tag:theconversation.com,2011:/au/topics/older-peoples-health-33308/articlesOlder people's health – The Conversation2023-11-02T19:13:32Ztag:theconversation.com,2011:article/2150742023-11-02T19:13:32Z2023-11-02T19:13:32ZI was a geriatrician on Old People’s Home for Teenagers. Here’s why I joined this TV experiment<figure><img src="https://images.theconversation.com/files/555958/original/file-20231025-23-112he5.jpg?ixlib=rb-1.1.0&rect=0%2C20%2C6884%2C4565&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>Many people will have heard about “intergenerational practice” via the TV.</p>
<p>This is the purposeful <a href="https://www.mdpi.com/1660-4601/19/18/11254">bringing together</a> of different generations, aiming to benefit all involved. It’s the idea central to ABC TV’s <a href="https://iview.abc.net.au/show/old-people-s-home-for-teenagers">Old People’s Home for Teenagers</a>, and its predecessor <a href="https://iview.abc.net.au/show/old-people-s-home-for-4-year-olds">Old People’s Home for 4 Year Olds</a>. Both show the positive aspects of mixing age groups, for the older people featured, as well as the teenagers or preschoolers.</p>
<p>I’m a <a href="https://anzsgm.org/publicinformation/">geriatrician</a>, a doctor who specialises in the medical care of older people, one of two geriatricians who took part in this TV experiment. Here’s why I got involved.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-people-get-old-190142">Curious Kids: why do people get old?</a>
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</em>
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<h2>The benefits of mixing it up</h2>
<p>The positive aspects of mixing age groups may seem intuitive. Just think of how special it can be when grandparents spend time with their grandchildren. When older and younger people are together, each <a href="https://onlinelibrary.wiley.com/doi/10.1111/ajag.12761">can share</a> their experiences and perspectives. Meaningful connections can develop.</p>
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<a href="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Addison talking with Annalise during filming" src="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555960/original/file-20231025-19-dsc0zw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Meaningful connections can develop, such as between teenager Addison and Annalise.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
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<p>But in Australia today, many older people have no such opportunities. Multi-generational households are the exception, not the norm. </p>
<p><a href="https://www.aihw.gov.au/reports/older-people/older-australians/contents/housing-and-living-arrangements">One quarter</a> of people aged 65 and over living in private homes live alone. <a href="https://www.propertycouncil.com.au/media-releases/retirement-villages-approaching-capacity-where-will-our-seniors-live-2">Nearly 200,000</a> live in retirement villages and <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/2021-22-GEN-Topic-Updates/People%20using%20aged%20care/People-using-aged-care-fact-sheet_2022.pdf">around the same number</a> live in residential aged care. Both of the latter, by definition, accommodate only a single generation. </p>
<p>Intergenerational programs overcome these barriers by creating a <a href="https://shop.earlychildhoodaustralia.org.au/product/rip2101/">structured and supported</a> forum in which two age groups can regularly connect. </p>
<p>These programs can involve <a href="https://www.metronorth.health.qld.gov.au/news/grandfriends-reduces-loneliness-isolation">different populations</a>: from toddlers through to university students, from independent, active retirees through to aged care residents and hospital patients.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-new-project-shows-combining-childcare-and-aged-care-has-social-and-economic-benefits-99837">A new project shows combining childcare and aged care has social and economic benefits</a>
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<p>Programs can take several forms, for example:</p>
<ul>
<li><p>playgroups are <a href="https://journals.sagepub.com/doi/10.1177/1476718X211059662">conducted in</a> aged care facilities</p></li>
<li><p>childcare and aged care facilities are <a href="https://agedcarenews.com.au/2022/06/21/the-herd-proudly-blazing-a-trail-for-the-future-of-intergenerational-care-and-learning/">in the same location</a></p></li>
<li><p>older volunteers in the community take part in <a href="https://www.abc.net.au/news/2023-10-03/ophft-making-connections-in-your-community/102908402">formal mentorship programs</a> for young adults.</p></li>
</ul>
<p>The <a href="https://pubmed.ncbi.nlm.nih.gov/33567363/">common aim</a> is to improve wellbeing, restore purpose, and bring joy to older participants, while helping to develop social skills, confidence and empathy in young people. These programs can potentially also address <a href="https://www.who.int/health-topics/ageism#tab=tab_1">ageism</a>, by creating understanding and empathy for each generation and by challenging negative stereotypes. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/kids-dressing-up-as-older-people-is-harmless-fun-right-no-its-ageist-whatever-bluey-says-212607">Kids dressing up as older people is harmless fun, right? No, it's ageist, whatever Bluey says</a>
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</p>
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<h2>There are challenges ahead</h2>
<p>There are wide-ranging challenges ageing may throw at us – an <a href="https://pubmed.ncbi.nlm.nih.gov/21925398/">increased burden</a> of chronic disease and frailty, a decline in physical and cognitive abilities, or changes in hearing, vision and balance.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Maz with walker, taking a puppy for a walk, Ayden holds out hand to puppy" src="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555961/original/file-20231025-15-xonqpw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The program encouraged both young people, such as Ayden, and older people, such as Maz, to be more active.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/steep-physical-decline-with-age-is-not-inevitable-heres-how-strength-training-can-change-the-trajectory-213131">Steep physical decline with age is not inevitable – here's how strength training can change the trajectory</a>
</strong>
</em>
</p>
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<p>Changes in occupational and social roles often also occur as we get older, for instance, as older people retire from paid work or care for a sick partner. Conversely, older people may lose their role as caregivers, after grandchildren grow up, or after the loss of a loved one. </p>
<p>All these ageing-related changes can lead to a loss of social connection and <a href="https://theconversation.com/i-tell-everyone-i-love-being-on-my-own-but-i-hate-it-what-older-australians-want-you-to-know-about-loneliness-166109">loneliness</a>. Loneliness itself is bad for health. Loneliness <a href="https://www.nature.com/articles/s41572-022-00355-9">increases risks</a> for depression, cardiovascular disease, dementia and may even lead to a shorter life span. Reducing loneliness in older adults remains a challenge.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-tell-everyone-i-love-being-on-my-own-but-i-hate-it-what-older-australians-want-you-to-know-about-loneliness-166109">'I tell everyone I love being on my own, but I hate it': what older Australians want you to know about loneliness</a>
</strong>
</em>
</p>
<hr>
<h2>How I got involved</h2>
<p>So when a chance to become involved in Old People’s Home for 4 Year Olds, I eagerly jumped on board. This featured an experimental intergenerational preschool. Young and old took part in a series of structured and supported activities such as playing dress-ups, going on walks and having a sports carnival.</p>
<p>At the time, intergenerational programs were far from mainstream, especially in Australia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Annelise and Alix walking outside on grass, trees in background" src="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555962/original/file-20231025-29-yvrjxr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Annelise said she was lonely at the start of the series, but formed a bond with teenager Amelie.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>I joined the TV program with a panel of experts including a physiotherapist and psychologist. </p>
<p>We screened the older adults at the start of the experiment for issues such as <a href="https://dementiaresearch.org.au/wp-content/uploads/2016/06/geriatric_depression_scale_short.pdf">depression</a>, and assessed signs of <a href="https://academic.oup.com/biomedgerontology/article/56/3/M146/545770?login=false">physical frailty</a> including speed of walking, muscle strength and activity levels. We then assessed them again after six weeks.</p>
<p>While we were cautiously hopeful, the overall improvements were better than anticipated, and some of the individual transformations were extraordinary. </p>
<p>For instance, three of four participants who originally screened positive for depression had scores in the normal range by the end of the program. For one woman in her 80s her score improved by eight points on a 15-point scale. Improvements in fitness levels across the group were impressive too.</p>
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<a href="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Dale and Abi outside, standing on grass, trees in background" src="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1130&fit=crop&dpr=1 754w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1130&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/555963/original/file-20231025-15-d2fqb3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1130&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Dale was concerned about how her visual impairment affected her day-to-day life, but soon connected with Abi.</span>
<span class="attribution"><span class="source">EndemolShine Australia</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Since then, the series has evolved to involve differing populations: from residents of aged care facilities and retirement villages, to older adults living in the community, and from preschoolers to teenagers.</p>
<p>Each program has been adapted to the needs of each group involved. At times, we have focused on a particular issue, such as loneliness, depression, concerns about memory, physical frailty and falls.</p>
<p>But in each we have continued to see benefits for both age groups, in line with what a <a href="https://www.sciencedirect.com/science/article/pii/S1568163721001471">growing evidence base</a> is telling us about the potential benefits of such programs. </p>
<p>This is perhaps even more so in the Old People’s Home for Teenagers series, with the second season currently on air. The teenage participants are articulate in describing how truly valuable it is for younger people to spend enriched time with older mentors. Their confidence increases, they take on new challenges, and new meaningful connections develop, many of which continue to <a href="https://www.abc.net.au/news/2023-10-01/old-peoples-home-for-teens-ongoing-intergenerational-friendships/102885166">enrich lives</a> long after the cameras stop rolling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-think-my-teen-is-depressed-how-can-i-get-them-help-and-what-are-the-treatment-options-206702">I think my teen is depressed. How can I get them help and what are the treatment options?</a>
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</em>
</p>
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<p>No-one is pretending such intergenerational programs are going to end loneliness for all older people, or can remove all the challenges they may face later in life. And equally, people do not need to be lonely, frail or isolated to participate.</p>
<p>Alongside the TV programs, there has been an <a href="https://www.abc.net.au/news/backstory/2023-10-03/old-peoples-home-4-year-olds-impact-and-success/102868168">upswing</a> in community interest in intergenerational practice, from researchers to educators to aged care providers, to hospitals/health services and schools. </p>
<p>We need continued investment into workforce training, support for such programs to develop, and robust evaluation of each program to ensure they meet the goals of all the stakeholders involved – especially those of the participants themselves. </p>
<p>The “Old People’s Home” model did not invent the concept of intergenerational programs. Nor are the models of practice used in each series the only way intergenerational programs must run. But they do demonstrate what intergenerational programs could achieve. </p>
<hr>
<p><em>Learn more about <a href="https://aiip.net.au/resources/">intergenerational programs</a> in Australia and find one <a href="https://aiip.net.au/about-us/intergenerational-programs-in-australia">near you</a>. If this article has raised issues for you, or if you’re concerned about someone you know, call Lifeline on 13 11 14.</em></p><img src="https://counter.theconversation.com/content/215074/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stephanie Ward has received some financial compensation for her time spent involved in the Old People's Home for 4 Year Olds/ Teenagers series for the Australian Broadcasting Commission and EndemolShine Australia. She has previously been a recipient of a research training stipend for a PhD on sleep apnoea and dementia risk. She is a chief investigator on several studies that have received funding from the National Health and Medical Research Council and the Medical Research Future Fund. Stephanie Ward is also a geriatrician at the Prince of Wales Hospital, Sydney.</span></em></p>Could teenagers get on with older people and vice versa? Turned out, they could. And both flourished.Stephanie Ward, Senior Research Fellow, Centre for Healthy Brain Ageing (CHeBA), UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2085272023-07-26T12:18:41Z2023-07-26T12:18:41ZWhere the government draws the line for Medicaid coverage leaves out many older Americans who may need help paying for medical and long-term care bills – new research<figure><img src="https://images.theconversation.com/files/539037/original/file-20230724-23-hxz8n7.jpg?ixlib=rb-1.1.0&rect=0%2C738%2C3929%2C2144&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many older people with health insurance coverage through Medicare still can't afford the care they need.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/senior-healthcare-assistance-in-a-home-royalty-free-image/1397246920?phrase=elder+care+drugs&adppopup=true">RichLegg/E+ via Getty Images</a></span></figcaption></figure><p><em>The <a href="https://theconversation.com/us/topics/research-brief-83231">Research Brief</a> is a short take about interesting academic work.</em></p>
<h2>The big idea</h2>
<p>Medicaid, which provides low-income Americans with health insurance coverage, currently excludes large numbers of adults over 65 with social, health and financial profiles similar to those of people the program does cover. Based on a <a href="https://doi.org/10.1080/08959420.2023.2195784">study we conducted</a>, we determined that if <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">strict eligibility rules for Medicaid</a> were changed to help cover such people, from 700,000 to 11.5 million people over 65 would be newly eligible for the program.</p>
<p>We analyzed data from the 2018 <a href="https://hrs.isr.umich.edu/about">Health and Retirement Study</a>, a large national survey of older adults conducted by the Institute for Social Research at the University of Michigan every two years, to determine how using five different financial eligibility criteria would increase the number of older adults who would qualify for Medicaid and what they would look like.</p>
<p>Depending on which rules were changed, we would expect to see one of the following scenarios:</p>
<ul>
<li><p>If the government switched from the <a href="https://healthcare.gov/glossary/federal-poverty-level-fpl/">official poverty measurement Medicaid uses</a> – currently an annual income of US$14,580 for one person – to its more accurate <a href="https://www.census.gov/topics/income-poverty/supplemental-poverty-measure.html">supplemental one</a>, which takes taxes, health care costs and certain other expenses into account, about 700,000 more older Americans would get Medicaid coverage.</p></li>
<li><p>If the <a href="https://www.verywellhealth.com/your-assets-magi-and-medicaid-eligibility-4144975">amount of assets that people can have</a> were in line with other programs, such as the <a href="https://www.medicare.gov/medicare-savings-programs">Medicare Savings Plan</a>, an additional 1.4 million people would qualify. Medicare Savings Programs help pay Medicare costs for older adults with limited income and savings.</p></li>
<li><p>If Medicaid stopped <a href="https://www.agingcare.com/articles/asset-limits-to-qualify-for-medicaid-141681.htm">considering assets</a> altogether, an additional 2 million would qualify. </p></li>
<li><p>If the income eligibility threshold were higher, equal to 138% of the <a href="https://www.healthinsurance.org/glossary/federal-poverty-level/">federal poverty level</a>, it would <a href="https://www.medicaid.gov/medicaid/eligibility/index.html">mirror how the government determines</a> whether adults under 65 can get Medicaid, and 4.7 million more older people could be covered by the program. </p></li>
<li><p>A measure that’s increasingly used to evaluate the vulnerability of older adults is the <a href="https://theconversation.com/turning-gray-and-into-the-red-the-true-cost-of-growing-old-in-america-127162">Elder Index</a>, which takes into account basic expenses like housing, health care and food. People over 65 with incomes that fall <a href="https://www.census.gov/library/visualizations/2021/demo/poverty_measure-how.html">above the official poverty line</a> but below the Elder Index are considered to be financially vulnerable. If the government used the Elder Index as a basis for Medicaid eligibility, 11.5 million additional older adults would qualify for the program.</p></li>
</ul>
<p>Unless the government adopted the Elder Index approach, most of the additional enrollees in these scenarios would have poor health and few financial assets.</p>
<h2>Why it matters</h2>
<p>The extra Medicaid enrollment would be in addition to the <a href="https://www.medicaid.gov/medicaid/eligibility/seniors-medicare-and-medicaid-enrollees/index.html">7.2 million older people</a> already in the program.</p>
<p>All the people who would potentially qualify under these different eligibility standards are unable to shoulder even modest long-term care costs without <a href="https://www.aarp.org/aarp-foundation/our-work/income/public-benefits-guide-senior-assistance/">public assistance</a> aside from their <a href="https://www.ssa.gov/news/press/factsheets/basicfact-alt.pdf">Social Security benefits</a> – one of the largest risks facing the over <a href="https://aspe.hhs.gov/reports/what-lifetime-risk-needing-receiving-long-term-services-supports-0">70% of older adults</a> who will have such needs. This risk persists in part because Medicare does not cover such needs. </p>
<p>Low-income adults who are excluded from Medicaid under existing criteria also face high health care costs that contribute to their financial insecurity. Researchers found that <a href="https://doi.org/10.1001/jamanetworkopen.2023.14211">1 in 5 Americans over 65 skipped, delayed or used less</a> medical care or drugs because of financial constraints. </p>
<p>Increasing the number of low-income older people with both Medicaid and Medicare coverage would reduce their out-of-pocket health spending. That would make it <a href="https://doi.org/10.1016/j.jfineco.2019.10.008">easier for them to hang on to their modest savings</a> and also enable them to expand their own caregiving options should they have high medical or <a href="https://www.aplaceformom.com/caregiver-resources/articles/average-cost-long-term-care">long-term care expenses</a> as they age.</p>
<h2>What still isn’t known</h2>
<p>Increasing the number of older people with Medicaid coverage would require more government funding, although the degree of extra spending would depend on which rules the government would change.</p>
<p>Based on the average cost per Medicaid user, our rough estimates suggest that the cost of expanding Medicaid coverage for older people in the first four of the five scenarios we considered would range between about $8 billion and about $51 billion per year. We could not provide an estimate for the Elder Index scenario because the profile of individuals brought into the program would be substantially different from the current Medicaid users, so the per-person costs would be harder to predict.</p>
<p>Accurately estimating these costs and the potential benefits for families and communities that would come from these changes would require additional research.</p><img src="https://counter.theconversation.com/content/208527/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Marc Cohen receives funding from the National Council on Aging (NCOA).</span></em></p><p class="fine-print"><em><span>Jane Tavares receives funding from the National Council on Aging</span></em></p>Increasing the number of older people with both Medicaid and Medicare would mean fewer of them would be forced to skimp on the care and treatment they need.Marc Cohen, Clinical Professor of Gerontology and Co-Director LeadingAge LTSS Center, UMass BostonJane Tavares, Senior Research Fellow and Lecturer of Gerontology, LeadingAge LTSS Center @UMass Boston, UMass BostonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1901472022-09-13T03:39:00Z2022-09-13T03:39:00ZWhat do aged care residents do all day? We tracked their time use to find out<figure><img src="https://images.theconversation.com/files/483173/original/file-20220907-20-97eqmm.jpg?ixlib=rb-1.1.0&rect=17%2C26%2C5809%2C3852&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/an-elderly-man-opening-a-window-curtain-8860207/">Photo by cottonbro/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>What’s the daily routine like for older people in residential aged care facilities? </p>
<p>To find out, we spent 312 hours observing 39 residents at six Australian aged care facilities to learn how and where they spend their time across the day. We wanted to know how socially engaged residents actually were and how this could affect their wellbeing. </p>
<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273412">Our study</a>, published in the journal PLOS One, highlights some long-standing issues in aged care but also provides promise. </p>
<p>Residents were largely active, both in terms of communicating with other people in the centre and in terms of doing activities. But there’s more we can do to create opportunities for socialising.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484157/original/file-20220913-1734-rns5m1.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">There’s more we can do to create opportunities for socialising in residential aged care.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/overseas-recruitment-wont-solve-australias-aged-care-worker-crisis-189126">Overseas recruitment won't solve Australia's aged care worker crisis</a>
</strong>
</em>
</p>
<hr>
<h2>Humans are a social species</h2>
<p>Transitioning from life at home to life in aged care can be challenging, often <a href="https://pubmed.ncbi.nlm.nih.gov/17444984/">linked with</a> loss of independence, loss of identity, and loss of control. </p>
<p>Many also associate moving into aged care with a decline in their <a href="https://www.academia.edu/16621669/Daily_life_in_a_nursing_home_Has_it_changed_in_25_years">social lives</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28804359">overall physical health</a>. </p>
<p>So it’s no surprise people living in aged care homes suffer from generally <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-021-02254-2">low levels of wellbeing</a>.</p>
<p><a href="https://pubmed.ncbi.nlm.nih.gov/26155723/">Previous research</a> has found residents hardly attend activities in their facility. The conversations they do have are often with care staff – these are very rare, short, and mainly about their physical care. </p>
<p>However, previous studies often fail to capture critical aspects of how and where socialisation occurs in aged care.</p>
<p>We know humans are a social creatures and that we’re <a href="https://www.nature.com/articles/s41562-018-0389-1">wired to connect</a>, with more social connections boosting our overall wellbeing. </p>
<p>That’s why we decided to take a closer look at how aged care residents spend their time.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="An older woman looks at a friend's phone." src="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483950/original/file-20220912-12-j1xjtu.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">Having good evidence on how people spend their time in aged care centres helps identify gaps so we can address them.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/TeWwYARfcM4">Photo by Georg Arthur Pflueger on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>What we found</h2>
<p>During the 312 hours we spent observing 39 residents, we found a day in the life of a resident looks something like this:</p>
<ul>
<li><p>waking up in the morning and getting ready for the day (with the help of personal care staff if necessary)</p></li>
<li><p>attending the dining room for breakfast and spending most of the morning in the common area or lounge room – perhaps participating in an activity run by the lifestyle staff at the facility – before returning to the dining room for lunch</p></li>
<li><p>after that, depending on whether there is an activity being organised, most will go back to their own rooms to recuperate before coming back to the dining room for dinner in the early evening.</p></li>
</ul>
<p>We found social interactions peak at breakfast, lunch and dinner.</p>
<p>Across the day, residents</p>
<ul>
<li><p>spent the greatest proportion of time (45%) in their own room </p></li>
<li><p>were alone 47.9% of the time </p></li>
<li><p>were inactive 25.6% of the time</p></li>
<li><p>were most likely to chat with other residents, followed by staff, then family</p></li>
<li><p>outside of meal times, residents had conversations in the common area or in their own rooms.</p></li>
</ul>
<p>Overall, residents spent more than half their time being socially and physically active.</p>
<p>Over a third of their time was spent with another resident. Spending time with other residents was most likely to be associated with a higher quality of life.</p>
<p>We also found spending time with staff or too much time alone was linked to poorer quality of life.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Older people play a board game." src="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483951/original/file-20220912-26-quidtk.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">Spending time with other aged care residents tends to be associated with a higher quality of life.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/s/photos/elderly-game">Photo by Singapore Stock Photos on Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Creating opportunities for socially active lives</h2>
<p>Based on our research, here are three things aged care providers and governments can do to improve older Australians’ wellbeing:</p>
<p><strong>1. Improve staffing</strong></p>
<p><a href="https://agedcare.royalcommission.gov.au/system/files/2020-06/RCD.9999.0256.0017.pdf">Staff shortages and time pressures</a> are key reasons why residents spend little time with staff. </p>
<p>Including more activities chosen and assisted by residents in aged care facilities could help create new social opportunities between residents and strengthen existing ones.</p>
<p><strong>2. Tailor <a href="https://montessorifordementia.com.au/">Montessori programs</a> to the aged care environment</strong></p>
<p>Montessori programs create a collaborative approach filled with self-directed activities with <a href="https://dementiashop.com.au/product-tag/aged-care-activities/">hands-on learning</a> and play. Activities include things like sorting and recognising objects, completing puzzles, and practising opening locks.</p>
<p>Montessori programs in small groups or led by family members would suit the smaller staff to resident ratios in many aged care centres. They would also help residents (including those with dementia) regain some independence, feel less bored or isolated and have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3600589/">sense of purpose</a>.</p>
<p><strong>3. Change the physical environment and offer more afternoon activities</strong></p>
<p>Changing the physical environment to accommodate for more social spaces would go a long way to help.</p>
<p>Increasing the number of activities in the afternoon would mean residents have more opportunities to socialise with each other, especially those who are busy with personal care routines in the mornings.</p>
<h2>Doing residential aged care differently</h2>
<p>After <a href="https://www.abc.net.au/4corners/who-cares/10258290">media reports</a> and a <a href="https://agedcare.royalcommission.gov.au/publications/final-report">royal commission</a> highlighted the failings of Australia’s aged care system, it’s time to think differently about aged care.</p>
<p>Our <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0273412">study</a> reveals residents can and do socialise, and that it can significantly improve people’s quality of life.</p>
<p>We must now find ways to change aged care environments and practices to create more social opportunities.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/complaints-missing-persons-assaults-contracting-outside-workers-in-aged-care-increases-problems-188745">Complaints, missing persons, assaults – contracting outside workers in aged care increases problems</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/190147/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Joyce Siette is affiliated with the Australian Association of Gerontology.</span></em></p><p class="fine-print"><em><span>Laura Dodds receives funding from Macquarie University. </span></em></p>We spent 312 hours observing 39 residents at six Australian aged care facilities to find out how and where they spend their time across the day.Joyce Siette, Research Fellow, Western Sydney UniversityLaura Dodds, Research assistant, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737822021-12-21T13:46:34Z2021-12-21T13:46:34ZHome for the holidays and worried about an older relative? Make observations, not assumptions<figure><img src="https://images.theconversation.com/files/438493/original/file-20211220-18663-1h14guy.jpg?ixlib=rb-1.1.0&rect=31%2C0%2C2086%2C1365&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">If you're worried about older loved ones' ability to care for themselves, try starting a conversation with nonjudgmental questions.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/adult-woman-and-senior-mother-talking-on-front-royalty-free-image/1209969659?adppopup=true">MoMo Productions/DigitalVision via Getty Images</a></span></figcaption></figure><p>With the second holiday season of the pandemic upon us, many people will have the opportunity to rejoin family and friends for celebrations. The pandemic has kept many of us apart longer than expected, and it may have been months since we’ve visited with our loved ones. In addition to enjoying food, folks and fun, there may be some not-so-pleasant surprises. </p>
<p>As <a href="https://uvahealth.com/findadoctor/profile/laurie-r-archbald-pannone">a geriatrician</a>, I often see patients whose families voice concerns about their health or well-being. This can be especially heightened if they haven’t seen each other in a while. The holidays can be an opportunity to not just <a href="https://theconversation.com/the-magnificent-history-of-the-maligned-and-misunderstood-fruitcake-173201">enjoy the fruitcake</a> but observe how your aging parents, grandparents or great-grandparents are doing at home. Objectively observing their functioning and memory can uncover warning signs that more evaluation is needed.</p>
<p>This can lead to uncomfortable situations and often feels like role reversal. Maintaining older adults’ <a href="https://doi.org/10.1186/1472-6955-7-11">autonomy and dignity</a> needs to be the core of all of these conversations. If you are concerned about someone’s health, approach the conversation with an open mind and genuine curiosity to listen to their thoughts. Don’t assume you understand their situation. Make observations, not assumptions.</p>
<p>To take a step back for a moment, I would emphasize to not form conclusions about anyone’s ability to care for themselves based on age. Many people do quite well taking care of themselves and remaining independent well into their 90s or more, while other people may <a href="https://cgjonline.ca/index.php/cgj/article/view/93">need more assistance</a> with self-care earlier in life.</p>
<h2>Everyday functioning</h2>
<p>Take a look around the house. Have loved ones been able to keep up with basic care of the home or yard? If not, these can be signs that someone may need more help at home. Sometimes that could mean simply hiring someone to clean the pool or shovel the snow. Other times, it may be a sign of limited physical function: Maybe they can’t move around as well or bend over to pick things up.</p>
<p>But if basic cleaning isn’t happening, that could also be a sign of limitations in cognitive function – perhaps they forget to remove the trash from the kitchen for weeks or don’t remember to go to the store for basic needs. Other times, it’s just a sign that they were too busy to mow the yard before your visit. Again, don’t make assumptions, make observations – and always see them in the larger context.</p>
<p>Watch how your loved one is moving around the house. If they have been told to use a cane or walker before, are they? Is their balance bad? Are they getting by with “furniture surfing,” holding on to furniture or walls while walking?</p>
<figure class="align-center ">
<img alt="A girl chats with an older woman as she walks through a home with a walker." src="https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/438494/original/file-20211220-19-1h30nmn.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">It’s not about age but skills, like how comfortably someone can move around their home.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/granddaughter-supporting-grandmother-using-mobility-royalty-free-image/1183554271?adppopup=true">FG Trade/E+ via Getty Images</a></span>
</figcaption>
</figure>
<p>What about driving? If you have concerns, remember there are many factors that may be playing a role. It’s about skills, <a href="https://theconversation.com/how-old-is-too-old-to-drive-111596">not age</a>. <a href="https://icsw.nhtsa.gov/people/injury/olddrive/arthritis/index.htm#:%7E:text=Having%20arthritis%20can%20make%20your,to%20check%20your%20blind%20spot.">Arthritis</a> in the neck might make it hard to look at crossing traffic. <a href="https://doi.org/10.3390/ijerph17207416">Vision problems</a> can cause blurring, especially at night. <a href="https://doi.org/10.1590/S1980-57642009DN30400004">Limitations in cognition</a> can also cause trouble, such as getting lost while driving somewhere familiar – like the grocery store or a friend’s house.</p>
<p>[<em>3 media outlets, 1 religion newsletter.</em> <a href="https://theconversation.com/us/newsletters/this-week-in-religion-76/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=religion-3-in-1">Get stories from The Conversation, AP and RNS.</a>]</p>
<p>If you notice signs of unsafe driving, it’s important to get loved ones evaluated for their own safety, as well as that of others on the road. Have an open and honest conversation with their health care clinician to review these concerns. There are also community resources to help navigate these difficult conversations, such as <a href="https://www.alz.org/help-support/caregiving/safety/dementia-driving">the site alz.org</a> for concerns about dementia and driving.</p>
<p>If you notice changes in your relative, remember too that the pandemic has put extra stress and anxiety on many people. Over the past two years, some of us have not just been social distancing but also experiencing <a href="https://theconversation.com/social-isolation-the-covid-19-pandemics-hidden-health-risk-for-older-adults-and-how-to-manage-it-141277">social isolation</a>. Feeling cut off from our community can lead to serious health problems. The <a href="https://www.nia.nih.gov/health/loneliness-and-social-isolation-tips-staying-connected">National Institute on Aging</a> has great resources to understand the difference between being lonely and being socially isolated, and <a href="https://theconversation.com/a-geriatrician-offers-4-tips-for-seniors-to-stay-connected-during-coronavirus-outbreak-133233">how to identify and act on these concerns</a>.</p>
<h2>See something, say something – with care</h2>
<p>The holidays can bring chaotic schedules. Many people can be overwhelmed by their commitments, or forget important plans, and it’s not necessarily <a href="https://theconversation.com/does-forgetting-a-name-or-word-mean-that-i-have-dementia-144565">a sign of dementia</a>. Anybody can forget to bring home cranberry sauce or which exact yogurt the grandkids like. </p>
<p>When it may be <a href="https://www.cdc.gov/aging/dementia/index.html">a sign of something more significant</a> is if memory loss affects daily life – especially things like eating, dressing and hygiene. If you notice that there may be <a href="https://theconversation.com/does-forgetting-a-name-or-word-mean-that-i-have-dementia-144565">more than typical forgetfulness</a>, then it is time to talk.</p>
<p>You can ask open nonjudgmental questions to start the conversation. Avoid making assumptions – something like “Why didn’t you tell us that you’re not safe at home?” won’t start a useful conversation. Instead, start by describing your observations: “I saw that you just stumbled in the hallway. Is that something you have noticed before?” Allow space for reflection and insight. Don’t tell other people how they “should” be feeling, but listen for their own thoughts and observations. </p>
<p>See if your loved one would allow you to join them at an upcoming clinic visit to discuss whether there is an issue and, if so, how to make things better. If so, be there primarily as an observer or to add in details when asked. If you are not able to attend, you can consider writing a letter to describe your observations, which the patient could share with their team at the next visit. </p>
<p>Getting together at the holidays is intended to be a reunion of family and community to enjoy the season. Nobody wants to focus on problems, but be observant. If you see warning signs that things may not be going well, say something – thoughtfully.</p><img src="https://counter.theconversation.com/content/173782/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laurie Archbald-Pannone does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>In tough conversations, show your respect for loved ones’ autonomy and dignity.Laurie Archbald-Pannone, Associate Professor of Medicine, Geriatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1062682019-09-25T12:49:38Z2019-09-25T12:49:38ZHow biscuits enriched with protein could keep the UK’s ageing population strong<figure><img src="https://images.theconversation.com/files/245529/original/file-20181114-194513-526fk1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Could biscuits be the answer when it comes to helping old people retain their strength?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/712555009?size=huge_jpg&src=lb-59856941&sort=newestFirst&offset=3">Shutterstock</a></span></figcaption></figure><p>The world’s ageing populations are increasing every year. In 2016, <a href="https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/populationestimates/articles/overviewoftheukpopulation/july2017">18%</a> of the UK’s population was aged 65 years or older – by 2046, this group will account for nearly a quarter of the people living in the British Isles. </p>
<p>Add to this the fact that normal ageing is associated with a gradual decline in muscle mass, known as <a href="https://www.iofbonehealth.org/what-sarcopenia">sarcopenia</a> which can impair muscle function and strength, it is crucial, now and in the future, to prolong people’s health span and their ability to be active and live independently. For that we need to understand the role of dietary intake of protein to promote healthy and active ageing.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S1876382018306309?via%3Dihub">New evidence</a> suggests that current dietary recommendations for protein intake may be insufficient to achieve this goal and that individuals might benefit by increasing their intake and frequency of consumption of high-quality protein.</p>
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<p>From the third decade of life we begin to lose muscle mass and, scarily, losses of between <a href="https://www.mdpi.com/2072-6643/10/3/360">30 to 50%</a> have been reported between the ages of 40 and 80. Loss of muscle function and strength reduces the ability to perform everyday tasks and also increases the risk of falling.</p>
<p>So what can we do about it? Current UK dietary recommendations for protein intake in adults is set at 0.75g/kg of body weight per day regardless of age. But international recommendations specifically for older people vary between 1.2 and 1.5g/kg/day – although these do not take account for physical activity level. From mid-life onwards, adults may <a href="https://www.sciencedirect.com/science/article/pii/S1876382018306309?via%3Dihub">benefit from a greater intake of protein</a> to slow the ageing of muscles. Looking at the current UK intake of protein, there seem to be key areas for improvement:</p>
<p><strong>1. Protein amount:</strong> The amount of protein intake tends to decline with age, partially due to what is called <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/jcsm.12192">anorexia of ageing</a>, which happens when older people don’t eat regularly enough. The latest <a href="https://www.gov.uk/government/collections/national-diet-and-nutrition-survey">National Diet and Nutrition Survey</a> (NDNS) <a href="https://www.gov.uk/government/statistics/ndns-results-from-years-7-and-8-combined">data</a> indicates that one in three of over-40s do not meet the lower UK target of protein intake, and more than 80% fail to meet the international recommendations for healthy ageing.</p>
<p><strong>2. Distribution of protein intake:</strong> Consumption of two to three meals or snacks each containing <a href="https://www.sciencedirect.com/science/article/pii/S1876382018306309?via%3Dihub">25 to 30g protein</a> throughout the day is required for muscles to function at their best. However, estimates of protein intake in adults in mid-life indicate protein-rich meals tend to be eaten towards the <a href="https://www.nature.com/articles/ejcn2011210">end of the day</a>, at lunch or dinnertime.</p>
<p><strong>3. Type of protein:</strong> In the UK the main source of protein in the diet is from animal sources such as meat, dairy and fish. Increasing intake of <a href="https://www.bbc.co.uk/news/science-environment-45814659">plant-based proteins</a> such as pulses, cereal products and nuts might be a more sustainable dietary pattern. </p>
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<h2>Taking the biscuit</h2>
<p>Our <a href="https://www.mdpi.com/2072-6643/10/3/360">research</a> is part of the <a href="https://research.ncl.ac.uk/proteinforlife/">Protein For Life</a> project, a recent partnership between academia and industry which aims to address the issue of declining muscle function due to malnutrition.</p>
<p>As part of this project, higher-protein biscuits were formulated containing different amounts of protein – either 12% or 20% of total energy coming from protein. To put this in perspective, a typical digestive biscuit has around 6% of total energy coming from protein. Products were also enriched with different sources of protein: animal protein (whey powder) or plant protein (peanut butter, soya and wheat crispies). Higher-protein biscuits offer a handy on-the-go snack which can top up protein anywhere, at any time, and help spread intake throughout the day.</p>
<p>According to <a href="https://www.food.gov.uk/business-guidance/packaging-and-labelling#the-legislation">current legislation</a> for front-of-pack labelling, these products could also be labelled as a “source of protein” or “high in protein” for the 12% and 20% protein biscuits respectively, alerting consumers to their “protein power”.</p>
<p>A group of older adults (40 and upwards) took part in a blind test to find out which biscuit (and therefore level of protein enrichment) was preferred, and whether they tasted good. Biscuit tasting at the trial site in Aberdeen (one of four across the UK) revealed that the source-of-protein biscuits (12%) were favoured over the high-protein biscuits (20%). This suggests that consumers might favour a more subtle approach to reformulating much-loved products with extra protein.</p>
<p>Although members of the test group were divided over the type of protein used, more indicated that they generally prefer plant over animal sources of protein. This potentially identifies a niche for food products enriched with plant proteins specifically, which would help to reduce the environmental impact of the protein-enriched biscuit. From our research into the use of plant proteins to support healthy ageing, we have created a <a href="https://admin.ktn-uk.co.uk/app/uploads/2019/04/KTN-Protein4Life-Booklet-Digital.pdf">framework for action</a> that explains clearly the issues facing the elderly – and what can be done by the government, the food industry and consumers themselves. </p>
<p>Our study raises important points about how the foods we eat affect our long-term health and our environment. Enriching biscuits with protein is a simple and easy way to ensure older people keep their protein levels at a constant level. It could help contribute to prolonged health and independence, and crucially, mean a better quality of life in old age.</p><img src="https://counter.theconversation.com/content/106268/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alex Johnstone receives funding from the Medical Research Council, The University of Aberdeen, The Scottish Government, Biological Sciences Research Council, Economic and Social Research Council, Engineering and Physical Sciences Research Council, National Health Service Endowments award, Tennovus Charity, Chief Scientist Office and European Community.</span></em></p><p class="fine-print"><em><span>Madeleine Myers 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>Delivering the extra protein older people need via biscuits could be a simple and effective way to help guard against muscle loss in ageing.Alex Johnstone, Personal Chair in Nutrition, The Rowett Institute, University of AberdeenMadeleine Myers, Research Assistant, University of AberdeenLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1168142019-05-28T19:47:31Z2019-05-28T19:47:31ZSurgery rates are rising in over-85s but the decision to operate isn’t always easy<figure><img src="https://images.theconversation.com/files/276679/original/file-20190528-193518-nwxvjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The decision about whether to operate can't just be based on age, though age-related decline is certainly a consideration. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y5VBtBgswLQ">Philippe Leone</a></span></figcaption></figure><p>In January, <a href="https://www.sbs.com.au/news/hip-replacement-for-107-year-old-a-success">107-year-old Daphne Keith</a> broke her hip and became the oldest Australian to have a partial hip replacement. This isn’t something you would have heard of two or three decades ago. </p>
<p>For Daphne, the decision was fairly clear-cut. Surgery, with all its risks, was a better option than the alternative: to be stuck in bed for the rest of her life. As she summed it up, “What do I have to lose?” </p>
<p>But in many cases the balance between benefits and harms of surgery for older people is not as clear-cut.</p>
<p>Advances in anaesthetic and surgical techniques (especially keyhole surgery) now allow older adults to undergo operations and procedures that were previously not possible.</p>
<p>As the population <a href="https://www.who.int/news-room/fact-sheets/detail/ageing-and-health">ages</a>, we’re operating on older and <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1002/bjs.11148">older people</a>. <a href="https://www.aihw.gov.au/getmedia/0b26353f-94fb-4349-b950-7948ace76960/ah16-6-17-health-care-use-older-australians.pdf.aspx">Rates for elective surgery</a> in Australia are increasing the most among those aged over 85.</p>
<p>So how do we decide who should and shouldn’t undergo surgery?</p>
<h2>Age is a factor, but not the only one</h2>
<p>As we age there are increasing differences between individuals in terms of how our minds and bodies function. Younger people – whether they’re aged five, 20 or even 40 – are generally very similar to their age-matched peers, in terms of their cognitive and physical abilities. </p>
<p>But if we compare older adults, there are marked differences in their function. Some 70-year-olds are fit, healthy and still working full-time. Other 70-year-olds have multiple medical conditions, are frail and living in nursing homes. </p>
<p>So decisions about surgery shouldn’t be based on age alone. </p>
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Read more:
<a href="https://theconversation.com/whats-happening-in-our-bodies-as-we-age-67931">What's happening in our bodies as we age?</a>
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<p>However, we can’t ignore the changes associated with ageing, which means sometimes the potential harms of surgery will outweigh the benefits.</p>
<p>The harms associated with surgery and anaesthesia include death, surgical complications, longer hospital stays and poorer long-term outcomes. This might mean not being able to return to the same physical or cognitive level of function or needing to go into a nursing home. </p>
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<img alt="" src="https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276682/original/file-20190528-193514-y3mgrq.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">Two 70-year-olds can be in very different health and have vastly different preferences for what they want out of their health care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1020771727?src=ECccqepuMQx8KTk8mGnOFA-1-89&size=huge_jpg">Rawpixel.com/Shutterstock</a></span>
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<p>The changes in our body as we age, as well as an increase in the number of diseases, and therefore medications we take, can increase the risks associated with surgery and anaesthesia. </p>
<p>Frailty is the strongest predictor of poor outcomes after surgery. Frailty is a decrease in our body’s reserves and our ability to recover from stressful events such as surgery. Frailty is usually associated with increasing age, but not all older people are frail, and you can be frail and still relatively young. </p>
<h2>Consider the patient’s preferences</h2>
<p>Patients <a href="https://www.ncbi.nlm.nih.gov/pubmed/25531451">tend to overestimate the benefits</a> of surgery and underestimate the harms. This highlights the importance of shared decision-making between patients and clinicians.</p>
<p><a href="https://jamanetwork.com/journals/jama/article-abstract/1910118">Shared decision-making</a> means the patient and clinicians come to a decision together, after discussing the options, benefits and harms, and after considering the patient’s values, preferences and circumstances. </p>
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Read more:
<a href="https://theconversation.com/surgery-isnt-always-the-best-option-and-the-decision-shouldnt-just-lie-with-the-doctor-64228">Surgery isn't always the best option, and the decision shouldn't just lie with the doctor</a>
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<p>Research shows that <a href="https://www.nejm.org/doi/full/10.1056/NEJMsa012528">as we age</a> many of us become less focused on longevity and prolonging life at all costs and much more focused on what that life is like, or our quality of life. </p>
<p>Outcomes such as living independently, staying in our own home, the ability to move around, and being mentally alert often become increasingly important in the decision-making process. This information about a person’s values is critical for shared decision-making conversations.</p>
<p>When considering these preferences, the discussion becomes more than just “could” we do this operation – it’s about “should” we do this operation? Someone living at home with early dementia may decide the risk of this worsening, and the possible need to move to a nursing home, is not worth any benefits of surgery.</p>
<p>It’s also important to note that, in some cases, cognitive impairment and dementia associated with ageing mean it’s not the patient (but <a href="https://www.publicadvocate.vic.gov.au/medical-consent">their appointee</a>) making decisions about surgery.</p>
<h2>Not everyone should be offered surgery</h2>
<p>The ageing of our population raises challenges for policymakers. More surgeries means greater pressure on the health budget. We don’t have a bottomless pit of health funding, so how do we decide who is eligible, based on fair and equitable resource allocation?</p>
<p>Given the marked variability between individuals as we age, decisions and policies about access to medical care (including surgery) should not be based on age alone. There should not be policies that say “no” to surgery based on age. </p>
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<img alt="" src="https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/276684/original/file-20190528-193540-s5cf6p.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">More surgery means greater expenditure.</span>
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<p>Equally, when considering resource allocation, it should not just be about how many years a person has to live, or blunt assessments based on how much their operation might cost the health system.</p>
<p>Take a decision about performing a hip replacement on a 90-year-old with arthritis, for example. A patient who has an elective hip replacement for arthritis and is able to remain living at home will probably “cost less” overall than if that same person would otherwise have had to live in a nursing home.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/who-gets-a-piece-of-the-pie-spending-the-health-budget-fairly-13997">Who gets a piece of the pie? Spending the health budget fairly</a>
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<p>However, this also does not mean we can, or should, offer surgery to everyone. </p>
<p>The practice of medicine, especially when considering older adults, needs to remain focused on individualised patient care. Decisions should be based on medical appropriateness of treatment combined with a patient’s goals and values.</p>
<p>To do this we need to train clinicians in shared decision-making and how to have these often difficult discussions. The goal is to have clinicians who are able to explore a patient’s values and preferences around outcomes, effectively communicate individualised information about options, benefits and harms, and then come to a decision together.</p><img src="https://counter.theconversation.com/content/116814/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire McKie 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>Rates of elective surgery are rising most among those aged over 85, due to advances in anaesthesia and techniques such as keyhole surgery. But it’s also much riskier.Claire McKie, Senior Lecturer, Clinical and Communication Skills, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1036862018-10-22T02:44:16Z2018-10-22T02:44:16ZHealth Check: how much physical activity is enough in older age?<figure><img src="https://images.theconversation.com/files/241563/original/file-20181022-105751-e4mrmy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Physical activity is just as important for people over 65 as anyone else.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/smiling-elderly-senior-couple-cycling-park-484335253?src=rJ452nrtQwKUSDtluqS82A-1-43">Andrey Popov/Shutterstock</a></span></figcaption></figure><p>We all know making physical activity a regular habit is important for health and well-being. But health promotion messages are often aimed at children and young people, with less focus on the importance of physical activity for older people. However, older age is a crucial time for being active every day.</p>
<p>Studies show physical activity, such as just increasing your daily number of steps, may help you <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141274">live longer</a>. This is the case even if you only started in older age. It can prevent and help to manage many <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/541233/Physical_activity_infographic.PDF">health conditions</a> including diabetes, some cancers, heart disease, and dementia.</p>
<p><a href="http://www.cmaj.ca/content/cmaj/early/2016/03/14/cmaj.150684.full.pdf">Exercise</a> is as effective as some medications in preventing or managing conditions such as heart disease and diabetes, and for rehabilitation after stroke. Besides the direct benefits, being more physically active can improve sleep, social connection, and overall feelings of happiness and well-being.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-in-terms-of-exercise-is-walking-enough-78604">Health Check: in terms of exercise, is walking enough?</a>
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<h2>How much activity is enough?</h2>
<p>Australia’s physical activity <a href="http://www.health.gov.au/internet/main/publishing.nsf/content/3244D38BBBEBD284CA257BF0001FA1A7/$File/choosehealth-brochure.pdf">guidelines</a> recommend people aged 65 years and over be:</p>
<blockquote>
<p>…active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility; and should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days. </p>
</blockquote>
<p>Unfortunately, <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.001%7E2014-15%7EMain%20Features%7EExercise%7E29">only 25% of older Australians</a> achieve this amount of activity. As few as 12% <a href="https://www.sciencedirect.com/science/article/pii/S0091743512004756?via%3Dihub">regularly undertake strengthening</a> activities (such as lifting weights) and 6% do balance activities (such as lunges or single-leg standing).</p>
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<a href="https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/240550/original/file-20181015-109207-19k4vq5.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">Too few older people do strengthening activities.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Doing something is better than nothing, even if achieving the amount recommended by guidelines is too difficult. Physical activity can include a range of options from exercise classes to active transport (such as cycling or walking), to gardening and home maintenance. </p>
<p>Starting small and building up the amount and intensity of activity, and choosing something enjoyable, are the best ways to start. </p>
<p>There are extra benefits from doing more than 30 minutes per day of activity. For those already participating in more vigorous activities, like running or cycling, turning 65 is no reason to stop. </p>
<h2>Why be active?</h2>
<p>Falls are common in older age. Around one in three people aged 65 and over fall each year. Falls often have lasting, devastating consequences for an older person and their family. Falls are not inevitable, and can be <a href="https://bjsm.bmj.com/content/bjsports/51/24/1750.full.pdf">prevented with exercise</a> that challenges balance. This means exercise performed in a standing position (rather than sitting) that usually involves movement of the body. Examples include knee squats, walking on the heels or toes, and stepping over obstacles.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/why-older-people-get-osteoporosis-and-have-falls-68145">Why older people get osteoporosis and have falls</a>
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<p>Older people face particular <a href="https://bjsm.bmj.com/content/49/19/1268.long">barriers</a> to being more physically active – these can be financial, physical, social or practical. Some older adults find electronic gadgets that help track daily physical activity useful for reminding and <a href="https://www.sciencedirect.com/science/article/pii/S2211335515000996">motivating</a> them to be more active.</p>
<p>Residents of some Australian states can also access the <a href="https://www.gethealthynsw.com.au/">Get Healthy</a> service for free information, motivation and support for making healthy lifestyle changes, including physical activity. The NSW Ministry of Health funds the <a href="https://www.activeandhealthy.nsw.gov.au/">Active and Healthy</a> website that includes a database of physical activity opportunities for people aged 50 years and over.</p>
<p>There are many options if you prefer to exercise in organised groups. Find out whether one of the <a href="http://walking.heartfoundation.org.au/">Heart Foundation</a> walking groups meets in your area – these groups are a way of keeping active in a fun and sociable way. Or for a bit more of a challenge, <a href="http://www.parkrun.com.au/">parkrun</a> is a free, weekly 5km timed running (or walking) event in more than 300 locations across Australia.</p>
<h2>What if I’m unwell?</h2>
<p>Research shows that even people with health issues can gain a lot from being more active. For example, people with <a href="http://www.cmaj.ca/content/cmaj/early/2016/03/14/cmaj.150684.full.pdf">knee and hip osteoarthritis</a> can benefit, in terms of reduced pain and improved function, from a range of physical activities. These include muscle strengthening, and aerobic and flexibility exercise, performed on land or in the water. </p>
<p>Similarly, people with <a href="http://www.cmaj.ca/content/cmaj/early/2016/03/14/cmaj.150684.full.pdf">diabetes</a> can improve their glucose control from aerobic exercise (such as walking or swimming), muscle strengthening or a combination of both.</p>
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<strong>
Read more:
<a href="https://theconversation.com/do-you-even-lift-why-lifting-weights-is-more-important-for-your-health-than-you-think-58635">Do you even lift? Why lifting weights is more important for your health than you think</a>
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<p>It’s important that frailer older people or people with particular health problems seek professional help to select physical activity options that are most suited to their particular abilities and health conditions. Such people should discuss plans to get more active with their GP, and then seek guidance from a <a href="https://www.physiotherapy.asn.au/APAWCM/Controls/FindaPhysio.aspxPP">physiotherapist</a> or <a href="https://www.essa.org.au/find-aep/">exercise physiologist</a>.</p>
<p>The new World Health Organisation <a href="http://www.who.int/ncds/prevention/physical-activity/gappa">Global Action Plan on Physical Activity</a> 2018-30 provides guidance on policy actions for governments and other organisations to make it easier for people to be more active. Safe, pleasant venues and leaders linked with health professionals and welcoming, enjoyable and affordable programs would help overcome <a href="https://bjsm.bmj.com/content/49/19/1268.long">barriers</a> reported by older people.</p><img src="https://counter.theconversation.com/content/103686/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne Tiedemann receives funding from the National Health and Medical Research Council of Australia.</span></em></p><p class="fine-print"><em><span>Cathie Sherrington receives funding from the National Health and Medical Research Council of Australia and is the President of the Australian and New Zealand Falls Prevention Society.</span></em></p>It’s never too late to start exercising, and age isn’t a reason to stop either.Anne Tiedemann, Associate Professor, Principal Research Fellow in Physical Activity for Healthy Ageing, University of SydneyCathie Sherrington, Professor, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1036882018-09-27T20:20:55Z2018-09-27T20:20:55ZFour lessons for Australia from England’s system of rating its aged care homes<figure><img src="https://images.theconversation.com/files/238016/original/file-20180926-149982-s7lwkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Ratings work mostly because they change the behaviour of care providers. </span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>ABC’s <a href="http://www.abc.net.au/news/2018-09-24/aged-care-nursing-home-hidden-camera-footage-assault-charges/10280944">Four Corners coverage</a> showing mistreatment of residents in Australia’s aged care facilities has led to much discussion about ideas to improve care. One proposal is to introduce ratings, which would provide a score reflecting the quality of residential aged care services. </p>
<p>Ratings have come up before in reports about aged care in Australia – in the 2004 “<a href="https://agedcare.health.gov.au/ageing-and-aged-care-publications-and-articles-ageing-and-aged-care-reports/australian-governments-final-response-to-the-review-of-pricing-arrangements-in-residential-aged-care-hogan-review-8-may-2007">Hogan Review</a>”, the Productivity Commission’s 2011 <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report">Caring for Older Australians</a> inquiry and, most recently, in the 2017 <a href="https://agedcare.health.gov.au/quality/review-of-national-aged-care-quality-regulatory-processes-report">Carnell-Paterson Review</a>, which led to the government establishing a new Aged Care Quality and Safety Commission. These reports all refer to the ratings system used in England. </p>
<p>In Australia, aged care homes are expected to meet <a href="https://www.aacqa.gov.au/providers/standards/existing-standards/existing-standards#accreditation-short-term-standards">44 accreditation standards</a>, receiving either a pass or fail for each one. These standards will be replaced in 2019 with <a href="https://www.aacqa.gov.au/providers/standards/new-standards">new aged care quality standards</a>, but homes will still only be expected to pass or fail each standard.</p>
<p>In the past, <a href="https://www.aacqa.gov.au/providers/promoting-quality/lets-talk-about-quality-updated-1-september-2015">virtually all providers passed accreditation</a>. This means it has been impossible to tell the difference between providers that excel and those that just scrape through.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weve-had-20-aged-care-reviews-in-20-years-will-the-royal-commission-be-any-different-103347">We've had 20 aged care reviews in 20 years – will the royal commission be any different?</a>
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</p>
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<p>England has had two attempts at using ratings since 2004. The current system was introduced in 2014 by the Care Quality Commission (CQC) – the body responsible for inspecting care in nursing homes. During CQC inspections, each home is <a href="https://www.cqc.org.uk/what-we-do/how-we-do-our-job/ratings">given a rating</a> against five questions: is it safe, is it effective, is it responsive, it is caring and is it well led? </p>
<p>The four ratings are: outstanding, good, requires improvement, or inadequate. At the end of the inspection, the home is given an overall rating. Homes are legally required to display their ratings, both at the home’s location and on its website.</p>
<p>Recent research shows these ratings are a <a href="https://www.researchgate.net/publication/327866642_Regulator_Quality_Ratings_and_Care_Home_Residents_Quality_of_Life">good indicator</a> of how residents feel about their quality of life in the home. Unsurprisingly, homes with lower rates of staff turnover and fewer staff vacancies also tend to <a href="https://www.pssru.ac.uk/pub/5328.pdf">perform better</a>. </p>
<p>So, what are the lessons for Australia?</p>
<h2>1. Ratings rarely affect consumer choice; they improve provider quality</h2>
<p>Consumers don’t usually use ratings to find care. Choosing an aged care home is not like choosing a hotel or restaurant. </p>
<p>People looking for care are often in the middle of a crisis, such as the death of a partner or an unexpected stay in hospital. The older person is too unwell to make the decision themselves. All too often, families simply choose the closest home or settle for any home that has a place.</p>
<p>Ratings work mostly because they change the behaviour of care providers. When a previous system of ratings in England was abandoned in 2008, providers that had been sceptical of the ratings beforehand argued for their <a href="https://www.nuffieldtrust.org.uk/research/rating-providers-for-quality-a-policy-worth-pursuing">re-introduction</a>. </p>
<p>People I interviewed for <a href="https://www.researchgate.net/publication/327220978_Improving_the_quality_of_residential_care_for_older_people_a_study_of_government_approaches_in_England_and_Australia?_sg=lIhaemEivaJUPXKm7Gjtq6M5Bss-AdHT0oGmB7kx0G6ch1G92566px4sctxfs5-woCQbDjB_jdJYWQ.K0ydggrwidC10d6sZL259zAve89x1TrGtXWRhhhEyeDHR7V1DeGQtZj_7I3rfEYKoCZyJ0oBe0OghqINs36dxQ&_sgd%5Bnc%5D=0&_sgd%5Bncwor%5D=0">my research</a> said this was because homes with the best ratings could negotiate better rates for care, and care home companies could use the ratings to set goals and targets for their staff. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/essential-reading-to-get-your-head-around-australias-aged-care-crisis-103325">Essential reading to get your head around Australia's aged care crisis</a>
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<h2>2. Quality is subjective, but only for the little things</h2>
<p>Discussions about quality in aged care often come back to the issue that everyone has personal preferences and it is difficult to agree on one definition of quality. The sort of example that comes up is whether a resident would be more interested if a home had Foxtel or Sky or if wine was served with meals.</p>
<p>These are not the sorts of questions that need ratings. Older people, or more frequently their families, can answer these questions themselves by visiting homes, trying the food, seeing the quality of accommodation and asking questions about, for instance, en-suite bathrooms and menu options.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=443&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=443&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=443&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=556&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=556&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238244/original/file-20180927-48647-14eif8c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=556&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">Most people enter aged care when they are too unwell to shop around.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>What people need help with is understanding what they cannot easily judge for themselves. Such as: </p>
<ul>
<li>does the home have enough staff and the right mix of skills?<br></li>
<li>does the home support its staff to form meaningful and supportive relationships, not only with the residents but also with families and with each other?</li>
<li>does the home use good practice in supporting people living with dementia, or in caring for people at the end of their lives?</li>
</ul>
<p>This is where the right sorts of ratings can help shed light on the parts of care that are difficult to assess. Most importantly, it gives providers a good steer on where to focus their efforts.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/seven-steps-to-help-you-choose-the-right-home-care-provider-72409">Seven steps to help you choose the right home care provider</a>
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</em>
</p>
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<h2>3. Be prepared to publicise poor care</h2>
<p>An important feature of the system in England is that the CQC regularly draws attention to poor care. It does this not just through the ratings but also through other reports it produces about care in England, such as the <a href="https://www.cqc.org.uk/publications/major-report/state-care">annual State of Care report</a>. The CQC also provides reports on specific issues – for instance, the difficulties older people with dementia face when they move <a href="https://www.cqc.org.uk/publications/themed-work/beyond-barriers-how-older-people-move-between-health-care-england">between care homes and hospitals</a>.</p>
<p>In the first three years of the current ratings scheme, while most homes were rated “good”, 21% of providers received “inadequate” or “requires improvement” ratings, something highlighted in <a href="https://www.cqc.org.uk/publications/major-report/state-adult-social-care-services-2014-2017">the State of Care report</a>. While about a fifth of the homes rated “inadequate” stayed the same at re-inspection, the CQC found 82% had improved their overall rating. Of the homes rated “requires improvement”, 58% improved at the next inspection. </p>
<p>Such transparency is currently impossible in Australia as the Aged Care Act 1997 restricts what can be made public about poor care in the first place.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
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<h2>4. Ratings are part of a package</h2>
<p>While not perfect, the ratings system in England has helped to communicate what good care looks like and given providers something to aim for. This is demonstrated by the <a href="https://www.skillsforcare.org.uk/Documents/Standards-legislation/CQC/Good-and-outstanding-care-guide.pdf">popularity of practice guidance</a> on how to get an “outstanding” rating. </p>
<p>But Australian policymakers need to assess other differences with England’s system. The CQC has considerable <a href="https://www.cqc.org.uk/guidance-providers/regulations-enforcement/enforcement-policy">enforcement and legislative powers</a> when compared to the Aged Care Quality Agency in Australia. The CQC can shut down providers and even bring criminal charges. Australia’s Quality Agency has to refer providers to the Health Department for action. </p>
<p>The UK also has a raft of rights-based legislation to protect vulnerable residents, such as the <a href="https://www.scie.org.uk/mca/dols/at-a-glance">Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards</a>. In Australia, reports into <a href="https://www.humanrights.gov.au/sites/default/files/content/age/ageing/human_rights_framework_for_ageing_and_health.pdf">human rights</a> and <a href="https://www.alrc.gov.au/sites/default/files/pdfs/publications/elder_abuse_131_final_report_31_may_2017.pdf">elder abuse</a> have highlighted the gaps in the legislation to protect the rights of older people. </p>
<p>There are also more organisations involved in care in England and the CQC’s activity is supplemented with safeguarding and quality monitoring by local councils, which organise care.</p>
<p>Ratings may be useful for improving quality in Australia, but should be seen as only one part of a very large and complex puzzle.</p><img src="https://counter.theconversation.com/content/103688/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This article is from research funded by the National Institute for Health Research (NIHR)’s Doctoral Research Fellowship Programme. The views expressed are those of the author and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.</span></em></p>In England, each home is given a rating against five questions: is it safe, is it effective, is it responsive, it is caring and is it well led?Lisa Trigg, Research Associate, London School of Economics and Political ScienceLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1035212018-09-23T20:11:28Z2018-09-23T20:11:28ZAustralia’s residential aged care facilities are getting bigger and less home-like<figure><img src="https://images.theconversation.com/files/237402/original/file-20180921-129847-1di589.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Residential aged care facilities should be more like a home and less like a hospital.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Most older people <a href="http://www.who.int/mental_health/publications/dementia_report_2012/en/">want to stay at home</a> as long as they can. When this is no longer possible, they move into residential aged care facilities, which become their home. But Australia’s care facilities for the aged are growing in size and becoming less home-like.</p>
<p>In 2010–11, 54% of residential aged care facilities in major Australian cities had <a href="https://www.aihw.gov.au/reports/aged-care/residential-aged-care-in-australia-2010-11/contents/table-of-contents">more than 60 places</a>, and the <a href="https://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-overview-booklet.pdf">size of the average facility</a> is growing. </p>
<p>Today, more than 200,000 Australians live or stay in residential aged care on any given day. There are <a href="https://www.gen-agedcaredata.gov.au/Topics/Services-and-places-in-aged-care">around 2,672 such facilities</a> in Australia. This equates to an average of around 75 beds per facility. </p>
<p>Large institutions for people with disability and mental illness, as well as orphaned children, were once commonplace. But now – influenced by the 1960s <a href="https://psychcentral.com/encyclopedia/deinstitutionalization/">deinstitutionalisation</a> movement – these have been closed down and replaced with smaller community-based services. In the case of aged care, Australia has gone the opposite way.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-our-residential-aged-care-system-doesnt-care-about-older-peoples-emotional-needs-103336">How our residential aged-care system doesn't care about older people's emotional needs</a>
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</p>
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<h2>Why is smaller better?</h2>
<p>Evidence shows that aged care residents have better well-being when given opportunities for self-determination and independence. Internationally, there has been a <a href="https://www.sciencedirect.com/science/article/pii/S1525861016300482">move towards</a> smaller living units where the design encourages this. These facilities feel <a href="https://www.ncbi.nlm.nih.gov/pubmed/26743545">more like a home</a> than a hospital.</p>
<p>The <a href="http://apps.who.int/iris/bitstream/handle/10665/186463/9789240694811_eng.pdf;jsessionid=731A680E51575BBDBEC07AFC9C449F23?sequence=1">World Health Organisation</a> has indicated that such models of care, where residents are also involved in running the facility, have advantages for older people, families, volunteers and care workers, and improve the quality of care.</p>
<p>In the US, the <a href="https://www.thegreenhouseproject.org/resources/research">Green House Project</a> has built more than 185 homes with around 10-12 residents in each. Studies show Green House residents’ enhanced quality of life doesn’t compromise <a href="https://www.ncbi.nlm.nih.gov/pubmed/26743545">clinical care</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/21158746">running costs</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/237405/original/file-20180921-129874-1o8sk2v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Older people have a better quality of life if they can be involved in outdoor activities.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Around 50% of residents living in <a href="https://www.gen-agedcaredata.gov.au/Resources/Factsheets-and-infographics/Care-needs-factsheet.pdf?ext=">aged care facilities</a> have dementia. And <a href="http://journals.sagepub.com/doi/abs/10.1177/1471301214532460">research has shown</a> that a higher quality of life for those with dementia is associated with buildings that help them engage with a variety of activities both inside and outside, are familiar, provide a variety of private and community spaces and the amenities and opportunities to take part in domestic activities.</p>
<p>In June 2018, an <a href="https://theconversation.com/caring-for-elderly-australians-in-a-home-like-setting-can-reduce-hospital-visits-97451">Australian study</a> found residents with dementia in aged-care facilities that provided a home-like model of care had far better quality of life and fewer hospitalisations than those in more standard facilities. The home-like facilities had up to 15 residents. </p>
<p>The study also found the cost of caring for older people in the smaller facilities was no higher, and in some cases lower, than in institutionalised facilities.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/caring-for-elderly-australians-in-a-home-like-setting-can-reduce-hospital-visits-97451">Caring for elderly Australians in a home-like setting can reduce hospital visits</a>
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<p>There are some moves in Australia towards smaller aged care services. For example, aged care provider <a href="https://www.wintringham.org.au/">Wintringham</a> has developed services with smaller facilities for older people who are homeless. Wintringham received the <a href="https://www.wintringham.org.au/built_environment.html">Building and Social Housing Foundation World Habitat Award 1997</a> for Wintringham Port Melbourne Hostel. Its innovative design actively worked against the institutional model.</p>
<h2>Bigger and less home-like</h2>
<p>Historically, nursing homes in Australia were small facilities, with <a href="https://www.anu.edu.au/fellows/jbraithwaite/_documents/Articles/The%20Nursing%20Home%20Industry.pdf">around 30 beds</a> each, often run as family businesses or provided by not-for-profit organisations. Between <a href="https://www.parliament.nsw.gov.au/lcdocs/other/9768/Aged%20care%20industry%20facts.pdf">2002 and 2013</a> the proportion of facilities with more than 60 beds doubled to 48.6%. <a href="http://www.stewartbrown.com.au/images/documents/StewartBrown---ACFPS-Residential-Care-Report-March-2017.pdf">Financial viability</a> rather than quality of care drove the increase in size.</p>
<p>Today, around 45% of <a href="https://gen-agedcaredata.gov.au/Resources/Access-data/2018/September/Aged-care-data-snapshot%E2%80%942018">facilities are operated</a> by the private for-profit sector, 40% by religious and charitable organisations, 13% by community-based organisations, 3% by state and territory governments, and less than 1% by local governments. </p>
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Read more:
<a href="https://theconversation.com/its-hard-to-make-money-in-aged-care-and-thats-part-of-the-problem-103339">It's hard to make money in aged care, and that's part of the problem</a>
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<p>In 2016, the <a href="https://gen-agedcaredata.gov.au/Resources/Access-data/2018/September/Aged-care-data-snapshot%E2%80%942018">Australian Institute of Health and Welfare</a> (AIHW) reported that residential care services run by government organisations were more likely to be in small facilities. One-fifth (22%) of <a href="https://www.gen-agedcaredata.gov.au/www_aihwgen/media/2017-Factsheets/Services-and-Places-Factsheet-2016%E2%80%9317_2.pdf?ext=.pdf">places in these facilities</a> are in services with 20 or fewer places. Almost half (49%) of privately-run residential places are found in services with more than 100 places. </p>
<p>All of this means that more older Australians are living out their last days in an institutional environment.</p>
<p>Once larger facilities become the norm, it will be difficult to undo. Capital infrastructure is built to have an <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/09_2016/2016_report_on_the_funding_and_financing_of_the_aged_care_industry_2.pdf">average 40-year life</a>, which will lock in the institutional model of aged care. </p>
<p>The built environment matters. The royal commission provides an opportunity to fundamentally critique the institutional model.</p><img src="https://counter.theconversation.com/content/103521/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ralph Hampson is affiliated with
Member Executive Committee, Australian Association of Gerontology Victorian Branch
Chair, Board of Directors, St Mary's House of Welcome, Fitzroy, Victoria </span></em></p>Large institutions for people with disability and mental illness were once commonplace. These have now been replaced with smaller community-based services. With aged care, we’re doing the opposite.Ralph Hampson, Senior Lecturer, Health and Ageing, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1032262018-09-16T20:16:42Z2018-09-16T20:16:42ZDaily low-dose aspirin doesn’t reduce heart-attack risk in healthy people<figure><img src="https://images.theconversation.com/files/236365/original/file-20180914-177935-49hb99.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">For decades, doctors have been prescribing low-dose aspirin for healthy people over the age of 70.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Taking low-dose aspirin daily <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1803955?query=featured_home">doesn’t preserve good health</a> or delay the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=featured_home">onset of disability</a> or dementia in healthy older people. This was one finding from our seven-year study that included more than 19,000 older people from Australia and the US.</p>
<p>We <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1805819?query=featured_home">also found</a> daily low-dose aspirin does not prevent heart attack or stroke when taken by elderly people who hadn’t experienced either condition before. However it does increase the risk of major bleeding.</p>
<p>It has long been established that aspirin saves lives when taken by people after a cardiac event such as a heart attack. And it had <a href="https://www.ncbi.nlm.nih.gov/pubmed/27064677">been apparent</a> since the 1990s there was a lack of adequate evidence to support the use of low-dose aspirin in healthy older people. Yet, many healthy older people continued being prescribed aspirin for this purpose.</p>
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Read more:
<a href="https://theconversation.com/how-australians-die-cause-1-heart-diseases-and-stroke-57423">How Australians Die: cause #1 – heart diseases and stroke</a>
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<p>With the growing proportion of elderly people in our community, a major focus of preventive medicine is to maintain the independence of this age-group for as long as possible. This has increased the need to resolve whether aspirin in the healthy elderly actually prolongs their good health.</p>
<p>Published in the <a href="https://www.nejm.org/">New England Journal of Medicine</a> today, the ASPirin in Reducing Events in the Elderly (<a href="https://aspree.org/aus/">ASPREE</a>) trial was the largest and most comprehensive clinical trial conducted in Australia. It compared the effects of aspirin and a placebo in people over the age of 70 without a medical condition that required aspirin.</p>
<p>Our findings mean millions of healthy people over the age of 70, and their doctors, will now know daily aspirin is not the answer to prolonging good health.</p>
<h2>Why aspirin for prevention?</h2>
<p>Aspirin was first synthesised in 1898. Since the 1960s it <a href="https://search.library.wisc.edu/catalog/999882520002121">has been known</a> that aspirin lowers the risk of heart attack and stroke among those who have had heart disease or stroke before. This is referred to as secondary prevention. </p>
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Read more:
<a href="https://theconversation.com/weekly-dose-aspirin-the-pain-and-fever-reliever-that-prevents-heart-attacks-strokes-and-maybe-cancer-64440">Weekly Dose: aspirin, the pain and fever reliever that prevents heart attacks, strokes and maybe cancer</a>
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<p>This effect has been attributed to aspirin’s ability to prevent platelets from clumping together and obstructing blood vessels – sometimes referred to as “thinning the blood”.</p>
<p>It had been assumed this protective action could be extrapolated to people who were otherwise healthy to prevent a first heart attack or stroke (known as primary prevention). A number of early primary prevention trials in middle-aged people appeared to confirm this view. </p>
<p>However more recent trials, including the <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1804988">ASCEND</a> trial in diabetes and the <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31924-X/fulltext">ARRIVE trial</a> in younger high-risk individuals, have thrown doubt on this proposition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236509/original/file-20180916-177956-pbmatn.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">Aspirin is known for its blood-thinning properties, which can also increase the risk of bleeding.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>In older people, any effect of aspirin on reducing heart disease or stroke might be expected to be enhanced because of their higher underlying risk. But aspirin’s adverse effects (mainly bleeding) might also be increased as older people are at higher risk of bleeding. </p>
<p>The balance between risks and benefits in this age group was previously quite unclear. This was also recognised in various <a href="https://www.ncbi.nlm.nih.gov/pubmed/27064677">clinical guidelines</a> for aspirin use, which specifically acknowledged the lack of evidence in people older than 70. </p>
<h2>The ASPREE trial</h2>
<p>A trial of aspirin in the elderly was first called for in the early 1990s. But since aspirin was off patent, there was little prospect of securing industry funding to support a large trial. But controversy arising around the use of aspirin for primary prevention in the mid 2000s led to Monash University receiving initial funding from the National Health and Medical Research Council. </p>
<p>Funding in Australia was only a part of that required to establish a trial the size and complexity of ASPREE. A grant from the US National Institute on Ageing (and subsequently from the US National Cancer Institute) made the study become feasible.</p>
<p>Another challenge was recruiting the necessary thousands of older volunteers who were healthy and living and often working in their community. Unlike most studies, we required participants who weren’t in hospital or sick.</p>
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<strong>
Read more:
<a href="https://theconversation.com/both-statins-and-a-mediterranean-style-diet-can-help-ward-off-heart-disease-and-stroke-64609">Both statins and a Mediterranean-style diet can help ward off heart disease and stroke</a>
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<p>This was addressed with the assistance of more than 2,000 GPs who collaborated with the research team supporting recruitment of their patients and overseeing their health. In Australia, 16 sites were established across south-eastern Australia, Tasmania, Victoria, the ACT and southern NSW, to localise study activity and host community events that kept our volunteers updated and involved.</p>
<p>ASPREE is the first major prevention trial to use disability-free survival as the primary health measure. Disability-free survival provides a single integrated measure of whether an intervention such as aspirin provides net benefit. The rationale is that there is little point for elderly people to be taking a preventive medication unless it preserves good health and unless benefits of the medication outweigh any adverse effects. </p>
<p>Large-scale preventive health studies like ASPREE will become increasingly important to help keep an ageing population fit, healthy, out of hospital and living independently. As new preventive opportunities arise they will typically require large clinical trials, and the structure of the Australian health system has proven an ideal setting for this type of study. </p>
<p>Other results from the <a href="https://aspree.org/aus/">ASPREE trial</a> will continue to appear for some time. These will describe longer-term effects of daily low dose aspirin on issues such as dementia and cancer. It will also provide valuable information about other strategies to promote healthy ageing well into the future.</p><img src="https://counter.theconversation.com/content/103226/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bayer AG provided the aspirin and placebo medication but otherwise had no role in the study.
The study was funded primarily by the US National Institute of Aging with major contributions from the US National Cancer Institute, the Australian National Health & Medical Research Council, the Victorian Cancer Agency and Monash University</span></em></p>Taking low-dose aspirin daily doesn’t delay the onset of disability in healthy older people. Nor does it prevent heart attack or stroke in those who hadn’t experienced either condition before.John McNeil, Professor, Head of School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1027062018-09-05T02:49:20Z2018-09-05T02:49:20ZDementia patients’ thinking ability may get worse in winter and early spring<figure><img src="https://images.theconversation.com/files/234957/original/file-20180905-45169-1713aem.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Thinking ability declines with age in those with dementia.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/tUyYnO_VdP0">Sam Wheeler/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>The seasons may affect the memory and thinking abilities of healthy older adults. A new study suggests changes in cognitive function may be associated with the time of year, declining significantly in winter and early spring. We also see new cases of mild cognitive impairment and dementia in these seasons.</p>
<p>Published today in the journal <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002647#pmed.1002647.ref002">PLOS Medicine</a>, the study suggests fluctuations in memory and thinking performance across seasons are equivalent to an approximate four-year difference in age. That is, the performance of people given memory and thinking tests in the summer and autumn would be equivalent to those about four years younger than when tested in spring and winter.</p>
<p>The authors also found new cases of <a href="https://www.alz.org/alzheimers-dementia/what-is-dementia/related_conditions/mild-cognitive-impairment">mild cognitive impairment</a> (a transitional diagnosis given prior to a dementia diagnosis) and dementia were 30% more likely in spring and winter relative to summer and autumn. </p>
<p>Dementia is when a person experiences a significant deterioration in memory and thinking abilities (cognitive function), noticed by themselves or a significant other. This goes together with a decline in their ability to perform everyday tasks such as paying bills, keeping on top of work, or even keeping themselves oriented to time and place, as well as mood changes.</p>
<p>These findings suggest there may be a need for more dementia care resources and community awareness during these colder months.</p>
<h2>What the research showed</h2>
<p>A group of researchers from Canada and the United States sought to answer the question of whether the season might influence poorer cognition in healthy adults, as well as those with dementia. Their questioning was based on previous findings in other areas of human biology, such as <a href="https://jamanetwork.com/journals/jamapsychiatry/article-abstract/493246">seasonal affective disorder</a> (depression associated with seasonal changes) and <a href="https://www.cambridge.org/core/journals/psychological-medicine/article/seasonality-of-symptom-onset-in-firstepisode-schizophrenia/BAFC8A432C269852168600809A6A5163">first-episode schizophrenia</a>. These findings suggest an association with time of year. </p>
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Read more:
<a href="https://theconversation.com/seasonal-affective-disorder-why-you-feel-under-the-weather-937">Seasonal Affective Disorder: why you feel under the weather</a>
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<p>Researchers have suggested these seasonal peaks in psychosis could be associated with stress and other social factors that may correspond with seasonal trends.</p>
<p>In the current study, the authors investigated data on around 2,700 healthy older adults from Chicago and around 500 dementia patients from Toronto. They found individuals tested in the months of July to October (summer-autumn in the Northern Hemisphere) displayed better performance than those tested in other months. This was true for both healthy adults and those with a dementia diagnosis.</p>
<p>They also found working memory (the ability to hold things in mind for a short time, such as memorising someone’s phone number) and speed of processing (how quickly someone is able to perform a task such as drawing a clock on a piece of paper) were most affected by the season. And the findings did not change if they accounted for the person’s mood, level of physical activity, sleep quality, time of day of testing, or thyroid integrity. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/234964/original/file-20180905-45143-1wizpia.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">The study authors argue being less physically active during the colder months wouldn’t make a difference to the findings.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/78hTqvjYMS4">Matthew Bennett/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>So, the authors argued this association was unlikely to be driven by outside environmental factors such as lower physical activity in winter months. Other confounding influences cannot be discounted. These include season-related injuries or pain such as arthritis, social isolation, changes in exposure to pollution or unaccounted-for biological factors. </p>
<h2>Biological changes</h2>
<p>Researchers also found changes in the biology of Alzheimer’s disease associated with the season. Alzheimer’s disease is a form of dementia mainly defined by two hallmark pathologies in the brain – a buildup of proteins called amyloid and tau. </p>
<p>In the purest sense, Alzheimer’s disease can only be diagnosed after death. But it is possible to measure levels of amyloid and tau during life using an imaging technique known as positron emission tomography (PET). This technology is still largely confined to research.</p>
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<strong>
Read more:
<a href="https://theconversation.com/what-causes-alzheimers-disease-what-we-know-dont-know-and-suspect-75847">What causes Alzheimer’s disease? What we know, don’t know and suspect</a>
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<p>Amyloid is known to become abnormal very early in the disease process. Examining spinal fluid extracted from participants, researchers found amyloid protein fluctuations in the cerebrospinal fluid of healthy older adults became more abnormal during winter months.</p>
<p>While the authors could not provide an explanation for this cyclical pattern in amyloid levels in the spinal fluid, they pointed out this aligned closely with memory and thinking patterns seen in the same adults.</p>
<h2>How should we read the findings?</h2>
<p>These findings are interesting and are some of the first in this area. But they need to be interpreted with a degree of scientific caution. </p>
<p>One major drawback is they’re predicated entirely on cross-sectional data. That is, people were not specifically followed during each season across the year to determine changes in their cognition. Researchers analysed data already available. </p>
<p>Further, these studies rely entirely on Northern Hemisphere data. This might not be applicable to the Southern Hemisphere.</p>
<p>These findings are correlational, so it cannot be said a particular season causes cognitive decline – it is merely associated with it. What one can imply from these data is more dementia care resources and community awareness may be needed during these months. </p>
<p>At a population level, these findings suggest a trend towards poorer cognitive performance and greater incidence of dementia cases in spring and winter, which might not simply be a case of “the winter blues”. These findings remind us to be mindful of dementia in our community, and that some may be particularly vulnerable at certain times of the year. </p>
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<strong>
Read more:
<a href="https://theconversation.com/getting-the-temperature-just-right-helps-people-with-dementia-stay-cool-97374">Getting the temperature just right helps people with dementia stay cool</a>
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<p>What remains to be done are studies specifically set up to measure cognitive performance in individuals throughout each season to determine if there really is something to feeling a bit mentally sluggish in the winter months.</p>
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<p><em>We are looking for volunteers to take part in our ongoing study to understand brain health and ageing. If you are interested, and between the ages of 40 and 65, please head to <a href="https://www.healthybrainproject.org.au/">The Healthy Brain Project</a>.</em></p>
<p><em>This article originally stated the research was published in the journal PLOS One. This has been corrected to PLOS Medicine.</em></p><img src="https://counter.theconversation.com/content/102706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rachel Buckley receives funding from the National Health and Medical Research Council and Australian Research Council with a Dementia Research Fellowship. </span></em></p>Have you noticed your thinking ability drops during winter and spring? A new study of healthy adults and dementia patients found cognitive function declines in the colder months.Rachel Buckley, Research Fellow, Harvard Medical School, Research Fellow, Florey Institute of Neuroscience and Mental HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/886902017-12-20T04:00:54Z2017-12-20T04:00:54ZAustralia’s aged care residents are very sick, yet the government doesn’t prioritise medical care<figure><img src="https://images.theconversation.com/files/199542/original/file-20171217-17842-1v6wu44.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The situation for older Australians isn't what was envisioned when the Aged Care act was introduced in 1997.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>It’s been 20 years since the government brought in the <a href="https://www.legislation.gov.au/Details/C2017C00241">Aged Care Act 1997</a> to <a href="http://onlinelibrary.wiley.com/doi/10.1046/j.1440-1800.2003.00164.x/abstract">deliver a new model of care</a> for older Australians who could no longer live at home and required assistance with daily tasks. The act aimed to facilitate choice and independence for the elderly, and direct services to those with the greatest needs.</p>
<p>But the legislative change also coincided with an era of advanced ageing and more complex needs in our elderly.</p>
<p>People who had previously entered low-level residential aged care (then called hostels), are now cared for in the community. Once they enter aged care, they’re older and sicker than before, and have more complex needs. Since 2008, the number of older Australians admitted to a residential aged care facility has <a href="https://www.gen-agedcaredata.gov.au/Resources/Factsheets-and-infographics/Care-needs-factsheet.pdf?ext=">remained steady</a>, but the proportion of people with high-care needs has progressively increased. </p>
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Read more:
<a href="https://theconversation.com/aussies-are-getting-older-and-the-health-workforce-needs-training-to-reflect-it-67710">Aussies are getting older, and the health workforce needs training to reflect it</a>
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<h2>Older and sicker Australians</h2>
<p>Currently, around <a href="https://www.gen-agedcaredata.gov.au/Resources/Factsheets-and-infographics/Care-needs-factsheet.pdf?ext=">half of people</a> living in aged care have dementia, depression, or another mental health or behavioural condition. The proportion of older people requiring high care for complex needs, which includes assistance with all activities of daily living such as eating and bathing, has quadrupled from 13% in 2009 to 61% in 2016.</p>
<p>When the act was introduced, more emphasis was placed on supporting older people to remain at home for as long as possible. Now, the transition to permanent care only occurs once all options have been exhausted. The needs of the elderly population often outgrow the available community aged care support. This then requires an admission into one of Australia’s 283,000 (subsidised) residential aged care beds. As a result, our aged care facilities are <a href="http://www.collegianjournal.com/article/S1322-7696(17)30015-X/abstract">increasingly functioning</a> as hospices for the frail elderly with complex care needs.</p>
<p>The main flaw of the act was to repeal the legal requirement for all aged-care facilities to provide 24-hour registered nursing care to assess and manage resident’s changing clinical needs, wounds and unrelieved pain. So residents have minimal access to this. <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/AgedCareWorkforce45/Report">Too few have access</a> to the necessary help from a geriatric medicine specialist (doctor), psychologist or social worker. And their families have minimal access to psychological and social support, and bereavement follow-up. </p>
<h2>Why was the act introduced?</h2>
<p>The 1997 act replaced two outdated and confusing 1950s laws to create a single statutory framework for Australian aged care services. It detailed the responsibilities of aged-care operators in relation to quality and compliance. It also empowered the relevant minister to set out principles covering matters such as quality of care, accountability and user rights.</p>
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<a href="https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=495&fit=crop&dpr=1 600w, https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=495&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=495&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=622&fit=crop&dpr=1 754w, https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=622&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/200115/original/file-20171220-4965-apdckg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=622&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">Older Australians are entering aged care older and sicker than before.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>The introduction of the act fuelled a much-needed capital works program funded by low interest bonds from older people entering residential aged care. This was meant to make aged care facilities more home-like, while also meeting care needs.</p>
<p>A major achievement of the act has been the amalgamation of hostels (social care accommodation for older people) and nursing homes (frail aged accommodation with 24-hour nursing care) into a single, user-pays regulated system. Now, people live in one institution, but are classified as having either low-care or high-care needs. </p>
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<strong>
Read more:
<a href="https://theconversation.com/the-shocking-state-of-oral-health-in-our-nursing-homes-and-how-family-members-can-help-77473">The shocking state of oral health in our nursing homes, and how family members can help</a>
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<p>This was to provide older people with an opportunity to “age in place”. So, to have a seamless transition into higher-level care as lower-level physical care needs intensified; and to ensure people living in an aged care facility received all of their care needs in one location. </p>
<h2>Major pitfalls of the act</h2>
<p>The act’s repeal of the legal requirement for 24-hour nursing care <a href="https://www.mja.com.au/journal/2000/173/2/healthcare-older-people-residential-care-who-cares">reflected the social model</a> of care underpinning the legislation. The idealistic yet impractical philosophy took the focus away from nursing and medical care. So now, the bulk of personal care is provided by a pool of untrained and unregulated aged-care workers supervised by a very small number of registered nurses. </p>
<p>Registered nurses employed in aged care are central to assessing, planning, monitoring and <a href="https://www.acn.edu.au/sites/default/files/representation/position_statements/the_role_of_the_rn_in_residential_aged_care.pdf">delivering complex care</a> to older people living in these facilities. But there are too few registered nurses (and they are often managing the facility) so they have limited capacity to ensure the older person’s function, comfort and dignity is optimised, their mobility maintained and dependence minimised. </p>
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Read more:
<a href="https://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942">Many older people in care die prematurely, and not from natural causes</a>
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<p>These skilled nurses also have few opportunities to ensure the resident’s family members receive the appropriate level of psycho-social and spiritual support they often need. Primarily because they’re dependent on the unskilled workers alerting them to changes in the resident’s condition or the families concerns. </p>
<p>Aged care facilities lack the clinical infrastructure of our hospitals. So, if a registered nurse is not on duty, there are few people the <a href="https://www.acn.edu.au/sites/default/files/representation/position_statements/the_role_of_the_rn_in_residential_aged_care.pdf">unskilled care workers</a> can call for timely clinical review.</p>
<p>If the GP can’t be contacted and the registered nurse is not on duty, an ambulance will be called and the frail older person will be transferred to hospital for assessment.</p>
<h2>What needs to happen</h2>
<p>Numerous inquiries have <a href="http://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-overview-booklet.pdf">highlighted the need</a> for a <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/AgedCareWorkforce45">skilled aged-care workforce</a> to ensure older Australians have access to the level and quality of health care they deserve. These health care gaps persist largely because the act’s principles, while possessing the status of law, are not subject to the same parliamentary control and public accountability. </p>
<p>A new nursing skill mix model is <a href="https://www.aph.gov.au/Parliamentary_Business/Committees/Senate/Community_Affairs/AgedCareWorkforce45">urgently required</a> in aged care to address the level of unmet health care needs. At a minimum, the act should be amended to stipulate appropriate staffing requirements for the delivery of <a href="https://www.acn.edu.au/sites/default/files/representation/position_statements/the_role_of_the_rn_in_residential_aged_care.pdf">direct clinical care</a>, including the presence of at least one registered nurse at all times. As part of the skill mix, a higher ratio of registered nurses and enrolled nurses supported by a team of care workers is required. </p>
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Read more:
<a href="https://theconversation.com/heres-why-we-need-nurse-resident-ratios-in-aged-care-homes-59682">Here's why we need nurse-resident ratios in aged care homes</a>
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<p>The availability of a nurse practitioner, with advanced training and prescribing rights, and a geriatrician to all aged care facilities would do much to improve timely access to medical care. It’s also likely the addition of this tier of health professionals into aged care would reduce the need for unnecessary emergency department presentations. These are often distressing for the resident and their family, as well as being costly to the system. </p>
<p>Unfortunately, the act fails our most vulnerable members of society and their families by not providing them with the skilled nursing, medical and allied health care they require in their last year, weeks or days of life.</p><img src="https://counter.theconversation.com/content/88690/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jane Phillips receives funding from relevant external funding organisations, including government-funded, foundation or research council grants. She is affiliated with Palliative Care Nurses Australia and The Australian Council of Nursing.</span></em></p><p class="fine-print"><em><span>Professor David Currow received unrestricted research grant from Mundipharma, is an unpaid member of an advisory board for Helsinn Pharmaceuticals, and has consulted Specialist Therapeutics and to Mayne Pharma and received intellectual property payments from Mayne Pharma.</span></em></p><p class="fine-print"><em><span>Deborah Parker receives research funding from a range of sources including government. She is affiliated with Palliative Care Nurses Australia, Palliative Care New South Wales, Australian College of Nursing and Australian Association of Gerontology. </span></em></p><p class="fine-print"><em><span>Nola Ries 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>Twenty years since the Aged Care Act was introduced, the situation for older Australians remains dire. They’re sicker and have more complex care needs, but little access to medical care.Jane Phillips, Director of IMPACCT, Professor of Palliative Nursing, University of Technology SydneyDavid Currow, Professor of Palliative Medicine, University of Technology SydneyDeborah Parker, Professor of Nursing Aged Care (Dementia), University of Technology SydneyNola Ries, Associate Professor, Faculty of Law, University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/870872017-11-13T18:56:40Z2017-11-13T18:56:40ZViolence between residents in nursing homes can lead to death and demands our attention<figure><img src="https://images.theconversation.com/files/194285/original/file-20171113-27579-h1ntxi.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Two high-level reports on elder abuse in aged care in Australia have recommended better reporting systems.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p>Some preventable deaths in nursing homes are a result of aggression between residents. This most commonly occurs in people with dementia, our new research has found. </p>
<p>Ours is the first study to examine the frequency and nature of resident-to-resident aggression resulting in the most severe outcome – death. In our analysis, almost 90% of residents involved in resident-to-resident aggression had a diagnosis of dementia. Three-quarters had a history of behavioural problems, including <a href="https://www.dementia.org.au/national/support-and-services/carers/behaviour-changes/wandering">wandering</a> and verbal and <a href="https://www.alzheimers.org.uk/info/20064/symptoms/92/aggression/2">physical aggression</a>, which are common symptoms of dementia.</p>
<p>Published in the Journal of the <a href="http://onlinelibrary.wiley.com/doi/10.1111/jgs.15051/full">American Geriatrics Society</a> today, we examined records for all resident-to-resident aggression-related deaths among nursing home residents reported to a coroner in Australia between 2000 and 2013.</p>
<p>We identified 28 deaths resulting from aggression between nursing home residents in Australia over the 14-year study period. This is within around 3,000 deaths that occurred from <a href="https://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942">non-natural causes</a>. However, due to reporting limitations, the number of deaths due to resident-to-resident aggression is likely to be the tip of the iceberg. </p>
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<strong>
Read more:
<a href="https://theconversation.com/many-older-people-in-care-die-prematurely-and-not-from-natural-causes-77942">Many older people in care die prematurely, and not from natural causes</a>
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<p>The rising global prevalence of dementia, particularly in the nursing home population, means aggressive behaviours between residents will increasingly be an issue. Two high-level reports on elder abuse in aged care in Australia have recommended better reporting systems so we can understand and prevent all such deaths in nursing homes.</p>
<h2>Aggression in nursing homes</h2>
<p>Resident-to-resident aggression is an <a href="https://www.ncbi.nlm.nih.gov/pubmed/25836385">umbrella term that includes</a> physical, verbal or sexual interactions that are considered to be negative, aggressive or intrusive. These behaviours can cause serious physical harm or psychological distress.</p>
<p>The prevalence of aggression between nursing home residents is difficult to determine. Recent <a href="http://annals.org/aim/article-abstract/2528279/prevalence-resident-resident-elder-mistreatment-nursing-homes">research estimates</a> at least 20% of nursing home residents in the US were involved in such incidents.</p>
<p>These typically occur between residents with a cognitive impairment or diagnosis of dementia. A <a href="https://academic.oup.com/ageing/article/44/3/356/49794">recent analysis</a> of the international literature revealed physical forms of aggression between residents occurred most frequently in communal areas of the nursing home and during the afternoon. This is when the behavioural and psychological <a href="https://www.dementia.org.au/about-dementia/carers/behaviour-changes/sundowning">dementia symptoms usually manifest</a> (also known as “sundowning”).</p>
<p>Most incidents appeared to be unprovoked, or were triggered by communication issues or a perceived invasion of personal space. Importantly, only one of the 18 studies reported a single death as the result of physical resident-to-resident aggression.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/194286/original/file-20171113-27585-1bzewno.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">Wandering is a common symptom of dementia.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
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<p>Our research found most exhibitors of aggression (85.7%) were male. The risk of death from aggression between residents was twice as high for male as for female residents. Those who exhibited aggression towards other residents were often younger and more recently admitted to the nursing home than their targets. </p>
<p>Incidents commonly involved a “push and fall”. Seven (25%) related deaths resulted in a coronial inquest, but criminal charges were rarely filed.</p>
<p>However, this is likely to be just the tip of the iceberg as there is much potential for underreporting and misclassification of resident-to-resident aggression deaths. We have limited data on how often incidents of aggression between residents in Australia occur but do not result in death.</p>
<h2>Reporting aggression</h2>
<p>Our limited data are primarily due to how our mandatory reporting framework is structured. The <a href="https://www.legislation.gov.au/Series/C2004A05206">Aged Care Act 1997</a> and associated <a href="https://www.legislation.gov.au/Details/F2017C00734">Accountability Principles 2014</a> require nursing home providers to report allegations or suspicions of abuse to the federal health department and police within 24 hours. These allegations include unlawful sexual contact, unreasonable use of force, or assault against care recipients.</p>
<p>According to the <a href="https://www.pc.gov.au/research/ongoing/report-on-government-services/2014/community-services">Productivity Commission’s annual report</a> on government services, the Commonwealth Department of Health received 2,625 notifications of assaults in nursing homes in the 2014-15 financial year. This is around 1.1% of all residents receiving care during that period. The majority (84%) of these reports were for alleged or suspected unreasonable use of force.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-elder-abuse-and-why-do-we-need-a-national-inquiry-into-it-55374">Explainer: what is elder abuse and why do we need a national inquiry into it?</a>
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<p>However, the legislation includes a discretion for providers not to report incidents of resident-to-resident aggression if the alleged offender has a previously assessed cognitive impairment and a behaviour management plan has been put in place for the care recipient within 24 hours of receipt of the allegation or suspicion of assault.</p>
<p>This means that the most common types of resident-to-resident aggression incidents (those involving cognitively impaired residents) are never collated and publicly reported. So we have no way of knowing the scale and severity of the problem.</p>
<p>The annual report statistics are also limited to identifying only the number of incidents. They do not include an analysis of the relationship between the target and exhibitor of aggression. This means we don’t know how many of the incidents were between residents or between residents and staff.</p>
<p>Finally, no other contextual information on the incidents is available in the annual report statistics. This represents a significant gap in knowledge on resident-to-resident aggression. In-depth analysis of contributing factors can help provide evidence to inform prevention strategies.</p>
<h2>Preventing aggression between residents</h2>
<p>This issue has not gone unnoticed. In its June 2017 report on <a href="https://www.alrc.gov.au/publications/elder-abuse-report">elder abuse</a>, the Australian Law Reform Commission recommended that aged care legislation should provide for a new serious incident response scheme. The scheme would require approved providers to notify an independent oversight body of any allegation or suspicion of a serious incident in their facility. </p>
<p>In relation to resident-to-resident aggression, these notifications would include incidents of physical abuse causing serious injury, or incidents occurring as part of a pattern of abuse. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/elder-abuse-report-ignores-impact-on-peoples-health-75926">Elder abuse report ignores impact on people's health</a>
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<p>The <a href="https://agedcare.health.gov.au/quality/review-of-national-aged-care-quality-regulatory-processes-report">federal government’s recent review</a> of aged care regulation supported this recommendation. The review was initiated in response to <a href="http://www.abc.net.au/news/2017-06-11/new-facility-to-be-built-to-replace-oakden-sa-budget/8607990">revelations of abuse and neglect</a> in South Australia’s Oakden Aged Mental Health Service.</p>
<p>Ensuring accurate reporting of incidents of aggression between residents, and raising community awareness of ageing-related issues, are important first steps to improve our aged care system and prevent harmful interactions between vulnerable older adults in care.</p><img src="https://counter.theconversation.com/content/87087/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Briony Murphy is a member of the Victorian executive committee of the Australian Association of Gerontology.</span></em></p><p class="fine-print"><em><span>Joseph Ibrahim received funding from the Commonwealth and State Health Department (Victoria) for this research.
Joseph also has funding grants from Dementia Training Australia and Victorian Managed Insurance Authority.
</span></em></p>The rising global prevalence of dementia, particularly in the nursing home population, means aggressive behaviours between residents will increasingly be an issue.Briony Murphy, PhD Candidate, Epidemiology & Forensic Medicine, Monash UniversityJoseph Ibrahim, Professor, Health Law and Ageing Research Unit, Department of Forensic Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/759152017-08-10T20:06:41Z2017-08-10T20:06:41ZBoth men and women need strong bones, but their skeletons grow differently across ages<figure><img src="https://images.theconversation.com/files/180143/original/file-20170728-23802-k5zg3c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bone is a dynamic tissue that is continually broken down and reformed throughout life.</span> <span class="attribution"><span class="source">from shutterstock.com</span></span></figcaption></figure><p><em>Men and women respond differently to diseases and treatments for biological, social and psychological reasons. In this series on <a href="https://theconversation.com/au/topics/gender-medicine-39178">Gender Medicine</a>, experts explore these differences and the importance of approaching treatment and diagnosis through a gender lens.</em></p>
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<p>Osteoporosis, a disease of ageing in which a person’s bones become brittle, putting them at high risk of fracture, is generally considered a woman’s disease. That’s because many more women than men have it. </p>
<p>It is estimated 23% of Australian women over the age of 50 <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129548481">have osteoporosis</a>, compared to 6% of men.</p>
<p>However, both men and women aged over 70 with a clinical diagnosis of osteoporosis and a history of risk factors – such as parent fracture history, certain medications or lifestyle – have a similar high risk of a hip fracture in the next ten years. </p>
<p>This risk is up to 43% chance of <a href="https://www.sheffield.ac.uk/FRAX/charts/Chart_AUS_hip_men_bmd.pdf">hip fracture for men</a> and 47% <a href="https://www.sheffield.ac.uk/FRAX/charts/Chart_AUS_hip_wom_bmd.pdf">for women</a>. While the prevalence of hip fractures is higher in women, men have a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3597289/">higher risk of death</a> following hip fracture. The reasons for this are not known.</p>
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<a href="https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=677&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=677&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=677&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=851&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=851&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180137/original/file-20170728-32241-4u9wsq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=851&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">Bone needs to be strong enough to provide support for the body, yet sufficiently flexible and light to allow movement.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/eltpics/7720067660/in/photolist-cLcn9Q-fKcZFw-WSTfDs-dUA8ZC-5Vxrs8-jD6hh8-rExcak-r9K4vR-q6iwD8-e8kGmT-b17U9z-bAc8e1-dYdfpa-dQG6fG-7MA9uW-ardxXU-pkaKpJ-55zSBY-fJLtRV-fZSuN2-ptbJq7-edTw6s-i75UVo-nu2UV-jdQ7MG-61NLbG-aFUB3g-qmNhzj-nwXUkG-7mXbeQ-87KL9Q-954op6-6sbPfa-bnWFb2-aGCput-9kJDFC-9yL3iX-7DHi3k-qU12UE-ndyTVb-bv7mcy-fhmAnb-bF1gCw-hg21qq-aBRNnC-VxwWpL-paYRbt-kJz1QG-c5gQRN-8pHHKM">eltpics/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>Bone is a dynamic tissue that is continually broken down and reformed throughout life. Bone health at any given age is determined by the balance between the amount of newly formed bone and the amount of old bone that is lost. </p>
<p>Risk of fracture in any individual is determined by the influence of the environment, nutrition and genes over their lifetime, which contribute to bone structure. The risk is determined by peak bone mass (which is the maximum amount of bone mass attained at adulthood), bone quality (the distribution of minerals in the bone) and bone loss with ageing.</p>
<p>Functionally, bone needs to be strong enough to provide support for the body, yet sufficiently flexible and light to allow movement. </p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/why-older-people-get-osteoporosis-and-have-falls-68145">Why older people get osteoporosis and have falls</a>
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<h2>Gender differences in adolescence and adulthood</h2>
<p>Gender differences in bone and muscle mass are not evident at birth or even until puberty. The <a href="https://www.dovepress.com/the-role-of-estrogen-in-bone-growth-and-formation-changes-at-puberty-peer-reviewed-article-CHC">growth pattern of bone</a> in boys is different from girls. Boys have two more years of growth before puberty, and the pubertal growth spurt in boys lasts for four years compared to three years in girls.</p>
<p>In childhood and adolescence, the balance of cellular activity is in favour of bone formation over bone resorption in both boys and girls. By the early 20s, women and men achieve <a href="https://www.nof.org/preventing-fractures/nutrition-for-bone-health/peak-bone-mass/">peak bone mass</a>, which is the consolidation of total bone mineral accrued over childhood and adolescence years.</p>
<p>A 10% increase in peak bone mass could <a href="https://academic.oup.com/edrv/article-lookup/doi/10.1210/er.2014-1007">reduce the risk of fracture by 50%</a> in women after the menopause. So, adolescence is a particularly critical period for bone health for the remainder of adult life. Failure to achieve peak bone mass by the end of adolescence leaves an individual with less reserve to withstand the normal losses during later life. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180135/original/file-20170728-23767-1yx8nt8.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">Adolescent boys are at higher risk of fracture due to gender-related lifestyle factors like risk taking and more physical activity.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/search/bmx?photo=gdGfwpiDVZs">Photo by Julia Komarova on Unsplash</a></span>
</figcaption>
</figure>
<p>Although more than 60% of the peak bone mass variance in girls or boys is <a href="http://www.sciencedirect.com/science/article/pii/S8756328209019711?via%3Dihub">genetically determined</a>, it is also influenced by modifiable factors such as diet. This includes dairy products as a natural source of calcium and proteins, vitamin D and regular weight-bearing physical activity. </p>
<p>Most gains in bone mass between the ages of 8 and 14 are due to an increase in bone length and size rather than bone mineral. This is one reason why <a href="http://jamanetwork.com/journals/jama/fullarticle/197303">fracture rates are higher during this period</a> relative to late teenage years. Bone mass lags behind growth in bone length, hence bone is temporarily weaker. </p>
<p>In general, adolescent boys are at higher risk of fracture <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856220/">compared to girls</a>. This is due to a combination of biological factors, as well as gender differences linked to levels of physical activities and risk taking.</p>
<p>Testosterone – the major sex hormone in males – increases bone size, while oestrogen – the major sex hormone in females – reduces further growth while <a href="https://www.dovepress.com/the-role-of-estrogen-in-bone-growth-and-formation-changes-at-puberty-peer-reviewed-article-CHC">improving the levels of mineral in bone</a>. This is why boys develop larger bones and higher peak bone mass than girls, contributing to a lower risk of fracture in adult men compared with adult women.</p>
<h2>Bone health in pregnancy</h2>
<p>Pregnancy increases the demand for calcium. It’s necessary for building the skeleton of the fetus and during breastfeeding. Poor maternal nutrition has long-term consequences for musculoskeletal development in both boys and girls, with reduced birth weight resulting in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872349/">reduced bone mass by adulthood</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/180141/original/file-20170728-23739-6gy6zh.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">Pregnancy increases the demands for calcium.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/eznix/14542795027/in/photolist-oa6Cii-5TNjAo-59KtU5-5TNiLh-5v6qDQ-5THWVF-4q18NQ-eU1L4U-iGYSC9-8VVePD-8VVkxz-aMtMyB-8VVds4-8VVcDT-a9vVFR-a9yHtf-9183DF-zoCeA-RoELg-abQGS8-6gjovV-fdyKRq-8VYfzf-niEvVf-RoELk-akpP9n-8VYmc7-67CUq6-8VVjag-8VYpcd-8VYjtG-8VVaWx-8VYoJU-oNuUF8-8VVddP-8VYo7U-8VVidZ-8VVfEe-8VYhyY-8VVgYK-8VYpaA-stEJ2-8VYhd3-cwN4Ty-97WgZL-97T9Gp-7N2KLG-8AN5VV-fGDT72-8VYjRS">nicolas michaud/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>This is why pregnant women need supplementation with calcium and vitamin D to improve skeletal growth and bone mass in newborn babies. Women can sometimes develop osteoporosis during pregnancy or breastfeeding because of poor nutrition. But the skeleton in the mother <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2720947/">will completely recover its lost bone</a> when breastfeeding stops.</p>
<p>Current evidence suggests the number of pregnancies and breastfeeding has no impact on the <a href="http://www.tandfonline.com/doi/full/10.1080/00016470510030274">risk of fractures later in life</a> when compared to peers who have not given birth. </p>
<h2>Loss of bone in the elderly</h2>
<p>On reaching adulthood, certainly by 30 years of age, bone mass remains largely constant and doesn’t begin to fall until the <a href="http://www.nature.com/nrrheum/journal/v11/n8/full/nrrheum.2015.48.html?WT.feed_name=subjects_skeleton&foxtrotcallback=true">fourth decade of life</a>.</p>
<p>Ageing is associated with a decline or loss of sex hormones in both men and women. Women are at a greater risk of developing osteoporosis because levels of oestrogen, the hormone that helps to conserve calcium in bone, decline rapidly at menopause. At this stage of life a lack of oestrogen results in accelerated bone loss.</p>
<p>Women experience a rapid loss of bone during the first five years after menopause, followed by <a href="http://www.nature.com/nrrheum/journal/v11/n8/full/nrrheum.2015.48.html?WT.feed_name=subjects_skeleton&foxtrotcallback=true">loss of bone with ageing at a much lower rate</a>. </p>
<p>Men avoid this phase of rapid bone loss, but they do experience loss of bone with ageing, <a href="http://www.nature.com/nrrheum/journal/v11/n8/full/nrrheum.2015.48.html?WT.feed_name=subjects_skeleton&foxtrotcallback=true">particularly after 70 years</a>. Peak levels of testosterone are attained at puberty after which they continue to fall throughout life. Reduction of testosterone levels can trigger declines in muscle mass, bone mass and physical function. Loss of muscle mass and function with age may also add to fracture risk by increasing the risk of falls.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/175563/original/file-20170626-326-12wiivd.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Both men and women over the age of 70 who have a clinical diagnosis of osteoporosis have a similar high risk of a hip fracture in the next ten years.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/alexanderdanling/4508983683/in/photolist-7SrHKZ-hr3n73-7Sw5yy-bf4YnF-5dsRys-hz35jz-6NoQrf-5fXqWL-xK6pZ-5Pc2bY-3c2BvB-9AXewx-8JpLDE-8e88pL-5Pc4if-9QHEaY-7PjbhD-AphVPF-T52aB1-6dXjKN-qFLYi7-5P7MEF-AXDuV5-AphVnD-q2vPzr-5Pc2ey-6JE5RU-A3V7qQ-aovzuJ-E87a6j-F3179a-HDcBf-5zJQtG-8PPWyj-8Ai6yq-7FAXR-9dF3vR-4JXCSy-7St6LS-4VcSPo-KgGM36-yBS2KG-ddTJv3-5M7YfP-bVEjzs-7Z8kfL-7LRo5P-bjN9g6-uKZw9-dth8uk">Alexander Danling/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<h2>Treatment</h2>
<p>Effective treatments are available to markedly reduce risks of fracture for both men and women and restore life expectancy to that of the non-fracture population. Drugs, <a href="https://www.osteoporosis.org.au/treatment-options">such as bisphosphonates</a>, are effective in both men and women. </p>
<p>Lifestyle factors can also reduce the risk of fracture. These include adequate nutrition, including vitamin D dietary calcium, and physical activity at all stages of life. </p>
<p>The best sources of calcium are diary products and vitamin D. While the latter is usually obtained from sun exposure, supplements are cheap and do not require exposure to the damaging effects of sun. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-how-do-our-bones-get-calcium-and-why-do-they-need-it-75227">Explainer: how do our bones get calcium and why do they need it?</a>
</strong>
</em>
</p>
<hr>
<p>Estimates suggest 91% of women and 63% of men aged 51-70 do not meet the <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/4364.0.55.008%7E2011-12%7EMedia%20Release%7EAustralian%20Health%20Survey:%20Usual%20Nutrient%20Intakes%20(Media%20Release)%7E411">average calcium requirements</a>. The <a href="https://www.osteoporosis.org.au/calcium">recommended average intake of calcium</a> for males and females is 1,000mg per day, rising to 1,300mg per day after 50 years for women and after 70 for men. This amount of calcium equates to three to five serves of <a href="https://www.osteoporosis.org.au/sites/default/files/files/calcium-food-table-web.pdf">calcium-rich foods</a> per day. </p>
<p>A large proportion of Australians also have <a href="http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.006Chapter2002011-12">low vitamin D status</a>. People of any age who don’t have adequate calcium and vitamin D intakes have increased risk of low bone mineral density with negative effects on bone strength. Research shows <a href="https://www.ncbi.nlm.nih.gov/pubmed/420146">people who consume more dairy products</a> have better peak bone mass and lower risk of fractures.</p>
<hr>
<p><strong><em>Read other articles in the series:</em></strong></p>
<p><em><a href="https://theconversation.com/medicines-gender-revolution-how-women-stopped-being-treated-as-small-men-77171">Medicine’s gender revolution: how women stopped being treated as ‘small men’</a></em></p>
<p><em><a href="https://theconversation.com/man-flu-is-real-but-women-get-more-autoimmune-diseases-and-allergies-77248">Man flu is real, but women get more autoimmune diseases and allergies</a></em></p>
<p><em><a href="https://theconversation.com/women-have-heart-attacks-too-but-their-symptoms-are-often-dismissed-as-something-else-76083">Women have heart attacks too, but their symptoms are often dismissed as something else</a></em></p>
<p><em><a href="https://theconversation.com/biology-is-partly-to-blame-for-high-rates-of-mental-illness-in-women-the-rest-is-social-75700">Biology is partly to blame for high rates of mental illness in women – the rest is social</a></em></p>
<p><em><a href="https://theconversation.com/what-happens-in-the-womb-affects-our-health-as-adults-but-girls-and-boys-respond-differently-76016">What happens in the womb affects our health as adults, but girls and boys respond differently</a></em></p><img src="https://counter.theconversation.com/content/75915/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Anderson receives funding from National Health and Medical Research Council of Australia.
Paul Anderson is affiliated with Australian and New Zealand Bone and Mineral Society. </span></em></p><p class="fine-print"><em><span>Howard Morris receives funding from National Health and Medical Research Council. He is affiliated with International Federation of Clinical Chemistry and Laboratory Medicine, the Australasian Association of Clinical Biochemists and the Australian and New Zealand Bone and Mineral Society. </span></em></p><p class="fine-print"><em><span>Deepti Sharma 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>Fracture risk is higher in older women than men, but in adolescence the reverse is true. These differences mean our approach to managing bone health for men and women changes across the ages.Paul Anderson, Associate Research Professor, School of Pharmacy and Medical Sciences, University of South AustraliaDeepti Sharma, PhD Candidate, School of Pharmacy and Medical Sciences, University of South AustraliaHoward Morris, Visiting Academic, School of Pharmacy and Medical Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/722612017-03-08T23:45:56Z2017-03-08T23:45:56ZContested spaces: we need to see public space through older eyes too<figure><img src="https://images.theconversation.com/files/159253/original/image-20170303-31744-1qjz5zl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Simple features, like a thoughtfully sited bench, can make a big difference to older people's ability to enjoy public spaces in the city.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/couple-back-park-480848737?src=CU3WMHNBi0lwEhpt2MlWHw-2-1">alexkich from www.shutterstock.com</a></span></figcaption></figure><p><em>This is the fifth article in our <a href="https://theconversation.com/au/topics/contested-spaces-36316">Contested Spaces</a> series. These pieces look at the conflicting uses, expectations and norms that people bring to public spaces, the clashes that result and how we can resolve these.</em></p>
<hr>
<p>The urban environment can have significant impacts on healthy ageing of older people, including how they enjoy and participate in their local community. Our <a href="http://www.cotaq.org.au/index.php">recent research</a> has identified that older people living in high-density Brisbane actively engage with well-designed neighbourhood public space. </p>
<p>Participation, interaction and physical activity hold the promise of <a href="http://apps.who.int/iris/bitstream/10665/67215/1/WHO_NMH_NPH_02.8.pdf">promoting health and independence</a> and reducing the risk of disablement for older people.</p>
<p>Our participants identified several key design considerations that help make public spaces usable and comfortable places. Many of these aspects are linked to walkability. </p>
<p>Successful public spaces become well-used venues for extending daily life beyond the home. But when public spaces are not well designed and maintained for everyday use and comfort, and their needs are not met, older people are discouraged from getting out and about. </p>
<h2>What do older people want?</h2>
<p>Our survey participants identified the key factors as:</p>
<ul>
<li><p>A wide variety of places for people to sit, to enjoy being out in public and watching people. Usable, universal design seating – rather than having to sit on the grass – is especially important for older people as rest-stops or destinations given their declining physical flexibility.</p></li>
<li><p>Hand rails on stairs and steep paths for safety and confidence.</p></li>
<li><p>Drinking fountains and trees to provide shade and comfort. A tree canopy provides comfort and protection from <a href="https://www.betterhealth.vic.gov.au/health/healthyliving/heat-stress-and-older-people">heat, humidity and sun exposure</a>. This is especially important in a sub-tropical <a href="https://theconversation.com/bad-luck-brisbane-muggy-cities-will-feel-future-heat-even-more-35205">climate like Brisbane’s</a>.</p></li>
<li><p>Plentiful and clean public toilets. The <a href="https://theconversation.com/caught-short-we-need-to-talk-about-public-toilets-60450">lack of such facilities can be debilitating</a> and an obstacle to some older people’s enjoyment of the public realm.</p></li>
<li><p>Wider walk paths and safer buffers between pedestrian paths and high-traffic roadways. In some areas, footpath and streetscape treatments could improve safety. An example would be to use trees and parking lanes to create a buffer between pedestrians and traffic.</p></li>
<li><p>Safer and clearly posted pedestrian crossings on busy thoroughfares to avoid or reduce the risk of pedestrian and motorist confusion at intersections. Older people avoided walking in some urban areas because of <a href="https://theconversation.com/to-keep-older-people-active-pedestrian-accessibility-must-improve-65134">concerns about crossing roads</a> with fast-moving traffic and little pedestrian amenity.</p></li>
</ul>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=678&fit=crop&dpr=1 600w, https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=678&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=678&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=852&fit=crop&dpr=1 754w, https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=852&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/159257/original/image-20170303-16360-tc9mya.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=852&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Paths, crossing and access points need to cater for people with various levels of mobility.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/dylanpassmore/6939311855/in/photolist-9tj4HJ-9tg4eT-9tg6dz-dAwrhJ-9rUVAB-9rUV5g-ha1LE2-7Jn8tY-9tj4YW-9tg6qv-9tj2W9-X74v-gSpiej-9tg7kt-gSp7Re-h9Ze7W-5ZALX-gSoU3E-h9Zm7t-6Uk2r3-DaEAe-dwwjxc-LSYQw-5mwf6J-EigoX-dwBQZL-3kHRjF-bzcMDR-7znwkc-5RMViy-dwwjSv-9mMoLi-wr5qX-b6hTX6-5RMV2J-a49Qsa-eEDw2t-c8j3y7-cr5HpU-9tg4HD-5RMUsW-oXhvvA-9tg4ZP-8KEdSk-5imwSx-5RMUKW-7VrQ7E-4wvWdG-8a7kZ8-6fQnnX">Dylan Passmore/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<ul>
<li>Clearer delineation on paths between areas for cyclists and runners and those who tend to move more slowly, such as older people and children. An example of where participants were uncomfortable was when the “strollers” must <a href="http://theconversation.com/contested-spaces-a-users-guide-to-shared-paths-72186">compete with numbers of runners and cyclists</a> using shared paths. Such infrastructure is shared with all segments of the population; the challenge is to design for all competing demands so no-one is excluded.</li>
</ul>
<p>Our research found it is the interplay of these needs that is important in activating public space for older people. We need to make these areas welcoming, comfortable and active. This requires spaces for people to walk, sit, people-watch and relax.</p>
<h2>Why do inclusive spaces matter?</h2>
<p>The benefit of good public space amenities in high-density neighbourhoods cannot be overstated. These features in public spaces are essential for older people’s participation and interaction in public – and indeed for everyone. </p>
<p>Our research highlights the potential impact these issues have on healthy ageing for older residents of high-density neighbourhoods. It gives us a better understanding of the design factors that make these areas more liveable and sustainable for older people. </p>
<p>The findings can help inform practical policies, programs and urban development design to help promote liveability, social engagement and healthy ageing in high-density neighbourhoods. This, in turn, can help preserve the independence and <a href="https://theconversation.com/aussies-are-getting-older-and-the-health-workforce-needs-training-to-reflect-it-67710">wellbeing of our ageing population</a>.</p>
<p>The World Health Organisation promotes healthy ageing as the ability to live an <a href="http://www.who.int/ageing/publications/Global_age_friendly_cities_Guide_English.pdf">active, safe and socially inclusive lifestyle</a>. </p>
<p>As the world <a href="http://data.worldbank.org/indicator/SP.URB.TOTL.IN.ZS">continues to urbanise</a>, various levels of government, the private sector and the community will need to work together to respond to the needs of older people. Issues of ageing in Australia and other parts of the developed world will become more critical in coming decades. </p>
<p>Current planning and development processes present several barriers to the provision of age-friendly infrastructure. Given the growing number of older people, and thus their increasing political influence, successful governments will need to respond to their needs and, in particular, the need for supportive social and physical environments.</p>
<hr>
<p><em>You can read other pieces in the series as they are published <a href="https://theconversation.com/au/topics/contested-spaces-36316">here</a>.</em></p><img src="https://counter.theconversation.com/content/72261/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Desley Vine receives funding from Australian Research Council, Private organisations including RSL Care, Ballycara, AVEO, Stockland, Ergon Energy. </span></em></p><p class="fine-print"><em><span>Laurie Buys receives funding from Australian Research Council, Private organisations including RSL Care, Ballycara, AVEO, Stockland, Ergon Energy, Cotton RDA, </span></em></p>Several key aspects of public open space can encourage older people to get out and about. And badly designed and maintained facilities have the opposite effect and can harm their wellbeing.Desley Vine, Research Fellow, Creative Industries Faculty, Queensland University of TechnologyLaurie Buys, Professor, Creative Industries Faculty, Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681492017-01-26T19:12:37Z2017-01-26T19:12:37ZWhy are we more likely to get cancer as we age?<figure><img src="https://images.theconversation.com/files/148834/original/image-20161206-25768-9pnyw2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's estimated our cells will replicate 10,000 trillion times in our lifetime. Errors in this process can lead to cancer.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>It’s a sobering fact that one in two Australian men and one in three Australian women will be diagnosed with some form of cancer by the age of <a href="https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics">85</a>. It’s even more alarming when you consider these statistics do not include the most common skin cancers (basal cell carcinoma and squamous cell carcinoma of the skin). It is <a href="http://www.cancer.org.au/about-cancer/what-is-cancer/facts-and-figures.html">estimated</a> hundreds of thousands of Australians are treated for these each year.</p>
<p>The number of new cases of cancer diagnosed has increased dramatically in the last three decades. In Australia, 47,445 new cases of cancer were <a href="https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics">diagnosed in 1982 and 122,093 in 2012</a>. This has led <a href="https://www.ncbi.nlm.nih.gov/pubmed/20814420">some</a> to think the risks of acquiring cancer are on the increase in modern society. </p>
<p>Of course, increased population accounts for much of the increase in these figures. But the other major factor is modern medicine increasing our lifespan. As we survive diseases and live longer, more of us are succumbing to cancer. </p>
<h2>The risk of cancer increases as we age</h2>
<p>A closer look at the cancer figures in relation to age at diagnosis shows a clear and dramatic increase in cancer as we age. For children and adults up to their forties, the incidence of cancer is quite low, but then increases quite dramatically as we get older.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=387&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=387&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=387&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=487&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=487&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148958/original/image-20161206-25727-1gn2qk4.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=487&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Estimated 2016 age-specific incidence rates for all cancers combined.</span>
<span class="attribution"><span class="source">AIHW analysis of the Australian Cancer Database</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>The incidence of cancer is around ten times higher in <a href="https://canceraustralia.gov.au/affected-cancer/what-cancer/cancer-australia-statistics">people 60 years and older, than in those under 60</a>.</p>
<h2>Cancer: a disease of our genes</h2>
<p>So, why is it we’re more likely to get cancer as we get older? Cancer is a disease caused by errors in our genes – the DNA code in our cells that provides the blueprints for all cell functions. These errors arise for a number of reasons. </p>
<p>Chemical carcinogens and radiation are two factors many immediately think of, and can be major players in some cancers. Chemical carcinogens in <a href="https://www.ncbi.nlm.nih.gov/pubmed/25712567">cigarette smoke</a> contributing to lung cancer and <a href="https://www.ncbi.nlm.nih.gov/pubmed/25414302">UV radiation</a> contributing to melanoma are two obvious examples. </p>
<p>We can also inherit some genetic errors. For example, defective BRCA genes are passed down in some families and contribute to a number of cancers, including those of the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27899183">breast and ovary</a>. Some viruses can also contribute to cancer, such as the human papillomavirus (HPV) with cervical cancer.</p>
<p>Another main reason for genetic errors arising, however, comes from normal biology. The body is made up of many trillions of individual cells, and in most cases these individual cells have a defined lifespan. </p>
<p>As these cells die they’re replaced by new cells that arise from the division of another cell into two; a process that requires replication of all of the cell’s DNA. </p>
<p>Despite this DNA replication being highly controlled and very accurate, the sheer number of times it is performed in the lifespan of a person (<a href="http://garlandscience.com/product/isbn/9780815344322">estimated</a> to be 10,000 trillion times!) means the introduction of a significant number of errors into the DNA of some of our cells from this fundamental process is inevitable.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148836/original/image-20161206-25721-1tpqn85.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">Longer life means more cancer.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Many gene errors are needed for cancer to develop</h2>
<p>So we all have “errors” in our genes. The vast majority of these errors have no effect, or simply add to our individual uniqueness. For example, some “errors” in the <a href="https://ghr.nlm.nih.gov/gene/MC1R">MC1R gene</a> have fortuitously given us individuals with red hair. </p>
<p>But some specific errors in certain genes can be “cancer-promoting” by causing the cells to become overactive and not restrained by the usual mechanisms the body cleverly employs to keep every cell in check. </p>
<p>Human cells are incredibly well controlled, with many safety mechanisms. This means single “cancer-promoting” errors in the DNA code of a cell do not cause cancer. Instead, many different “cancer-promoting” errors are required in genes that control specific types of cell processes, like cell division, programmed cell death and cell movement. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/16024784">Studies</a> have shown the number of different “cancer-promoting” genetic errors required in a single cell is at least six. For the development of most cancers it is likely many more are needed. Only when all of these errors are present in the same cell can that cell have a chance to progress to producing a cancer. </p>
<p>To accumulate the “<a href="https://www.ncbi.nlm.nih.gov/pubmed/21376230">right</a>” set of errors to drive transformation of a normal cell into cancer normally takes a long time. Thus, the longer we live, the more time there is for errors in our genes to accumulate. </p>
<p>At present there is not much we can do to prevent ageing. But we can reduce risks from external factors, such as avoiding chemical carcinogens like those in cigarette smoke, reducing exposure to UV radiation from the sun and, where appropriate, participating in vaccination programs for HPV.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/68149/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Stuart Pitson receives funding from the National Health and Medical Research Council of Australia. </span></em></p>Modern medicine is increasing our lifespan. But as we survive diseases and live longer, more of us are succumbing to cancer.Stuart Pitson, NHMRC Senior Research Fellow, Centre for Cancer Biology, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/701962017-01-26T19:12:25Z2017-01-26T19:12:25ZOlder people still have sex, but it’s the intimacy and affection that matters more<figure><img src="https://images.theconversation.com/files/152342/original/image-20170111-29019-164ekli.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sexuality is still an important part of life for older people, but it's seldom discussed and rarely researched. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>Sexuality encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction and what we think, feel and believe about them. It has been a research focus for over a hundred years, and highlighted as an important part of the human experience. Since the <a href="https://www.kinseyinstitute.org/research/publications/staff-publications-alfred-kinsey.php">first studies on human sexuality</a> in the 1940s, research has consistently demonstrated that sexual interest and activity are sustained <a href="http://www.apa.org/monitor/2012/12/later-life-sex.aspx">well into old age</a>. However, only a fraction of the research has explored sexuality in the later years of life.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/3395224">Most of the early research</a> on sexuality and ageing looked at the sexual behaviours and biology of older adults, generally ignoring the wider concept of sexuality. When researchers did discuss sexuality more broadly, many referred to sexuality as the domain of the young, and emphasised this was a major barrier to the study of sexuality in older adults. </p>
<h2>Sexuality in later life ignored</h2>
<p>Towards the end of the 20th century, research expanded to include <a href="http://www.tandfonline.com/doi/abs/10.3109/01612848109140864?needAccess=true&">attitudes towards sexual expression</a> in older adults, and the biological aspects of sexuality and ageing. Consistently, the research showed sexual expression is possible for older adults, and sustained sexual activity into old age is more likely for those who had active sex lives earlier in life. </p>
<p>By the late 1980s, there was a strong focus on the biological aspects of ageing. This expanded to include the reasons behind sexual decline. The research found these were highly varied and many older adults remain sexually active well into later life.</p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pubmed/3395224">despite evidence</a> adults continue to desire and pursue sexual expression well into later life, both society in general and many health professionals have inadvertently helped perpetuate the myth of the asexual older person. This can happen through an unintentional lack of recognition, or an avoidance of a topic that makes some people uncomfortable.</p>
<h2>Why does this matter?</h2>
<p>These ageist attitudes can have an impact on older adults not only in their personal lives, but also in relation to their health needs. Examples include the <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa067423">failure of medical personnel</a> to test for sexually transmissible infections in older populations, or the refusal of patients to take prescribed medications because of adverse impacts on erection rigidity. We need more health practitioners to be conscious of and incorporate later life sexuality into the regular health care of older adults. We still have a long way to go. </p>
<p>By ignoring the importance of sexuality for many older adults, we fail to acknowledge the role that sexuality plays in many people’s relationships, health, well-being and quality of life. Failure to address sexual issues with older patients may lead to or exacerbate marital problems and result in the withdrawal of one or both partners from other forms of intimacy. Failure to discuss sexual health needs with patients can also lead to incorrect medical diagnoses, such as the <a href="http://journals.sagepub.com/doi/abs/10.3109/00048679309072118">misdiagnosis of dementia</a> in an older patient with HIV.</p>
<h2>It’s not about ‘the deed’ itself</h2>
<p>In a <a href="http://iha.acu.edu.au/projects/older-adult-sexuality-and-intimacy-study-oasis/">recent survey</a> examining sexuality in older people, adults aged between 51 and 89 were asked a series of open-ended questions about sexuality, intimacy and desire, and changes to their experiences in mid-life and later life. This information was then used to create a series of statements that participants were asked to group together in ways they felt made sense, and to rank the importance of each statement. </p>
<p>The most important themes that emerged from the research encompassed things such as partner compatibility, intimacy and pleasure, and factors that influence the experience of desire or the way people express themselves sexually. Although people still considered sexual expression and sexual urges to be important, they were not the focus for many people over 45. </p>
<p>Affectionate and intimate behaviours, trust, respect and compatibility were more important aspects of sexuality than intercourse for most people. Overall, the message was one about the quality of the experience and the desire for connection with a partner, and not about the frequency of sexual activities.</p>
<p>People did discuss barriers to sexual expression and intimacy such as illness, mood or lack of opportunity or a suitable partner, but many felt these were not something they focused on in their own lives. This is in line with the data that shows participants place a greater importance on intimacy and affectionate behaviours such as touching, hugging and kissing, rather than intercourse. </p>
<p>These results help us challenge the existing stereotype of the “asexual older person” and the idea intercourse is necessary to be considered sexually active. They also make it clear researchers and health practitioners need to focus on a greater variety of ways we can improve the experience and expressions of sexuality and intimacy for adults from mid-life onwards beyond medical interventions (like Viagra) that focus on prolonging or enhancing intercourse.</p>
<hr>
<p><em>If you are interested in participating in similar surveys, you can register online at acu.edu.au/OASIS.</em></p>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/70196/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>Most of the early research on sexuality and ageing looked at the sexual behaviours and biology of older adults, generally ignoring the wider concept of sexuality.Ashley Macleod, PhD Candidate / Research Assistant, Australian Catholic UniversityMarita McCabe, Director, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/691502017-01-25T19:53:59Z2017-01-25T19:53:59ZHeart disease: what happens when the ticker wears and tears<figure><img src="https://images.theconversation.com/files/148579/original/image-20161205-19407-b966rt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Our heart works hard for every second we are alive. Eventually its processes will wear out. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em> </p>
<hr>
<p>Nothing predicts the risk of heart disease more than age. Although seen at any age, rates of heart disease increase markedly in older people. It remains not only the <a href="http://aihw.gov.au/deaths/leading-causes-of-death/">leading cause of death in our community</a>, but also the key reason many older people cannot perform the physical activities they want and need for daily life. </p>
<p>Given our increasing lifespan, we need to better understand how and why the heart and blood vessels (cardiovascular system) age, and whether we can slow down the processes involved.</p>
<p>Heart disease can cause heart attack, angina, heart failure or eventually, sudden cardiac death. Heart disease includes stroke, aneurysm and other diseases of the arteries - the tubes that carry oxygenated blood from the heart to parts of the body.</p>
<p>Most of this list of serious conditions can be traced back to atherosclerosis in our arteries. This refers to build up of cholesterol and other factors such as modified cholesterol, cellular debris and cells associated with inflammation in the walls of arteries that obstructs blood flow. This leads to a blockage due to blood clots (thrombosis).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=302&fit=crop&dpr=1 600w, https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=302&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=302&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=380&fit=crop&dpr=1 754w, https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=380&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/149609/original/image-20161212-31375-1ap43av.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=380&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 diagram of atherosclerosis and an image of an artery containing plaque.</span>
<span class="attribution"><span class="source">Wikimedia Commons</span></span>
</figcaption>
</figure>
<h2>What happens in the heart as we age?</h2>
<p>Does the heart wear out? Is there a timer ticking away somewhere in our body that eventually says “enough,” or do we cumulatively inflict damage over time?</p>
<p>The simple answer is: a little bit of the first two and quite a lot of the third. Continuous exposure to the risk factors for heart disease over decades plays a large part. Tobacco products, high blood pressure, abnormal blood fats and diabetes are all slow-burning toxins to the walls of arteries, and the longer the exposure, the more damage they do.</p>
<p>Ageing particularly affects the structure and function of arteries. Two important structural protein fibres hold the larger arteries together: collagen and elastin. </p>
<p>Collagen is inelastic but strong. It takes most of the burden of the pressure inside arteries brought about by the power of the heart pumping blood around the body.</p>
<p>As the name suggests, elastin is elastic, and has many of the characteristics of rubber. By stretching when the heart pumps blood, elastin helps cushion the fluctuations in pressure inside the artery. Like rubber, it is extremely tolerant of repetitive stretching and relaxation. But like rubber, it will eventually wear out. </p>
<p>After decades of repetitions (60 to 80 times a minute, 24 hours a day) more of the load is taken by the stiffer collagen and less by the softer, compliant elastin. As there is now less cushioning of each powerful beat of the heart, the systolic blood pressure (the peak pressure when the heart is actively pumping blood into the arteries) increases. </p>
<p>Blood moves more quickly through stiffer pipes so the diastolic blood pressure (the lowest pressure with each beat when the heart is relaxing and refilling) tends to fall. </p>
<p>Older people with stiff arteries have a bigger difference between their systolic and diastolic blood pressures. Regular physical activity, healthy nutrition and a good hormonal balance can delay this process.</p>
<h2>What are the effects of the ageing heart?</h2>
<p>High systolic pressure damages the walls of arteries. There are also other consequences downstream in the very small arteries that feed oxygen and nutrients to the organs of the body. They are subjected to a faster moving pulse of blood at a higher pressure, which rapidly falls away. </p>
<p>This means they’re pulled and stretched more vigorously with each beat, and that disturbs their function. Damage to small arteries in the brain can cause multiple tiny strokes, the <a href="https://www.fightdementia.org.au/about-dementia/types-of-dementia/vascular-dementia">cause of many cases of dementia</a>. </p>
<p>Damage to arteries in the kidney results in impaired function. As the kidney has an important role in regulating blood pressure in the rest of the body, a vicious cycle can be established where high blood pressure begets more high blood pressure, and more kidney damage leads to kidney failure.</p>
<p>The most vulnerable part of our arteries is the inner lining of their walls. This plays a vital function, acting as a barrier between the blood stream and the wall of the artery as well as controlling the function of the muscle layer of the wall. This widens or narrows the artery in accord with the oxygen needs of the organs of the body. </p>
<p>If they are damaged by tobacco smoke, a poor diet, diabetes or other risk factors, this barrier function can be lost, allowing the various ingredients of atherosclerosis to accumulate in the wall. </p>
<p>Atherosclerosis in the coronary arteries causes narrowing which can progress to blockage. Age is not necessarily the problem here but these build up over time and the longer the exposure to these damaging factors the more likely heart disease will emerge.</p>
<p>This is the underlying cause of most heart disease in the community. </p>
<p>As collagen is the major structural protein in the ageing heart, it is stiffer. Heart muscle cells are not replaced as quickly as they are lost. This less elastic heart does not fill as well, may not empty as well and therefore does not pump as well.</p>
<p>Heart failure is when the pumping ability has fallen to the extent the blood supply to the body is insufficient to meet the needs of daily living. Fortunately this only occurs after the vast reserve capacity of the healthy heart has been overcome. </p>
<p>Another consequence of these changes is that the electrical impulses the heart generates to activate each beat travel less efficiently across the heart. This is a cause of atrial fibrillation, a form of irregular heart beat that can lead to stroke, especially in older people. </p>
<p>Ageing of our cells is a lifelong race between production of new cells and loss of the old. As we get older the loss due to self-inflicted damage or acute disease challenges the replacement systems. </p>
<p>This is one of several natural processes that provide a ticking clock for our heart muscle. Staying physically and mentally active, being aware of the things that damage your arteries and having regular heart checks is the way to healthy ageing.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/69150/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Garry Jennings receives funding from the National Health and Medical Research Council.
He is Senior Director of Baker IDI Heart & Diabetes Institute, Chief Medical Advisor of the Heart Foundation, a Board member of Ballarat Health Services, Nucleus Network and the Australian Cardiac Outcomes Registry.</span></em></p>Given our increasing lifespan, we need to better understand how and why the cardiovascular system ages and whether we can slow down the processes involved.Garry Jennings, Chief Medical Advisor at National Heart Foundation of Australia; Senior Director, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/676982017-01-25T19:53:56Z2017-01-25T19:53:56ZArthritis isn’t just a condition affecting older people, it likely starts much earlier<figure><img src="https://images.theconversation.com/files/149195/original/image-20161208-31405-1d8emw0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No-one wakes up at 65 with arthritis. It's a condition that starts earlier in life and perhaps goes unnoticed until it worsens later in life. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>Arthritis is an umbrella term for over 100 conditions affecting the joints. All result in pain and often severely limit the activities a person can do. There are many different types of arthritis, each with a different cause.</p>
<p>Arthritis is a major cause of disability in Australia and world-wide. It also presents a significant cost to the community. In Australia, arthritis <a href="http://www.move.org.au/Research/PDFs/PLS/APWS-PLS.aspx">costs $55.8 billion per year</a>. </p>
<p>Most people think of arthritis as a disease of the elderly. While this is where it’s most commonly seen, it’s not where it starts. No-one wakes up with arthritis at 65. The different types of arthritis have different causes, but most of these start much earlier in life with mild symptoms that often go unnoticed. It’s usually only as the condition worsens over time that symptoms are noticed, and this is usually in older age.</p>
<p>Two of the most common types of arthritis are osteoarthritis and gout.</p>
<h2>Osteoarthritis</h2>
<p>Osteoarthritis is common as people age, and most frequently affects the hands, neck, back, knees and hips. Many people get osteoarthritis due to a familial tendency to develop it. Clearly we can’t change this.</p>
<p>We describe osteoarthritis as a disease of ageing, but it often begins many decades before a person has joint problems. In the past it was thought osteoarthritis was due to “wear and tear” of the joints and was thus inevitable. We now know this is not the case and there are a number of causes of osteoarthritis, with obesity being one of the most common contributing factors.</p>
<p>Osteoarthritis is more common in women than men, and is exacerbated by age. Over the age of 60 years, <a href="http://www.aihw.gov.au/osteoarthritis/who-gets-osteoarthritis/">more than 30% of people</a> have osteoarthritis.</p>
<p>It was previously thought that obesity affects joints because of the extra load the person carries, but this wouldn’t explain osteoarthritis in the hands. We now know obesity also causes inflammation in the joints as well as the extra loading. Obesity affects joints across all of the life span, so damage is already present in middle age, but becomes worse over time.</p>
<p>Hormones and injuries to joints also play a part in osteoarthritis. Many women develop hand osteoarthritis at menopause.</p>
<p>Maintaining a healthy weight, avoiding injuries to joints and regular exercise in order to strengthen muscles around the joints, are all important for the prevention of osteoarthritis. </p>
<p>Muscle strengthening exercises are very effective for reducing pain in osteoarthritis. Anti-inflammatory creams <a href="https://www.oarsi.org/sites/default/files/docs/2014/non_surgical_treatment_of_knee_oa_march_2014.pdf">have been shown to improve joint pain</a>. Medications such as paracetamol and anti-inflammatory tablets should only be used in the short term, and with advice from a doctor.</p>
<h2>Gout</h2>
<p>Gout is a very different type of arthritis. It results from a build-up of uric acid in the body. Uric acid is normally produced in the body, but some people don’t process uric acid effectively, so it builds up. Under some circumstances, such as changes in the diet, medications such as diuretics or excess intake of alcohol, this build-up can be <a href="http://www.move.org.au/Conditions-and-Symptoms/Gout">deposited in the joints</a>. This causes arthritis, experienced as a very painful, swollen joint.</p>
<p>Gout is more common in men than women, although women catch up after menopause. As with osteoarthritis, it tends to run in families. Gout becomes more common as we age because uric acid is able to accumulate with time. This is mainly because the kidneys cannot eliminate it as well as they used to, often as a result of other conditions such as diabetes or high blood pressure that over years may effect the kidneys. Some commonly used medications such as diuretics (or “water tablets”) can make this worse.</p>
<p>Diet is important for preventing gout. Alcohol needs to be taken in moderation, especially beer, both to prevent development of gout and to reduce the number of episodes. There are some types of food such as offal (liver, kidney) and shell fish that may result in an increased production of uric acid in the body and precipitate gout. One new risk factor for gout is a high intake of fructose, a sweetener commonly used in many soft drinks. Obesity can also make gout worse, so needs to be prevented as part of gout treatment.</p>
<p>Many people will also need medications to keep their gout in check. Gout can readily be treated with medications such as anti-inflammatories or colchicine. If gout occurs repeatedly, medication can also be prescribed to prevent this.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67698/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Flavia Cicuttini receives funding from NHMRC, MOVE Australia, Australian Arthritis Foundation, Monash University, The Alfred Foundation, Medibank Health Research Fund
Member of the RMA
</span></em></p>Most people think of arthritis as a disease of the elderly. While this is where it’s most commonly seen, it’s not where it starts.Flavia Cicuttini, Head, Musculoskeletal Unit DEPM, and Head Rheumatology Unit, Alfred Hospital, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/679302017-01-24T19:18:30Z2017-01-24T19:18:30ZWhy we lose our hearing and vision as we age<figure><img src="https://images.theconversation.com/files/152206/original/image-20170110-12672-15g6ms2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">We experience lots of changes in our body as we age, and our eyes and ears are no exception. Unfortunately this toys with our senses. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As the baby boomer generation begins to age, the prevalence of both eye and ear disease will rise exponentially, as there is a strong correlation between vision loss, hearing loss and ageing.</p>
<p>The <a href="http://www.who.int/mediacentre/factsheets/fs282/en/">World Health Organisation estimates</a> that 285 million people worldwide are visually impaired, with 82% of people with blindness aged 50 and above. Australia alone will have 800,000 people aged 40 or over with low vision or hearing loss by 2020.</p>
<p>As people age, they often experience a number of changes in their physical, mental and social health. Among these are eye and ear changes, and diseases that usually result in vision and hearing loss. Changes to our eyes and ears occur as a result of disease, genetic factors, “wear and tear” and environmental factors.</p>
<h2>What happens in our eyes as we age?</h2>
<p>There are a range of changes in our eyes that occur as a result of age. For example, over time the whites of the eyes, or “sclera”, undergo changes due to exposure to ultraviolet light. </p>
<p>These changes include a yellowing or browning of the white of the eye due to fatty or cholesterol deposits in the conjunctiva – the mucous membrane that covers the eye – also related to ageing and exposure to ultraviolet light. </p>
<p>Over time, changes also occur in the conjunctiva, such as a thinning of the membrane. This often results in dry eye, a condition caused mainly by reduced production of tears and reduced mucous from the conjunctiva.</p>
<p>As we age, we often experience a decrease in the strength of our muscles. This is no different in the eye, and the muscles in our eyelids can become weaker over time. Reduced tone in the muscle that gives shape to our lens, as well as stiffening of the natural lens with age, causes presbyopia (inability to see near objects), necessitating the use of reading glasses.</p>
<p>Eye disorders that commonly occur in older adults include:</p>
<ul>
<li><p><strong>macular degeneration</strong>. This terms describes <a href="https://theconversation.com/explainer-what-is-age-related-macular-degeneration-59889">damage to the pigmented oval</a> in the centre of the retina resulting in decreased central vision and seeing fine detail. This happens as we age because of deposits of fine grains that build up in the retina.</p></li>
<li><p><strong>Cataracts</strong>. This is a <a href="https://theconversation.com/explainer-what-are-cataracts-63699">clouding of the lens</a> that covers the eye. These are thought to be caused by breakdown and degradation of lens proteins, and are considered a part of the normal ageing of the lens. </p></li>
<li><p><strong>Diabetic retinopathy</strong>. This is damage to the retina resulting from diabetes. Type 2 diabetes is age related and the duration and control of blood glucose levels often determine whether or not diabetic retinopathy does or does not develop.</p></li>
<li><p><strong>Glaucoma</strong>. When <a href="https://theconversation.com/explainer-what-is-glaucoma-the-sneak-thief-of-sight-64807">glaucoma</a> occurs, the optic nerve is progressively damaged resulting in loss of the peripheral visual field.</p></li>
</ul>
<p>Among older Australians, cataract is the most common eye disease and cause of visual impairment (over <a href="https://www.health.gov.au/internet/main/publishing.nsf/Content/D1A5409787D800F2CA257C73007F12F3/%24File/eyehlth.pdf">70% of people in Australia</a> aged 80 years and over have cataracts), followed by age-related macular degeneration (occurring in <a href="http://www.aihw.gov.au/media-release-detail/?id=6442464587">3.1% of older people</a>).</p>
<h2>What happens in our ears as we age?</h2>
<p>As we get older, we experience changes all over our body, including the ears. Commonly, people’s ears (outer ears, that is) become bigger, earwax accumulates more easily and there is more cartilage in the external ear canal.</p>
<p>There is also often a stiffening of the eardrum and <a href="https://www.nursingtimes.net/roles/older-people-nurses/exploring-the-anatomy-and-physiology-of-ageing-part-6-the-eye-and-ear/1840889.article">changes to the neural</a> (nerve) system.</p>
<p>These changes contribute to older people suffering from hearing loss and central <a href="https://theconversation.com/is-your-child-having-trouble-learning-they-may-have-auditory-processing-disorder-62491">auditory processing disorders</a>, in which the ear cannot properly process sounds.</p>
<h2>How these changes affect daily life</h2>
<p>As a result of these numerous eye and ear changes and diseases, older people typically have vision and hearing problems that include sensitivity to light and difficulty visualising distant objects or reading print. </p>
<p>Hearing problems include difficulty with perceiving and discriminating sounds (including speech), understanding speech (particularly in poor listening situations such as when there is high background noise or echo), and processing auditory information.</p>
<p>These difficulties interfere with older adults’ everyday functioning and participation in activities. People with sensory loss may have difficulty performing independent activities of daily living such as bathing and shopping. This means they’re more at risk of problems with <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1448344/">mental health and social interaction</a>.</p>
<p>One of the most disabling effects of vision and hearing loss is decreased ability to communicate with others. People with severe vision loss (low vision or legal blindness) have difficulty lip reading or perceiving non-verbal cues (such as facial expression or gestures). </p>
<p>Those with hearing loss have communication difficulties including difficulty perceiving sounds or following a conversation. For people with loss of both senses, communication difficulties are much worse. They can’t adequately receive a verbal message and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4030176/">frequently misunderstand conversation</a>.</p>
<h2>Management of sensory loss</h2>
<p>Management of sensory loss requires assessment by professionals (such as optometrists and audiologists) who will recommend the appropriate management plan that may include the use of a visual or hearing device.</p>
<p>Speech pathologists also play a role, with programs including speech perception training or communication programs for clients and carers. </p>
<p>Early identification and intervention can help those with vision and hearing loss so the effects of these sensory losses can be minimised, improving their quality of life.</p>
<hr>
<p><em>Acknowledgement: Dr Julian Sack (Ophthalmologist) for his input. Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67930/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Chyrisse Heine 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>Changes to our eyes and ears occur as a result of disease, genetic factors, “wear and tear” and environmental factors.Chyrisse Heine, Speech Pathologist/Audiologist Senior Lecturer, La Trobe UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/681452017-01-24T19:17:56Z2017-01-24T19:17:56ZWhy older people get osteoporosis and have falls<figure><img src="https://images.theconversation.com/files/148820/original/image-20161206-25721-hgzja7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Older people are more likely to have falls as their balance and muscle strength usually isn't what it was. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As the world’s population lives longer, the significance of osteoporosis and fractures increases.</p>
<p>In Australia, it is estimated that <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">4.74 million Australians aged over 50</a> have osteoporosis, osteopenia (less severe than osteoporosis) or poor bone health. By 2022, <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">it’s estimated this will increase</a> to 6.2 million, with one fracture occurring every 2.9 minutes.</p>
<p>In 2012, the <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">total cost of poor bone health</a> in adults aged over 50 was A$2.75 billion, and 64% of this cost was directly associated with treating and managing fractures.</p>
<h2>What is osteoporosis?</h2>
<p>Osteoporosis is a condition in which bones become fragile and brittle, leading to higher risk of breakage. This occurs when bones lose minerals such as calcium more quickly than the body can replace them.</p>
<p>In Australia, osteoporosis
affects <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">one in three women and one in five men</a> over the age of 50.</p>
<p>Referred to as a “silent” disease, osteoporosis generally has no symptoms and is rarely diagnosed until bones break or fracture. Osteoporosis is the disease and fractures are the outcome we are trying to prevent.</p>
<h2>Why do we get osteoporosis as we age?</h2>
<p>Our bones are living tissue and are in a continual state of renewal. As we age, more bone is broken down (resorbed) than is replaced by new bone. Thus our bones get thinner and more fragile as we age. This is particularly true during menopause for women and in men with lower levels of sex steroid hormones such as testosterone.</p>
<p>“Primary osteoporosis” is bone loss that can be attributed to ageing or the known hormonal consequences of ageing, such as the decline in oestrogen and testosterone. These hormones help regulate bone renewal that occurs naturally as we age. </p>
<p>As the level of these hormones decline from about the age of 50 in women and around 60 in men, the rate of bone breakdown is faster than the growth of new bone to replace it. Over time this leads to weaker, thinner bones. In women, the risk abruptly increases from the time of menopause, coinciding with a significant drop in circulating levels of oestrogen.</p>
<p>“Secondary osteoporosis” occurs as a consequence of another disease (such as coeliac disease with associated calcium malabsorption), or as an adverse consequence of therapy for another disease where medication might bring it on.</p>
<p>Thin bones of a poorer quality structure are more likely to break. The vast majority of fractures occur as a result of a fall from standing height. Vertebral or spinal fractures are the exception, frequently occurring without a fall or significant “trigger event”.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=431&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=431&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=431&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148822/original/image-20161206-25730-9h561e.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We’re more likely to have a hip fracture if our parents did.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Why do we fall over when we get older?</h2>
<p>There are many reasons older adults are susceptible to falls. These include side effects of some medications, vision impairments and less ability to prevent tripping over as balance, muscle mass and strength decline with age.</p>
<p>The risk of fracture due to poor bones increases with age, and this is further enhanced by osteoporosis. </p>
<p>Genetics also plays a role in an individual’s risk of fracture. Those of us with parents who had a hip fracture have an increased risk of fracture. The most common sites of fracture in older adults are the hip, vertebrae or spine, wrist or the humerus (upper arm or shoulder).</p>
<p>About <a href="https://www.ncbi.nlm.nih.gov/pubmed/10083688">30% of older adults</a> fall at least once a year. The less often you fall, the less likely you are to break a bone.</p>
<p>People aged 70 and over <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">accounted for 70% of the total</a> acute hospital inpatient costs in 2012. Hip fractures <a href="http://www.osteoporosis.org.au/sites/default/files/files/Burden%20of%20Disease%20Analysis%202012-2022.pdf">impose the highest burden</a> both in terms of cost and decline in health-related quality of life.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/25792491">Results from a recent study</a> show most fracture patients have not fully recovered their previous level of quality of life by 18 months after the fracture.</p>
<h2>Preventing osteoporosis and falls</h2>
<p>Preventing falls in older people is an important way to prevent fractures. Adults who have good balance and muscle strength are often able to “save themselves” when they trip. Exercises that improve balance (such as Tai Chi) and help maintain muscle mass (weight-bearing and resistance exercises) are beneficial.</p>
<p>Preventing osteoporosis involves regular weight-bearing and resistance exercise, adequate calcium in the diet (at least three serves of dairy or equivalent per day) and an adequate level of vitamin D in the bloodstream.</p>
<p>Sunlight exposure on the skin is the primary source of vitamin D, but we need to practise safe sun exposure to reduce the risk of skin cancer. The recommendations vary by <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">skin type, latitude and season</a>. For people with moderately fair skin, six to seven minutes before 11am or after 3pm during summertime is considered sufficient. </p>
<p>During wintertime, the daily recommended sun exposure increases to between seven and 40 minutes <a href="https://www.mja.com.au/open/2013/2/1/building-healthy-bones-throughout-life-evidence-informed-strategy-prevent-osteoporosis">depending on where you live in Australia</a>.</p>
<p>While lifestyle factors such as nutrition and exercise can make an important difference to bone health over time, if an older adult has several risk factors for fracture their doctor may discuss the benefits of “bone active” medication. These medications slow the rate bone breaks down as we age. In general these medications halve the risk of fracture and are much more effective than lifestyle measures alone.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/68145/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerrie Sanders has previously received an Honarorium from Sanofi Pty Ltd for presenting on the Burden of Osteoporosis. She has previously received several project grants from the National Health and Medical Council. One of these projects on the burden of disease study on osteoporosis received supplementary funding from Merck Pty Ltd. Prof Saanders is a member of the scientific advisory committees for both Osteoporosis Australia andfd the International Osteoporosis Foundation. </span></em></p>In 2012 the total cost of poor bone health in adults aged over 50 years was A$2.75 billion, and 64% of this cost was the direct cost associated with treating and managing fractures.Kerrie Sanders, Professor -Musculoskeletal Science, Nutrition and Health economics, IHA, Australian Catholic UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/676992017-01-23T19:17:16Z2017-01-23T19:17:16ZFive common myths about the ageing brain and body<figure><img src="https://images.theconversation.com/files/145362/original/image-20161110-26299-1dj1vgg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Will you still be able to do the crossword when you're 80? Yep, better than ever, probably.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>The world’s population, and Australia’s, is ageing. The number of adults aged 65 and over is <a href="http://www.abs.gov.au/websitedbs/d3310114.nsf/home/population%20pyramid%20-%20australia">increasing</a>, as is the proportion of the population they represent. However, there are a number of myths associated with what happens to our brain and bodies as we age.</p>
<h2>1. Dementia is an inevitable part of ageing</h2>
<p>Dementia prevalence increases with age. That is, your chance of having a diagnosis of dementia is greater the older you are. But if you are lucky enough to reach old age, you won’t necessarily have dementia. Dementia is a clinical diagnosis that is characterised by impairments in cognition (the way we think) and functional abilities (that enable us to live independently). </p>
<p>The major type of dementia is Alzheimer’s disease, although there are many other types, such as vascular dementia (related to vascular changes in the brain such as stroke), frontotemporal dementia (brain atrophy most pronounced in temporal and frontal cortical regions of the brain), Lewy body dementia (related to a particular protein deposit called a Lewy body) and mixed - where different types occur at the same time.</p>
<p>However, <a href="http://www.sciencedirect.com/science/article/pii/S0140673613615706">less than 2% of adults</a> 65-69 years of age have a dementia diagnosis, and this rises to over 30% for those 90 years and over. The flip side of this is that nearly 70% of those aged 90 years and over don’t have dementia. In Australia in 2014, the <a href="http://www.abs.gov.au/ausstats%5Cabs@.nsf/mediareleasesbyCatalogue/F95E5F868D7CCA48CA25750B0016B8D8?Opendocument">median age at death</a> was 79 years for males and 85 years for females; so, most of us won’t die with a dementia diagnosis. </p>
<h2>2. Cognition declines from the 20s</h2>
<p>Cognition refers to the way we think, but there are lots of types of thinking skills. For example, the speed at which we can respond (processing speed), our ability to remember objects (general memory), and our knowledge of words and their meaning (vocabulary knowledge). These cognitive domains show different patterns of change across adulthood. </p>
<p>Processing speed and general memory do appear to decline from the 20s, which means we are slower at responding to relevant cues and a bit more forgetful as we age. But this is not the case for vocabulary knowledge. On average, we will reach our <a href="http://www.sciencedirect.com/science/article/pii/S0160289607001298">peak word knowledge in our 60s</a>, and our performance will not markedly decline after that. In fact, <a href="http://cdp.sagepub.com/content/13/4/140.full.pdf+html">multiple studies show</a> the older your age, the better your performance on the New York Times crossword. </p>
<h2>3. I can’t change my risk of dementia</h2>
<p>It has been estimated that <a href="http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(14)70136-X/abstract">up to 30% of worldwide dementia cases</a> are preventable through lifestyle choices. Evidence shows mid-life heart factors, especially diabetes, high blood pressure, obesity and physical inactivity, increase the risk of developing dementia in late-life, as does having depression, smoking and having low educational attainment.</p>
<p>So, one way to decrease your risk of dementia is to reduce your heart risk factors - for example, exercise more and reduce your weight if you are obese. Engaging with cognitively stimulating activities such as formal (such as university) and informal (such as short-courses) education, and social meetings, has been shown to reduce the risk of dementia. </p>
<p>This evidence ties in nicely with <a href="http://www.sciencedirect.com/science/article/pii/S0140673613615706">recent studies</a> from Europe and the US, which have demonstrated an individual’s risk of dementia has actually decreased over the past two decades. Why? Well, it is appears that older adults are now more physically and cognitively healthy than their predecessors.</p>
<h2>4. I’ll get dementia if my parents did</h2>
<p>Late-life dementia, which is diagnosed when you are 65 years and over, is only influenced slightly by the genetics your parents passed onto you. Nine genes have been identified that either increase or decrease your risk for dementia. There is one that carries some influence: apolipoprotein E. If you have one combination (E4E4 alleles), you are at 15 times more likely to get dementia as someone with the more typical combination (E3E3). However, all other identified genes have only a small effect, with each putting you at a <a href="http://www.sciencedirect.com/science/article/pii/S1474442212702594">20% increased or decreased risk</a> of developing the disease. </p>
<p>To put these genetic risks in perspective, they are smaller than each of the lifestyle factors mentioned above. That is, dementia is more likely to be caused by obesity (60% more likely) or being inactive (80% more likely). These comparisons are not perfect, as it may be that genes related to dementia also relate to these lifestyle factors, but it does show how powerful lifestyle factors are.</p>
<h2>5. My weight will stay the same</h2>
<p>Simple physics energy laws tell us that if the calories we are eating match the energy we are burning, our weight will essentially be stable. Most people believe in this simple and truthful nutritional dogma, but fail to take into account the significant effects of ageing on energy metabolism. </p>
<p>As we age, our body composition changes. In particular, we tend to have a reciprocal change in fat (increase) and muscle (decrease), and these changes appear to be different in men and women. Men appear to have a <a href="https://www.ncbi.nlm.nih.gov/pubmed/16277818">steeper decline in muscle tissue</a>, which accounts for a decline in the total energy expenditure of about 3% per decade.</p>
<p>In women, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/16277818">rate is slightly slower</a> compared to men (about 2% per decade). This simply means if you continue to eat and exercise at the same level as you age, you will likely gain weight, and this will mostly consist of body fat. </p>
<p>Ageing is not a passive biological process. We need to better understand our body and its changes if we want to maintain health and prevent the onset of diseases such as dementia.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67699/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hannah Keage had received funding from the NHMRC and Brain Foundation. She is affiliated with the Australasian Cognitive Neuroscience Society and Australian Association of Gerontology. </span></em></p><p class="fine-print"><em><span>Blossom Stephan has received funding from NIHR, Alzheimer's Research UK and the MRC. </span></em></p>There are a number of myths associated with what happens to our brain and bodies as we age.Hannah Keage, Senior Lecturer in Psychology, University of South AustraliaBlossom Christa Maree Stephan, Senior lecturer, Newcastle UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/677102017-01-23T19:17:07Z2017-01-23T19:17:07ZAussies are getting older, and the health workforce needs training to reflect it<p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As our population ages and life expectancy increases, the need for comprehensive health and care services for older people becomes greater. Older people access health services across lots of different settings, but the ability for different services to share patient information is poor, and the opportunity to shift the costs from state and federal systems provides disincentives for them to coordinate services.</p>
<p>By 2031, <a href="https://www.adelaide.edu.au/apmrc/pubs/policy-briefs/APMRC_Policy_Brief_Vol_2_2.pdf">almost one in five people</a> will be aged 65 and over. If the system does not change by then, poorly equipped and uncoordinated services will fail our most vulnerable. Health carers need to be trained in dealing with the issues of the ageing population, and we need to be able to identify appropriate models of care that reflect the whole person’s needs.</p>
<h2>Training for GPs</h2>
<p>Older people use GPs more than younger people, so primary care is often their first point of contact. But there is little recognition of the care and training needed for GPs to tackle complex health and social concerns, including for people with dementia. <a href="https://www.fightdementia.org.au/files/Timely_Diagnosis_Can_we_do_better.pdf">Timely and accurate diagnosis</a> of dementia allows the person to make choices while they are still able. This requires the GP to differentiate the normal signs of ageing from dementia and recognise the importance of early diagnosis. </p>
<p>One financial incentive to encourage GPs to engage with patients is the “75+ health assessments”. First introduced in 1999, these assessments are designed to identify risk factors and plan interventions. However, uptake has been low, with <a href="http://ro.uow.edu.au/cgi/viewcontent.cgi?article=3149&context=smhpapers">only one in five eligible people</a> taking part. </p>
<p>Restructuring primary care from “Divisions of General Practice” in the 90s, to “Medicare Locals” in 2011 and now “Primary Health Networks” has meant aged care initiatives are in a mess. Aged care is one of the six priority areas for primary health networks but each network can still tackle the issue in their own way, resulting in no overall state or national approach.</p>
<h2>Hospital care</h2>
<p>Hospital admissions for those aged 85 and over have risen rapidly compared to overall admissions. <a href="http://www.aihw.gov.au/publication-detail/?id=60129543133">This group of older Australians</a>, while representing only 2% of the population, accounted for 7% of all hospital admissions and 13% of days spent in hospital. As the baby boomers age and this number <a href="http://www.aihw.gov.au/publication-detail/?id=60129543133">doubles by 2031</a>, hospitals will struggle.</p>
<p>More people die in hospitals than any other setting in Australia, so they need to acknowledge the role they have in providing acute and palliative care for older people. Often care for older people in hospital means fast-tracking them through the emergency department and if possible returning them home (including residential care) without admission.</p>
<p>Hospital staff need training in palliative care and dementia. Specialised medical, nursing and allied health positions (such as physiotherapists and occupational therapists) in geriatrics and dementia fall well short of what is required to keep pace with demand. For example, aggression from someone with dementia who is not able to talk may be due to pain, and clinicians need to know how to identify and treat the problem. </p>
<h2>Aged care services</h2>
<p><a href="http://www.pc.gov.au/inquiries/completed/aged-care/report/aged-care-volume1.pdf">Aged care services</a> are provided to over a million people in their homes. The <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/04_2016/strategic_roadmap_for_aged_care_web.pdf">Aged Care Reform agenda</a> is a ten-year program that sets out ways to improve services, recognise the role of carers and provide better information about services. </p>
<p>Unlike GPs and hospitals, increased numbers of aged care places subsidised by the government has helped aged care services to prepare for the increased demand posed by an ageing population. However, dementia projections remain a challenge. </p>
<p>Currently, care for most older people with advanced dementia occurs in residential aged care, settings in which care of the dying is becoming core business. </p>
<p>Recent government initiatives such as the <a href="http://www.careseaarch.com.au/PAToolkit">Palliative Approach Toolkit</a> and <a href="http://www.decisionassist.org.au">Decision Assist</a> have provided resources and education to meet the growing demands of palliative and end of life care for older people.</p>
<p>Another option to residential aged care, the <a href="https://agedcare.health.gov.au/programs/home-care-packages-programme">Home Care Packages Program</a>, enables the person to remain at home. Continued growth of this program under the aged care reform agenda with support for individuals with complex care needs will add pressure on GPs to identify and treat conditions that untreated would result in hospital admissions. </p>
<p>Like residential aged care, home care packages rely heavily on a workforce with limited formal qualification and no regulation. While in residential aged care, unregulated workers are more likely to be supervised, and home care workers may deliver care with limited direct supervision of a regulated worker. </p>
<p>With the demand for the <a href="https://agedcare.health.gov.au/sites/g/files/net1426/f/documents/04_2016/strategic_roadmap_for_aged_care_web.pdf">aged care workforce nearly tripling</a>, the need for an appropriately skilled and regulated workforce is clear. We still don’t know how this can be done, or how to make sure workers are properly trained.</p>
<p>The baby boomers now needing more care expect a flexible and tailored approach to their needs. At present, the primary, acute and aged care workforce may not be adequately prepared to meet these expectations.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67710/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Deborah Parker is a Board Director of Carrington Care. She has received funding from the Department of Health and Ageing for the Palliative Approach Toolkit and Decision Assist and is currently Vice President of Palliative Care NSW, a member of the Palliative Care Nurses Australia and the Australian Association of Gerontology. </span></em></p>As our population ages and life expectancy increases so does the need for comprehensive health and care services for older people.Deborah Parker, Professor of Nursing Aged Care (Dementia), University of Technology SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/696192017-01-22T19:10:59Z2017-01-22T19:10:59ZMedicine for older people is the same for anyone else: treat the person, not just the body<figure><img src="https://images.theconversation.com/files/153560/original/image-20170120-5227-1rz00z2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Modern medicine too often posits doctors as mechanics and people as machines needing to be fixed. </span> <span class="attribution"><span class="source">Neil Kumar/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>In the 16th century, French philosopher Rene Descartes moved the body from the sacred to the profane by separating it from the mind. The body thus became a proper object of study by the emerging natural sciences. From anatomy flowed physiology and the birth of what we know as modern medicine. The model of the body as a machine which can be broken and therefore fixed has had great success, unimaginable only 100 years ago.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1289841/pdf/jrsocmed00206-0064.pdf">The problems with this model</a> seem well understood, and are best explained in a <a href="http://www.nejm.org/doi/pdf/10.1056/NEJM198203183061104">landmark paper on suffering</a> in medicine written 30 years ago. It points out bodies cannot suffer, only persons. A model with the body at the centre, focusing on the disease and how to get rid of it, fails to respond to the suffering of the person. Modern clinicians in this model do not see suffering as it is. We are merely the mechanics that fix the broken machine that is your body.</p>
<p>While this is admittedly a bleak, generalised view of modern medicine and some specialities such as general practice, geriatrics and palliative medicine do transcend this model, my experiences of hospital-based medicine give me reason to examine its effects.</p>
<p>I have always assumed older people were just like me, except older. As time goes on, fewer are older and more are younger. We all want the same things. Long productive lives, fulfilling relationships and to be able to do things. It is only as we age that we begin to understand the value of independence. It is invisible to the well and young.</p>
<p>Palliative medicine has shown me that people value their independence more than their lives. While discussions about death are often met with stoic indifference, rarely do people facing loss of independence remain unmoved.</p>
<p>Medical intervention in older people has the same aims as that in younger people. To cure, maintain or comfort. Being older just means you are more likely to have diseases already. Unfortunately, one of these diseases is frailty. Frailty is becoming <a href="http://jamanetwork.com/journals/jama/fullarticle/204046">increasingly recognised</a> as its own entity. Currently there is no cure for frailty and ageing, as its cause cannot be prevented.</p>
<p>To be frail means you are much more likely to need help to do things. You are more likely to have a chronic disease and you are less likely to survive a serious disease. It also means the part about cure “at any cost” can have quite a cost. The burden of the treatment can outweigh the benefit, the risks of death or disability loom. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/148213/original/image-20161201-30244-1i3zsbg.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&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 adage of ‘curing at any cost’ can have a significant cost in older patients.</span>
<span class="attribution"><span class="source">Screenshot, Youtube</span></span>
</figcaption>
</figure>
<p>An ethical approach to medicine requires we obtain consent for interventions we propose. Informed consent implies that accurate information about prognosis can be communicated to the patient. This has proved elusive <a href="https://theconversation.com/how-much-time-have-i-got-doc-the-problems-with-predicting-survival-at-end-of-life-52700">even for blunt measures</a>, such as whether or not someone will live. </p>
<p>When it comes to the likely effect on independence, estimating the risk of functional decline for an older individual facing a serious event becomes an inexact science.</p>
<p>The difficulties become more apparent when viewed within the idea of the body as machine and doctor as mechanic. Seeing only the body and not the person leaves me with inexact probabilities as guides. </p>
<p>Cure at any cost means I am unable within my own mind to comprehend the effect on the person. The frenetic pace of the hospital environment denies me the time. Lack of life experience for a younger doctor makes many considerations invisible. Death aversion within medical culture colours consultations.</p>
<p>My work in a busy emergency department has taught me older people are indeed like the rest of us. They want to be seen, recognised as people and treated as adults. It’s easy to find out something about the person. They don’t want superhuman medicos. They want us to be honest and to be able to express uncertainty. </p>
<p>A greater part of the satisfaction I find in my work comes from helping older people confront what is in front of them, and helping them make decisions in the context of them as a person, not just the failing lumber of the body.</p>
<hr>
<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/69619/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill Lukin has received funding from the Emergency Medicine Foundation. A Queensland Government funded organization promoting research in Emergency Medicine.</span></em></p>A model that has the body at the centre and a reductionist view of disease fails to respond to the suffering of the person.Bill Lukin, Consultant Emergency Physician and Palliative Medicine Trainee Physician, Clinical Associate Lecturer at the School of Medicine, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/679312017-01-22T19:10:49Z2017-01-22T19:10:49ZWhat’s happening in our bodies as we age?<figure><img src="https://images.theconversation.com/files/147685/original/image-20161128-32008-1en24xe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">There are many processes that occur as a result of 'wear and tear' in the body.</span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p><em>This article is part of our series on <a href="https://theconversation.com/au/topics/older-peoples-health-33308">older people’s health</a>. It looks at the changes and processes that occur in our body as we age, the conditions we’re more likely to suffer from and what we can do to prevent them.</em></p>
<hr>
<p>As we reach adulthood, we notice changes in our bodies at every stage of ageing. We might find we need glasses when we hit our thirties, we can’t keep weight off as easily into our forties, we mightn’t feel as strong playing sport with the kids in our fifties, and we can’t hear a conversation across a crowded dinner table in our sixties. </p>
<p>All of these occur because the cells and processes in our bodies have existed for longer and longer periods of time. There are many theories as to why our body ages, but two main explanations are that the DNA within our genes determine how long we will live; the other is that over time, our body and DNA are damaged until they <a href="http://genetics.thetech.org/original_news/news10">can no longer function as before</a>, often referred to as “wear and tear”. </p>
<h2>The ageing brain</h2>
<p>As we age, the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596698/">volume of the brain declines</a>. There are many explanations for this, including cell death, in which the brain cells’ structure declines over time. </p>
<p>Although the precise reasons for the decline in brain volume remain unclear, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2596698/">some research indicates</a> it may be due to hormone levels, and wear and tear. </p>
<p>Some also believe that the volume of blood reaching the brain decreases due to conditions within the blood vessels and associated systems. However, this doesn’t have a great impact on a person’s ability to remember, as the brain has the ability to compensate for these changes. </p>
<p>You may have heard of neuroplasticity. This is the term used to explain how the brain can rewire itself by creating new pathways within the nerve cells to <a href="http://genetics.thetech.org/original_news/news10">compensate for damage to an area</a>. These new pathways are created when new experiences occur. So doing crosswords all of your life won’t increase the number of pathways, but if you add a new activity that you need to learn and practise, then new pathways can form. </p>
<p>While the risk of dementia increases with age due to many of the <a href="https://www.fightdementia.org.au/about-dementia/types-of-dementia">hundreds of causes</a> being more present as we age, it is not a normal part of the ageing process. It is a result of damage to the brain. The reason why it is more likely to occur as we age is simply because the longer we live, the longer we expose ourselves to possible damage to the body through disease or injury, which are the main causes of dementia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=543&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=543&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147688/original/image-20161128-32054-3jpxms.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=543&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Doing crosswords in old age will only improve brain function if it’s a new activity.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p><a href="https://www.fightdementia.org.au/about-dementia/types-of-dementia/alzheimers-disease">Alzheimer’s Disease</a>, the most common cause of dementia in Australia, occurs when there is plaque build-up in the brain. This is as a result of protein build-up over time that inevitably causes tangles in the neurons (brain cells).</p>
<h2>Changes in muscle strength</h2>
<p>As we age, there’s a decrease in the amount and strength of muscle tissue, due mostly to the influence of decreasing hormones. To make up for the muscle mass lost during each day of strict bed rest, older people may need to exercise <a href="http://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/the-aging-body/changes-in-the-body-with-aging">for up to two weeks</a>. </p>
<p>However, additional decreases in muscle occur due to a decrease in activity, not just as part of the normal ageing process. </p>
<h2>Decrease in bone density</h2>
<p>As the body ages it absorbs less calcium from food, a vital mineral for bone strength. At the same time, changes in hormone levels affect the density of the bones. </p>
<p>Ageing people also often spend less time in the sun, thereby reducing their Vitamin D intake. This in turn reduces calcium absorption.</p>
<p>It is important people continue to exercise as they age. Exercise will not only help to maintain muscle strength, but also assist in combatting the decrease in bone density that occurs as the body ages, thereby reducing the risk of falls and hip fractures.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=493&fit=crop&dpr=1 600w, https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=493&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=493&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=619&fit=crop&dpr=1 754w, https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=619&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/147689/original/image-20161128-32054-1h9h55k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=619&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Exercise will help to combat common fractures in old age.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>Changes to our senses</h2>
<p>Changes that occur directly as a result of ageing include those to vision, hearing, taste and smell. Impacts of the changes in vision are usually the first things noticed, making a person feel that they are ageing. </p>
<p>Changes to the eye that occur as part of the ageing process include stiffening and colouring of the lens, a reduction in the number of nerve cells, and a decrease in fluid in the eye. These lead to difficulty in focusing on close objects, seeing in low light becomes more difficult, and the <a href="http://www.merckmanuals.com/home/older-people%E2%80%99s-health-issues/the-aging-body/changes-in-the-body-with-aging">ability to adapt to changes</a> in light decline.</p>
<p>Some people appear clumsy, as their ability to judge the distance between objects - a cup and table, for example, or the height of stairs - becomes a problem. Many people do not realise their spills and trips are occurring as a result of shifts in their vision, known as depth perception changes. Eyes can also become drier, making them feel irritated. This can be treated with lubricating drops. </p>
<p>Changes in hearing include changes in registering high-pitched sounds, and words may become difficult to understand. Speaking more loudly to someone in this circumstance does not help, as the pitch is the problem, not the volume. Instead speaking slightly slower and concentrating on complete words can be helpful. </p>
<p>Taste and smell often decrease as part of the normal ageing process, as the cells responsible decrease in number and the ability to regenerate worn out cells <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2579627/">decreases with age</a>. The results make food less tasty and people less likely to eat. In addition, people’s taste can change altogether, so people who loved chocolate as a young person may prefer chilli as they age. </p>
<p>Overall there are many changes to the body as part of the normal ageing process as well as many that occur as a result of lifestyle factors. We are not all fated to age in a negative spiral. Many lifestyle choices made earlier in life can assist us in the future. With proactive decisions and community understanding, we can look forward to adapting to a positive ageing process.</p>
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<p><em>Read other articles in the series <a href="https://theconversation.com/au/topics/older-peoples-health-33308">here</a>.</em></p><img src="https://counter.theconversation.com/content/67931/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Hee 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>Cells and processes in our body have existed for longer and longer periods of time.Lisa Hee, Director of Healthy Ageing and Dementia Programs School of Nursing and Midwifery, PhD candidate in ?, CQUniversity AustraliaLicensed as Creative Commons – attribution, no derivatives.