>Granger, who died in December 2023, is credited with making avocado toast fashionable. Little did he know that his lasting legacy would inspire a meme that symbolized generational tension.Aarushi Bhandari, Assistant Professor of Sociology, Davidson CollegeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2174952024-01-10T23:10:59Z2024-01-10T23:10:59ZBreaking the curve: A call for comprehensive scoliosis awareness and care<figure><img src="https://images.theconversation.com/files/568748/original/file-20240110-29-9agwvv.jpg?ixlib=rb-1.1.0&rect=1417%2C0%2C7257%2C5787&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Scoliosis is a prevalent and underappreciated condition across Canada.</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/breaking-the-curve-a-call-for-comprehensive-scoliosis-awareness-and-care" width="100%" height="400"></iframe>
<p><a href="https://www.cbc.ca/news/canada/wait-times-marketplace-1.6620306">Cael</a> was a typical 15-year-old — until the discovery of an already advanced abnormal curvature of his spine. </p>
<p>“I felt like the Hunchback of Notre Dame,” Cael told CBC News, recalling the emotionally draining and gruesome two-year wait for spinal surgery during which his curve progressed to a whopping 108 degrees.</p>
<p><a href="https://doi.org/10.1016/s0140-6736(08)60658-3">Scoliosis is an abnormal twisting and curving of the spine that can develop at any age, but mostly occurs during rapid growth spurts in children</a>, and as part of spine aging in adults over the age of 60. </p>
<p>Of all types of scoliosis in children, adolescent idiopathic scoliosis is the most prevalent, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">accounting for as many as nine in 10 cases and impacting up to one in 20 adolescents globally</a>. On the other end of the age spectrum, a staggering <a href="https://doi.org/10.1097/01.brs.0000160842.43482.cd">two-thirds of older adults are also affected</a>.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-everything-you-need-to-know-about-scoliosis-28409">Explainer: everything you need to know about scoliosis</a>
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</em>
</p>
<hr>
<p>In clinical care, research and education related to scoliosis, disparities persist worldwide. Despite its widespread prevalence, scoliosis often goes undiagnosed, or has delayed diagnosis as in Cael’s case. It also receives limited attention in clinical and public health education, leading to significant gaps in health care.</p>
<p>This general lack of awareness has serious implications for thousands of people like Cael.</p>
<h2>Gaps in effective care</h2>
<p>In the United States, fewer than half of states legislate <a href="https://doi.org/10.1186/1748-7161-8-17">school-based scoliosis screening in children</a>. Even worse, Canada discontinued screening back in <a href="https://canadiantaskforce.ca/wp-content/uploads/2016/09/1994-red-brick-en.pdf">1979</a> because it was not considered cost-effective. </p>
<p>Pediatricians’ <a href="https://cps.ca/en/documents/position/greig-health-record-technical-report">screening</a> practices vary, and some cases of scoliosis in children are only discovered when an unrelated chest X-ray reveals a curved spine. With about <a href="https://doi.org/10.1007/s00586-011-2074-1">30 per cent of cases being hereditary</a>, parents may not recognize the signs early on.</p>
<p>The <a href="https://www.srs.org/Files/Patient-Brochures/Patient.Adolescent_Idiopathic_Scoliosis_Handbook_for_Patients.pdf">recommended care</a> in North America involves bracing for mild to moderate curves (25° to 45°) and surgery for curves exceeding 45°. Shockingly, <a href="https://doi.org/10.1097/brs.0b013e318059b5f7">32 per cent of Canadian children</a>, like Cael, face delayed referrals, discovering significant curves when they finally see specialists.</p>
<figure class="align-center ">
<img alt="X-ray images of two human torsos showing signs of scoliosis" src="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=666&fit=crop&dpr=1 754w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=666&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/568729/original/file-20240110-27-7zzgup.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=666&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Radiologic comparison of adult idiopathic scoliosis (A) and adult degenerative scoliosis (B).</span>
<span class="attribution"><span class="source">(Cho KJ, Kim YT, Shin SH, Suk SI)</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<p>Despite documented success in managing scoliosis through early <a href="https://doi.org/10.1016/j.spinee.2015.01.019">screening</a>, <a href="https://doi.org/10.1016/j.physio.2023.07.005">exercise rehabilitation</a> and <a href="https://doi.org/10.1056/nejmoa1307337">brace</a> treatment, global health-care education often neglects this condition. </p>
<p>The general lack of global awareness leaves physicians, nurses and other practitioners unaware of effective treatments and referral processes, contributing to the misunderstanding and under-treatment of patients. Consequently, when children with scoliosis eventually reach specialists for care, they may encounter challenges navigating the health-care system as they transition into adulthood.</p>
<h2>Sex disparities</h2>
<p>It is unclear why adolescent idiopathic <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">scoliosis affects mainly girls</a>. The more severe the curve, the more likely the patient is female. Due to their specific biology, <a href="https://doi.org/10.1016/j.semarthrit.2016.07.013">females</a> also face a five-fold higher risk of progressive deformities and are 10 times more likely, compared to males, to require surgery.</p>
<p>Despite generally uncomplicated <a href="https://doi.org/10.1097/00007632-200107010-00015">pregnancies and deliveries</a>, women with scoliosis often face <a href="https://doi.org/10.1097/bpo.0000000000002499">difficulties receiving pain control</a> during labour, with higher epidural failure rates. Moreover, they often suffer pregnancy-related back pain, and their spine <a href="https://doi.org/10.7759/cureus.46782">curvature may worsen after pregnancy</a>.</p>
<h2>Health-care access barriers</h2>
<p>Health-care access in the U.S. is influenced by a range of factors including race, income and health insurance coverage. </p>
<p>Patients with <a href="https://doi.org/10.1097/bpo.0000000000002551">better insurance</a> plans tend to seek pediatric orthopedic care at a younger age. Those with public insurance tend to have worse spine curvatures by the time they reach a scoliosis specialist; this is particularly striking among Black patients with public insurance, who are <a href="https://doi.org/10.1097/bpo.0000000000002213">67 per cent less likely</a> to be diagnosed at a stage early enough for effective brace treatment compared to Black patients with private insurance.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/iMmQZ6J6WrE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">A brief overview on recognizing idiopathic scoliosis produced by Veritas Health.</span></figcaption>
</figure>
<p>While Canada’s health-care system covers spinal fusion for severe scoliosis, the lack of a national insurance program in the U.S. leads to varying out-of-pocket expenses for patients. </p>
<p>Those without insurance often cannot afford surgery at all. </p>
<p>But even with Canada’s universal coverage, patients typically wait <a href="http://waittimes.alberta.ca/WaitTimeTrends.jsp?rcatID=56&rhaID=All_34_&doSearch=true&urgencyCode=9&facilityID=-9_&checkedRegionNo=0&oldCheckedRegionNo=0&oldCheckedFacilityNo=0&ifDisplayFacility=false&ifDisplayPhysician=false&command=goToAccessGoals&chartType=access_goal&subChartType=90_75_50_25_AVERAGE_&disabledChartType=trend&status=processAjax&ifHavingFPTMeasurement=true#WaitTimeInfo">an entire year</a> for surgery due to a shortage of providers. Because of regional variability in resources such as access to spinal surgeons, funding and specialized facilities, some kids, like Cael, wait even longer, experiencing physical, emotional and psychological burdens, while their curves get progressively worse. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-healthy-is-the-canadian-health-care-system-82674">How healthy is the Canadian health-care system?</a>
</strong>
</em>
</p>
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<p>Delayed surgery in Canada cost the health-care system <a href="https://www.childrenshealthcarecanada.ca/en/child-health-advocacy/no-child-elects-wait_october2023.pdf">$44.6 million</a> due to more complex surgeries, extended hospital stays, readmission and re-operation rates.</p>
<h2>Workforce and research disparities</h2>
<p>Ongoing gender disparities in the health-care workforce and lack of research funding for this female-predominant condition continue to hamper effective action.</p>
<p><a href="https://doi.org/10.1016/j.wneu.2018.09.152">Fewer than five per cent of spinal surgeons</a> identify as women. <a href="https://journals.lww.com/annalsofsurgery/toc/2011/04000">Glass-ceiling</a> effects surround women surgeons in this male-dominated culture, perpetuating gendered training environments, being held to higher standards and earning lower wages. The dearth of senior women role models and mentors is a further barrier for career advancement and retention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/canadas-health-care-crisis-is-gendered-how-the-burden-of-care-falls-to-women-215751">Canada’s health-care crisis is gendered: How the burden of care falls to women</a>
</strong>
</em>
</p>
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<p>Furthermore, <a href="https://doi.org/10.1038/d41586-023-01472-5">research funding</a> for diseases, such as scoliosis, that mainly affect females has historically lagged far behind funding for male-predominant diseases. <a href="https://doi.org/10.1002/9781119374855.ch26">Improving workforce diversity</a> is an important facet of addressing health disparities and shaping research agendas.</p>
<p>Inequities abound in scoliosis care and research. The impact of lack of awareness and delayed care extends beyond physical challenges. The patient and their family suffer emotionally, incurring significant financial burden while fearing the future. </p>
<p>The message is clear, we must do better for this underserved population.</p><img src="https://counter.theconversation.com/content/217495/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>Scoliosis is a treatable condition, but only if detected early. Greater awareness of the condition and its dynamics will greatly aid in patient care moving forward.Sanja Schreiber, Adjunct Professor, Faculty of Rehabilitation Medicine - Physical Therapy, University of AlbertaEmily Somers, Professor of Internal Medicine, Environmental Health Sciences, and Obstetrics & Gynecology, University of MichiganLicensed 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/2113302023-10-10T17:36:24Z2023-10-10T17:36:24ZAmerica’s farmers are getting older, and young people aren’t rushing to join them<figure><img src="https://images.theconversation.com/files/552404/original/file-20231005-29-2cqeho.jpg?ixlib=rb-1.1.0&rect=30%2C45%2C5032%2C3324&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Seeking greenhorns with green thumbs.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/caucasian-farmer-standing-in-field-checking-crop-royalty-free-image/678824087">Steve Smith/Tetra Images via Getty Images</a></span></figcaption></figure><figure class="align-center zoomable">
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<p>Hardworking American farmers keep the world fed and clothed. But the farming labor force has a problem: It’s aging rapidly.</p>
<p>The <a href="https://www.nass.usda.gov/Publications/Highlights/2019/2017Census_Farm_Producers.pdf">average American farmer is 57 and a half years old</a>, according to the most recent data from the U.S. Department of Agriculture. That’s up sharply from 1978, when the figure was <a href="https://agcensus.library.cornell.edu/wp-content/uploads/1982-United_States-CHAPTER_1_State_Data-121-Table-05.pdf">just a smidge over 50</a>.</p>
<p><a href="https://scholar.google.com/citations?user=lEIbjzkAAAAJ&hl=en&oi=ao">As researchers</a> <a href="https://www.humansci.msstate.edu/associate.php?id=377">who study well-being</a> <a href="https://www.agecon.msstate.edu/people/jjg8">in rural areas</a>, we wanted to understand this trend and its implications. So we <a href="https://doi.org/10.1093/ppar/prad015">dug into the data</a>.</p>
<h2>Amber waves of graying</h2>
<p>We found that the average age of farmers was fairly consistent across the country, even though the <a href="https://www.census.gov/library/visualizations/2022/comm/aging-nation-median-age.html">general population’s age</a> varies quite a bit from place to place. </p>
<p>For example, the <a href="https://www.nass.usda.gov/Publications/AgCensus/2017/Full_Report/Volume_1,_Chapter_1_State_Level/Maine/mev1.pdf">average Maine farmer</a> is just a few months older than the <a href="https://www.nass.usda.gov/Publications/AgCensus/2017/Full_Report/Volume_1,_Chapter_1_State_Level/Utah/utv1.pdf">average farmer in Utah</a>, even though the average Maine resident is <a href="https://www.census.gov/newsroom/press-releases/2023/population-estimates-characteristics.html">more than a decade older</a> than the average Utahn. </p>
<p>To be fair, we did find some local differences. For example, in New York County – better known as Manhattan – the average farmer is just north of 31. Next door in Hudson County, New Jersey, the average farmer is more than 72.</p>
<p>On the whole, though, America’s farming workforce is getting older. If the country doesn’t recruit new farmers or adapt to having fewer, older ones, it could put the nation’s food supply at risk. Before panicking, though, it’s worth asking: Why is this happening? </p>
<h2>A tough field to break into</h2>
<p>To start, there are <a href="https://www.youngfarmers.org/22survey/">real barriers to entry</a> for young people – at least those who weren’t born into multigenerational farming families. It takes money to buy the land, equipment and other stuff you need to run a farm, and younger people have <a href="https://www.federalreserve.gov/publications/files/scf17.pdf">less wealth</a> than older ones. </p>
<p>Young people born into family farms may have fewer opportunities to take them over due to <a href="https://www.ers.usda.gov/amber-waves/2020/february/consolidation-in-us-agriculture-continues/">consolidation in agriculture</a>. And those who do have the chance may not seize it, since they often report that <a href="https://www.onthefarm.life/">rural life is more challenging</a> than living in a city or suburb. </p>
<p>The <a href="https://www.choicesmagazine.org/choices-magazine/theme-articles/farm-stress/addressing-farm-stress-essential-insights-for-agricultural-economists">overall stress of the agriculture industry</a> is also a concern: Farmers are often at the mercy of weather, supply shortages, volatile markets and other factors entirely out of their control.</p>
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<p>In addition to understanding why fewer younger people want to go into agriculture, it’s important to consider aging farmers’ needs. Without younger people to leave the work to, farmers are left with intense labor — physically and mentally – to accomplish, on top of the ordinary <a href="https://theconversation.com/aging-is-complicated-a-biologist-explains-why-no-two-people-or-cells-age-the-same-way-and-what-this-means-for-anti-aging-interventions-202096">challenges of aging</a>.</p>
<p>In other words, the U.S. needs to increase opportunities for younger farmers while also supporting farmers as they age. </p>
<h2>Opportunities to help</h2>
<p>The USDA <a href="https://www.usda.gov/partnerships/underserved-veteran-farmers-ranchers-foresters">already has programs</a> to <a href="https://www.farmers.gov/your-business/beginning-farmers">aid new farmers</a>, as well as <a href="https://www.fsa.usda.gov/programs-and-services/farm-loan-programs/minority-and-women-farmers-and-ranchers/index">farmers of color and female farmers</a>, and those who <a href="https://www.farmers.gov/your-business/small-scale-producers">operate small farms</a>. Expanding these programs’ reach and impact could help bring new talent into the field. </p>
<p>Congress could do just that when it <a href="https://theconversation.com/these-four-challenges-will-shape-the-next-farm-bill-and-how-the-us-eats-202555">reauthorizes the farm bill</a> – a package of laws covering a wide range of food – and agriculture-related programs that get passed roughly every five years.</p>
<p>The farm bill also includes <a href="https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program">nutrition aid</a> and funds <a href="https://www.ers.usda.gov/agriculture-improvement-act-of-2018-highlights-and-implications/rural-development">telehealth</a> and <a href="http://www.nifa.usda.gov/about-nifa/how-we-work/extension/cooperative-extension-system">training and educational outreach for farmers</a>, all of which could help meet the needs of young and aging farmers alike. Notably, the <a href="https://www.nifa.usda.gov/about-nifa/how-we-work/extension/cooperative-extension-system">Cooperative Extension Service</a> offers programs that range from <a href="https://4-h.org/">4-H</a> and youth development, including introduction to agriculture, to providing on-site technical help.</p>
<p>Congress was supposed to reauthorize the farm bill by Sept. 30, 2023, but it <a href="https://modernfarmer.com/2023/10/the-farm-bill-expired-what-happens-now">missed that deadline</a>. It now faces a new deadline of Dec. 31, but due to <a href="https://theconversation.com/ouster-of-speaker-mccarthy-highlights-house-republican-fractures-in-an-increasingly-polarized-america-214993">dysfunction in the House of Representatives</a>, many expect the process to drag on into 2024.</p>
<p>Also in 2024, the USDA will release its next <a href="https://www.nass.usda.gov/AgCensus/">Census of Agriculture</a>, giving researchers new insight into America’s farming workforce. We expect it will show that the average age of U.S. farmers has reached a new all-time high.</p>
<p>If you believe otherwise – well, we wouldn’t bet the farm.</p><img src="https://counter.theconversation.com/content/211330/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David R. Buys receives funding from the Centers for Disease Control and Prevention, the United States Department of Agriculture National Institute of Food and Agriculture (NIFA), the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration, and the National Institutes of Health.</span></em></p><p class="fine-print"><em><span>As Director of the Southern Rural Development Center, one of the nation's four Regional Rural Development Centers (RRDCs) focused on enhancing capacity in research and Extension among Land-Grant Universities, John J. Green is involved in projects funded through the U.S. Department of Agriculture's National Institute of Food and Agriculture. Relevant to this topic are base funding support for RRDCs and the Agricultural and Food Research Initiative Competitive Program grant 2021-67023-34425 and his participation in the Rural Population Research Network (W5001). He also receives support as part of the Interdisciplinary Network on Rural Population Health and Aging funded by the National Institute on Aging grant R24-AG065159. The opinions expressed here are those of the authors and do not necessarily reflect the views of these funders.</span></em></p><p class="fine-print"><em><span>As an Assistant Professor of Human Development and Family Science at Mississippi State University, Mary Nelson Robertson is involved in projects supported by United States Department of Agriculture (USDA) National Institute of Food and Agriculture (NIFA) Rural Health and Safety Education Grant No. 2020-46100-32841, Department of Health and Human Services Substance Abuse and Mental Health Services Administration Rural Opioids Technical Assistance (ROTA) Grant No. 5H79TI083275-02, and USDA NIFA Farm and Ranch Stress Assistance Network (FRSAN): Southern Region Grant No. 2020-70028-32730 from the University of Tennessee Extension Service, and USDA NIFA FRSAN: State Department of Agriculture Grant No. 2021-70035-35566 from Mississippi Department of Agriculture and Commerce.</span></em></p>It’s part of a decadeslong trend.David R. Buys, Associate Professor of Health, Mississippi State UniversityJohn J. Green, Director of the Southern Rural Development Center & Professor of Agricultural Economics, Mississippi State UniversityMary Nelson Robertson, Assistant Professor of Human Development and Family Science, Mississippi State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104552023-10-03T20:23:30Z2023-10-03T20:23:30ZLGBTQ+ Americans feel they are just getting by in retirement and face greater financial risks<figure><img src="https://images.theconversation.com/files/543816/original/file-20230821-33177-njffxw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Even financially comfortable LGBTQ+ Americans may find themselves vulnerable to economic shocks.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/lesbian-couple-paying-bills-and-using-laptop-at-royalty-free-image/1400799722">MoMo Productions/DigitalVision via Getty Images</a></span></figcaption></figure><p>While preparing for retirement can be difficult for anyone, LGBTQ+ Americans face unique challenges that can cast a shadow over their golden years. For example, LGBTQ+ people over age 60 leave the workforce sooner, are less likely to believe that their retirement savings are on track and struggle more to pay medical bills than their straight and cisgender counterparts. They’re also twice as likely to report having experienced discrimination in the past year.</p>
<p>These findings are based on <a href="https://www.ncoa.org/article/a-profile-of-lgbtq-older-adults">our analysis</a> of data from the Federal Reserve Board’s annual <a href="https://www.federalreserve.gov/consumerscommunities/shed.htm">Survey of Household Economics and Decisionmaking</a>, or SHED. We used data from 2019 to 2021 to compare the nearly 500 LGBTQ+ respondents age 60 and older with their cisgender counterparts. </p>
<p>When asked how they were managing financially, most older LGBTQ+ adults considered themselves to be either “living comfortably” or “doing OK.” However, they also said they faced big economic challenges that could threaten their long-term well-being. </p>
<p>For example, they had a harder time affording dental care. Significantly fewer LGBTQ+ respondents said they owned their home, which means they have less opportunity to build equity that can be used later in life. </p>
<p>Retired LGBTQ+ respondents were somewhat younger and more likely to leave the workforce for reasons other than reaching traditional retirement age. In fact, nearly 1 in 3 retired because of health problems, 1 in 4 retired because of disliking their work, and almost 1 in 6 said they were forced to retire. Far smaller shares of straight and cisgender respondents reported similar outcomes – for example, only 1 in 9 said they were forced to retire.</p>
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<p>We also found that a greater percentage of older LGBTQ+ adults had annual incomes under $25,000 compared with their straight and cisgender counterparts – 15% versus 12%.</p>
<p>Finally, a bigger share of LGBTQ+ older adults said they had trouble paying bills like their rent or mortgage, and many more relied on government food and housing assistance programs compared with non-LGBTQ+ older adults.</p>
<h2>Why it matters</h2>
<p>How older LGBTQ+ adults fare during their later work years and in retirement is an issue of growing importance, since the overall LGBTQ+ population has reached an estimated <a href="https://hrc-prod-requests.s3-us-west-2.amazonaws.com/We-Are-Here-120821.pdf">20 million</a>, or nearly 8% of all American adults. Many younger people who identify as LGBTQ+ experience discrimination, whether <a href="https://www.americanprogress.org/article/discrimination-and-barriers-to-well-being-the-state-of-the-lgbtqi-community-in-2022/">on the job</a> or in their <a href="https://www.hrw.org/report/2018/07/23/you-dont-want-second-best/anti-lgbt-discrimination-us-health-care">access to health care</a>, which can have repercussions later in life.</p>
<p>People identifying as LGBTQ+ are significantly more likely than non-LGBTQ+ respondents to experience bias while receiving or even scheduling medical care. This is consistent with other research showing that LGBTQ+ adults are more likely to report that their health care provider <a href="https://www.kff.org/report-section/lgbt-peoples-health-and-experiences-accessing-care-report/">doesn’t believe them</a>, often blames them personally for having a health problem and dismisses their concerns. Not surprisingly, such discrimination can and does lead to <a href="https://doi.org/10.7759/cureus.1184">needless sickness</a> and even early death. </p>
<p>Prejudice is also common in the workplace: According to a <a href="https://news.nationwide.com/download/1190709/nfm-22096ao.pdf">Nationwide Retirement Institute report</a>, half of LGBTQ+ employees personally experienced or witnessed anti-LGBTQ+ comments at work, which, together with other forms of discrimination, can lead to fewer advancement opportunities and pay gaps. </p>
<h2>What still isn’t known</h2>
<p><a href="https://ncoa.org/article/80-percent-of-older-americans-cannot-pay-for-long-term-care-or-withstand-a-financial-shock-new-study-shows">Recent research</a> shows that most <a href="https://ncoa.org/article/80-percent-of-older-americans-cannot-pay-for-long-term-care-or-withstand-a-financial-shock-new-study-shows">older Americans can’t afford</a> their share of health care costs or long-term care. In fact, 80% of adults age 60 or older lack the savings needed to pay for more than two years in a nursing home and would not be able to absorb a financial shock such as a major illness or home repair.</p>
<p>For older LGBTQ+ adults, who experience greater levels of discrimination and have fewer financial resources than their straight and cisgender counterparts, the proportion of those who couldn’t afford later-life expenses would surely be higher. Yet researchers still don’t know how this population fares when faced with potential financial shocks or the need for long-term care. </p>
<p>For example, given that LGBTQ+ people are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6371094/#:%7E:text=As%20well%20as%20experiencing%20health,stages%20of%20life%20%5B4%5D.">less likely to have spouses or relatives</a> to serve as their caregivers, are they able to pay for long-term care if needed? Are they more likely to have to rely on institutional care rather than aging at home like their straight and cisgender counterparts? These and other questions require further study.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/210455/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging. </span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging.</span></em></p><p class="fine-print"><em><span>Molly Wylie does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Gays, lesbians and other sexual minorities can face significant economic challenges with age.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center, UMass BostonJane Tavares, Senior Research Fellow and Lecturer of Gerontology, LeadingAge LTSS Center @UMass Boston, UMass BostonMolly Wylie, Ph.D. Candidate in Gerontology, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/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/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>
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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>
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<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/2124332023-09-25T12:21:28Z2023-09-25T12:21:28ZAerobic and strength training exercise combined can be an elixir for better brain health in your 80s and 90s, new study finds<figure><img src="https://images.theconversation.com/files/549420/original/file-20230920-21-t9p644.jpg?ixlib=rb-1.1.0&rect=16%2C24%2C5475%2C3630&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pilates is a form of mind-body exercise that involves weight resistance and strength training. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/mature-woman-doing-mermaid-exercise-on-pilates-royalty-free-image/944882744?phrase=seniors+exercise&adppopup=true">Thomas Barwick/Stone via Getty Images</a></span></figcaption></figure><p>People in the oldest stage of life who regularly engage in aerobic activities and strength training exercises perform better on cognitive tests than those who are either sedentary or participate only in aerobic exercise. That is the <a href="https://doi.org/10.1007/s11357-023-00885-4">key finding of our new study</a>, published in the journal GeroScience.</p>
<p>We assessed 184 cognitively healthy people ranging in age from 85 to 99. Each participant reported their exercise habits and underwent a comprehensive battery of neuropsychological tests that were designed to evaluate various dimensions of cognitive function. </p>
<p>We found that those who incorporated both aerobic exercises, such as swimming and cycling, and strength exercises like weightlifting into their routines – regardless of intensity and duration – had better mental agility, quicker thinking and greater ability to shift or adapt their thinking.</p>
<p>Using a well-known cognitive screening tool called the <a href="https://mocacognition.com/">Montreal Cognitive Assessment</a> that provides a balanced view of many aspects of cognition, we found that people who didn’t engage in any physical exercise scored lower than those who did both cardio and strength training. This difference was slight but significant even when controlling for other factors like education and how much people exercised. In addition, the group that did both types of exercises did better in specific cognitive activities, like symbol coding, beyond just the screening results. </p>
<p>It’s important to note that while our study establishes a correlation between a mix of aerobic and strength training exercises and higher cognitive test scores, the design of the study did not enable us to determine a causal relationship.</p>
<p>Nonetheless, the results suggest that a varied exercise routine is associated with improved cognitive functioning in people who are in their late 80s and beyond. We conducted the study as part of a large, multisite collaboration with the <a href="https://mcknightbrain.org/">McKnight Brain Research Foundation</a>, which has institutes at the University of Florida, the University of Miami, the University of Arizona and the University of Alabama-Birmingham. </p>
<h2>Why it matters</h2>
<p>The aging of the global population makes cognitive health a pressing issue. The number of people diagnosed with Alzheimer’s disease in the U.S. is projected to reach <a href="https://www.statista.com/statistics/216624/projected-numbers-of-alzheimers-sufferers-aged-65-and-over-in-the-us/#statisticContainer">almost 14 million by 2060</a>, up from just over 6 million as of 2020. Our findings not only offer hope for healthier aging but also present a practical approach to maintaining or even enhancing cognitive health in the last decades of life.</p>
<p>These results are not just numbers; they represent real-world thinking abilities that can affect the quality of life for those entering their golden years.</p>
<p>The fact that nearly 70% of our study participants were already engaging in some physical exercise prior to signing up for our study challenges the stereotype that old age and physical inactivity must go hand in hand. </p>
<p>Our findings provide an evidence base for health care providers to consider recommending a mixed regimen of aerobic and strength exercises as part of their patients’ wellness plans. Studies show that when cognitive decline is slowed, people <a href="https://aspe.hhs.gov/reports/risk-costs-severe-cognitive-impairment-older-ages-key-findings-our-literature-review-projection-0">spend less on medical care</a> and experience a <a href="https://www.cdc.gov/aging/publications/chronic-diseases-brief.html">higher quality of life</a>. </p>
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<figcaption><span class="caption">The aging body is like a machine that needs more upkeep and maintenance to stay intact.</span></figcaption>
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<h2>What’s next</h2>
<p>Some of the next questions we hope to answer include: What types of aerobic and strength exercises are most effective for cognitive health? Is walking as effective as jogging? Does lifting weights have the same impact as resistance band exercises? And how much exercise is needed to see noticeable cognitive benefits? </p>
<p>Another critical question is the potential of exercise as a treatment for neurocognitive disorders among older people. Our results suggest that physical activity is a preventive measure. But could it also be an active treatment for cognitive decline? This is an exciting development and one that is opening up all sorts of new possibilities for helping people live fully across their entire life span.</p>
<p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take on interesting academic work.</em></p><img src="https://counter.theconversation.com/content/212433/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s long been known that exercise helps maintain strength and agility as we age. New research points to the importance of exercise type in supporting cognitive health in the latest decades of life.Brian Ho, PhD Candidate in Clinical & Health Psychology, University of FloridaRonald Cohen, Professor of Clinical and Health Psychology, University of FloridaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/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>
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<figcaption><span class="caption">RESPECT is intended to help people plan for palliative and end-of-life care.</span></figcaption>
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<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/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>
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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>
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<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/2125032023-08-30T23:01:53Z2023-08-30T23:01:53ZMedicare starts a long road to cutting prices for drugs, starting with 10 costing it $50.5 billion annually – a health policy analyst explains why negotiations are promising but will take years<figure><img src="https://images.theconversation.com/files/545372/original/file-20230829-23-kg9w8p.jpg?ixlib=rb-1.1.0&rect=0%2C30%2C6720%2C4436&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Americans pay far more for prescription drugs compared with people in other high-income countries. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sorting-weekly-medication-royalty-free-image/1190823309?adppopup=true">Willie B. Thomas/Digital Vision via Getty Images</a></span></figcaption></figure><p>The Biden administration released on Aug. 29, 2023, a <a href="https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf">list of the first 10 drugs</a> that will be up for negotiations with pharmaceutical companies over their Medicare prices.</p>
<p>The drugs are purchased through <a href="https://www.medicare.gov/drug-coverage-part-d">Medicare Part D</a>, a prescription drug coverage program for Americans ages 65 and older. The 10 medications accounted for more than US$50.5 billion in gross costs between June 1, 2022, and May 31, 2023.</p>
<p>Provisions authorizing these negotiations were part of the <a href="https://www.irs.gov/inflation-reduction-act-of-2022">Inflation Reduction Act</a> which Congress passed in 2022, allowing Medicare to negotiate drug prices for the first time. Pending successful negotiations, these changes would amount to what researchers estimated to be net savings of about <a href="https://doi.org/10.18553/jmcp.2023.29.8.868">$1.8 billion in 2026</a>. The <a href="https://www.cbo.gov/system/files/2022-09/PL117-169_9-7-22.pdf">Congressional Budget Office projected an even bigger savings of $3.7 billion</a>.</p>
<p>The top 10 list includes such drugs as Johnson & Johnson’s <a href="https://www.xarelto-us.com/">Xarelto</a>, which treats blood clots, and Amgen’s <a href="https://www.enbrel.com/">Enbrel</a>, which treats rheumatoid arthritis and psoriasis.</p>
<p>Negotiations are expected to begin in October and continue until August 2024, with lower prices going into effect in 2026. </p>
<p>Democrats have <a href="https://www.cbsnews.com/news/inflation-reduction-act-drug-costs-medicare-seniors-cbs-news-explains/">hailed the new law’s drug pricing provisions as game-changing</a>. They’re likely to make the issue a centerpiece of their <a href="https://apnews.com/article/medicare-prescription-drug-negotiations-biden-inflation-2bf6775c3431111a2cd03fd033caefa7">2024 election campaigns</a>. Democrats are further emboldened as public opinion polls show <a href="https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-december-2022/">overwhelming support for the policy among Americans</a>.</p>
<p>As a scholar who <a href="https://scholar.google.com/citations?user=QY68LSIAAAAJ&hl=en">researches the politics of health policy</a>, I’m skeptical that Medicare drug price negotiations will end up making as big a difference as Democrats have promised, at least in the near future. While U.S. prescription drug prices are excessive, the true potential of the policy is unclear, as it remains <a href="https://www.politico.com/news/2023/08/29/drugmakers-trade-groups-push-back-against-medicare-drug-price-negotiations-00111936">muddled in lawsuits</a> and <a href="https://www.biopharmadive.com/news/pharma-drug-pricing-negotiation-bill-ceo-response/628872/">industry opposition</a>. However, if it can withstand the ongoing attacks and become settled law, Americans ages 65 and up could see real financial relief down the line.</p>
<p><iframe id="22UTr" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/22UTr/8/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
<h2>Cutting drug costs for Medicare enrollees</h2>
<p>The <a href="https://www.irs.gov/inflation-reduction-act-of-2022">Inflation Reduction Act</a> allows the Centers for Medicare & Medicaid Services to negotiate prices with the companies that make some of the most expensive drugs in the Medicare program, including life-saving cancer and diabetes treatments like <a href="https://www.imbruvica.com/">Imbruvica</a> and <a href="https://www.januvia.com/">Januvia</a>.</p>
<p>If the negotiations proceed as planned, the drug-price-negotiation provision is expected to <a href="https://www.cbo.gov/system/files/2022-09/PL117-169_9-7-22.pdf">save the U.S. government about $98.5 billion</a> by 2031 by allowing it to pay less on prescription drugs for Americans on Medicare – nearly <a href="https://medicareadvocacy.org/medicare-enrollment-numbers/#">66 million people</a>. The Biden administration hopes that these cost savings will be passed down to Americans 65 and older through <a href="https://www.kff.org/medicare/issue-brief/how-would-drug-price-negotiation-affect-medicare-part-d-premiums/">reduced Medicare Part D premiums</a> and lower out-of-pocket costs.</p>
<p>The Inflation Reduction Act provides <a href="https://theconversation.com/why-letting-medicare-negotiate-drug-prices-wont-be-the-game-changer-for-health-care-democrats-hope-it-will-be-188560">additional benefits for older Americans</a>, including limiting their out-of-pocket expenses for prescription drugs to no more than $2,000 annually, limiting the growth of Medicare Part D premiums, eliminating out-of-pocket costs for vaccines and providing premium subsidies to low-income people ages 65 and older.</p>
<p>The Inflation Reduction Act also includes a separate provision that requires drugmakers, under certain conditions, to <a href="https://www.cms.gov/files/document/fact-sheet-part-b-rebatable-drug-coinsurance-reduction.pdf">provide the Medicare program</a> with rebates if drug price increases outpace inflation, <a href="https://www.cms.gov/files/document/reduced-coinsurance-part-b-rebatable-drugs-apr-1-june-30.pdf">starting in January of 2023</a>. That measure is expected to <a href="https://www.cbo.gov/system/files/2022-07/senSubtitle1_Finance.pdf">yield $71 billion in savings</a> over a decade. </p>
<figure class="align-center ">
<img alt="A Black female pharmacist shows Black woman some prescription medications." src="https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/478839/original/file-20220811-8881-5qqn2f.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">Government negotiations with pharmaceutical companies over drug pricing should lower medical costs for many people ages 65 and older.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-pharmacist-helping-a-senior-lady-choose-the-royalty-free-image/1352510394?adppopup=true">Marko Geber/DigitalVision via Getty Images</a></span>
</figcaption>
</figure>
<h2>Penalties for companies that won’t negotiate</h2>
<p>The 10 drugs that the Centers for Medicare & Medicaid Services <a href="https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf">have selected</a> accounted for $3.4 billion in out-of-pocket spending in 2022 <a href="https://www.cnbc.com/2023/08/29/10-drugs-to-face-medicare-price-negotiations-see-the-list.html">for Americans ages 65 and older</a> and $50.5 billion, or about 20%, of <a href="https://www.cms.gov/files/document/fact-sheet-medicare-selected-drug-negotiation-list-ipay-2026.pdf">total Part D gross prescription drug costs</a> from June 1, 2022, to May 31, 2023. </p>
<p>Pharmaceutical companies have to sign agreements to participate in the upcoming negotiations by October 2023. Based on criteria such as public feedback and consultation, as well as the clinical value of the drug, the Centers for Medicare & Medicaid Services will make an initial price offer in early 2024, with the potential to <a href="https://www.cms.gov/files/document/fact-sheetrevised-drug-price-negotiation-program-guidance-june-2023.pdf">further negotiate the price until August 2024</a>. Going forward, additional drugs will be subject to negotiations.</p>
<p>If drugmakers don’t negotiate, they will face stiff penalties in the form of a tax, reaching as high as <a href="https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act/#bullet02">95% of U.S. pharmaceutical product sales</a>. Alternatively, the companies may pull their drugs from the Medicare and Medicaid markets, meaning that seniors on Medicare would lose access to them.</p>
<h2>Why US drug prices are so high</h2>
<p><a href="https://www.healthsystemtracker.org/chart-collection/how-do-prescription-drug-costs-in-the-united-states-compare-to-other-countries/">Americans pay substantially more for prescription drugs</a> compared with people who live in countries with similar economies, like Germany, the U.K. and Australia. While Americans spent more than <a href="https://www.healthsystemtracker.org/chart-collection/how-do-prescription-drug-costs-in-the-united-states-compare-to-other-countries/">$1,100 a year</a> in 2019, Germans paid $825, the British paid $285 and Australians paid $434 per person.</p>
<p>The <a href="https://theconversation.com/why-the-us-has-higher-drug-prices-than-other-countries-111256">reasons for this disparity are multilayered</a> and include the overall <a href="https://theconversation.com/us-health-care-system-a-patchwork-that-no-one-likes-85252">complexity of the U.S. health care system</a> and the <a href="https://www.kff.org/other/report/follow-the-pill-understanding-the-u-s/">lack of transparency in the drug supply chain</a>. Of course, many other countries also directly <a href="https://theconversation.com/why-the-us-has-higher-drug-prices-than-other-countries-111256">set prices for drugs or use their monopoly on health services to drive down costs</a>.</p>
<p>For example, Dulera, an asthma drug, costs <a href="https://www.provista.com/blog/blog-listing/us-drug-prices-exceed-those-in-11-similar-countries">50 times more in the U.S.</a> than the international average. Januvia, a diabetes drug that is among the first 10 drugs up for price negotiation, and Combigan, a glaucoma drug, cost about <a href="https://www.cusd.com/Downloads/EBC_013020_US_v_Int_RX_Drug_Prices.pdf">10 times more</a>.</p>
<p>These costs impose a <a href="https://www.commonwealthfund.org/publications/journal-article/2018/nov/whats-driving-prescription-drug-prices-us">big burden on Americans</a> – <a href="https://www.commonwealthfund.org/publications/journal-article/2018/nov/whats-driving-prescription-drug-prices-us">1 in 5 of whom</a> skip at least some of their prescribed medications due to the expense. Those 65 and older are <a href="https://www.kff.org/health-costs/poll-finding/kff-health-tracking-poll-february-2019-prescription-drugs/">particularly affected</a> by these problems.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&rect=34%2C17%2C5657%2C3763&q=45&auto=format&w=1000&fit=clip"><img alt="Older adult customer standing at a pharmacy checkout stand, with pharmacist explaining something." src="https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&rect=34%2C17%2C5657%2C3763&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545363/original/file-20230829-17-5vd6tm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The first 10 drugs selected for negotiated pricing can be picked up at a pharmacy.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/female-owner-holding-prescription-paper-with-senior-royalty-free-image/944238626?adppopup=true">Maskot/Getty Images</a></span>
</figcaption>
</figure>
<h2>Strong resistance</h2>
<p>It’s too soon to say how big the impact of the drug pricing provisions will be and whether this policy will be sustained. </p>
<p>Drugmakers have opposed any <a href="https://doi.org/10.1111%2Fj.0887-378X.2004.00311.x">governmental regulation of drug prices for decades</a>. They are fighting the <a href="https://www.politico.com/news/2023/08/29/drugmakers-trade-groups-push-back-against-medicare-drug-price-negotiations-00111936">measure in court</a> and running a public relations campaign that warns of reduced investments in life-saving cures because their financial incentives are reduced. </p>
<p>Even if the drug price negotiations survive the industry’s legal challenges, it’s possible that future Republican administrations won’t embrace or enforce this policy. This is because potential Republican wins in the 2024 presidential and congressional elections could unravel or severely curtail the new drug negotiation policy. Indeed, Republicans have been working <a href="https://www.politico.com/news/2023/08/29/biden-drug-prices-gop-00113404">feverishly on designing a strategy</a> to use the negotiations against Democrats in the upcoming elections.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/9qI-2sLtp4M?wmode=transparent&start=12" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">If successful, the price negotiations could substantially lower the cost of some of the most in-demand drugs.</span></figcaption>
</figure>
<h2>Weighing the prospects</h2>
<p>In my view, the government’s efforts to cut prices for prescription drugs that Part D enrollees obtain are a step in the right direction. For now, the <a href="https://doi.org/10.18553/jmcp.2023.29.8.868">effect will likely be small</a> because patients already receive discounts on the listed drugs, bringing the net savings down substantially. However, the potential for real savings for Americans ages 65 and older will undoubtedly grow as more drugs become subject to negotiation. </p>
<p>At the same time, drug manufacturers have indicated that they are willing to take their legal battles against the Medicare drug pricing reform <a href="https://www.nytimes.com/2023/07/23/us/politics/medicare-drug-price-negotiations-lawsuits.html">all the way to the Supreme Court</a>. If that happens, there’s a <a href="https://www.medpagetoday.com/opinion/the-health-docket/105818">good chance they will prevail</a> because the arguments made in their lawsuits are likely to appeal to the Supreme Court’s conservative majority, which <a href="https://www.medpagetoday.com/opinion/the-health-docket/105818">has been favorable</a> to many of the arguments made by drugmakers in their lawsuits. </p>
<p>Moreover, drugmakers could also simply pull their drugs from Medicare and Medicaid to force the government’s hand. The Centers for Medicare & Medicaid Services seems to have deliberately chosen drugs that <a href="https://www.statnews.com/2023/08/29/10-drugs-medicare-price-negotiation">make up a high percentage of manufacturers’ drug sales</a> to counter this possibility. The industry has a <a href="https://www.amazon.com/American-Sickness-Healthcare-Became-Business/dp/1594206759">history of skillfully exploiting loopholes</a> and <a href="https://theconversation.com/prescription-drug-costs-would-have-been-a-major-campaign-issue-so-what-will-happen-now-that-coronavirus-is-center-stage-132493">possesses a vast lobbying apparatus</a>. </p>
<p>It’s also too soon to know if this is going to be a win for American patients overall. It’s possible that Americans who aren’t covered by Medicare <a href="https://rollcall.com/2022/08/10/senates-medicare-drug-pricing-may-ripple-into-private-market">may actually see prices go up</a>. That’s because if drugmakers do make less money on drugs for people enrolled in Part D, they might make up for those lost profits by charging more for drugs that other people depend on.</p>
<p>And lastly, it’s possible that there will be <a href="https://www.nytimes.com/2023/07/23/us/politics/medicare-drug-price-negotiations-lawsuits.html">fewer new prescription drugs</a> – as an indirect result of this policy that’s supposed to improve access to health care – because it <a href="https://www.kff.org/medicare/issue-brief/explaining-the-prescription-drug-provisions-in-the-inflation-reduction-act">may reduce drugmakers incentives</a>. While the number of cases is likely small, it would potentially take a toll on patients who might have seen a cure to their disease – or some relief from their symptoms.</p><img src="https://counter.theconversation.com/content/212503/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Simon F. Haeder 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>The drug pricing reform may drastically lower prices for some of the most critical life-saving drugs in the long run. But numerous obstacles stand in the way.Simon F. Haeder, Associate Professor of Public Health, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2104492023-08-28T12:01:46Z2023-08-28T12:01:46ZShort naps can improve memory, increase productivity, reduce stress and promote a healthier heart<figure><img src="https://images.theconversation.com/files/542889/original/file-20230815-21-42kbnn.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5190%2C3457&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Short naps at the right time of day can benefit alertness and overall health in myriad ways.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/young-man-asleep-royalty-free-image/1352026356?phrase=Nap&adppopup=true">Tara Moore/Digital Vision via Getty Images</a></span></figcaption></figure><p>Napping during the day is an ancient custom that is practiced worldwide. </p>
<p>While some people view napping as a luxurious indulgence, others see it as a way to maintain alertness and well-being. But napping can come with drawbacks as well as benefits. </p>
<p>As an <a href="https://health.tamu.edu/experts/steven-bender.html">orofacial pain specialist</a>, I have extensive education in sleep medicine and how sleep impacts wellness, due mostly to the relationship between sleep and painful conditions such as headaches and facial pain. My training involved all aspects of sleep, especially sleep breathing disorders, insomnia and sleep-related movement disorders. </p>
<p>As such, I’m aware of the complex nature of napping, and why a short nap – that is, a nap during the daytime that lasts from 20 to 30 minutes – may be beneficial in myriad ways. </p>
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<figcaption><span class="caption">While napping is generally a good habit for many people, there are some caveats to consider.</span></figcaption>
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<h2>An abundance of health benefits</h2>
<p>Research shows that there are many benefits to napping. Short naps can <a href="https://doi.org/10.1016/j.smrv.2022.101666">boost mental functioning and memory</a>, as well as <a href="https://www.apa.org/monitor/2016/07-08/naps">improve alertness, attention and reaction time</a>. </p>
<p>Short naps are also linked to <a href="https://www.media.mit.edu/articles/that-moment-when-you-re-nodding-off-is-a-sweet-spot-for-creativity/">increased productivity and creativity</a>. Because napping seems to improve creative thinking, some companies have attempted to harness this by introducing <a href="https://www.yahoo.com/now/nap-job-10-companies-100300632.html">napping rooms into the workplace</a>. </p>
<p>What’s more, it appears the brain uses nap time to process information gathered throughout the day, which appears to <a href="https://doi.org/10.1111/jsr.12728">enhance problem-solving abilities</a>. One small study revealed that people who took short naps were less frustrated and impulsive, which <a href="http://dx.doi.org/10.1016/j.paid.2015.06.013">resulted in better focus and efficiency</a> when performing work-related tasks. Napping may even lead to an improved ability <a href="https://doi.org/10.1007%2Fs40675-020-00193-9">to learn new motor skills</a>, such as a golf swing or the playing of a musical instrument. This is because these memories or skills become consolidated in the brain during sleep, whether at night or while napping.</p>
<p>Napping can also reduce stress. One study found that naps of approximately 20 minutes <a href="https://doi.org/10.5114/biolsport.2021.103569">improved the overall mood of participants</a>. However, longer naps lasting more than 30 minutes are not typically associated with improved mood and <a href="https://vitalrecord.tamhsc.edu/asked-grumpy-nap/">increased feelings of well-being</a>. </p>
<p>Short naps may also be associated with a <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">reduced risk of cardiovascular diseases</a>. If we are awake more than we should be, we tend to have a buildup of the “fight or flight” chemicals in our bodies. Studies show that more consistent sleep <a href="https://doi.org/10.1007/s11906-018-0874-y">will help lower these chemicals</a>, resulting in a normalization of blood pressure and heart rates. Napping <a href="https://doi.org/10.1007/s11906-018-0874-y">appears to help this process</a> for some people. </p>
<p>But just as in nighttime sleep, some people may have trouble drifting off for a nap, especially when they have limited time. Progressive muscle relaxation techniques have been shown to be <a href="https://doi.org/10.1111/jsr.13574">beneficial for both nighttime sleep and napping</a>. Other nonspecific relaxation techniques, like listening to relaxing music, appear to also be beneficial for falling asleep. Interestingly, many people overestimate their time awake when trying to sleep and underestimate <a href="https://psycnet.apa.org/doi/10.1037/a0025730">the time they actually spent sleeping</a>. </p>
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<figcaption><span class="caption">Make sure the nap is short.</span></figcaption>
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<h2>Napping can have drawbacks</h2>
<p>One condition associated with napping longer than 30 minutes is <a href="https://www.sleepfoundation.org/how-sleep-works/sleep-inertia">sleep inertia</a> – the grogginess and disorientation that people sometime experience after waking from a longer nap. </p>
<p>Usually, the longer the nap, the more sleep inertia there is to overcome. This can impair cognitive function from several minutes up to half an hour. In many cases, these effects can be <a href="https://doi.org/10.2147/NSS.S188911">minimized by consuming caffeine</a> directly after the nap. </p>
<p>But it is important to note that <a href="https://theconversation.com/can-coffee-or-a-nap-make-up-for-sleep-deprivation-a-psychologist-explains-why-theres-no-substitute-for-shut-eye-206847">caffeine is not a substitute for sleep</a>. Caffeine acts to temporarily block the action of a chemical known as adenosine, a sleep-promoting agent that builds up during waking hours. If you are habitually dependent on caffeine consumption to keep you awake and alert, it may suggest that there is an underlying sleep disorder such as <a href="https://www.nhlbi.nih.gov/health/insomnia#">insomnia</a> or <a href="https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631#">sleep apnea</a>, in which a person temporarily stops breathing during sleep. </p>
<p>Long or late afternoon naps can also interfere with nighttime sleep, either by leading to difficulties falling asleep or staying asleep during the night. This disruption of the regular <a href="https://www.sciencedirect.com/topics/neuroscience/sleep-waking-cycle#">sleep-wake cycle</a> can result in <a href="https://my.clevelandclinic.org/health/diseases/23970-sleep-deprivation">overall sleep deprivation</a>, which <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">can have numerous negative health effects</a>. </p>
<p>What’s more, for those age 60 and up, longer naps – beyond 30 minutes – <a href="https://doi.org/10.1016/j.smrv.2022.101682">may increase the risk for cardiovascular problems</a>. Researchers found that older adults taking naps for more than one hour per day have a higher incidence of increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels, sometimes known as metabolic syndrome. </p>
<p>The reason for this phenomenon is mostly unknown. Older individuals tend to nap more frequently than younger adults partly due to <a href="http://dx.doi.org/10.1016/j.smrv.2016.09.002">more disturbed sleep during the night</a>. This could be related to more pain or other health factors that will interfere with sleep, sleep altering medications and altered sleep rhythms seen with aging. </p>
<h2>Best practices</h2>
<p>So, to maximize benefits while reducing risks, here are some tips: Keep naps short to avoid sleep inertia and nighttime sleep disruptions. Nap in the early afternoon, as that aligns with a decrease in energy levels after lunch and with <a href="https://www.health.harvard.edu/staying-healthy/is-your-daily-nap-doing-more-harm-than-good#">the body’s natural circadian dip</a>, which is an increase in sleepiness similar to what occurs at dusk. Avoid late afternoon naps, finish naps at least four to six hours before bedtime, and create the right environment by napping in a quiet, comfortable and dimly lit space. </p>
<p>If you’re struggling with daytime sleepiness, it’s best to address the root cause rather than relying solely on napping. Reducing caffeine consumption, maintaining a regular sleep schedule and getting adequate nighttime sleep are essential steps to reduce daytime sleepiness. </p>
<p>Ultimately, napping should complement a healthy sleep routine, not serve as a <a href="https://theconversation.com/can-coffee-or-a-nap-make-up-for-sleep-deprivation-a-psychologist-explains-why-theres-no-substitute-for-shut-eye-206847">substitute for sufficient nighttime rest</a>. A balanced approach to napping can contribute to a more energized, focused and resilient life.</p><img src="https://counter.theconversation.com/content/210449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven Bender 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>Naps can be rejuvenating and beneficial to attentiveness and overall health, but the length of naps and the time of day are key.Steven Bender, Clinical Associate Professor, Texas A&M UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2120032023-08-23T07:55:34Z2023-08-23T07:55:34ZThe intergenerational report tries to scare us about ageing. It’s an old fear, and wrong<p>The “problem” of Australia’s ageing population has been a concern for decades. Indeed, I have aged along with it. </p>
<p>The first official report on the subject was produced in a report of the National Population Council entitled <a href="https://www.semanticscholar.org/paper/Greying-Australia%3A-future-impacts-of-population-Kendig-McCalum/fde9a7a1a12e9504ca0bc1847a3eb6f3438e07db">Greying Australia: Future Impacts of Population Ageing</a>, which came out as I entered my 30s, sporting a full head of dark hair.</p>
<p>The latest <a href="https://treasury.gov.au/intergenerational-report">Intergenerational Report</a>, to be released on Thursday, comes weeks after – with thinner and greyer hair – I celebrated reaching the official pension age of 67 (raised from 60 for women and 65 for men). </p>
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<span class="caption">John Quiggin, 1990s.</span>
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<p>While ageing brings with it some regrets it is, as French actor Maurice Chevalier is supposed to have said: not so bad, when you consider the alternative.</p>
<p>But while individual Australians continue to age at a rate of one year per year, discussion of population ageing seems stuck in a 1980s timewarp. </p>
<p>The 2021 Intergenerational Report contained an extensive, and gloomy, discussion of the change in what it called the “old-age dependency ratio” – which it defined as the ratio of Australians of “working age”, which it said was 15–64, to those over 65.</p>
<p>But it seems to have escaped the notice of the authors in the treasury that the school leaving age has climbed to 17, and the pension age has climbed to 67. </p>
<p>This reflects a much bigger problem. Projections of “population ageing” usually produce a future society that is exactly like the one we have at present except that there are more old people and fewer young people. </p>
<p>In particular, it is usually assumed people of every given age will have much the same characteristics and live in much the same way as do at present. </p>
<p>The idea is wrong for at least three reasons.</p>
<p>First, lifetime patterns of work have changed radically, and will continue to do so. </p>
<p>In practice, most young people are dependent on their parents into their early 20s, sometimes beyond. </p>
<p>Some are dependent on their 65+ grandparents, meaning they are supported by rather than supporting the age group the treasury regards as dependants.</p>
<p>Older Australians are twice as likely to be employed as before. 40 years ago, in 1983, only <a href="https://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/6291.0.55.001Nov%202005?OpenDocument">5%</a> of Australians aged 65 and over were employed. Now it’s <a href="https://www.abs.gov.au/statistics/labour/employment-and-unemployment/labour-force-australia-detailed/jun-2023">11.4%</a>.</p>
<p>With an increased pension age and the end of defined-benefit superannuation (which rewarded early retirement), we can expect that trend to continue. </p>
<p>While the 2021 Intergenerational Report noted these trends, it seemed to ignore them in arriving at its conclusions.</p>
<h2>Longer lives are good things</h2>
<p>There’s a second reason why it isn’t right to assume that older people in the future will be much like older Australians have always been (except more numerous).</p>
<p>Those older Australians will be living longer precisely because they are healthier.</p>
<p>Today, the typical 65-year-old can expect to live <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy">21</a> more years. In the 1950s it was only <a href="https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/life-expectancy">14</a> more years. Medical progress, along with improvements in work safety and lifestyle changes, have made it possible to remain healthy for longer (though COVID might undermine this). </p>
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Read more:
<a href="https://theconversation.com/the-intergenerational-report-sets-the-scene-for-2063-but-what-is-it-211694">The intergenerational report sets the scene for 2063 – but what is it?</a>
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<p>Drug treatments are now available for chronic conditions like arthritis that used to go untreated. Even dementia, where there has been little if any advance in treatment, appears to be declining in its <a href="https://agedcare.royalcommission.gov.au/system/files/2020-06/RCD.9999.0034.0006.pdf">age-specific prevalence</a>. </p>
<p>This decline is a byproduct of improved cardiovascular health and (more speculatively) increased education levels among the middle-aged and old. </p>
<p>As before, the really big costs in the medical system are incurred in the last year of life. By definition, the last year comes only once in each lifetime, meaning more years than before are healthy.</p>
<h2>Working different, working longer</h2>
<p>And there’s a third reason why it’s wrong to assume that older people in the future will be much like those today: technological progress has largely eliminated many unskilled jobs.</p>
<p>Two things flow from this. One is that young people need to spend more time than before in education in order to acquire skills.</p>
<p>The other is that the decline in unskilled jobs involving hard physical labour makes it easier for people to work much longer should they want to.</p>
<p>Yet talk about population ageing nearly always presents it as a near-catastrophe. Treasurer Joe Hockey didn’t help, introducing the 2015 Intergenerational Report by saying Australians would “<a href="https://www.smh.com.au/politics/federal/intergenerational-report-joe-hockey-warns-difficult-days-lie-ahead-20150219-13jnkx.html">fall off their chairs</a>” when they read it.</p>
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Read more:
<a href="https://theconversation.com/intergenerational-reports-ought-to-spark-action-as-well-as-scare-us-163505">Intergenerational reports ought to spark action, as well as scare us</a>
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<p>As it happens, we are facing a catastrophe, and it has scarcely been mentioned in the five intergenerational reports to date. It’s catastrophic climate change. </p>
<p>We are living in a world of near-continuous wildfire emergencies and other climatic disasters. Even with determined action, things are only likely to get worse for the next generation. </p>
<p>In these circumstances, worrying about the need to raise taxes by a few percentage points over 40 years to pay for things like more aged care shows an astonishing lack of concern about the future.</p><img src="https://counter.theconversation.com/content/212003/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Quiggin is 67 and hopes to continue aging for some decades to come</span></em></p>The financial impacts of an ageing Australia aren’t particularly worrisome, but we’ve been worrying for decades.John Quiggin, Professor, School of Economics, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2116762023-08-23T00:49:41Z2023-08-23T00:49:41ZKeeping up with advanced MRI: Kim Kardashian promotes whole-body scans. Could they be worth the hype?<p>The worlds of pop culture and advanced imaging technology intersected recently when Kim Kardashian promoted a commercial whole-body magnetic resonance imaging (MRI) service on social media as a tool to detect cancer and aneurysms. </p>
<p>The post attracted criticism from members of the <a href="https://www.aafp.org/pubs/afp/collections/choosing-wisely/250.html">medical community</a>, who <a href="https://www.dailymail.co.uk/health/article-12389553/Kim-Kardashian-slammed-doctors-promoting-rip-2-500-MRI-scan-Instagram-claims-spot-cancers-years-advance-save-lives.html">expressed concern</a> about the lack of evidence for widespread use of this technology in people who are disease free. </p>
<p>Despite these concerns, the information provided by whole-body MRI scanning for mapping anatomy and function has great potential for helping us understand how changes in the brain and body are associated with health outcomes over the human lifespan.</p>
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<h2>Not new, but improved</h2>
<p>Whole-body <a href="https://theconversation.com/the-science-of-medical-imaging-magnetic-resonance-imaging-mri-15030">MRI scanning</a> has been available for a decade or more. MRI <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/mri-scan">uses</a> strong magnetic fields to coax a signal from water molecules. Given our body is <a href="https://www.ncbi.nlm.nih.gov/books/NBK541059/">approximately 60%</a> water by volume, MRI scans can be used to generate images over the length of our body. In a clinical setting, scans are then studied by radiologists who look for potential abnormalities.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8519652/">Recent technical improvements</a> mean detailed images of the body from head to toe can now be obtained in less than half an hour. This technique has been primarily used for cancer detection. </p>
<p>In Australia, whole-body MRI was recently added to the Medicare Benefits Schedule for people with a <a href="http://www.mbsonline.gov.au/internet/mbsonline/publishing.nsf/Content/Factsheet-Whole%20Body%20MRI">high genetic risk of cancer</a>.</p>
<p>Despite the usefulness of whole-body MRI for cancer detection for high-risk people, there are <a href="https://www.aafp.org/pubs/afp/collections/choosing-wisely/250.html">concerns</a> around widespread use of this technology in the general population without appropriate oversight by trained medical practitioners. </p>
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Read more:
<a href="https://theconversation.com/the-science-of-medical-imaging-magnetic-resonance-imaging-mri-15030">The science of medical imaging: magnetic resonance imaging (MRI)</a>
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<h2>The risk of overdiagnosis</h2>
<p>If an abnormality is detected in an otherwise healthy person, the significance of the abnormality is often unclear and treatment options may be limited. Anatomy can vary significantly between people and there is no guarantee an unusual imaging finding has negative implications for an individual, particularly if the person does not have any symptoms of poor health.</p>
<p>The anxiety and potentially invasive investigations triggered by an MRI finding may have a negative effect on the person’s overall wellbeing. In many cases, the stress may outweigh the health value of the discovery. </p>
<p>The scans are not cheap either. The whole-body MRI offered by Prenuvo in the United States and promoted by Kardashian costs <a href="https://www.prenuvo.com/pricing/">almost A$4,000</a>. </p>
<p>Despite these concerns, it is highly likely whole-body imaging will add to our understanding of how changes in the body contribute to healthy ageing and the development of disease. </p>
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Read more:
<a href="https://theconversation.com/low-and-middle-income-countries-struggle-to-provide-health-care-to-some-while-others-get-too-much-medicine-190446">Low- and middle-income countries struggle to provide health care to some, while others get too much medicine</a>
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<h2>How parts of the body talk to each other</h2>
<p>One potential application of whole-body MRI is to inform our understanding of the interactions between the brain and the rest of the body. </p>
<p>A multitude of studies demonstrate how the health of our brain and other organs are intimately linked. Body systems that interact with the brain include the <a href="https://www.nature.com/articles/nrn3346">gut</a> and <a href="https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.106.678995">heart</a>. The brain also partners with our <a href="https://www.sciencedirect.com/science/article/abs/pii/S1526590016300712">musculoskeletal system</a> and <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/hbm.20870">fat distribution in the body</a>. </p>
<p>A number of Australian studies have used MRI to investigate brain-body connections, including work from the Personality and Total Health (PATH) Through Life study that shows optimal blood pressure is <a href="https://www.frontiersin.org/articles/10.3389/fnagi.2021.694982/full">linked with healthy brain ageing</a>. </p>
<p>University of Melbourne research published earlier this year shows a number of chronic diseases are associated with <a href="https://www.nature.com/articles/s41591-023-02296-6">accelerated ageing of the brain and other organs</a>. The study used artificial intelligence to predict the age of participants based on assessments of brain and body structure and function, and found an increased gap between a subject’s brain or body age and their chronological age was associated with a range of poor health outcomes. They further identified networks of advanced ageing patterns that spread from affected organs into other body systems.</p>
<p>The latter study is notable because it used data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, a large-scale population study collecting health information from half a million participants aged 40 and over, including MRI scans of the brain, heart and abdomen in 100,000 subjects. </p>
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Read more:
<a href="https://theconversation.com/ai-can-help-detect-breast-cancer-but-we-dont-yet-know-if-it-can-improve-survival-rates-210800">AI can help detect breast cancer. But we don't yet know if it can improve survival rates</a>
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<h2>Studying healthy people to track changes</h2>
<p>Other large prospective imaging studies include the <a href="https://abcdstudy.org/">Adolescent Brain Cognitive Development (ABCD) study</a> which uses brain imaging and other assessments to track the development of more than 10,000 children in the United States beginning at age nine, and the German <a href="https://neurodegenerationresearch.eu/cohort/the-rhineland-study/">Rhineland study</a> with a planned enrolment of 30,000 participants aged 30 or older. </p>
<p>A substantial number of people who will participate in these studies are healthy. Over time, some of the study participants will develop health issues. So these studies offer a unique opportunity to use imaging to identify markers for poor health outcomes. Investigation could lead to ways to prevent these issues. </p>
<p>One of the key challenges in these large-scale imaging studies is how to identify relevant changes on MRI scans. The standard approach of using a radiologist to visually review scans does not scale when studies recruit thousands of participants. Artificial intelligence methods are very well suited to the task of tagging brain and body structures on MRI scans, and one important use of these large studies is to develop AI-based image labelling. </p>
<p>An Australian-based study of similar scale would have the potential to deliver similar benefits for our population. And such large-scale research could help develop an evidence base to support or debunk the use of advanced technologies such as whole-body MRI scans for helping people maintain good health and identifying health issues as early as possible. </p>
<p>For the time being, more research is needed to fully explore the potential of whole-body MRI scanning. Meanwhile, there is a growing demand for a <a href="https://theconversation.com/what-are-these-cancer-vaccines-im-hearing-about-and-what-similarities-do-they-share-with-covid-vaccines-197988">personalised approach</a> to health care. And once something shows up in our social media feed it can be surprising how soon it’s widely available. </p>
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Read more:
<a href="https://theconversation.com/brain-fingerprinting-of-adolescents-might-be-able-to-predict-mental-health-problems-down-the-line-187765">'Brain fingerprinting' of adolescents might be able to predict mental health problems down the line</a>
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<img src="https://counter.theconversation.com/content/211676/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Heath Pardoe receives funding from the National Institutes of Health, USA. He works for the Florey Institute of Neuroscience and Mental Health.</span></em></p>Doctors weren’t happy when celebrity Kim Kardashian promoted whole-body MRI scans recently. But that doesn’t mean they don’t hold promise for understanding ageing on a grander scale.Heath Pardoe, Associate professor, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2112662023-08-22T18:54:13Z2023-08-22T18:54:13ZAging with a healthy brain: How lifestyle changes could help prevent up to 40% of dementia cases<figure><img src="https://images.theconversation.com/files/543822/original/file-20230821-21-8h55nn.jpg?ixlib=rb-1.1.0&rect=0%2C11%2C7360%2C4451&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modifiable risk factors for dementia include high blood pressure, obesity, physical inactivity, diabetes, smoking, excessive alcohol consumption and infrequent social contact.</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/aging-with-a-healthy-brain-how-lifestyle-changes-could-help-prevent-up-to-40-of-dementia-cases" width="100%" height="400"></iframe>
<p>A 65-year-old woman repeatedly seeks medical help for her failing memory. She is first told it’s nothing to worry about, then, a year later, that it’s “just normal aging.” Until finally, the penny drops: “It’s Alzheimer’s. There is no cure.” </p>
<p>Scenarios like this one are too common.</p>
<p>Dementia remains largely underdetected, even in high-income countries such as Canada where <a href="https://doi.org/10.1136%2Fbmjopen-2016-011146">rates of undetected cases exceed 60 per cent</a>. Beliefs that cognitive deficits are normal in elderly people, and the lack of knowledge of dementia symptoms and of diagnostic criteria amongst medical doctors have been identified as the <a href="https://doi.org/10.1590%2FS1980-57642011DN05040011">main culprits of missed cases and delayed diagnosis</a>.</p>
<p>Age-related memory losses should not be shaken off as just part of normal aging. Occasionally forgetting where we parked the car or where we left our keys can happen to everyone, but when these situations become frequent it’s important to seek medical advice. </p>
<p>While many individuals experiencing mild changes in their ability to think and remember information will not go on to develop dementia, in others, these declines constitute an early warning sign. Research has shown <a href="https://doi.org/10.1111/acps.12336">that people with mild changes in cognition</a> are at a greater risk of developing dementia later in life. </p>
<p>In fact, it has been demonstrated that <a href="https://doi.org/10.3390/ijms20225536">the disease process (changes in the brain’s structure and metabolism)</a> starts decades before the appearance of symptoms such as memory loss. Moreover, it is <a href="https://doi.org/10.1038/s43587-022-00269-x">increasingly recognized in the scientific community</a> that interventions that aim to slow down or <a href="https://doi.org/10.1016/S0140-6736(15)60461-5">prevent</a> disease development are more likely to be effective when initiated early in the disease course. </p>
<p>Despite this, protocols for early detection <a href="https://canadiantaskforce.ca/guidelines/published-guidelines/cognitive-impairment/">are not standard</a> in the medical community, in part because significant gaps remain in our understanding of dementia. </p>
<h2>Dementia and an aging population</h2>
<p>In my research, I use advanced brain MRI methods to characterize brain health in older adults who are at high risk of developing dementia. The goal is to identify new biomarkers of early pathology, which could lead to improved detection methods in the future. </p>
<figure class="align-center ">
<img alt="A woman with gray hair with health care worker in scrubs." src="https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543761/original/file-20230821-27-g1ams7.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">
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<span class="caption">By 2050, the number of Canadians living with dementia is expected to exceed 1.7 million.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>The proportion of senior Canadians is growing in our population. Dementia is strongly associated with aging, so the number of Canadians diagnosed with dementia — including Alzheimer’s — is expected to rise considerably in the next few decades, reaching an expected <a href="https://www.ctvnews.ca/health/nearly-one-million-canadians-will-live-with-dementia-by-2030-alzheimer-society-predicts-1.6056849">1.7 million</a> Canadians by 2050. That’s more than the <a href="https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1710000901">population of Manitoba</a>! </p>
<p>This projected increase will put an enormous pressure on our already strained health-care systems if no significant actions are taken to reverse this trend. This means that effective prevention strategies are now more urgent than ever.</p>
<p>Recent <a href="https://www.ctvnews.ca/health/promising-new-drug-to-treat-alzheimer-s-in-pipeline-of-approval-in-canada-1.6443850">news about promising new drugs</a> to treat Alzheimer’s disease also highlight the need for early detection. <a href="https://doi.org/10.1056/NEJMoa2212948">Clinical trials</a> showed that these drugs are most effective at slowing cognitive decline when administered early in the disease course. </p>
<p>Although these new treatment options represent breakthroughs for the Alzheimer’s field, more research is needed. These new therapies act on only one disease process (lowering the levels of amyloid, a substance thought to be toxic for neurons), so they may slow cognitive decline in <a href="https://doi.org/10.1093/braincomms/fcad175">only a narrow subset of patients</a>. A proper characterization of other processes, on a personalized basis, is required to combine these treatments with other strategies. </p>
<p>This is not to mention the significant increase in financial and human resources that will be necessary to deliver these new treatments, which could hinder access to them, especially in low- and middle-income countries, where <a href="https://doi.org/10.1016/S0140-6736(20)30367-6">dementia cases are rising the most</a>.</p>
<h2>Lifestyle and brain health</h2>
<figure class="align-center ">
<img alt="Five older adults seated and doing arm exercises" src="https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543760/original/file-20230821-25-z8e7mg.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">
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<span class="caption">Seniors participating in a seated exercise class. Physical inactivity is a modifiable risk factor for dementia.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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<p>Lifestyle changes, on the other hand, have been shown to decrease the risk of developing dementia with minimal costs and no side-effects. By making dementia risk assessment a part of routine medical visits for older adults, those who are most at risk could be identified and counselled on how to maintain brain health and cognition. </p>
<p>At-risk individuals likely need those interventions the most (potentially a combination of pharmaceutical and lifestyle interventions), but anyone can benefit from adopting healthy lifestyle habits, which are known to protect from diseases not only of the brain, but also of the heart and other organs.</p>
<p>According to an <a href="https://www.thelancet.com/article/S0140-6736(20)30367-6/fulltext">influential report</a>, published in <em>The Lancet</em> in 2020, 40 per cent of dementia cases can be attributed to 12 modifiable risk factors. These include high blood pressure, obesity, physical inactivity, diabetes, smoking, excessive alcohol consumption and infrequent social contact. </p>
<p>This means that, by adopting positive lifestyle habits, we could theoretically prevent about 40 per cent of dementias, according to the report. While there is no guarantee of warding off cognitive decline, people can greatly reduce their risk of dementia by increasing their physical activity levels, ensuring they are mentally active and increasing social contact, while avoiding smoking and limiting alcohol consumption. </p>
<figure class="align-center ">
<img alt="A group of older adults attending an art class, and their teacher" src="https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543759/original/file-20230821-27982-v420lw.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">By encouraging people to be physically, mentally and socially active, we can potentially keep a significant number of dementia cases at bay.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Some evidence also suggests that a <a href="https://doi.org/10.3945/an.117.015495">Mediterranean diet</a>, which emphasizes high consumption of plants (especially leafy greens) while reducing saturated fats and meat intake, <a href="https://doi.org/10.1093/ajcn/nqx070">is also beneficial for brain health</a>. </p>
<p>In short, by encouraging people to be physically, mentally and socially active, a significant number of dementia cases could potentially be kept at bay. </p>
<h2>Barriers to healthy lifestyles</h2>
<p>At the same time, focusing on policy changes could address the societal inequalities that lead to the occurrence of several risk factors, <a href="https://aaic.alz.org/downloads2020/2020_Race_and_Ethnicity_Fact_Sheet.pdf">and higher prevalence of dementia</a>, in <a href="https://content.iospress.com/articles/journal-of-alzheimers-disease/jad201209">ethnic minorities</a> and vulnerable populations. Despite having a universal health-care system, Canada still has health inequalities. People <a href="https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html">at greater risk of health conditions</a> include those with lower socioeconomic status, people with disabilities, Indigenous people, racialized people, immigrants, ethnic minorities and LGBTQ2S people.</p>
<p>Policy changes could address these inequalities not only by promoting healthy lifestyles, but also by taking action to improve the <a href="https://doi.org/10.1016/j.joclim.2021.100035">circumstances in which people of these communities live</a>. Examples include <a href="https://doi.org/10.1093/heapro/dav022">improving access to sport centres</a> or prevention clinics for people with lower incomes and designing cities that are conducive to active lifestyles. Governments need to evaluate and address the barriers that prevent people from specific groups from adopting healthy lifestyle habits. </p>
<p>We must be ambitious about prevention. The future of our health-care system and that of our own health depends on it.</p><img src="https://counter.theconversation.com/content/211266/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stefanie Tremblay receives funding from the Canadian Institutes of Health Research (CIHR). She is affiliated with Dragonfly Mental Health, a not-for-profit organization advocating for better mental health in academia. </span></em></p>While there is no guarantee of warding off cognitive decline, encouraging people to be physically, mentally and socially active could potentially keep a significant number of dementia cases at bay.Stefanie Tremblay, PhD candidate in medical physics, studying MRI biomarkers of declining brain health in aging, Concordia UniversityLicensed as Creative Commons – attribution, no derivatives.