
Older people’s risk of abuse is rising. Can an ad campaign protect them?
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Elder abuse is an emerging public health and safety issue for communities of high-income countries.
The most recent data from Australia’s National Elder Abuse Prevalence Study, which surveyed 7,000 older people living in the community, found one in six self-reported being a victim of some form of abuse. But this did not include older people living in residential aged care or those with cognitive impairment, such as dementia – so is likely an underestimate.
This week the Australian government announced a multi-million dollar advertising campaign it hopes will address this serious and abhorrent abuse.
But is investing in community awareness of elder abuse the best use of scarce resources?

What is elder abuse?
The World Health Organization (WHO) defines elder abuse as
[…] a single, or repeated act, or lack of appropriate action, occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.
Australia usually defines older people as those over 65. The exact age varies between countries depending on the overall health status of a nation and its vulnerable population groups. The WHO definitions of an older adult for sub-Saharan Africa, for example, is over 50. And there are communities with poorer health status and shorter lifespans within country borders, including our First Nations people.
Elder abuse can take on many different forms including physical, sexual, psychological, emotional, or financial abuse and neglect.
Living longer and wealthier
The number of older people in our society is greater than it has ever been. Around 17% Australians are aged 65 and over. By 2071, older Australians will make up between 25% and 27% of the total population.
People are living longer, accumulating substantial wealth and are vulnerable to abuse due to cognitive, physical or functional limitations.
Longer lifespans increase the time of possible exposure to abuse. Australian men aged 65 can expect to live another 20.2 years, while women aged 65 are likely to live another 22.8 years. (Life expectancy for First Nations men and women remains significantly shorter.)
Australian men are now 143 times more likely to reach the age of 100 than they were in 1901. Women are 82 times more likely.
Older people hold a large proportion of our nation’s wealth, making them vulnerable to financial abuse. Recent research by the Australian Council of Social Service and UNSW Sydney reveals older households (with people over 65) are 25% wealthier than the average middle-aged household and almost four times as wealthy as the average under-35 household.
Finally, older people have higher levels of impairment in their thinking, reasoning and physical function. Cognitive impairment, especially dementia, increases from one in 67 Australians under 60 to almost one in two people aged over 90.
Over half of Australians aged 65 years and over have disability. A particularly vulnerable group are the 258,374 older Australians who receive government-funded home care.
Who perpetrates elder abuse?
Sadly, most of the perpetrators of elder abuse are known to their victims. They are usually a member of the family, such as a life partner, child or grandchild.
Elder abuse causes significant illness and even early death. Financial abuse (across all ages) costs the community billions of dollars. Specific data for financial elder abuse is limited but indicates massive costs to individual survivors and the community.
Despite this, the level of awareness of elder abuse is likely to be much lower than for family violence or child abuse. This is partly due to the comparatively recent concept of elder abuse, with global awareness campaigns only developed over the past two decades.
Is an advertising campaign the answer?
The federal government has allocated A$4.8 million to an advertising campaign on television, online and in health-care clinics to reach the broader community. For context, last year the government spent $131.4 million on all media campaigns, including $32.6 million on the COVID vaccination program, $2 million on Japanese encephalitis and $3.2 million on hearing health awareness.
The campaign will likely benefit a small number of people who may be victims and have the capacity to report their perpetrators to authorities. It will generate some heartbreaking anecdotes. But it is unlikely to achieve broad community or systemic change.
There is little research evidence to show media campaigns alter the behaviour of perpetrators of elder abuse. And suggesting the campaign raises awareness of the issue for older people who are survivors of abuse sounds more like blaming victims than empowering them.
We don’t know how the government will judge the success of the campaign, so taxpayers won’t know whether a reasonable return on this investment was achieved. There may also be opportunity costs associated with the initiative – that is, lost opportunities for other actions and strategies. It could be more effective and efficient to target high-risk subgroups or to allocate funding to policy, practice reform or research that has direct tangible benefits for survivors. https://www.youtube.com/embed/DeK2kaqplTI?wmode=transparent&start=0 The Australian Human Rights Commission’s campaign from last year.
But the campaign can’t hurt, right?
Actually, the dangers that could come with an advertising campaign are two-fold.
First it may well oversimplify a highly complex issue. Identifying and managing elder abuse requires an understanding of the person’s vulnerabilities, their decision-making capacity and ability to consent, the will and preferences of victim and the role of perpetrator in the older person’s life. Abuse happens in the context of family and social networks. And reporting abuse can have consequences for the victim’s quality of life and care.
Consider the complexities of a case where an older person declines to have her grandson reported to police for stealing her money and medication because of her fear of becoming socially isolated. She might even feel responsible for the behaviour having raised the grandson and not want him to have a criminal record.
Secondly, a public campaign can create the illusion government and our institutions have the matter “in hand”. This might slow the opportunity for real change.
Ideally, the campaign will strengthen the argument for better policies, reporting procedures, policing, prosecution and judgements that are aligned. But these ends will also need investment in more research to build better communities that take good care of older people.
Joseph Ibrahim, Professor, Aged Care Medical Research Australian Centre for Evidence Based Aged Care, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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What is a ‘vaginal birth after caesarean’ or VBAC?
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A vaginal birth after caesarean (known as a VBAC) is when a woman who has had a caesarean has a vaginal birth down the track.
In Australia, about 12% of women have a vaginal birth for a subsequent baby after a caesarean. A VBAC is much more common in some other countries, including in several Scandinavian ones, where 45-55% of women have one.
So what’s involved? What are the risks? And who’s most likely to give birth vaginally the next time round?
MVelishchuk/Shutterstock What happens? What are the risks?
When a woman chooses a VBAC she is cared for much like she would during a planned vaginal birth.
However, an induction of labour is avoided as much as possible, due to the slightly increased risk of the caesarean scar opening up (known as uterine rupture). This is because the medication used in inductions can stimulate strong contractions that put a greater strain on the scar.
In fact, one of the main reasons women may be recommended to have a repeat caesarean over a vaginal birth is due to an increased chance of her caesarean scar rupturing.
This is when layers of the uterus (womb) separate and an emergency caesarean is needed to deliver the baby and repair the uterus.
Uterine rupture is rare. It occurs in about 0.2-0.7% of women with a history of a previous caesarean. A uterine rupture can also happen without a previous caesarean, but this is even rarer.
However, uterine rupture is a medical emergency. A large European study found 13% of babies died after a uterine rupture and 10% of women needed to have their uterus removed.
The risk of uterine rupture increases if women have what’s known as complicated or classical caesarean scars, and for women who have had more than two previous caesareans.
Most care providers recommend you avoid getting pregnant again for around 12 months after a caesarean, to allow full healing of the scar and to reduce the risk of the scar rupturing.
National guidelines recommend women attempt a VBAC in hospital in case emergency care is needed after uterine rupture.
During a VBAC, recommendations are for closer monitoring of the baby’s heart rate and vigilance for abnormal pain that could indicate a rupture is happening.
If labour is not progressing, a caesarean would then usually be advised.
Giving birth in hospital is recommended for a vaginal birth after a caesarean. christinarosepix/Shutterstock Why avoid multiple caesareans?
There are also risks with repeat caesareans. These include slower recovery, increased risks of the placenta growing abnormally in subsequent pregnancies (placenta accreta), or low in front of the cervix (placenta praevia), and being readmitted to hospital for infection.
Women reported birth trauma and post-traumatic stress more commonly after a caesarean than a vaginal birth, especially if the caesarean was not planned.
Women who had a traumatic caesarean or disrespectful care in their previous birth may choose a VBAC to prevent re-traumatisation and to try to regain control over their birth.
We looked at what happened to women
The most common reason for a caesarean section in Australia is a repeat caesarean. Our new research looked at what this means for VBAC.
We analysed data about 172,000 low-risk women who gave birth for the first time in New South Wales between 2001 and 2016.
We found women who had an initial spontaneous vaginal birth had a 91.3% chance of having subsequent vaginal births. However, if they had a caesarean, their probability of having a VBAC was 4.6% after an elective caesarean and 9% after an emergency one.
We also confirmed what national data and previous studies have shown – there are lower VBAC rates (meaning higher rates of repeat caesareans) in private hospitals compared to public hospitals.
We found the probability of subsequent elective caesarean births was higher in private hospitals (84.9%) compared to public hospitals (76.9%).
Our study did not specifically address why this might be the case. However, we know that in private hospitals women access private obstetric care and experience higher caesarean rates overall.
What increases the chance of success?
When women plan a VBAC there is a 60-80% chance of having a vaginal birth in the next birth.
The success rates are higher for women who are younger, have a lower body mass index, have had a previous vaginal birth, give birth in a home-like environment or with midwife-led care.
For instance, an Australian study found women who accessed continuity of care with a midwife were more likely to have a successful VBAC compared to having no continuity of care and seeing different care providers each time.
An Australian national survey we conducted found having continuity of care with a midwife when planning a VBAC can increase women’s sense of control and confidence, increase their chance to be upright and active in labour and result in a better relationship with their health-care provider.
Seeing the same midwife throughout your maternity care can help. Tyler Olson/Shutterstock Why is this important?
With the rise of caesareans globally, including in Australia, it is more important than ever to value vaginal birth and support women to have a VBAC if this is what they choose.
Our research is also a reminder that how a woman gives birth the first time greatly influences how she gives birth after that. For too many women, this can lead to multiple caesareans, not all of them needed.
Hannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney University; Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney University, and Lilian Peters, Adjunct Research Fellow, Western Sydney University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Can’t Start Tasks? Try This Now!
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Oftentimes, we know what we need to do, and might even find it’s easy once we get going, but getting started is all-too-easily procrastinated.
So, how to get past this, when “just do it” isn’t working?
When it’s time to get going
These tips are by and for people with ADHD, who typically have particular difficulty with this, but can help most people regardless:
- Overwhelmed? Choose three priority tasks to focus on instead of trying to do everything at once—just don’t get stuck in deciding which three!
- No sense of urgency? Use a Pomodoro timer to help give the task time boundaries; scheduling breaks in the same way can also help.
- The task isn’t appealing? Pair the task with rewards like snacks, music, or a cozy setup (this approach is called “temptation bundling”).
- The task feels daunting? Break it into smaller steps and/or use tools like WikiHow to reduce how much you need to plan ahead, and enable you to do it step by step.
- Too many barriers? Clear obstacles such as clutter, missing supplies, or noise to make starting easier. But watch out! Lest you end up renovating your house while avoiding the original task. So, to preclude this derailment, set a clearly-defined parameter for what you’re going to do before the task, and when that’s done, switch to the task before embarking on any sidequests that occurred to you along the way.
For more on each of these, enjoy:
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Why You Can’t Deep Squat (And the Benefits You’re Missing)
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Matt Hsu fought his own battle with chronic pain from the age of 16 in his feet, knees, hips, back, shoulders, elbows, forearms, wrists, hands, and head. Seeking answers, he’s spent a career in corrective exercise, posture alignment, structural integration, orthopedic exercise, sports medicine, and has more certifications than we care to list. In short, he knows his stuff.
Yes you can (with some work)
The deep squat, also called Asian squat, Slav squat, sitting squat, resting squat, primal squat, and various other names, is an important way of sitting that has implications for a lot of aspects of health.
Why it’s so important: it preserves the mobility of our hips, ankles, and everything in between, and maintaining especially the hip mobility makes a big difference not only to general health, but also to reducing the risk of injury. It also maintains lower body strength, making falls in older age less likely in the first place, and if falls do happen, makes injury less likely, and if injury does happen, makes the injury likely less severe.
An important misconception: there is a popular, but unfounded, belief that the ability or inability to do this is decided by genes—or if not outright decided, that at the very least Asians and Slavs have a genetic advantage. However, this is simply not true. Westerners and others can learn to do it just fine, and on the flipside, Asians and Slavs who grew up in the West may often struggle with it. The truth is, the deciding factor is lifestyle: if your culture involves sitting this way more often, you’ll be able to do it more comfortably and easily than if you’re just now trying it for the first time.
Factors that you can control: you can’t change where you grew up, but you can change how you sit down now. Achieving the squat requires repeated position practice, and the more frequently you do so (even if you just start with a few seconds and work your way up to longer periods), the better you’ll get at it. And, on the contrary, sitting in chairs weakens and shortens the muscles involved, so any time you spend sitting in chairs is working against you. There are many reasons it’s advisable to avoid sitting in chairs more than necessary, and this is one of them.
10almonds tip: a limiting factor for many people initially is ankle flexibility, which may result in one’s center of gravity being a bit far back, leading to a tendency to have to change something to avoid toppling over backwards. Rather than holding onto something immobile (e.g. furniture) in front of where you are sitting, consider simply holding an object in front of you in your hands. A book is a fine example; holding that in front of you (feel free to read the book) will shift your center of gravity forwards a bit, and will thus allow you to sit there a little longer, thus improving your strength and flexibility while you do, until you can do it without holding something in front of you. If you try with a book and you’re still prone to toppling backwards, try with something heavier, but do use the minimum weight necessary, because ultimately the counterbalance is just a crutch to get you to where you need to be.
For more visual advice on how to do it, enjoy:
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Climate Change Threatens the Mental Well-Being of Youths. Here’s How To Help Them Cope.
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We’ve all read the stories and seen the images: The life-threatening heat waves. The wildfires of unprecedented ferocity. The record-breaking storms washing away entire neighborhoods. The melting glaciers, the rising sea levels, the coastal flooding.
As California wildfires stretch into the colder months and hurricane survivors sort through the ruins left by floodwaters, let’s talk about an underreported victim of climate change: the emotional well-being of young people.
A nascent but growing body of research shows that a large proportion of adolescents and young adults, in the United States and abroad, feel anxious and worried about the impact of an unstable climate in their lives today and in the future.
Abby Rafeek, 14, is disquieted by the ravages of climate change, both near her home and far away. “It’s definitely affecting my life, because it’s causing stress thinking about the future and how, if we’re not addressing the problem now as a society, our planet is going to get worse,” says Abby, a high school student who lives in Gardena, California, a city of 58,000 about 15 miles south of downtown Los Angeles.
She says wildfires are a particular worry for her. “That’s closer to where I live, so it’s a bigger problem for me personally, and it also causes a lot of damage to the surrounding areas,” she says. “And also, the air gets messed up.”
In April, Abby took a survey on climate change for kids ages 12-17 during a visit to the emergency room at Children’s Hospital of Orange County.
Rammy Assaf, a pediatric emergency physician at the hospital, adapted the survey from one developed five years ago for adults. He administered his version last year to over 800 kids ages 12-17 and their caregivers. He says initial results show climate change is a serious cause of concern for the emotional security and well-being of young people.
Assaf has followed up with the kids to ask more open-ended questions, including whether they believe climate change will be solved in their lifetimes; how they feel when they read about extreme climate events; what they think about the future of the planet; and with whom they are able to discuss their concerns.
“When asked about their outlook for the future, the first words they will use are helpless, powerless, hopeless,” Assaf says. “These are very strong emotions.”
Assaf says he would like to see questions about climate change included in mental health screenings at pediatricians’ offices and in other settings where children get medical care. The American Academy of Pediatrics recommends that counseling on climate change be incorporated into the clinical practice of pediatricians and into medical school curriculums, but not with specific regard to mental health screening.
Assaf says anxiety about climate change intersects with the broader mental health crisis among youth, which has been marked by a rise in depression, loneliness, and suicide over the past decade, though there are recent signs it may be improving slightly.
A 2022 Harris Poll of 1,500 U.S. teenagers found that 89% of them regularly think about the environment, “with the majority feeling more worried than hopeful.” In addition, 69% said they feared they and their families would be affected by climate change in the near future. And 82% said they expected to have to make key life decisions — including where to live and whether to have children — based on the state of the environment.
And the impact is clearly not limited to the U.S. A 2021 survey of 10,000 16- to 25-year-olds across 10 countries found “59% were very or extremely worried and 84% were at least moderately worried” about climate change.
Susan Clayton, chair of the psychology department at the College of Wooster in Ohio, says climate change anxiety may be more pronounced among younger people than adults. “Older adults didn’t grow up being as aware of climate change or thinking about it very much, so there’s still a barrier to get over to accept it’s a real thing,” says Clayton, who co-created the adult climate change survey that Assaf adapted for younger people.
By contrast, “adolescents grew up with it as a real thing,” Clayton says. “Knowing you have the bulk of your life ahead of you gives you a very different view of what your life will be like.” She adds that younger people in particular feel betrayed by their government, which they don’t think is taking the problem seriously enough, and “this feeling of betrayal is associated with greater anxiety about the climate.”
Abby believes climate change is not being addressed with sufficient resolve. “I think if we figure out how to live on Mars and explore the deep sea, we could definitely figure out how to live here in a healthy environment,” she says.
If you are a parent whose children show signs of climate anxiety, you can help.
Louise Chawla, professor emerita in the environmental design program at the University of Colorado-Boulder, says the most important thing is to listen in an open-ended way. “Let there be space for kids to express their emotions. Just listen to them and let them know it’s safe to express these emotions,” says Chawla, who co-founded the nonprofit Growing Up Boulder, which works with the city’s schools to encourage kids to engage civically, including to help shape their local environment.
Chawla and others recommend family activities that reinforce a commitment to the environment. They can be as simple as walking or biking and participating in cleanup or recycling efforts. Also, encourage your children to join activities and advocacy efforts sponsored by environmental, civic, or religious organizations.
Working with others can help alleviate stress and feelings of powerlessness by reassuring kids they are not alone and that they can be proactive.
Worries about climate change should be seen as a learning opportunity that might even lead some kids to their life’s path, says Vickie Mays, professor of psychology and health policy at UCLA, who teaches a class on climate change and mental health — one of eight similar courses offered recently at UC campuses.
“We should get out of this habit of ‘everything’s a mental health problem,’” Mays says, “and understand that often a challenge, a stress, a worry can be turned into advocacy, activism, or a reach for new knowledge to change the situation.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.
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.
This article first appeared on KFF Health News and is republished here under a Creative Commons license.
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Rise And (Really) Shine!
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Q&A with 10almonds Subscribers!
Q: Would love to hear more ideas about effective first thing in the morning time management to get a great start on your day.
A: There are a lot of schools of thought about what’s best in this regard! Maybe we’ll do a main feature sometime. But some things that are almost universally agreed upon are:
- Prepare your to-do list the night before
- Have some sort of buffer between waking up and getting to productivity.
- For me (hi, your writer here) it’s my first coffee of the day. It’s not even about the caffeine, it’s about the ritual of it, it’s a marker that separates my night from the day and tells my brain what gear to get into.
- Others may like to exercise first thing in the morning
- For still yet others, it could be a shower, cold or otherwise
- Some people like a tall glass of lemon water to rehydrate after sleeping!
- If you take drinkable morning supplements such as this pretty awesome nootropic stack, it’s a great time for that and an excellent way to get the brain-juices flowing!
- When you do get to productivity: eat the frog first! What this means is: if eating a frog is the hardest thing you’ll have to do all day, do that first. Basically, tackle the most intimidating task first. That way, you won’t spend your day stressed/anxious and/or subconsciously wasting time in order to procrastinate and avoid it.
- Counterpart to the above: a great idea is to also plan something to look forward to when your working day is done. It doesn’t matter much what it is, provided it’s rewarding to you, that makes you keen to finish your tasks to get to it.
Have a question you’d like to see answered here? Hit reply to this email, or use the feedback widget at the bottom! We always love to hear from you
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Cranberry juice really can help with UTIs – and reduce reliance on antibiotics
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Cranberry juice has been used medicinally for centuries. Our new research indicates it should be a normal aspect of urinary tract infection (UTI) management today.
While some benefits of cranberry compounds for the prevention of UTIs have been suspected for some time, it hasn’t been clear whether the benefits from cranberry juice were simply from drinking more fluid, or something in the fruit itself.
For our study, published this week, we combined and collectively assessed 3,091 participants across more than 20 clinical trials.
Our analysis indicates that increasing liquids reduces the rate of UTIs compared with no treatment, but cranberry in liquid form is even better at reducing UTIs and antibiotic use.
Julie Falk/Flickr, CC BY-NC-ND Are UTIs really that bad?
Urinary tract infections affect more than 50% of women and 20% of men in their lifetime.
Most commonly, UTIs are caused from the bug called Escherichia coli (E.coli). This bug lives harmlessly in our intestines, but can cause infection in the urinary tract. This is why, particularly for women, it is recommended people wipe from front to back after using the toilet.
An untreated UTI can move up to the kidneys and cause even more serious illness.
Even when not managing infection, many people are anxious about contracting a UTI. Sexually active women, pregnant women and older women may all be at increased risk.
Why cranberries?
To cause a UTI, the bacteria need to attach to the wall of the urinary bladder. Increasing fluids helps to flush out bacteria before it attaches (or makes its way up into the bladder).
Some beneficial compounds in cranberry, such as proanthocyanidins (also called condensed tannins), prevent the bacteria from attaching to the wall itself.
While there are treatments, over 90% of the bugs that cause UTIs exhibit some form of microbial resistance. This suggests that they are rapidly changing and some cases of UTI might be left untreatable.
The juice of cranberries has long been thought to have infection-fighting properties. duckeesue/Shutterstock What we found
Our analysis showed a 54% lower rate of UTIs from cranberry juice consumption compared to no treatment. This means that significantly fewer participants who regularly consumed cranberry juice (most commonly around 200 millilitres each day) reported having a UTI during the periods assessed in the studies we analysed.
Cranberry juice was also linked to a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on analysis of indirect and direct effects across six studies. The use of cranberry compounds, whether in drinks or tablet form, also reduced the prevalence of symptoms associated with UTIs.
While some studies we included presented conflicts of interest (such as receiving funding from cranberry companies), we took this “high risk of bias” into account when analysing the data.
The study found extra hydration helped but not to the same extent as cranberry juice. Pixelshot/Shutterstock So, when can cranberry juice help?
We found three main benefits of cranberry juice for UTIs.
1. Reduced rates of infections
Increasing fluids (for example, drinking more water) reduced the prevalence of UTIs, and taking cranberry compounds (such as tablets) was also beneficial. But the most benefits were identified from increasing fluids and taking cranberry compounds at the same time, such as with cranberry juice.
2. Reduced use of antibiotics
The data shows cranberry juice lowers the need to use antibiotics by 59%. This was identified as fewer participants in randomised cranberry juice groups required antibiotics.
Increasing fluid intake also helped reduce antibiotic use (by 25%). But this was not as useful as increasing fluids at the same time as using cranberry compounds.
Cranberry compounds alone (such as tablets without associated increases in fluid intake) did not affect antibiotic use.
3. Reducing symptoms
Taking cranberry compounds (in any form, liquid or tablet) reduced the symptoms of UTIs, as measured in the overall data, by more than five times.
Take home advice
While cranberry juice cannot treat a UTI, it can certainly be part of UTI management.
If you suspect that you have a UTI, see your GP as soon as possible.
Christian Moro, Associate Professor of Science & Medicine, Bond University and Charlotte Phelps, Senior Teaching Fellow, Medical Program, Bond University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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