Falling: Is It Due To Age Or Health Issues?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small 😎
❝What are the signs that a senior is falling due to health issues rather than just aging?❞
Superficial answer: having an ear infection can result in a loss of balance, and is not particularly tied to age as a risk factor
More useful answer: first, let’s consider these two true statements:
- The risks of falling (both the probability and the severity of consequences) increase with age
- Health issues (in general) tend to increase with age
With this in mind, it’s difficult to disconnect the two, as neither exist in a vacuum, and each is strongly associated with the other.
So the question is easier to answer by first flipping it, to ask:
❝What are the health issues that typically increase with age, that increase the chances of falling?❞
A non-exhaustive list includes:
- Loss of strength due to sarcopenia (reduced muscle mass)
- Loss of mobility due to increased stiffness (many causes, most of which worsen with age)
- Loss of risk-awareness due to diminished senses (for example, not seeing an obstacle until too late)
- Loss of risk-awareness due to reduced mental focus (cognitive decline producing absent-mindedness)
Note that in the last example there, and to a lesser extent the third one, reminds us that falls also often do not happen in a vacuum. There is (despite how it may sometimes feel!) no actual change in our physical relationship with gravity as we get older; most falls are about falling over things, even if it’s just one’s own feet:
The 4 Bad Habits That Cause The Most Falls While Walking
Disclaimer: sometimes a person may just fall down for no external reason. An example of why this may happen is if a person’s joint (for example an ankle or a knee) has a particular weakness that means it’ll occasionally just buckle and collapse under one’s own weight. This doesn’t even have to be a lot of weight! The weakness could be due to an old injury, or Ehlers-Danlos Syndrome (with its characteristic joint hypermobility symptoms), or something else entirely.
Now, notice how:
- all of these things can happen at any age
- all of these things are more likely to happen the older we get
- none of these things have to happen at any age
That last one’s important to remember! Aging is often viewed as an implacable Behemoth, but the truth is that it is many-faceted and every single one of those facets can be countered, to a greater or lesser degree.
Think of a room full of 80-year-olds, and now imagine that…
- One has the hearing of a 20-year-old
- One has the eyesight of a 20-year-old
- One has the sharp quick mind of a 20-year-old
- One has the cardiovascular fitness of a 20-year-old
…etc. Now, none of those things in isolation is unthinkable, so remember, there is no magic law of the universe saying we can’t have each of them:
Age & Aging: What Can (And Can’t) We Do About It?
Which means: that goes for the things that increase the risk of falling, too. In other words, we can combat sarcopenia with protein and resistance training, maintain our mobility, look after our sensory organs as best we can, nourish our brain and keep it sharp, etc etc etc:
Train For The Event Of Your Life! (Mobility As A Long-Term “Athletic” Goal For Personal Safety)
Which doesn’t mean: that we will necessarily succeed in all areas. Your writer here, broadly in excellent health, and whose lower body is still a veritable powerhouse in athletic terms, has a right ankle and left knee that will sometimes just buckle (yay, the aforementioned hypermobility).
So, it becomes a priority to pre-empt the consequences of that, for example:
- being able to fall with minimal impact (this is a matter of knowing how, and can be learned from “soft” martial arts such as aikido), and
- ensuring the skeleton can take a knock if necessary (keeping a good balance of vitamins, minerals, protein, etc; keeping an eye on bone density).
See also:
Fall Special ← appropriate for the coming season, but it’s about avoiding falling, and reducing the damage of falling if one does fall, including some exercises to try at home.
Take care!
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How Regularity Of Sleep Can Be Even More Important Than Duration
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A recent, large (n=72,269) 8-year prospective* observational study of adults aged 40-79 has found an association between irregular sleep and major cardiovascular events.
*this means they started the study at a given point, and measured what happened for the next eight years—as opposed to a retrospective study, which would look at what had happened during the previous 8 years.
As to what qualifies as major cardiovascular events, they counted:
- Heart attack
- Cardiac arrest
- Stroke
- Cardiovascular death (any)
Irregular sleep, meanwhile, was defined per a bell curve of participants. Based on a sleep regularity index (SRI) score, those with a score of 87 or more were on the “regular” side of the curve, and those with a score of 72 or lower were on the “irregular” side of the curve.
What they found is that irregular sleep is associated with major cardiovascular events, regardless of the actual amount of sleep that people got. So in other words, you could be sleeping 9 hours per day, but if it’s a different 9 hours each day, your cardiovascular risk will still be higher.
How much higher?
- For those in the middle of the curve (so, moderate irregularity), it was 8% higher than those on the “regular” side.
- For those on the “irregular” side of the curve, it was 26% higher than those on the “regular” side.
All of the above is after taking into account confounding variables such as age, physical activity levels, discretionary screen time, fruit, vegetable, and coffee intake, alcohol consumption, smoking, mental health issues, medication use, and shift work. Which is quite something, given that shift work is a very common reason for irregular sleep schedules in a lot of people.
Limitations
While, as noted above, they did their best to account for a lot of things, this was an observational study, not an interventional study or a randomized controlled trial, and as such, it cannot truly establish cause and effect.
For example, an observational study in the 90s found that the sport most strongly associated with longevity was polo. For any unfamiliar, it’s a game played on horseback with mallets and balls. Why was this game so much better than, say, swimming? And the answer is most likely that polo is played almost entirely by very rich people. It wasn’t the sport that enhanced longevity—it was the wealth.
So similarly here, it could be for example that people who are predisposed to heart conditions, are prone to having irregular schedules. We won’t know for sure until we have interventional studies (and we probably can’t get RCTs for this, for practical reasons).
Still, it seems likely that the association is indeed causal, in which case, having a regular sleep schedule if at all possible seems like a very good way to look after one’s health.
You can read more about the study here:
Irregular sleep may elevate risk of major cardiovascular events
Practical take-away
This study strongly suggests that sleep regularity is even more important than sleep duration.
This means that there is extra reason to not sleep in past one’s normal getting-up time, even if one had a less restful night.
That’s the end of sleep that’s the most important in practical terms, too, because we can control our getting-up time, whereas we can’t really control our going-to-sleep time, because it’s perfectly possible to just lie there awake.
So, controlling the getting-up time is really the key to the whole thing. See also:
Calculate (And Enjoy) The Perfect Night’s Sleep
And for scope, you might enjoy reading:
Morning Larks vs Night Owls: How Much Can We Control Our Sleep Schedule?
Enjoy!
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Hemp Seeds vs Flax Seeds – Which is Healthier?
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Our Verdict
When comparing hemp seeds to flax seeds, we picked the flax.
Why?
Both are great, but quite differently so! In other words, they both have their advantages, but on balance, we prefer the flax’s advantages.
Part of this come from the way in which they are sold/consumed—hemp seeds must be hulled first, which means two things as a result:
- Flax seeds have much more fiber (about 8x more)
- Hemp seeds have more protein (about 2x more), proportionally, at least ← this is partly because they lost a bunch of weight by losing their fiber to the hulling, so the “per 100g” values of everything else go up, even though the amount per seed didn’t change
Since people’s diets are more commonly deficient in fiber than protein, and also since 8x is better than 2x, we consider this a win for flax.
Of course, many people enjoy hemp or flax specifically for the healthy fatty acids, so how do they stack up in that regard?
- Flax seeds have more omega-3s
- Hemp seeds have more omega-6s
This, for us, is a win for flax too, as the omega-3s are generally what we need more likely to be deficient in. Hemp enthusiasts, however, may argue that the internal balance of omega-3s to omega-6s is closer to an ideal ratio in hemp—but nutrition doesn’t exist in a vacuum, so we have to consider things “as part of a balanced diet” (because if one were trying to just live on hemp seeds, one would die), and most people’s diets are skewed far too far in favor or omega-6 compared to omega-3. So for most people, the higher levels of omega-3s are the more useful.
Want to learn more?
Take care!
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How Primary Care Is Being Disrupted: A Video Primer
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How patients are seeing their doctor is changing, and that could shape access to and quality of care for decades to come.
More than 100 million Americans don’t have regular access to primary care, a number that has nearly doubled since 2014. Yet demand for primary care is up, spurred partly by record enrollment in Affordable Care Act plans. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades.
KFF Health News senior correspondent Julie Appleby breaks down what is happening — and what it means for patients.
More From This Investigation
Primary Care Disrupted
Known as the “front door” to the health system, primary care is changing. Under pressure from increased demand, consolidation, and changing patient expectations, the model of care no longer means visiting the same doctor for decades. KFF Health News looks at what this means for patients.
Credits
Hannah Norman Video producer and animator Oona Tempest Illustrator and creative director 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.
Subscribe to KFF Health News’ free Morning Briefing.
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Managing Sibling Relationships In Adult Life
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Managing Sibling Relationships In Adult Life
After our previous main feature on estrangement, a subscriber wrote to say:
❝Parent and adult child relationships are so important to maintain as you age, but what about sibling relationships? Adult choices to accept and move on with healthier boundaries is also key for maintaining familial ties.❞
And, this is indeed critical for many of us, if we have siblings!
Writer’s note: I don’t have siblings, but I do happen to have one of Canada’s top psychologists on speed-dial, and she has more knowledge about sibling relationships than I do, not to mention a lifetime of experience both personally and professionally. So, I sought her advice, and she gave me a lot to work with.
Today I bring her ideas, distilled into my writing, for 10almonds’ signature super-digestible bitesize style.
A foundation of support
Starting at the beginning of a sibling story… Sibling relationships are generally beneficial from the get-go.
This is for reasons of mutual support, and an “always there” social presence.
Of course, how positive this experience is may depend on there being a lack of parental favoritism. And certainly, sibling rivalries and conflict can occur at any age, but the stakes are usually lower, early in life.
Growing warmer or colder
Generally speaking, as people age, sibling relationships likely get warmer and less conflictual.
Why? Simply put, we mature and (hopefully!) get more emotionally stable as we go.
However, two things can throw a wrench into the works:
- Long-term rivalries or jealousies (e.g., “who has done better in life”)
- Perceptions of unequal contribution to the family
These can take various forms, but for example if one sibling earns (or otherwise has) much more or much less than another, that can cause resentment on either or both sides:
- Resentment from the side of the sibling with less money: “I’d look after them if our situations were reversed; they can solve my problems easily; why do they resent that and/or ignore my plight?”
- Resentment from the side of the sibling with more money: “I shouldn’t be having to look after my sibling at this age”
It’s ugly and unpleasant. Same goes if the general job of caring for an elderly parent (or parents) falls mostly or entirely on one sibling. This can happen because of being geographically closer or having more time (well… having had more time. Now they don’t, it’s being used for care!).
It can also happen because of being female—daughters are more commonly expected to provide familial support than sons.
And of course, that only gets exacerbated as end-of-life decisions become relevant with regard to parents, and tough decisions may need to be made. And, that’s before looking at conflicts around inheritance.
So, all that seems quite bleak, but it doesn’t have to be like that.
Practical advice
As siblings age, working on communication about feelings is key to keeping siblings close and not devolving into conflict.
Those problems we talked about are far from unique to any set of siblings—they’re just more visible when it’s our own family, that’s all.
So: nothing to be ashamed of, or feel bad about. Just, something to manage—together.
Figure out what everyone involved wants/needs, put them all on the table, and figure out how to:
- Make sure outright needs are met first
- Try to address wants next, where possible
Remember, that if you feel more is being asked of you than you can give (in terms of time, energy, money, whatever), then this discussion is a time to bring that up, and ask for support, e.g.:
“In order to be able to do that, I would need… [description of support]; can you help with that?”
(it might even sometimes be necessary to simply say “No, I can’t do that. Let’s look to see how else we can deal with this” and look for other solutions, brainstorming together)
Some back-and-forth open discussion and even negotiation might be necessary, but it’s so much better than seething quietly from a distance.
The goal here is an outcome where everyone’s needs are met—thus leveraging the biggest strength of having siblings in the first place:
Mutual support, while still being one’s own person. Or, as this writer’s psychology professor friend put it:
❝Circling back to your original intention, this whole discussion adds up to: siblings can be very good or very bad for your life, depending on tons of things that we talked about, especially communication skills, emotional wellness of each person, and the complexity of challenges they face interdependently.❞
Our previous main feature about good communication can help a lot:
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Lost for words? Research shows art therapy brings benefits for mental health
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Creating art for healing purposes dates back tens of thousands of years, to the practices of First Nations people around the world. Art therapy uses creative processes, primarily visual art such as painting, drawing or sculpture, with a view to improving physical health and emotional wellbeing.
When people face significant physical or mental ill-health, it can be challenging to put their experiences into words. Art therapists support people to explore and process overwhelming thoughts, feelings and experiences through a reflective art-making process. This is distinct from art classes, which often focus on technical aspects of the artwork, or the aesthetics of the final product.
Art therapy can be used to support treatment for a wide range of physical and mental health conditions. It has been linked to benefits including improved self-awareness, social connection and emotional regulation, while lowering levels of distress, anxiety and even pain scores.
In a study published this week in the Journal of Mental Health, we found art therapy was associated with positive outcomes for children and adolescents in a hospital-based mental health unit.
An option for those who can’t find the words
While a person’s engagement in talk therapies may sometimes be affected by the nature of their illness, verbal reflection is optional in art therapy.
Where possible, after finishing an artwork, a person can explore the meaning of their work with the art therapist, translating unspoken symbolic material into verbal reflection.
However, as the talking component is less central to the therapeutic process, art therapy is an accessible option for people who may not be able to find the words to describe their experiences.
Art therapy has supported improved mental health outcomes for people who have experienced trauma, people with eating disorders, schizophrenia and dementia, as well as children with autism.
Art therapy has also been linked to improved outcomes for people with a range of physical health conditions. These include lower levels of anxiety, depression and fatigue among people with cancer, enhanced psychological stability for patients with heart disease, and improved social connection among people who have experienced a traumatic brain injury.
Art therapy has been associated with improved mood and anxiety levels for patients in hospital, and lower pain, tiredness and depression among palliative care patients.
Our research
Mental ill-health, including among children and young people, presents a major challenge for our society. While most care takes place in the community, a small proportion of young people require care in hospital to ensure their safety.
In this environment, practices that place even greater restriction, such as seclusion or physical restraint, may be used briefly as a last resort to ensure immediate physical safety. However, these “restrictive practices” are associated with negative effects such as post-traumatic stress for patients and health professionals.
Worryingly, staff report a lack of alternatives to keep patients safe. However, the elimination of restrictive practices is a major aim of mental health services in Australia and internationally.
Our research looked at more than six years of data from a child and adolescent mental health hospital ward in Australia. We sought to determine whether there was a reduction in restrictive practices during the periods when art therapy was offered on the unit, compared to times when it was absent.
We found a clear association between the provision of art therapy and reduced frequency of seclusion, physical restraint and injection of sedatives on the unit.
We don’t know the precise reason for this. However, art therapy may have lessened levels of severe distress among patients, thereby reducing the risk they would harm themselves or others, and the likelihood of staff using restrictive practices to prevent this.
That said, hospital admission involves multiple therapeutic interventions including talk-based therapies and medications. Confirming the effect of a therapeutic intervention requires controlled clinical trials where people are randomly assigned one treatment or another.
Although ours was an observational study, randomised controlled trials support the benefits of art therapy in youth mental health services. For instance, a 2011 hospital-based study showed reduced symptoms of post-traumatic stress disorder among adolescents randomised to trauma-focussed art therapy compared to a “control” arts and crafts group.
What do young people think?
In previous research we found art therapy was considered by adolescents in hospital-based mental health care to be the most helpful group therapy intervention compared to other talk-based therapy groups and creative activities.
In research not yet published, we’re speaking with young people to better understand their experiences of art therapy, and why it might reduce distress. One young person accessing art therapy in an acute mental health service shared:
[Art therapy] is a way of sort of letting out your emotions in a way that doesn’t involve being judged […] It let me release a lot of stuff that was bottling up and stuff that I couldn’t explain through words.
A promising area
The burgeoning research showing the benefits of art therapy for both physical and especially mental health highlights the value of creative and innovative approaches to treatment in health care.
There are opportunities to expand art therapy services in a range of health-care settings. Doing so would enable greater access to art therapy for people with a variety of physical and mental health conditions.
Sarah Versitano, Academic, Master of Art Therapy Program, Western Sydney University and Iain Perkes, Senior Lecturer, Child and Adolescent Psychiatry, UNSW Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Galveston Diet – by Dr. Mary Claire Haver
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We’ve previously reviewed “It’s Not You, It’s Your Hormones” by nutritionist Nikki Williams, and noted at the time that it was very similar to the bestselling “The Galveston Diet”, not just in its content but all the way down its formatting. Some Amazon reviewers have even gone so far as to suggest that “It’s Not You, It’s Your Hormones” (2017) brazenly plagiarized “The Galveston Diet” (2023). However, after carefully examining the publication dates, we feel quite confident that the the earlier book did not plagiarize the later one.
Of course, we would not go so far as to make a counter-accusation of plagiarism the other way around; it was surely just a case of Dr. Haver having the same good ideas 6 years later.
Still, while the original book by Nikki Williams did not get too much international acclaim, the later one by Dr. Mary Claire Haver has had very good marketing and thus received a lot more attention, so let’s review it:
Dr. Haver’s basic principle is (again) that we can manage our hormonal fluctuations, by managing our diet. Specifically, in the same three main ways:
- Intermittent fasting
- Anti-inflammatory diet
- Eating more protein and healthy fats
Why should these things matter to our hormones? The answer is to remember that our hormones aren’t just the sex hormones. We have hormones for hunger and satedness, hormones for stress and relaxation, hormones for blood sugar regulation, hormones for sleep and wakefulness, and more. These many hormones make up our endocrine system, and affecting one part of it will affect the others.
Will these things magically undo the effects of the menopause? Well, some things yes, other things no. No diet can do the job of HRT. But by tweaking endocrine system inputs, we can tweak endocrine system outputs, and that’s what this book is for.
The style is once again very accessible and just as clear, and Dr. Haver also walks us just as skilfully through the changes we may want to make, to avoid the changes we don’t want. The recipes are also very similar, so if you loved the recipes in the other book, you certainly won’t dislike this book’s menu.
In the category of criticism, there is (as with the other book by the other author) some extra support that’s paywalled, in the sense that she wants the reader to buy her personally-branded online plan, and it can feel a bit like she’s holding back in order to upsell to that.
Bottom line: this book is (again) aimed at peri-menopausal and post-menopausal women. It could also (again) definitely help a lot of people with PCOS too, and, when it comes down to it, pretty much anyone with an endocrine system. It’s (still) a well-evidenced, well-established, healthy way of eating regardless of age, sex, or (most) physical conditions.
Click here to check out The Galveston Diet, and enjoy its well-told, well-formatted advice!
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