The Circadian Rhythm: Far More Than Most People Know

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The Circadian Rhythm: Far More Than Most People Know

This is Dr. Satchidananda (Satchin) Panda, the scientist behind the discovery of the blue-light sensing cell type in the retina, and the many things it affects. But, he’s discovered more…

First, what you probably know (with a little more science)

Dr. Panda discovered that melanopsin, a photopigment, is “the primary candidate for photoreceptor-mediated entrainment”.

To put that in lay terms, it’s the brain’s go-to for knowing approximately what time of day or night it is, according to how much light there is (or isn’t), and how long it has (or hasn’t) been there.

But… the brain’s “go-to” isn’t the only method. By creating mice without melanopsin, he was able to find that they still keep a circadian rhythm, even in complete darkness:

Melanopsin (Opn4) Requirement for Normal Light-Induced Circadian Phase Shifting

In other words, it was a helpful, but not completely necessary, means of keeping a circadian rhythm.

So… What else is going on?

Dr. Panda and his team did a lot of science that is well beyond the scope of this main feature, but to give you an idea:

  • With jargon: it explored the mechanisms and transcription translation negative feedback loops that regulate chronobiological processes, such as a histone lysine demathlyase 1a (JARID1a) that enhances Clock-Bmal1 transcription, and then used assorted genomic techniques to develop a model for how JARID1a works to moderate the level of Per transcription by regulating the transition between its repression and activation, and discovered that this heavily centered on hepatic gluconeogenesis and glucose homeostasis, facilitated by the protein cryptochrome regulating the fasting signal that occurs when glucagon binds to a G-protein coupled receptor, triggering CREB activation.
  • Without jargon: a special protein tells our body how to respond to eating/fasting at different times of day—and conversely, certain physiological responses triggered by eating/fasting help us know what time of day it is.
  • Simplest: our body keeps on its best cycle if we eat at the same time every day

This is important, because our circadian rhythm matters for a lot more than sleeping/waking! Take hormones, for example:

  • Obvious hormones: testosterone and estrogen peak in the mornings around 9am, progesterone peaks between 10pm and 2am
  • Forgotten hormones: cortisol peaks in the morning around 8:30am, melatonin peaks between 10pm and 2am
  • More hormones: ghrelin (hunger hormone) peaks around 10am, leptin (satiety hormone) peaks 20 minutes after eating a certain amount of satiety-triggering food (protein does this most quickly), insulin is heavily tied to carbohydrate intake, but will still peak and trough according to when the body expects food.

What does this mean for us in practical terms?

For a start, it means that intermittent fasting can help guard against metabolic and related diseases (including inflammation, and thus also cancer, diabetes, arthritis, and more) a lot more if we practice it with our circadian rhythm in mind.

So that “8-hour window” for eating, that many intermittent fasting practitioners adhere to, is going to do much, much better if it’s 10am to 6pm, rather than, say, 4pm to midnight.

Additionally, Dr. Panda and his team found that a 12-hour eating window wasn’t sufficient to help significantly.

Time-Restricted Feeding Is a Preventative and Therapeutic Intervention against Diverse Nutritional Challenges

Some other take-aways:

  • For reasons beyond the scope of this article, it’s good to exercise a) early b) before eating, so getting in some exercise between 8.30am and 10am is ideal
  • It also means it’s beneficial to “front-load” eating, so a large breakfast at 10am, and smaller meals/snacks afterwards, is best.
  • It also means that getting sunlight (even if cloud-covered) around 8.30am helps guard against metabolic disorders a lot, since the light remains the body’s go-to way of knowing the time.
    • We realize that sunlight is not available at 8.30am at all latitudes at all times of year. Artificial is next-best.
  • It also means sexual desire will typically peak in men in the mornings (per testosterone) and women in the evenings (per progesterone), but this is just an interesting bit of trivia, and not so relevant to metabolic health

What to do next…

Want to stabilize your own circadian rhythm in the best way, and also help Dr. Panda with his research?

His team’s (free!) app, “My Circadian Clock”, can help you track and organize all of the body’s measurable-by-you circadian events, and, if you give permission, will contribute to what will be the largest-yet human study into the topics covered today, to refine the conclusions and learn more about what works best.

Check out the iOS app here | Check out the Android app here

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  • The Worst Cookware Lurking In Your Kitchen (Toxicologist Explains)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Dr. Yvonne Burkart gives us a rundown of the worst offenders, and what to use instead:

    Hot mess

    The very worst offender is non-stick cookware, the kind with materials such as Teflon. These are the most toxic, due to PFAS chemicals.

    Non-stick pans release toxic gases, leach chemicals into food, and release microplastic particles, which can accumulate in the body.

    One that a lot of people don’t think about, in that category, is the humble air-fryer, which often as not has a non-stick cooking “basket”. These she describes as highly toxic, as they combine plastic, non-stick coatings, and high heat, which can release fumes and other potentially dangerous chemicals into the air and food.

    You may be wondering: how bad is it? And the answer is, quite bad. PFAS chemicals are linked to infertility, hypertension in pregnancy, developmental issues in children, cancer, weakened immune systems, hormonal disruption, obesity, and intestinal inflammation.

    Dr. Burkart’s top picks for doing better:

    1. Pure ceramic cookware: top choice for safety, particularly brands like Xtrema, which are tested for heavy metal leaching.
    2. Carbon steel & cast iron: durable and safe; can leach iron in acidic foods (for most people, this is a plus, but some may need to be aware of it)
    3. Stainless steel: lightweight and affordable but can leach nickel and chromium in acidic foods at high temperatures. Use only if nothing better is available.

    And specifically as alternatives to air-fryers: glass convection ovens or stainless steel ovens are safer than conventional air fryers. The old “combination oven” can often be a good choice here.

    For more on all of these, enjoy:

    Click Here If The Embedded Video Doesn’t Load Automatically!

    Want to learn more?

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    Take care!

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  • Longevity Noodles

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Noodles may put the “long” into “longevity”, but most of the longevity here comes from the ergothioneine in the mushrooms! The rest of the ingredients are great too though, including the noodles themselves—soba noodles are made from buckwheat, which is not a wheat, nor even a grass (it’s a flowering plant), and does not contain gluten*, but does count as one of your daily portions of grains!

    *unless mixed with wheat flour—which it shouldn’t be, but check labels, because companies sometimes cut it with wheat flour, which is cheaper, to increase their profit margin

    You will need

    • 1 cup (about 9 oz; usually 1 packet) soba noodles
    • 6 medium portobello mushrooms, sliced
    • 3 kale leaves, de-stemmed and chopped
    • 1 shallot, chopped, or ¼ cup chopped onion of any kind
    • 1 carrot, diced small
    • 1 cup peas
    • ½ bulb garlic, minced
    • 2 tbsp rice vinegar
    • 1 tsp grated fresh ginger
    • 1 tsp black pepper, coarse ground
    • 1 tsp red chili flakes
    • ½ tsp MSG or 1 tbsp low-sodium soy sauce
    • Avocado oil, for frying (alternatively: extra virgin olive oil or cold-pressed coconut oil are both perfectly good substitutions)

    Method

    (we suggest you read everything at least once before doing anything)

    1) Cook the soba noodles per the packet instructions, rinse, and set aside

    2) Heat a little oil in a skillet, add the shallot, and cook for about 2 minutes.

    3) Add the carrot and peas and cook for 3 more minutes.

    4) Add the mushrooms, kale, garlic, ginger, peppers, and vinegar, and cook for 1 more minute, stirring well.

    5) Add the noodles, as well as the MSG or low-sodium soy sauce, and cook for yet 1 more minute.

    6) Serve!

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

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  • Accidental falls in the older adult population: What academic research shows

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    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

    This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.

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  • What To Leave Off Your Table (To Stay Off This Surgeon’s)
  • Supergreen Superfood Salad Slaw

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    When it comes to “eating the rainbow”, in principle green should be the easiest color to get in, unless we live in a serious food desert (or serious food poverty). In practice, however, a lot of meals could do with a dash more green. This “supergreen superfood salad slaw” is remarkably versatile, and can be enjoyed as a very worthy accompaniment to almost any main.

    You will need

    For the bits:

    • ½ small green cabbage, finely diced
    • 7 oz tenderstem broccoli, finely chopped
    • 2 stalks celery, finely chopped (if allergic, simply omit)
    • ½ cucumber, diced into small cubes
    • 2 oz kale, finely shredded
    • 4 green (spring) onions, thinly sliced

    For the dressing:

    • 1 cup cashews (if allergic, substitute 1 cup roasted chickpeas)
    • ½ cup extra virgin olive oil
    • 2 oz baby spinach
    • 1 oz basil leaves
    • 1 oz chives
    • ¼ bulb garlic
    • 2 tbsp nutritional yeast
    • 1 tbsp chia seeds
    • Juice of two limes

    Method

    (we suggest you read everything at least once before doing anything)

    1) Combine the ingredients from the “bits” category in a bowl large enough to accommodate them comfortably

    2) Blend the ingredients from the “dressing” category in a blender until very smooth (the crux here is you do not want any stringy bits of spinach remaining)

    3) Pour the dressing onto the bits, and mix well to combine. Refrigerate, ideally covered, until ready to serve.

    Enjoy!

    Want to learn more?

    For those interested in some of the science of what we have going on today:

    Take care!

    Don’t Forget…

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  • Thinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have extra protection following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.

    The new standards cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.

    The move is part of sweeping reforms of the cosmetic surgery industry and the regulation of medical practitioners, including who is allowed to call themselves a surgeon.

    It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a highly unregulated area of medicine.

    Why do people want cosmetic surgery?

    Australians spent an estimated A$473 million on cosmetic surgery procedures in 2023.

    The major reason people want cosmetic surgery relates to concerns about their body image. Comments from their partners, friends or family about their appearance is another reason.

    The way cosmetic surgery is portrayed on social media is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised.

    The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is even more necessary.

    People don’t always get the results they expect

    Most people are satisfied with their surgical outcomes and feel better about the body part that was previously concerning them.

    However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a positive evaluation may be needed to justify these experiences.

    People who are likely to be unhappy with their results are those with unrealistic expectations for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.

    What’s changing?

    According to the new standards, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.

    For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy.

    It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards.

    It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.

    What about the mental health assessment?

    The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”.

    According to the guidelines from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.

    While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions.

    So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have.

    Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.

    Of course, there are not enough mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution.

    Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns.

    In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.

    If you’re considering cosmetic surgery

    The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these four steps if you’re considering cosmetic surgery:

    1. have an independent physical and mental health assessment before you commit to cosmetic surgery

    2. make an informed decision knowing the risks

    3. choose your practitioner, knowing their training and qualifications

    4. discuss your care after your operation and where you can go for support.

    My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.The Conversation

    Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Understanding and Responding to Self-Harm – by Dr. Allan House

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    Whether it’s yourself, or (statistically much more likely) a loved one, it’s common to be faced with the deeply unpleasant reality of self-harm. This is a case where most definitely, “forewarned is forearmed”.

    Dr. House covers not just the “what” and “why” of self-harm, but also the differences between suicidal and non-suicidal self-harm, as well as the impulsive and the planned.

    Stylistically, the book is well-written, well-edited, and well-formatted. All this makes for easy reading and efficient learning.

    Much of the book is, of course, given over to how to help in cases of self-harm. More specifically: how to approach things with both seriousness and compassion, and how to help in a way that doesn’t create undue pressure.

    Because, as Dr. House explains and illustrates, a lot of well-meaning people end up causing more harm, by their botched attempts to help.

    This book looks to avoid such tragedies.

    Bottom line: if you’d rather know these things now, instead of wishing you’d known later, then this book is the one-stop guide it claims to be.

    Click here to check out Understanding and Responding to Self-Harm, and be prepared!

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