America’s Health System Isn’t Ready for the Surge of Seniors With Disabilities
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The number of older adults with disabilities — difficulty with walking, seeing, hearing, memory, cognition, or performing daily tasks such as bathing or using the bathroom — will soar in the decades ahead, as baby boomers enter their 70s, 80s, and 90s.
But the health care system isn’t ready to address their needs.
That became painfully obvious during the covid-19 pandemic, when older adults with disabilities had trouble getting treatments and hundreds of thousands died. Now, the Department of Health and Human Services and the National Institutes of Health are targeting some failures that led to those problems.
One initiative strengthens access to medical treatments, equipment, and web-based programs for people with disabilities. The other recognizes that people with disabilities, including older adults, are a separate population with special health concerns that need more research and attention.
Lisa Iezzoni, 69, a professor at Harvard Medical School who has lived with multiple sclerosis since her early 20s and is widely considered the godmother of research on disability, called the developments “an important attempt to make health care more equitable for people with disabilities.”
“For too long, medical providers have failed to address change in society, changes in technology, and changes in the kind of assistance that people need,” she said.
Among Iezzoni’s notable findings published in recent years:
Most doctors are biased. In survey results published in 2021, 82% of physicians admitted they believed people with significant disabilities have a worse quality of life than those without impairments. Only 57% said they welcomed disabled patients.
“It’s shocking that so many physicians say they don’t want to care for these patients,” said Eric Campbell, a co-author of the study and professor of medicine at the University of Colorado.
While the findings apply to disabled people of all ages, a larger proportion of older adults live with disabilities than younger age groups. About one-third of people 65 and older — nearly 19 million seniors — have a disability, according to the Institute on Disability at the University of New Hampshire.
Doctors don’t understand their responsibilities. In 2022, Iezzoni, Campbell, and colleagues reported that 36% of physicians had little to no knowledge of their responsibilities under the 1990 Americans With Disabilities Act, indicating a concerning lack of training. The ADA requires medical practices to provide equal access to people with disabilities and accommodate disability-related needs.
Among the practical consequences: Few clinics have height-adjustable tables or mechanical lifts that enable people who are frail or use wheelchairs to receive thorough medical examinations. Only a small number have scales to weigh patients in wheelchairs. And most diagnostic imaging equipment can’t be used by people with serious mobility limitations.
Iezzoni has experienced these issues directly. She relies on a wheelchair and can’t transfer to a fixed-height exam table. She told me she hasn’t been weighed in years.
Among the medical consequences: People with disabilities receive less preventive care and suffer from poorer health than other people, as well as more coexisting medical conditions. Physicians too often rely on incomplete information in making recommendations. There are more barriers to treatment and patients are less satisfied with the care they do get.
Egregiously, during the pandemic, when crisis standards of care were developed, people with disabilities and older adults were deemed low priorities. These standards were meant to ration care, when necessary, given shortages of respirators and other potentially lifesaving interventions.
There’s no starker example of the deleterious confluence of bias against seniors and people with disabilities. Unfortunately, older adults with disabilities routinely encounter these twinned types of discrimination when seeking medical care.
Such discrimination would be explicitly banned under a rule proposed by HHS in September. For the first time in 50 years, it would update Section 504 of the Rehabilitation Act of 1973, a landmark statute that helped establish civil rights for people with disabilities.
The new rule sets specific, enforceable standards for accessible equipment, including exam tables, scales, and diagnostic equipment. And it requires that electronic medical records, medical apps, and websites be made usable for people with various impairments and prohibits treatment policies based on stereotypes about people with disabilities, such as covid-era crisis standards of care.
“This will make a really big difference to disabled people of all ages, especially older adults,” said Alison Barkoff, who heads the HHS Administration for Community Living. She expects the rule to be finalized this year, with provisions related to medical equipment going into effect in 2026. Medical providers will bear extra costs associated with compliance.
Also in September, NIH designated people with disabilities as a population with health disparities that deserves further attention. This makes a new funding stream available and “should spur data collection that allows us to look with greater precision at the barriers and structural issues that have held people with disabilities back,” said Bonnielin Swenor, director of the Johns Hopkins University Disability Health Research Center.
One important barrier for older adults: Unlike younger adults with disabilities, many seniors with impairments don’t identify themselves as disabled.
“Before my mom died in October 2019, she became blind from macular degeneration and deaf from hereditary hearing loss. But she would never say she was disabled,” Iezzoni said.
Similarly, older adults who can’t walk after a stroke or because of severe osteoarthritis generally think of themselves as having a medical condition, not a disability.
Meanwhile, seniors haven’t been well integrated into the disability rights movement, which has been led by young and middle-aged adults. They typically don’t join disability-oriented communities that offer support from people with similar experiences. And they don’t ask for accommodations they might be entitled to under the ADA or the 1973 Rehabilitation Act.
Many seniors don’t even realize they have rights under these laws, Swenor said. “We need to think more inclusively about people with disabilities and ensure that older adults are fully included at this really important moment of change.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Accidental falls in the older adult population: What academic research shows
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Accidental falls are among the leading causes of injury and death among adults 65 years and older worldwide. As the aging population grows, researchers expect to see an increase in the number of fall injuries and related health spending.
Falls aren’t unique to older adults. Nealy 684,000 people die from falls each year globally. Another 37.3 million people each year require medical attention after a fall, according to the World Health Organization. But adults 65 and older account for the greatest number of falls.
In the United States, more than 1 in 4 older adults fall each year, according to the National Institute on Aging. One in 10 report a fall injury. And the risk of falling increases with age.
In 2022, health care spending for nonfatal falls among older adults was $80 billion, according to a 2024 study published in the journal Injury Prevention.
Meanwhile, the fall death rate in this population increased by 41% between 2012 and 2021, according to the latest CDC data.
“Unfortunately, fall-related deaths are increasing and we’re not sure why that is,” says Dr. Jennifer L. Vincenzo, an associate professor at the University of Arkansas for Medical Sciences in the department of physical therapy and the Center for Implementation Research. “So, we’re trying to work more on prevention.”
Vincenzo advises journalists to write about how accidental falls can be prevented. Remind your audiences that accidental falls are not an inevitable consequence of aging, and that while we do decline in many areas with age, there are things we can do to minimize the risk of falls, she says. And expand your coverage beyond the national Falls Prevention Awareness Week, which is always during the first week of fall — Sept. 23 to 27 this year.
Below, we explore falls among older people from different angles, including injury costs, prevention strategies and various disparities. We have paired each angle with data and research studies to inform your reporting.
Falls in older adults
In 2020, 14 million older adults in the U.S. reported falling during the previous year. In 2021, more than 38,700 older adults died due to unintentional falls, according to the CDC.
A fall could be immediately fatal for an older adult, but many times it’s the complications from a fall that lead to death.
The majority of hip fractures in older adults are caused by falls, Vincenzo says, and “it could be that people aren’t able to recover [from the injury], losing function, maybe getting pneumonia because they’re not moving around, or getting pressure injuries,” she says.
In addition, “sometimes people restrict their movement and activities after a fall, which they think is protective, but leads to further functional declines and increases in fall risk,” she adds.
Factors that can cause a fall include:
- Poor eyesight, reflexes and hearing. “If you cannot hear as well, anytime you’re doing something in your environment and there’s a noise, it will be really hard for you to focus on hearing what that noise is and what it means and also moving at the same time,” Vincenzo says.
- Loss of strength, balance, and mobility with age, which can lessen one’s ability to prevent a fall when slipping or tripping.
- Fear of falling, which usually indicates decreased balance.
- Conditions such as diabetes, heart disease, or problems with nerves or feet that can affect balance.
- Conditions like incontinence that cause rushed movement to the bathroom.
- Cognitive impairment or certain types of dementia.
- Unsafe footwear such as backless shoes or high heels.
- Medications or medication interactions that can cause dizziness or confusion.
- Safety hazards in the home or outdoors, such as poor lighting, steps and slippery surfaces.
Related Research
Nonfatal and Fatal Falls Among Adults Aged ≥65 Years — United States, 2020–2021
Ramakrishna Kakara, Gwen Bergen, Elizabeth Burns and Mark Stevens. Morbidity and Mortality Weekly Report, September 2023.Summary: Researchers analyzed data from the 2020 Behavioral Risk Factor Surveillance System — a landline and mobile phone survey conducted each year in all 50 U.S. states and the District of Columbia — and data from the 2021 National Vital Statistics System to identify patterns of injury and death due to falls in the U.S. by sex and state for adults 65 years and older. Among the findings:
- The percentage of women who reported falling was 28.9%, compared with 26.1% of men.
- Death rates from falls were higher among white and American Indian or Alaska Native older adults than among older adults from other racial and ethnic groups.
- In 2020, the percentage of older adults who reported falling during the past year ranged from 19.9% in Illinois to 38.0% in Alaska. The national estimate for 18 states was 27.6%.
- In 2021, the unintentional fall-related death rate among older adults ranged from 30.7 per 100,000 older adults in Alabama to 176.5 in Wisconsin. The national estimate for 26 states was 78.
“Although common, falls among older adults are preventable,” the authors write. “Health care providers can talk with patients about their fall risk and how falls can be prevented.”
Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012-2018
Briana Moreland, Ramakrishna Kakara and Ankita Henry. Morbidity and Mortality Weekly Report, July 2020.Summary: Researchers compared data from the 2018 Behavioral Risk Factor Surveillance System. Among the findings:
- The percentage of older adults reporting a fall increased from 2012 to 2016, then slightly decreased from 2016 to 2018.
- Even with this decrease in 2018, older adults reported 35.6 million falls. Among those falls, 8.4 million resulted in an injury that limited regular activities for at least one day or resulted in a medical visit.
“Despite no significant changes in the rate of fall-related injuries from 2012 to 2018, the number of fall-related injuries and health care costs can be expected to increase as the proportion of older adults in the United States grows,” the authors write.
Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies
Gwen Bergen, et al. American Journal of Lifestyle Medicine, October 2019.Summary: Researchers used data from the 2016 U.S. Behavioral Risk Factor Surveillance System to better understand the association between falls and fall injuries in older adults and factors such as health, state and demographic characteristics. Among the findings:
- Depression had the strongest association with falls and fall injuries. About 40% of older adults who reported depression also reported at least one fall; 15% reported at least one fall injury.
- Falls and depression have several factors in common, including cognitive impairment, slow walking speed, poor balance, slow reaction time, weakness, low energy and low levels of activity.
- Other factors associated with an increased risk of falling include diabetes, vision problems and arthritis.
“The multiple characteristics associated with falls suggest that a comprehensive approach to reducing fall risk, which includes screening and assessing older adult patients to determine their unique, modifiable risk factors and then prescribing tailored care plans that include evidence-based interventions, is needed,” the authors write.
Health care use and cost
In addition to being the leading cause of injury, falls are the leading cause of hospitalization in older adults. Each year, about 3 million older adults visit the emergency department due to falls. More than 1 million get hospitalized.
In 2021, falls led to more than 38,000 deaths in adults 65 and older, according to the CDC.
The annual financial medical toll of falls among adults 65 years and older is expected to be more than $101 billion by 2030, according to the National Council on Aging, an organization advocating for older Americans.
Related research
Healthcare Spending for Non-Fatal Falls Among Older Adults, USA
Yara K. Haddad, et al. Injury Prevention, July 2024.Summary: In 2015, health care spending related to falls among older adults was roughly $50 billion. This study aims to update the estimate, using the 2017, 2019 and 2021 Medicare Current Beneficiary Survey, the most comprehensive and complete survey available on the Medicare population. Among the findings:
- In 2020, health care spending for non-fatal falls among older adults was $80 billion.
- Medicare paid $53.3 billion of the $80 billion, followed by $23.2 billion paid by private insurance or patients and $3.5 billion by Medicaid.
“The burden of falls on healthcare systems and healthcare spending will continue to rise if the risk of falls among the aging population is not properly addressed,” the authors write. “Many older adult falls can be prevented by addressing modifiable fall risk factors, including health and functional characteristics.”
Cost of Emergency Department and Inpatient Visits for Fall Injuries in Older Adults Lisa Reider, et al. Injury, February 2024.
Summary: The researchers analyzed data from the 2016-2018 National Inpatient Sample and National Emergency Department Sample, which are large, publicly available patient databases in the U.S. that include all insurance payers such as Medicare and private insurance. Among the findings:
- During 2016-2018, more than 920,000 older adults were admitted to the hospital and 2.3 million visited the emergency department due to falls. The combined annual cost was $19.2 billion.
- More than half of hospital admissions were due to bone fractures. About 14% of these admissions were due to multiple fractures and cost $2.5 billion.
“The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched [emergency department]-based fall prevention efforts and investments in geriatric emergency departments,” the authors write.
Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury Among Adults Aged 65 and Older, United States 2019
Briana L. Moreland, Jaswinder K. Legha, Karen E. Thomas and Elizabeth R. Burns. Journal of Aging and Health, June 2024.Summary: The researchers calculated hip fracture-related U.S. emergency department visits, hospitalizations and deaths among older adults, using data from the Healthcare Cost and Utilization Project and the National Vital Statistics System. Among the findings:
- In 2019, there were 318,797 emergency department visits, 290,130 hospitalizations and 7,731 deaths related to hip fractures among older adults.
- Nearly 88% of emergency department visits and hospitalizations and 83% of deaths related to hip fractures were caused by falls.
- These rates were highest among those living in rural areas and among adults 85 and older. More specifically, among adults 85 and older, the rate of hip fracture-related emergency department visits was nine times higher than among adults between 65 and 74 years old.
“Falls are common among older adults, but many are preventable,” the authors write. “Primary care providers can prevent falls among their older patients by screening for fall risk annually or after a fall, assessing modifiable risk factors such as strength and balance issues, and offering evidence-based interventions to reduce older adults’ risk of falls.”
Fall prevention
Several factors, including exercising, managing medication, checking vision and making homes safer can help prevent falls among older adults.
“Exercise is one of the best interventions we know of to prevent falls,” Vincenzo says. But “walking in and of itself will not help people to prevent falls and may even increase their risk of falling if they are at high risk of falls.”
The National Council on Aging also has a list of evidence-based fall prevention programs, including activities and exercises that are shown to be effective.
The National Institute on Aging has a room-by-room guide on preventing falls at home. Some examples include installing grab bars near toilets and on the inside and outside of the tub and shower, sitting down while preparing food to prevent fatigue, and keeping electrical cords near walls and away from walking paths.
There are also national and international initiatives to help prevent falls.
Stopping Elderly Accidents, Deaths and Injuries, or STEADI, is an initiative by the CDC’s Injury Center to help health care providers who treat older adults. It helps providers screen patients for fall risk, assess their fall risk factors and reduce their risk by using strategies that research has shown to be effective. STEADI’s guidelines are in line with the American and British Geriatric Societies’ Clinical Practice Guidelines for fall prevention.
“We’re making some iterations right now to STEADI that will come out in the next couple of years based on the World Falls Guidelines, as well as based on clinical providers’ feedback on how to make [STEADI] more feasible,” Vincenzo says.
The World Falls Guidelines is an international initiative to prevent falls in older adults. The guidelines are the result of the work of 14 international experts who came together in 2019 to consider whether new guidelines on fall prevention were needed. The task force then brought together 96 experts from 39 countries across five continents to create the guidelines.
The CDC’s STEADI initiative has a screening questionnaire for consumers to check their risk of falls, as does the National Council on Aging.
On the policy side, U.S. Rep. Carol Miller, R-W.V., and Melanie Stansbury, D-N.M., introduced the Stopping Addiction and Falls for the Elderly (SAFE) Act in March 2024. The bill would allow occupational and physical therapists to assess fall risks in older adults as part of the Medicare Annual Wellness Benefit. The bill was sent to the House Subcommittee on Health in the same month.
Meanwhile, older adults’ attitudes toward falls and fall prevention are also pivotal. For many, coming to terms with being at risk of falls and making changes such as using a cane, installing railings at home or changing medications isn’t easy for all older adults, studies show.
“Fall is a four-letter F-word in a way to older adults,” says Vincenzo, who started her career as a physical therapist. “It makes them feel ‘old.’ So, it’s a challenge on multiple fronts: U.S. health care infrastructure, clinical and community resources and facilitating health behavior change.”
Related research
Environmental Interventions for Preventing Falls in Older People Living in the Community
Lindy Clemson, et al. Cochrane Database of Systematic Reviews, March 2023.Summary: This review includes 22 studies from 10 countries involving a total of 8,463 older adults who live in the community, which includes their own home, a retirement facility or an assisted living facility, but not a hospital or nursing home. Among the findings:
- Removing fall hazards at home reduced the number of falls by 38% among older adults at a high risk of having a fall, including those who have had a fall in the past year, have been hospitalized or need support with daily activities. Examples of fall hazards at home include a stairway without railings, a slippery pathway or poor lighting.
- It’s unclear whether checking prescriptions for eyeglasses, wearing special footwear or installing bed alarm systems reduces the rate of falls.
- It’s also not clear whether educating older adults about fall risks reduces their fall risk.
The Influence of Older Adults’ Beliefs and Attitudes on Adopting Fall Prevention Behaviors
Judy A. Stevens, David A. Sleet and Laurence Z. Rubenstein. American Journal of Lifestyle Medicine. January 2017.Summary: Persuading older adults to adopt interventions that reduce their fall risk is challenging. Their attitudes and beliefs about falls play a large role in how well they accept and adopt fall prevention strategies, the authors write. Among the common attitudes and beliefs:
- Many older adults believe that falls “just happen,” are a normal result of aging or are simply due to bad luck.
- Many don’t acknowledge or recognize their fall risk.
- For many, falls are considered to be relevant only for frail or very old people.
- Many believe that their home environment or daily activities can be a risk for fall, but do not consider biological factors such as dizziness or muscle weakness.
- For many, fall prevention simply consists of “being careful” or holding on to things when moving about the house.
“To reduce falls, health care practitioners have to help patients understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention,” the authors write. “They should offer patients individualized fall prevention interventions as well as provide ongoing support to help patients adopt and maintain fall prevention strategies and behaviors to reduce their fall risk. Implementing prevention programs such as CDC’s STEADI can help providers discuss the importance of falls and fall prevention with their older patients.”
Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?
Jennifer L. Vincenzo, Gwen Bergen, Colleen M. Casey and Elizabeth Eckstrom. The Gerontologist, June 2024.Summary: The authors recommend approaching fall prevention from the lens of chronic disease management programs because falls and fall risk are chronic issues for many older adults.
“Policymakers, health systems, and community partners can consider aligning fall risk management with the [Expanded Chronic Care Model], as has been done for diabetes,” the authors write. “This can help translate high-quality research on the effectiveness of fall prevention interventions into daily practice for older adults to alter the trajectory of older adult falls and fall-related injuries.”
Disparities
Older adults face several barriers to reducing their fall risk. Accessing health care services and paying for services such as physical therapy is not feasible for everyone. Some may lack transportation resources to go to and from medical appointments. Social isolation can increase the risk of death from falls. In addition, physicians may not have the time to fit in a fall risk screening while treating older patients for other health concerns.
Moreover, implementing fall risk screening, assessment and intervention in the current U.S. health care structure remains a challenge, Vincenzo says.
Related research
Mortality Due to Falls by County, Age Group, Race, and Ethnicity in the USA, 2000-19: A Systematic Analysis of Health Disparities
Parkes Kendrick, et al. The Lancet Public Health, August 2024.Summary: Researchers analyzed death registration data from the U.S. National Vital Statistics System and population data from the U.S. National Center for Health Statistics to estimate annual fall-related mortality. The data spanned from 2000 to 2019 and includes all age groups. Among the findings:
- The disparities between racial and ethnic populations varied widely by age group. Deaths from falls among younger adults were highest for the American Indian/Alaska Native population, while among older adults it was highest for the white population.
- For older adults, deaths from falls were particularly high in the white population within clusters of counties across states including Florida, Minnesota and Wisconsin.
- One factor that could contribute to higher death rates among white older adults is social isolation, the authors write. “Studies suggest that older Black and Latino adults are more likely to have close social support compared with older white adults, while AIAN and Asian individuals might be more likely to live in multigenerational households,” they write.
“Among older adults, current prevention techniques might need to be restructured to reduce frailty by implementing early prevention and emphasizing particularly successful interventions. Improving social isolation and evaluating the effectiveness of prevention programs among minoritized populations are also key,” the authors write.
Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation
Mariana Wingood, et al. Clinical Interventions in Aging, February 2024.Summary: Researchers analyzed the electronic health record data of 108,751 older adults attending outpatient rehabilitation within a large U.S. health care system across seven states, between 2018 and 2022. Among the findings:
- More than 44% of the older adults were at risk of falls; nearly 35% had a history of falls.
- The most common risk factors for falls were diminished strength, gait and balance.
- Compared to white older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%) and Hispanics had the highest prevalence of falls with injury (56.1%).
“Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire-related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks,” the authors write.
Resources and articles
- National Institute on Aging
- National Council on Aging
- Gerontological Society of America
- Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients, a 2023 report from the U.S Department of Health and Human Services’ Office of Inspector General.
- 6 tips for improving new coverage of older people, a tip sheet from The Journalist’s Resource.
- Crosswalk and pedestrian safety: What you need to know from recent research, from The Journalist’s Resource.
- Aging-in-place technology challenges and trends, a resource from the Association of Health Care Journalists.
- Successful aging at home: what reporters should know, a resource from the Association of Health Care Journalists.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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Can We Side-Step Age-Related Alienation?
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When The World Moves Without Us…
We’ve written before about how reduced social engagement can strike people of all ages, and what can be done about it:
How To Beat Loneliness & Isolation
…but today we’re going to talk more about a specific aspect of it, namely, the alienation that can come with old age—and other life transitions too, but getting older is something that (unless accident or incident befall us first) all of us will definitely do.
What’s the difference?
Loneliness is a status, alienation is more of a process. It can be the alienation in the sense of an implicit “you don’t belong here” message from the world that’s geared around the average person and thus alienates those who are not that (a lack of accessibility to people with disabilities can be an important and very active example of this), and it can also be an alienation from what we’ve previously considered our “niche” in the world—the loss of purpose many people feel upon retirement fits this bill. It can even be a more generalized alienation from our younger selves; it’s easy to have a self-image that doesn’t match one’s current reality, for instance.
Read more: Estranged by Time: Alienation in the Aging Process
So, how to “un-alienate”?
To “un-alienate”, that is to say, to integrate/reintegrate, can be hard. Some things may even be outright impossible, but most will not be!
Consider how, for example, former athletes become coaches—or for that matter, how former party-goers might become party-hosts (even if the kind of “party” might change with time, give or take the pace at which we like to live our lives).
What’s important is that we take what matters the most to us, and examine how we can realistically still engage with that thing.
This is different from trying to hold on grimly to something that’s no longer our speed.
Letting go of the only thing we’ve known will always be scary; sometimes it’s for the best, and sometimes what we really need is just more of a pivot, like the examples above. The crux lies in knowing which:
- Is our relationship with the thing (whatever it may be) still working for us, or is it just bringing strife now?
- If it’s not working for us, is it because of a specific aspect that could be side-stepped while keeping the rest?
- If we’re going to drop that thing entirely (or be dropped by it, which, while cruel, also happens in life), then where are we going to land?
This latter is one where foresight is a gift, because if we bury our heads in the sand we’re going to land wherever we’re dropped, whereas if we acknowledge the process, we can make a strategic move and land on our feet.
Here’s a good pop-science article about this—it’s aimed at people around retirement age, but honestly the advice is relevant for people of all ages, and facing all manner of life transitions, e.g. career transitions (of which retirement is of course the career transition to end all career transitions), relationship transitions (including B/B/B/B: births, betrothals/break-ups, and bereavements) health transitions (usually: life-changing illnesses and/or disabilities—which again, happens to most of us if something doesn’t get us first), etc. So with all that in mind, this becomes more of a “how to reassess your life at those times when it needs reassessing”:
How to Reassess Your Life in Retirement
But that doesn’t mean that letting go is always necessary
Sometimes, the opposite! Sometimes, the age-old advice to “lean in” really is all the situation calls for, which means:
- Be ready to say “yes” to things, and if nobody’s asking, be ready to “hey, do you wanna…?” and take a “build it and they will come” approach. This includes with people of different ages, too! Intergenerational friendships can be very rewarding for all concerned, if done right. Communities that span age-ranges can be great for this—they might be about special interests (this writer has friends ranging through four generations from playing chess, for instance), they could be religious communities if we be religious, LGBT groups if that fits for us, even mutual support groups such as for specific disabilities or chronic illness if we have such—notice how the very things that might isolate us can also bring us together!
- Be open-minded to new experiences; it’s easy to get stuck in a rut of “I’ve never done that” and mistake that self-assessment for an uncritical assumption of “I’m not the kind of person who does that”. Sometimes, you really won’t be! But at least think about it and entertain the possibility, before dismissing it out of hand. And, here’s a life tip: it can be really good to (within the realms of safety, and one’s personal moral principles, of course) take an approach of “try anything once”. Even if we’re almost certain we won’t like it, and even if we then turn out to indeed not like it, it can be a refreshing experience—and now we can say “Yep, tried that, not doing that again” from a position of informed knowledge. That’s the only way we get to look back on a richly lived life of broad experiences, after all, and it is never too late for such.
- Be comfortable prioritizing quality over quantity. This goes for friends, it goes for activities, it goes for experiences. The topic of “what’s the best number of friends to have?” has been a matter of discussion since at least ancient Greek times (Plato and Aristotle examined this extensively), but whatever number we might arrive at, it’s clear that quality is the critical factor, and quantity after that is just a matter of optimizing.
In short: make sure you’re investing—in your relationships, in your areas of interest, in your community (whatever that may mean for you personally), and most of all, and never forget this: in yourself.
Take care!
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Curious Kids: what are the main factors in forming someone’s personality?
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“What are the main factors in forming someone’s personality?” – Emma, age 10, from Shanghai
Hello Emma, and thank you for this very interesting question!
Let’s start by exploring what we mean by personality. Have you noticed no two people are completely alike? We all see, experience, and understand the world in different ways.
For example, some people love spending time with friends and being the centre of attention, whereas other people are more shy and enjoy having time to themselves.
Your unique personality is shaped by your genes as well as various influences in your environment. And your personality plays an important role in how you interact with the world.
The big five
Did you know there are scientists who spend time researching personality? Their research is concerned with describing the ways people differ from each other, and understanding how these differences could be important for other parts of life such as our health and how well we do in school or at work.
There are many different perspectives on personality. A widely accepted viewpoint based on a lot of research is called the five factor model or the “big five”. According to this theory, a great deal of a person’s personality can be summarised in terms of where they sit on five dimensions, called traits:
- the introversion-extraversion trait refers to how much someone is outgoing and social (extroverted) or prefers being with smaller groups of friends or focusing on their own thoughts (introverted)
- agreeableness captures how much someone tends to be cooperative and helps others
- openness to experience refers to how much a person is creative and enjoys experiencing new things
- neuroticism describes a person’s tendency to experience negative feelings, like worrying about things that could go wrong
- conscientiousness encompasses how much a person is organised, responsible, and dedicated to things that are important to them, like schoolwork or training for a sports team.
A person can have high, low, or moderate levels of each of these traits. And understanding whether someone has higher or lower levels of the big five can tell us a lot about how we might expect them to behave in different situations.
So what shapes our personalities?
A number of factors shape our personalities, including our genes and social environment.
Our bodies are made up of many very small structures called cells. Within these cells are genes. We inherit genes from our parents, and they carry the information needed to make our bodies and personalities. So, your personality may be a bit like your parents’ personalities. For example, if you’re an outgoing sort of person who loves to meet new people, perhaps one or both of your parents are very social too.
Our personalities are influenced by the genes we get from our parents.
KieferPix/ShutterstockPersonalities are also affected by our environment, such as our experiences and our relationships with family and friends. For example, some research has shown our relationships with our parents can influence our personality. If we have loving and warm relationships, we may be more agreeable and open. But if our relationships are hurtful or stressful, this may increase our neuroticism.
Another study showed that, over time, young children who were more physically active were less introverted (less shy) and less likely to get very upset when things don’t go their way, compared to children who were less physically active. Although we don’t know why this is for sure, one possible explanation is that playing sport leads to reduced shyness because it introduces children to different people.
While we’re learning more about personality development all the time, research in this area presents quite a few challenges. Many different biological, cultural and environmental influences shape our development, and these factors can interact with each other in complex ways.
Is our personality fixed once we become adults?
Although we develop most of our personality when we are young, and people’s personalities tend to become more stable as they get older, it is possible for aspects of a person’s personality to change, even when they are fully grown.
A good example of this can be seen among people who seek treatment for conditions like anxiety or depression. People who respond well to working with a psychologist can show decreases in neuroticism, indicating they become less likely to worry a lot or feel strong negative feelings when something stressful happens.
Hello, Curious Kids! Do you have a question you’d like an expert to answer? Ask an adult to send your question to mailto:curiouskids@theconversation.edu.au
Tim Windsor, Professor, Director, Generations Research Initiative, College of Education, Psychology and Social Work, Flinders University and Natalie Goulter, Lecturer, College of Education, Psychology and Social Work, Flinders University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What’s the difference between ‘strep throat’ and a sore throat? We’re developing a vaccine for one of them
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What’s the difference? is a new editorial product that explains the similarities and differences between commonly confused health and medical terms, and why they matter.
It’s the time of the year for coughs, colds and sore throats. So you might have heard people talk about having a “strep throat”.
But what is that? Is it just a bad sore throat that goes away by itself in a day or two? Should you be worried?
Here’s what we know about the similarities and differences between strep throat and a sore throat, and why they matter.
Prostock-studio/Shutterstock How are they similar?
It’s difficult to tell the difference between a sore throat and strep throat as they look and feel similar.
People usually have a fever, a bright red throat and sometimes painful lumps in the neck (swollen lymph nodes). A throat swab can help diagnose strep throat, but the results can take a few days.
Thankfully, both types of sore throat usually get better by themselves.
How are they different?
Most sore throats are caused by viruses such as common cold viruses, the flu (influenza virus), or the virus that causes glandular fever (Epstein-Barr virus).
These viral sore throats can occur at any age. Antibiotics don’t work against viruses so if you have a viral sore throat, you won’t get better faster if you take antibiotics. You might even have some unwanted antibiotic side-effects.
But strep throat is caused by Streptococcus pyogenes bacteria, also known as strep A. Strep throat is most common in school-aged children, but can affect other age groups. In some cases, you may need antibiotics to avoid some rare but serious complications.
In fact, the potential for complications is one key difference between a viral sore throat and strep throat.
Generally, a viral sore throat is very unlikely to cause complications (one exception is those caused by Epstein-Barr virus which has been associated with illnesses such as chronic fatigue syndrome, multiple sclerosis and certain cancers).
But strep A can cause invasive disease, a rare but serious complication. This is when bacteria living somewhere on the body (usually the skin or throat) get into another part of the body where there shouldn’t be bacteria, such as the bloodstream. This can make people extremely sick.
Invasive strep A infections and deaths have been rising in recent years around the world, especially in young children and older adults. This may be due to a number of factors such as increased social mixing at this stage of the COVID pandemic and an increase in circulating common cold viruses. But overall the reasons behind the increase in invasive strep A infections are not clear.
Another rare but serious side effect of strep A is autoimmune disease. This is when the body’s immune system makes antibodies that react against its own cells.
The most common example is rheumatic heart disease. This is when the body’s immune system damages the heart valves a few weeks or months after a strep throat or skin infection.
Around the world more than 40 million people live with rheumatic heart disease and more than 300,000 die from its complications every year, mostly in developing countries.
However, parts of Australia have some of the highest rates of rheumatic heart disease in the world. More than 5,300 Indigenous Australians live with it.
Strep throat is caused by Streptococcus bacteria and can be treated with antibiotics if needed. Kateryna Kon/Shutterstock Why do some people get sicker than others?
We know strep A infections and rheumatic heart disease are more common in low socioeconomic communities where poverty and overcrowding lead to increased strep A transmission and disease.
However, we don’t fully understand why some people only get a mild infection with strep throat while others get very sick with invasive disease.
We also don’t understand why some people get rheumatic heart disease after strep A infections when most others don’t. Our research team is trying to find out.
How about a vaccine for strep A?
There is no strep A vaccine but many groups in Australia, New Zealand and worldwide are working towards one.
For instance, Murdoch Children’s Research Institute and Telethon Kids Institute have formed the Australian Strep A Vaccine Initiative to develop strep A vaccines. There’s also a global consortium working towards the same goal.
Companies such as Vaxcyte and GlaxoSmithKline have also been developing strep A vaccines.
What if I have a sore throat?
Most sore throats will get better by themselves. But if yours doesn’t get better in a few days or you have ongoing fever, see your GP.
Your GP can examine you, consider running some tests and help you decide if you need antibiotics.
Kim Davis, General paediatrician and paediatric infectious diseases specialist, Murdoch Children’s Research Institute; Alma Fulurija, Immunologist and the Australian Strep A Vaccine Initiative project lead, Telethon Kids Institute, and Myra Hardy, Postdoctoral Researcher, Infection, Immunity and Global Health, Murdoch Children’s Research Institute
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Are You A Calorie-Burning Machine?
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Burn, Calorie, Burn
In Tuesday’s newsletter, we asked you whether you count calories, and got the above-depicted, below-described set of answers:
- About 56% said “I am somewhat mindful of calories but keep only a rough tally”
- About 32% said “I do not count calories / I don’t think it’s important for my health”
- About 13% said “I rigorously check and record the calories of everything I consume”
So what does the science say, about the merits of all these positions?
A food’s calorie count is a good measure of how much energy we will, upon consuming the food, have to use or store: True or False?
False, broadly. It can be, at best, a rough guideline. Do you know what a calorie actually is, by the way? Most people don’t.
One thing to know before we get to that: there’s “cal” vs “kcal”. The latter is generally used when it comes to foodstuffs, and it’s what we’ll be meaning whenever we say “calorie” here. 1cal is 1/1000th of a kcal, that’s all.
Now, for what a calorie actually is:
A calorie is the amount of energy needed to raise the temperature of 1 liter of water by 1℃
Question: so, how to we measure how much food is needed to do that?
Answer: by using a bomb calorimeter! Which is the exciting name for the apparatus used to literally burn food and capture the heat produced to indeed raise the temperature of 1 liter of water by 1℃.
If you’re having trouble imagining such equipment, here it is:
Bomb Calorimeter: Definition, Construction, & Operation (with diagram and FAQs)
The unfortunate implication of the above information
A kilogram of sawdust contains about a 1000 kcal, give or take what wood was used and various other conditions.
However, that does not mean you can usefully eat the sawdust. In other words:
Calorie count tells us only how good something is at raising the temperature of water if physically burned.
Now do you see why oils and sugars have such comparably high calorie counts?
And while we may talk about “burning calories” as a metaphor, we do not, in fact, have a little wood stove inside us burning the food we eat.
A calorie is a calorie: True or False?
Definitely False! Building on from the above… We will get very little energy from sawdust; it’s not just that we can’t use it; we can’t store it either; it’ll mostly pass through as fiber.
(however, please do not use sawdust to get your daily dose of fiber either, as it is not safe for human consumption and may give you diseases, depending on what is lurking in it)
But let’s look at oil and sugar, two very high-calorie categories of food, because they’re really easy to physically burn and they give off a good flame.
A bomb calorimeter may treat them quite equally, but to our body, they are metabolically very different indeed.
For a start, most sugars will get absorbed and processed much more quickly than most oils, and that can overwhelm the liver (responsible for glycogen management), and lead to non-alcoholic fatty liver disease, diabetes, and more. Metabolic syndrome in general, and if you keep it up too much and you may find it’s now a lottery between dying of NAFLD, diabetes, or heart disease (it’ll usually be the heart disease that kills).
See also:
- Which Sugars Are Healthier, And Which Are Just The Same?
- 10 Ways To Balance Blood Sugars
- How To Unfatty A Fatty Liver
Meanwhile, we know all about the different kinds of nutritional profiles that oils can have, and some can promote having high energy without putting on fat, while others can strain the heart. Not even “a fat is a fat”, so “a calorie is a calorie” doesn’t get much mileage outside of a bomb calorimeter!
See also:
A calorie-controlled / calorie-restricted diet is an effective weight loss strategy: True or False?
True, usually! Surprise!
- On the one hand: calories are a wildly imprecise way to reckon the value of food, and using them as a guide to health can be dangerously misleading
- On the other hand: the very activity of calorie-counting itself promotes mindful eating, which is very good for the health
There is a strong difference between the mind of somebody who is carefully logging their pre-bedtime piece of chocolate and reflecting on its nutritional value, vs someone who isn’t sure whether this is their second or third glass of wine, nor how much the glass contained.
So if you want to get most of the benefits of a calorie-controlled diet without counting calories, you may try taking a “mindful eating” approach to diet.
However! If you want to do this for weight loss, be aware, that you will have to practice it all the time, not just for one meal here and there.
You can read more on how to do “mindful eating” here:
Dr. Rupy Aujla: The Kitchen Doctor | Mindful Eating & Interoception
Take care!
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Resveratrol & Healthy Aging
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Resveratrol & Healthy Aging
Resveratrol is the compound found in red grapes, and thus in red wine, that have resulted in red wine being sometimes touted as a heart-healthy drink.
However, at the levels contained in red wine, you’d need to drink 100–1000 glasses of wine per day (depending on the wine) to get the dose of resveratrol that were associated with heart health benefits in mouse studies.
(if you are not a mouse, you might need to drink even more than that)
Further reading: can we drink to good health?
Resveratrol supplementation
Happily, resveratrol supplements exist. But what does resveratrol do?
It lowers blood pressure:
Effect of resveratrol on blood pressure: a meta-analysis of randomized controlled trials
It improves blood lipid levels:
It improves insulin sensitivity:
It has neuroprotective effects too:
Resveratrol promotes clearance of Alzheimer’s disease amyloid-beta peptides
Is it safe?
For most people, it is generally recognized as safe. However, if you are on blood-thinners or otherwise have a bleeding disorder, you might want to skip it:
Antiplatelet activity of synthetic and natural resveratrol in red wine
You also might want to check with your pharmacist/doctor, if you’re on blood pressure meds, anxiety meds, or immunosuppressants, as it can increase the amount of these drugs that will then stay in your system:
Resveratrol modulates drug- and carcinogen-metabolizing enzymes in a healthy volunteer study
And as ever, of course, if unsure just check with your pharmacist/doctor, to be on the safe side.
Where to get it?
We don’t sell it, but here’s an example product on Amazon for your convenience
Enjoy!
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