What is silicosis and what does research say about it?
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Silicosis is a progressive, debilitating and sometimes fatal lung disease caused by breathing silica dust from cutting, drilling, chipping or grinding materials such as granite, sandstone, slate or artificial stone. The dust gets trapped in the lung tissue, causing inflammation, scarring and permanent damage.
Silicosis is a job-related lung disease and has no cure. The disease mostly affects workers in construction, stone countertop fabrication, mining, and even those who sandblast and stonewash denim jeans to create a ‘worn out’ look.
Silica is one of the most common minerals in nature. About 59% of the Earth’s crust is made of silica, found in quartz, granite, sandstone, slate and sand. Historically, people at the highest risk for the disease have worked in natural environments — mining, digging tunnels or doing quarry work. The disease was first documented by the Greek physician Hippocrates, who in 430 B.C. described breathing disorders in metal diggers.
But in recent decades there’s been renewed attention to the disease due to its more rapid progression and severity among younger workers. Research has shown that the culprit is artificial stone mostly used for countertops for kitchens and bathrooms, which has a very high silica content.
The new generation of coal miners is also at an increased risk of silicosis, in addition to black lung, because layers of coal have become thinner, forcing them to dig deeper into rock, as explained in a joint investigation by the Pittsburgh Post-Gazette and the Medill Investigative Lab at Northwestern University published on Dec. 4. CBS Sunday Morning also had a report on the same issue among West Virginia coal miners, aired as part of its Dec. 10 episode.
Silicosis in modern industries
Artificial, or engineered, stone used for countertops, also known as “quartz,” is formed from finely crushed rocks mixed with resin. Quartz is a natural mineral, but man-made products like many quartz countertops consist of not just quartz, but also resin, colors and other materials that are used to style and strengthen them.
The silica content of artificial stone is about 90%, compared with the 3% silica content of natural marble and 30% silica content in granite stones, according to the authors of a 2019 systematic review published in the International Journal of Environmental Research and Public Health.
The first reported case of silicosis associated with working with artificial stone was from Italy in 2010, according to a 2020 study published in Allergy. Since then, more studies have documented the growing number of cases among artificial stone workers, many of whom are from marginalized populations, such as immigrants.
A July 2023 study published in JAMA Internal Medicine found that in California, the disease mainly occurred among young Latino immigrant men. The disease was severe in most men by the time they sought care.
An August 2022 study, published in Occupational & Environmental Medicine, analyzing the Global Silicosis Registry, with workers in Israel, Spain, Australia and the U.S., found “a substantial emerging population of workers worldwide with severe and irreversible silica-associated diseases,” due to exposure from silica dust from engineered stone.
Other modern occupations such as denim sandblasting, work on dental prostheses, manufacturing of electrical cables and working on jewelry and semi-precious stones also put workers at risk of silicosis.
In the wake of modern-day silicosis cases, researchers have called for larger studies to better understand the disease and the discovery of effective treatments.
In the U.S. about 2.3 million workers are exposed to silica dust on the job, according to the American Lung Association. Other estimates show approximately 10 million workers in India, 3.2 million in the European Union and 2 million in Brazil work with material containing silica.
However, “the reporting system for occupational injuries and illnesses in the United States fails to capture many cases, leading to a poor understanding of silicosis incidence and prevalence,” writes Ryan F. Hoy, who has published extensively on the topic, in a June 2022 article in Respirology.
A 2015 study in the Morbidity & Mortality Weekly Report found the annual number of silicosis deaths declined from 185 people in 1999 to 111 in 2013, but the decline appeared to have leveled off between 2010 and 2013, the authors write. Another 2015 study in MMWR, examining silicosis deaths between 2001 and 2010, found the death rate from silicosis was significantly higher among Black people compared with whites and other races. Men also have a significantly higher death rate from silicosis than women.
The 2019 Global Burden of Disease Study estimates that more than 12,900 people worldwide die from silicosis each year.
Silicosis has no cure, but it’s preventable when workers have access to proper respiratory protection and are educated on safe practices set by regulatory bodies such as the U.S. National Institute for Occupational Safety and Health. The European Network on Silica also has guidelines on handling and using materials containing silica. A March 2023 study published in Environmental Science and Pollution Research International finds that “education, training, and marketing strategies improve respirator use, while training and education motivate workers to use dust control measures.”
Silicosis symptoms and treatment
Symptoms of silicosis include cough, fatigue, shortness of breath and chest pain. There’s no specific test for silicosis. The first signs may show in an abnormal chest X-ray and a slowly developing cough, according to the American Lung Association.
Silicosis symptoms don’t appear right away in most cases, usually taking several years to develop working with silica dust. However, studies indicate that symptoms of silicosis due to exposure to artificial stone appear quicker than exposure to natural silica sources, potentially due to the higher concentration of silica in artificial stone.
There are three types of silicosis: acute (most commonly caused by working with artificial stone), accelerated and chronic, depending on the level of exposure to silica dust, according to the Centers for Disease Control and Prevention, which explains the severity of each type on its website.
Complications from silicosis can include tuberculosis, lung cancer, chronic bronchitis, kidney disease and autoimmune disorders. In some cases, silicosis can cause severe scarring of the lung tissue, leading to a condition called progressive massive fibrosis, or PMF. Some patients may require a lung transplant.
Lung damage from silicosis is irreversible, so treatment of silicosis is aimed at slowing down the disease and relieving its symptoms.
In 1995, the World Health Organization called for the elimination of silicosis by 2030, but research studies and news stories show it remains a threat to many workers.
Below, we have gathered several studies on the topic to help journalists bolster their reporting with academic research.
Research roundup
Artificial Stone Associated Silicosis: A Systematic Review
Veruscka Leso, et al. International Journal of Environmental Research and Public Health, February 2019.
This systematic review aims to verify the association between exposure to silica dust in artificial stone and the development of silicosis.
Researchers narrowed down their selection from 75 papers to seven studies that met their inclusion criteria. The seven studies were from Australia, Israel and Spain. Most of the studies are observational and impede a definite association between exposure to silica while working with artificial stone and developing silicosis, the authors note.
However, “the unusually high incidence of the disease that was reported over short periods of investigations, and the comparable occupational histories of affected workers, all being involved in the manufacture and manipulation of engineered stones, may indicate a cause-effect relationship of this type.”
The review of studies reveals a lack of basic preventive measures such as lack of access to disposable masks; lack of information and training on the dangers of silica dust; and lack of periodic medical examinations, including a chest X-ray, among workers. There was limited environmental monitoring of dust levels at the workplace. Also, there was no dust suppression system, such as the use of water when polishing the stones, or effective ventilation. Machinery and tools weren’t properly set up and didn’t undergo routine checks, the authors write.
The authors recommend environmental monitoring for assessing silica levels in the workplace and verifying the effectiveness of personal protections. They also recommend the health surveillance of workers exposed to silica dust.
“Stakeholders, manufacturers, occupational risk prevention services, insurance companies for occupational accidents and diseases, business owners, occupational health physicians, general practitioners, and also employees should be engaged, not only in designing/planning processes and operational working environments, but also in assessing the global applicability of proactive preventive and protective measures to identify and control crystalline silica exposure, especially in new and unexpected exposure scenarios, the full extent of which cannot yet be accurately predicted,” they write.
Silica-Related Diseases in the Modern World
Ryan F. Hoy and Daniel C. Chambers. Allergy, November 2020.
The study is a review of the mineralogy of silica, epidemiology, clinical and radiological features of the various forms of silicosis and other diseases associated with exposure to silica.
The primary factor associated with the development of silicosis is the intensity and duration of cumulative exposure to silica dust. Most countries regulate silica dust occupational exposure limits, generally in the range of 0.05 mg/m3 to 0.1 mg/m3, although the risk of dust exposure to workers still remains high at those levels.
The study provides a list of activities that could expose workers to silica dust. They include abrasive blasting of sand and sandstone; cement and brick manufacturing; mixing, glazing or sculpting of china, ceramic and pottery; construction involving bricklaying, concrete cutting, paving and demolition; sandblasting denim jeans; working with and polishing dental materials; mining and related milling; handling raw material during paint manufacturing; road and highway construction and repair; soap and cosmetic production; blasting and drilling tunnels; and waste incineration.
“Despite the large number of workers in the construction sector, there have been few studies of [silica dust] exposure in this industry,” the authors note.
Other than silicosis, conditions associated with silica exposure include sarcoidosis, an inflammatory disease that commonly affects the lungs and lymph nodes, autoimmune disease, lung cancer and pulmonary infections.
“Recent outbreaks of silica-associated disease highlight the need for constant vigilance to identify and control new and well-established sources of silica exposure. While there are currently no effective treatments for silicosis, it is a completely preventable lung disease,” the authors write.
A Systematic Review of the Effectiveness of Dust Control Measures Adopted to Reduce Workplace Exposure
Frederick Anlimah, Vinod Gopaldasani, Catherine MacPhail and Brian Davies. Environmental Science and Pollution Research International, March 2023.
This study provides an overview of various interventions and their effectiveness in preventing exposure to silica dust based on a review of 133 studies from 16 countries, including the U.S., Canada, China, India, Taiwan and Australia, and published between 2010 and 2020.
These dust control measures range from simple work practices such as the use of respirators to more sophisticated technologies, such as water and air curtains and foam technology, the authors note.
The review finds increasing research interest in dust reduction, mainly in China. But overall, regulatory influence remains inadequate in preventing miners’ exposure to silica dust.
“Results from the review suggest that adopted interventions increase knowledge, awareness, and attitudes about respirator usage and generate positive perceptions about respirator usage while reducing misconceptions,” the authors write. “Interventions can increase the use, proper use, and frequency of use of respirators and the adoption readiness for dust controls but may not provide sustained motivation in workers for the continual use of dust controls or [personal protective equipment.]”
Notes from the Field: Surveillance of Silicosis Using Electronic Case Reporting — California, December 2022–July 2023
Jennifer Flattery, et al. Morbidity and Mortality Weekly Report, November 2023.
This study examines the use of electronic case reporting to identify silicosis cases in California. Electronic case reporting, or eCR, is the automated, real-time exchange of case report information between electronic health records at health facilities at state and local public health agencies in the U.S. It is a joint effort between the Association of Public Health Laboratories, the Council of State and Territorial Epidemiologists, and the CDC. Currently, 208 health conditions can be reported using eCR. All 50 states and other U.S.-affiliated jurisdictions are connected to eCR. Once a public health agency receives a case report, it reaches out to the patient for contact tracing or other actions.
From October 2022 to July 2023, the California Department of Public Health received initial silicosis case reports for 41 individuals. A review of medical records confirmed 19 cases and 16 probable cases. Six of the 41 cases were considered unlikely to be silicosis after a review of medical records.
Notably, engineered stone countertop fabrication was a significant source of exposure, especially among Hispanic and Latino workers.
At least seven of the 19 confirmed cases were associated with the fabrication of engineered stone — quartz — countertops. The 19 patients’ ages ranged from 33 to 51 and all were Hispanic or Latino. One patient died and two had both lungs replaced. One was evaluated for a lung transplant.
The median age of the 35 patients with probable or confirmed silicosis was 65, ranging from 33 to 89 years, and 91% were men.
“It is important that health care providers routinely ask patients about their work as an important determinant of health,” the authors write. “Being aware of the risks associated with work exposures, as well as the regulations, medical monitoring, and prevention strategies that address those risks can help guide patient care.”
Additional research
Understanding the Pathogenesis of Engineered Stone-Associated Silicosis: The Effect of Particle Chemistry on the Lung Cell Response
Chandnee Ramkissoon, et al. Respirology, December 2023.
Silicosis, Tuberculosis and Silica Exposure Among Artisanal and Small-Scale Miners: A Systematic Review and Modelling Paper
Patrick Howlett, et al. PLOS Global Public Health, September 2023.
Silicosis Among Immigrant Engineered Stone (Quartz) Countertop Fabrication Workers in California
Jane C. Fazio, et al. JAMA Internal Medicine, July 2023.
Silicosis and Tuberculosis: A Systematic Review and Meta-Analysis
P. Jamshidi, et al. Pulmonology, June 2023.
From Basic Research to Clinical Practice: Considerations for Treatment Drugs for Silicosis
Rou Li, Huimin Kang and Shi Chen. International Journal of Molecular Science, May 2023.
Silicosis After Short-Term Exposure
J. Nowak-Pasternak, A. Lipińska-Ojrzanowska and B. Świątkowska. Occupational Medicine, January 2023.
Occupational Silica Exposure and Dose-Response for Related Disorders—Silicosis, Pulmonary TB, AIDs and Renal Diseases: Results of a 15-Year Israeli Surveillance
Rachel Raanan, et al. International Journal of Environmental Research and Public Health, November 2022.
Demographic, Exposure and Clinical Characteristics in a Multinational Registry of Engineered Stone Workers with Silicosis
Jeremy Tang Hua, et al. Occupational & Environmental Medicine, August 2022.
Current Global Perspectives on Silicosis — Convergence of Old and Newly Emergent Hazards
Ryan F. Hoy, et al. Respirology, March 2022.
The Association Between Silica Exposure, Silicosis and Tuberculosis: A systematic Review and Metal-Analysis
Rodney Ehrlich, Paula Akugizibwe, Nandi Siegfried and David Rees. BMC Public Health, May 2021.
Silicosis, Progressive Massive Fibrosis and Silico-Tuberculosis Among Workers with Occupational Exposure to Silica Dusts in Sandstone Mines of Rajasthan State
Subroto Nandi, Sarang Dhatrak, Kamalesh Sarkar. Journal of Family Medicine and Primary Care, February 2021.
Artificial Stone Silicosis: Rapid Progression Following Exposure Cessation
Antonio León-Jiménez, et al. Chest, September 2020.
Silica-Associated Lung Disease: An Old-World Exposure in Modern Industries
Hayley Barnes, Nicole S.L. Goh, Tracy L. Leong and Ryan Hoy. Respirology, September 2019.
Australia Reports on Audit of Silicosis for Stonecutters
Tony Kirby. The Lancet, March 2019.
Artificial Stone-Associated Silicosis: A Rapidly Emerging Occupational Lung Disease
Ryan F. Hoy, et al. Occupational & Environmental Medicine, December 2017.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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How we diagnose and define obesity is set to change – here’s why, and what it means for treatment
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Obesity is linked to many common diseases, such as type 2 diabetes, heart disease, fatty liver disease and knee osteoarthritis.
Obesity is currently defined using a person’s body mass index, or BMI. This is calculated as weight (in kilograms) divided by the square of height (in metres). In people of European descent, the BMI for obesity is 30 kg/m² and over.
But the risk to health and wellbeing is not determined by weight – and therefore BMI – alone. We’ve been part of a global collaboration that has spent the past two years discussing how this should change. Today we publish how we think obesity should be defined and why.
As we outline in The Lancet, having a larger body shouldn’t mean you’re diagnosed with “clinical obesity”. Such a diagnosis should depend on the level and location of body fat – and whether there are associated health problems.
World Obesity Federation What’s wrong with BMI?
The risk of ill health depends on the relative percentage of fat, bone and muscle making up a person’s body weight, as well as where the fat is distributed.
Athletes with a relatively high muscle mass, for example, may have a higher BMI. Even when that athlete has a BMI over 30 kg/m², their higher weight is due to excess muscle rather than excess fatty tissue.
Some athletes have a BMI in the obesity category. Tima Miroshnichenko/Pexels People who carry their excess fatty tissue around their waist are at greatest risk of the health problems associated with obesity.
Fat stored deep in the abdomen and around the internal organs can release damaging molecules into the blood. These can then cause problems in other parts of the body.
But BMI alone does not tell us whether a person has health problems related to excess body fat. People with excess body fat don’t always have a BMI over 30, meaning they are not investigated for health problems associated with excess body fat. This might occur in a very tall person or in someone who tends to store body fat in the abdomen but who is of a “healthy” weight.
On the other hand, others who aren’t athletes but have excess fat may have a high BMI but no associated health problems.
BMI is therefore an imperfect tool to help us diagnose obesity.
What is the new definition?
The goal of the Lancet Diabetes & Endocrinology Commission on the Definition and Diagnosis of Clinical Obesity was to develop an approach to this definition and diagnosis. The commission, established in 2022 and led from King’s College London, has brought together 56 experts on aspects of obesity, including people with lived experience.
The commission’s definition and new diagnostic criteria shifts the focus from BMI alone. It incorporates other measurements, such as waist circumference, to confirm an excess or unhealthy distribution of body fat.
We define two categories of obesity based on objective signs and symptoms of poor health due to excess body fat.
1. Clinical obesity
A person with clinical obesity has signs and symptoms of ongoing organ dysfunction and/or difficulty with day-to-day activities of daily living (such as bathing, going to the toilet or dressing).
There are 18 diagnostic criteria for clinical obesity in adults and 13 in children and adolescents. These include:
- breathlessness caused by the effect of obesity on the lungs
- obesity-induced heart failure
- raised blood pressure
- fatty liver disease
- abnormalities in bones and joints that limit movement in children.
2. Pre-clinical obesity
A person with pre-clinical obesity has high levels of body fat that are not causing any illness.
People with pre-clinical obesity do not have any evidence of reduced tissue or organ function due to obesity and can complete day-to-day activities unhindered.
However, people with pre-clinical obesity are generally at higher risk of developing diseases such as heart disease, some cancers and type 2 diabetes.
What does this mean for obesity treatment?
Clinical obesity is a disease requiring access to effective health care.
For those with clinical obesity, the focus of health care should be on improving the health problems caused by obesity. People should be offered evidence-based treatment options after discussion with their health-care practitioner.
Treatment will include management of obesity-associated complications and may include specific obesity treatment aiming at decreasing fat mass, such as:
- support for behaviour change around diet, physical activity, sleep and screen use
- obesity-management medications to reduce appetite, lower weight and improve health outcomes such as blood glucose (sugar) and blood pressure
- metabolic bariatric surgery to treat obesity or reduce weight-related health complications.
Treatment for clinical obesity may include support for behaviour change. Shutterstock/shurkin_son Should pre-clinical obesity be treated?
For those with pre-clinical obesity, health care should be about risk-reduction and prevention of health problems related to obesity.
This may require health counselling, including support for health behaviour change, and monitoring over time.
Depending on the person’s individual risk – such as a family history of disease, level of body fat and changes over time – they may opt for one of the obesity treatments above.
Distinguishing people who don’t have illness from those who already have ongoing illness will enable personalised approaches to obesity prevention, management and treatment with more appropriate and cost-effective allocation of resources.
What happens next?
These new criteria for the diagnosis of clinical obesity will need to be adopted into national and international clinical practice guidelines and a range of obesity strategies.
Once adopted, training health professionals and health service managers, and educating the general public, will be vital.
Reframing the narrative of obesity may help eradicate misconceptions that contribute to stigma, including making false assumptions about the health status of people in larger bodies. A better understanding of the biology and health effects of obesity should also mean people in larger bodies are not blamed for their condition.
People with obesity or who have larger bodies should expect personalised, evidence-based assessments and advice, free of stigma and blame.
Louise Baur, Professor, Discipline of Child and Adolescent Health, University of Sydney; John B. Dixon, Adjunct Professor, Iverson Health Innovation Research Institute, Swinburne University of Technology; Priya Sumithran, Head of the Obesity and Metabolic Medicine Group in the Department of Surgery, School of Translational Medicine, Monash University, and Wendy A. Brown, Professor and Chair, Monash University Department of Surgery, School of Translational Medicine, Alfred Health, Monash University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Accidental falls in the older adult population: What academic research shows
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Accidental falls are among the leading causes of injury and death among adults 65 years and older worldwide. As the aging population grows, researchers expect to see an increase in the number of fall injuries and related health spending.
Falls aren’t unique to older adults. Nealy 684,000 people die from falls each year globally. Another 37.3 million people each year require medical attention after a fall, according to the World Health Organization. But adults 65 and older account for the greatest number of falls.
In the United States, more than 1 in 4 older adults fall each year, according to the National Institute on Aging. One in 10 report a fall injury. And the risk of falling increases with age.
In 2022, health care spending for nonfatal falls among older adults was $80 billion, according to a 2024 study published in the journal Injury Prevention.
Meanwhile, the fall death rate in this population increased by 41% between 2012 and 2021, according to the latest CDC data.
“Unfortunately, fall-related deaths are increasing and we’re not sure why that is,” says Dr. Jennifer L. Vincenzo, an associate professor at the University of Arkansas for Medical Sciences in the department of physical therapy and the Center for Implementation Research. “So, we’re trying to work more on prevention.”
Vincenzo advises journalists to write about how accidental falls can be prevented. Remind your audiences that accidental falls are not an inevitable consequence of aging, and that while we do decline in many areas with age, there are things we can do to minimize the risk of falls, she says. And expand your coverage beyond the national Falls Prevention Awareness Week, which is always during the first week of fall — Sept. 23 to 27 this year.
Below, we explore falls among older people from different angles, including injury costs, prevention strategies and various disparities. We have paired each angle with data and research studies to inform your reporting.
Falls in older adults
In 2020, 14 million older adults in the U.S. reported falling during the previous year. In 2021, more than 38,700 older adults died due to unintentional falls, according to the CDC.
A fall could be immediately fatal for an older adult, but many times it’s the complications from a fall that lead to death.
The majority of hip fractures in older adults are caused by falls, Vincenzo says, and “it could be that people aren’t able to recover [from the injury], losing function, maybe getting pneumonia because they’re not moving around, or getting pressure injuries,” she says.
In addition, “sometimes people restrict their movement and activities after a fall, which they think is protective, but leads to further functional declines and increases in fall risk,” she adds.
Factors that can cause a fall include:
- Poor eyesight, reflexes and hearing. “If you cannot hear as well, anytime you’re doing something in your environment and there’s a noise, it will be really hard for you to focus on hearing what that noise is and what it means and also moving at the same time,” Vincenzo says.
- Loss of strength, balance, and mobility with age, which can lessen one’s ability to prevent a fall when slipping or tripping.
- Fear of falling, which usually indicates decreased balance.
- Conditions such as diabetes, heart disease, or problems with nerves or feet that can affect balance.
- Conditions like incontinence that cause rushed movement to the bathroom.
- Cognitive impairment or certain types of dementia.
- Unsafe footwear such as backless shoes or high heels.
- Medications or medication interactions that can cause dizziness or confusion.
- Safety hazards in the home or outdoors, such as poor lighting, steps and slippery surfaces.
Related Research
Nonfatal and Fatal Falls Among Adults Aged ≥65 Years — United States, 2020–2021
Ramakrishna Kakara, Gwen Bergen, Elizabeth Burns and Mark Stevens. Morbidity and Mortality Weekly Report, September 2023.Summary: Researchers analyzed data from the 2020 Behavioral Risk Factor Surveillance System — a landline and mobile phone survey conducted each year in all 50 U.S. states and the District of Columbia — and data from the 2021 National Vital Statistics System to identify patterns of injury and death due to falls in the U.S. by sex and state for adults 65 years and older. Among the findings:
- The percentage of women who reported falling was 28.9%, compared with 26.1% of men.
- Death rates from falls were higher among white and American Indian or Alaska Native older adults than among older adults from other racial and ethnic groups.
- In 2020, the percentage of older adults who reported falling during the past year ranged from 19.9% in Illinois to 38.0% in Alaska. The national estimate for 18 states was 27.6%.
- In 2021, the unintentional fall-related death rate among older adults ranged from 30.7 per 100,000 older adults in Alabama to 176.5 in Wisconsin. The national estimate for 26 states was 78.
“Although common, falls among older adults are preventable,” the authors write. “Health care providers can talk with patients about their fall risk and how falls can be prevented.”
Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012-2018
Briana Moreland, Ramakrishna Kakara and Ankita Henry. Morbidity and Mortality Weekly Report, July 2020.Summary: Researchers compared data from the 2018 Behavioral Risk Factor Surveillance System. Among the findings:
- The percentage of older adults reporting a fall increased from 2012 to 2016, then slightly decreased from 2016 to 2018.
- Even with this decrease in 2018, older adults reported 35.6 million falls. Among those falls, 8.4 million resulted in an injury that limited regular activities for at least one day or resulted in a medical visit.
“Despite no significant changes in the rate of fall-related injuries from 2012 to 2018, the number of fall-related injuries and health care costs can be expected to increase as the proportion of older adults in the United States grows,” the authors write.
Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies
Gwen Bergen, et al. American Journal of Lifestyle Medicine, October 2019.Summary: Researchers used data from the 2016 U.S. Behavioral Risk Factor Surveillance System to better understand the association between falls and fall injuries in older adults and factors such as health, state and demographic characteristics. Among the findings:
- Depression had the strongest association with falls and fall injuries. About 40% of older adults who reported depression also reported at least one fall; 15% reported at least one fall injury.
- Falls and depression have several factors in common, including cognitive impairment, slow walking speed, poor balance, slow reaction time, weakness, low energy and low levels of activity.
- Other factors associated with an increased risk of falling include diabetes, vision problems and arthritis.
“The multiple characteristics associated with falls suggest that a comprehensive approach to reducing fall risk, which includes screening and assessing older adult patients to determine their unique, modifiable risk factors and then prescribing tailored care plans that include evidence-based interventions, is needed,” the authors write.
Health care use and cost
In addition to being the leading cause of injury, falls are the leading cause of hospitalization in older adults. Each year, about 3 million older adults visit the emergency department due to falls. More than 1 million get hospitalized.
In 2021, falls led to more than 38,000 deaths in adults 65 and older, according to the CDC.
The annual financial medical toll of falls among adults 65 years and older is expected to be more than $101 billion by 2030, according to the National Council on Aging, an organization advocating for older Americans.
Related research
Healthcare Spending for Non-Fatal Falls Among Older Adults, USA
Yara K. Haddad, et al. Injury Prevention, July 2024.Summary: In 2015, health care spending related to falls among older adults was roughly $50 billion. This study aims to update the estimate, using the 2017, 2019 and 2021 Medicare Current Beneficiary Survey, the most comprehensive and complete survey available on the Medicare population. Among the findings:
- In 2020, health care spending for non-fatal falls among older adults was $80 billion.
- Medicare paid $53.3 billion of the $80 billion, followed by $23.2 billion paid by private insurance or patients and $3.5 billion by Medicaid.
“The burden of falls on healthcare systems and healthcare spending will continue to rise if the risk of falls among the aging population is not properly addressed,” the authors write. “Many older adult falls can be prevented by addressing modifiable fall risk factors, including health and functional characteristics.”
Cost of Emergency Department and Inpatient Visits for Fall Injuries in Older Adults Lisa Reider, et al. Injury, February 2024.
Summary: The researchers analyzed data from the 2016-2018 National Inpatient Sample and National Emergency Department Sample, which are large, publicly available patient databases in the U.S. that include all insurance payers such as Medicare and private insurance. Among the findings:
- During 2016-2018, more than 920,000 older adults were admitted to the hospital and 2.3 million visited the emergency department due to falls. The combined annual cost was $19.2 billion.
- More than half of hospital admissions were due to bone fractures. About 14% of these admissions were due to multiple fractures and cost $2.5 billion.
“The $20 billion in annual acute treatment costs attributed to fall injury indicate an urgent need to implement evidence-based fall prevention interventions and underscores the importance of newly launched [emergency department]-based fall prevention efforts and investments in geriatric emergency departments,” the authors write.
Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury Among Adults Aged 65 and Older, United States 2019
Briana L. Moreland, Jaswinder K. Legha, Karen E. Thomas and Elizabeth R. Burns. Journal of Aging and Health, June 2024.Summary: The researchers calculated hip fracture-related U.S. emergency department visits, hospitalizations and deaths among older adults, using data from the Healthcare Cost and Utilization Project and the National Vital Statistics System. Among the findings:
- In 2019, there were 318,797 emergency department visits, 290,130 hospitalizations and 7,731 deaths related to hip fractures among older adults.
- Nearly 88% of emergency department visits and hospitalizations and 83% of deaths related to hip fractures were caused by falls.
- These rates were highest among those living in rural areas and among adults 85 and older. More specifically, among adults 85 and older, the rate of hip fracture-related emergency department visits was nine times higher than among adults between 65 and 74 years old.
“Falls are common among older adults, but many are preventable,” the authors write. “Primary care providers can prevent falls among their older patients by screening for fall risk annually or after a fall, assessing modifiable risk factors such as strength and balance issues, and offering evidence-based interventions to reduce older adults’ risk of falls.”
Fall prevention
Several factors, including exercising, managing medication, checking vision and making homes safer can help prevent falls among older adults.
“Exercise is one of the best interventions we know of to prevent falls,” Vincenzo says. But “walking in and of itself will not help people to prevent falls and may even increase their risk of falling if they are at high risk of falls.”
The National Council on Aging also has a list of evidence-based fall prevention programs, including activities and exercises that are shown to be effective.
The National Institute on Aging has a room-by-room guide on preventing falls at home. Some examples include installing grab bars near toilets and on the inside and outside of the tub and shower, sitting down while preparing food to prevent fatigue, and keeping electrical cords near walls and away from walking paths.
There are also national and international initiatives to help prevent falls.
Stopping Elderly Accidents, Deaths and Injuries, or STEADI, is an initiative by the CDC’s Injury Center to help health care providers who treat older adults. It helps providers screen patients for fall risk, assess their fall risk factors and reduce their risk by using strategies that research has shown to be effective. STEADI’s guidelines are in line with the American and British Geriatric Societies’ Clinical Practice Guidelines for fall prevention.
“We’re making some iterations right now to STEADI that will come out in the next couple of years based on the World Falls Guidelines, as well as based on clinical providers’ feedback on how to make [STEADI] more feasible,” Vincenzo says.
The World Falls Guidelines is an international initiative to prevent falls in older adults. The guidelines are the result of the work of 14 international experts who came together in 2019 to consider whether new guidelines on fall prevention were needed. The task force then brought together 96 experts from 39 countries across five continents to create the guidelines.
The CDC’s STEADI initiative has a screening questionnaire for consumers to check their risk of falls, as does the National Council on Aging.
On the policy side, U.S. Rep. Carol Miller, R-W.V., and Melanie Stansbury, D-N.M., introduced the Stopping Addiction and Falls for the Elderly (SAFE) Act in March 2024. The bill would allow occupational and physical therapists to assess fall risks in older adults as part of the Medicare Annual Wellness Benefit. The bill was sent to the House Subcommittee on Health in the same month.
Meanwhile, older adults’ attitudes toward falls and fall prevention are also pivotal. For many, coming to terms with being at risk of falls and making changes such as using a cane, installing railings at home or changing medications isn’t easy for all older adults, studies show.
“Fall is a four-letter F-word in a way to older adults,” says Vincenzo, who started her career as a physical therapist. “It makes them feel ‘old.’ So, it’s a challenge on multiple fronts: U.S. health care infrastructure, clinical and community resources and facilitating health behavior change.”
Related research
Environmental Interventions for Preventing Falls in Older People Living in the Community
Lindy Clemson, et al. Cochrane Database of Systematic Reviews, March 2023.Summary: This review includes 22 studies from 10 countries involving a total of 8,463 older adults who live in the community, which includes their own home, a retirement facility or an assisted living facility, but not a hospital or nursing home. Among the findings:
- Removing fall hazards at home reduced the number of falls by 38% among older adults at a high risk of having a fall, including those who have had a fall in the past year, have been hospitalized or need support with daily activities. Examples of fall hazards at home include a stairway without railings, a slippery pathway or poor lighting.
- It’s unclear whether checking prescriptions for eyeglasses, wearing special footwear or installing bed alarm systems reduces the rate of falls.
- It’s also not clear whether educating older adults about fall risks reduces their fall risk.
The Influence of Older Adults’ Beliefs and Attitudes on Adopting Fall Prevention Behaviors
Judy A. Stevens, David A. Sleet and Laurence Z. Rubenstein. American Journal of Lifestyle Medicine. January 2017.Summary: Persuading older adults to adopt interventions that reduce their fall risk is challenging. Their attitudes and beliefs about falls play a large role in how well they accept and adopt fall prevention strategies, the authors write. Among the common attitudes and beliefs:
- Many older adults believe that falls “just happen,” are a normal result of aging or are simply due to bad luck.
- Many don’t acknowledge or recognize their fall risk.
- For many, falls are considered to be relevant only for frail or very old people.
- Many believe that their home environment or daily activities can be a risk for fall, but do not consider biological factors such as dizziness or muscle weakness.
- For many, fall prevention simply consists of “being careful” or holding on to things when moving about the house.
“To reduce falls, health care practitioners have to help patients understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention,” the authors write. “They should offer patients individualized fall prevention interventions as well as provide ongoing support to help patients adopt and maintain fall prevention strategies and behaviors to reduce their fall risk. Implementing prevention programs such as CDC’s STEADI can help providers discuss the importance of falls and fall prevention with their older patients.”
Reframing Fall Prevention and Risk Management as a Chronic Condition Through the Lens of the Expanded Chronic Care Model: Will Integrating Clinical Care and Public Health Improve Outcomes?
Jennifer L. Vincenzo, Gwen Bergen, Colleen M. Casey and Elizabeth Eckstrom. The Gerontologist, June 2024.Summary: The authors recommend approaching fall prevention from the lens of chronic disease management programs because falls and fall risk are chronic issues for many older adults.
“Policymakers, health systems, and community partners can consider aligning fall risk management with the [Expanded Chronic Care Model], as has been done for diabetes,” the authors write. “This can help translate high-quality research on the effectiveness of fall prevention interventions into daily practice for older adults to alter the trajectory of older adult falls and fall-related injuries.”
Disparities
Older adults face several barriers to reducing their fall risk. Accessing health care services and paying for services such as physical therapy is not feasible for everyone. Some may lack transportation resources to go to and from medical appointments. Social isolation can increase the risk of death from falls. In addition, physicians may not have the time to fit in a fall risk screening while treating older patients for other health concerns.
Moreover, implementing fall risk screening, assessment and intervention in the current U.S. health care structure remains a challenge, Vincenzo says.
Related research
Mortality Due to Falls by County, Age Group, Race, and Ethnicity in the USA, 2000-19: A Systematic Analysis of Health Disparities
Parkes Kendrick, et al. The Lancet Public Health, August 2024.Summary: Researchers analyzed death registration data from the U.S. National Vital Statistics System and population data from the U.S. National Center for Health Statistics to estimate annual fall-related mortality. The data spanned from 2000 to 2019 and includes all age groups. Among the findings:
- The disparities between racial and ethnic populations varied widely by age group. Deaths from falls among younger adults were highest for the American Indian/Alaska Native population, while among older adults it was highest for the white population.
- For older adults, deaths from falls were particularly high in the white population within clusters of counties across states including Florida, Minnesota and Wisconsin.
- One factor that could contribute to higher death rates among white older adults is social isolation, the authors write. “Studies suggest that older Black and Latino adults are more likely to have close social support compared with older white adults, while AIAN and Asian individuals might be more likely to live in multigenerational households,” they write.
“Among older adults, current prevention techniques might need to be restructured to reduce frailty by implementing early prevention and emphasizing particularly successful interventions. Improving social isolation and evaluating the effectiveness of prevention programs among minoritized populations are also key,” the authors write.
Demographic Comparisons of Self-Reported Fall Risk Factors Among Older Adults Attending Outpatient Rehabilitation
Mariana Wingood, et al. Clinical Interventions in Aging, February 2024.Summary: Researchers analyzed the electronic health record data of 108,751 older adults attending outpatient rehabilitation within a large U.S. health care system across seven states, between 2018 and 2022. Among the findings:
- More than 44% of the older adults were at risk of falls; nearly 35% had a history of falls.
- The most common risk factors for falls were diminished strength, gait and balance.
- Compared to white older adults, Native American/Alaska Natives had the highest prevalence of fall history (43.8%) and Hispanics had the highest prevalence of falls with injury (56.1%).
“Findings indicate that rehabilitation providers should perform screenings for these impairments, including incontinence and medication among females, loss of feeling in the feet among males, and all Stay Independent Questionnaire-related fall risk factors among Native American/Alaska Natives, Hispanics, and Blacks,” the authors write.
Resources and articles
- National Institute on Aging
- National Council on Aging
- Gerontological Society of America
- Home Health Agencies Failed To Report Over Half of Falls With Major Injury and Hospitalization Among Their Medicare Patients, a 2023 report from the U.S Department of Health and Human Services’ Office of Inspector General.
- 6 tips for improving new coverage of older people, a tip sheet from The Journalist’s Resource.
- Crosswalk and pedestrian safety: What you need to know from recent research, from The Journalist’s Resource.
- Aging-in-place technology challenges and trends, a resource from the Association of Health Care Journalists.
- Successful aging at home: what reporters should know, a resource from the Association of Health Care Journalists.
This article first appeared on The Journalist’s Resource and is republished here under a Creative Commons license.
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The first pig kidney has been transplanted into a living person. But we’re still a long way from solving organ shortages
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In a world first, we heard last week that US surgeons had transplanted a kidney from a gene-edited pig into a living human. News reports said the procedure was a breakthrough in xenotransplantation – when an organ, cells or tissues are transplanted from one species to another. https://www.youtube.com/embed/cisOFfBPZk0?wmode=transparent&start=0 The world’s first transplant of a gene-edited pig kidney into a live human was announced last week.
Champions of xenotransplantation regard it as the solution to organ shortages across the world. In December 2023, 1,445 people in Australia were on the waiting list for donor kidneys. In the United States, more than 89,000 are waiting for kidneys.
One biotech CEO says gene-edited pigs promise “an unlimited supply of transplantable organs”.
Not, everyone, though, is convinced transplanting animal organs into humans is really the answer to organ shortages, or even if it’s right to use organs from other animals this way.
There are two critical barriers to the procedure’s success: organ rejection and the transmission of animal viruses to recipients.
But in the past decade, a new platform and technique known as CRISPR/Cas9 – often shortened to CRISPR – has promised to mitigate these issues.
What is CRISPR?
CRISPR gene editing takes advantage of a system already found in nature. CRISPR’s “genetic scissors” evolved in bacteria and other microbes to help them fend off viruses. Their cellular machinery allows them to integrate and ultimately destroy viral DNA by cutting it.
In 2012, two teams of scientists discovered how to harness this bacterial immune system. This is made up of repeating arrays of DNA and associated proteins, known as “Cas” (CRISPR-associated) proteins.
When they used a particular Cas protein (Cas9) with a “guide RNA” made up of a singular molecule, they found they could program the CRISPR/Cas9 complex to break and repair DNA at precise locations as they desired. The system could even “knock in” new genes at the repair site.
In 2020, the two scientists leading these teams were awarded a Nobel prize for their work.
In the case of the latest xenotransplantation, CRISPR technology was used to edit 69 genes in the donor pig to inactivate viral genes, “humanise” the pig with human genes, and knock out harmful pig genes. https://www.youtube.com/embed/UKbrwPL3wXE?wmode=transparent&start=0 How does CRISPR work?
A busy time for gene-edited xenotransplantation
While CRISPR editing has brought new hope to the possibility of xenotransplantation, even recent trials show great caution is still warranted.
In 2022 and 2023, two patients with terminal heart diseases, who were ineligible for traditional heart transplants, were granted regulatory permission to receive a gene-edited pig heart. These pig hearts had ten genome edits to make them more suitable for transplanting into humans. However, both patients died within several weeks of the procedures.
Earlier this month, we heard a team of surgeons in China transplanted a gene-edited pig liver into a clinically dead man (with family consent). The liver functioned well up until the ten-day limit of the trial.
How is this latest example different?
The gene-edited pig kidney was transplanted into a relatively young, living, legally competent and consenting adult.
The total number of gene edits edits made to the donor pig is very high. The researchers report making 69 edits to inactivate viral genes, “humanise” the pig with human genes, and to knockout harmful pig genes.
Clearly, the race to transform these organs into viable products for transplantation is ramping up.
From biotech dream to clinical reality
Only a few months ago, CRISPR gene editing made its debut in mainstream medicine.
In November, drug regulators in the United Kingdom and US approved the world’s first CRISPR-based genome-editing therapy for human use – a treatment for life-threatening forms of sickle-cell disease.
The treatment, known as Casgevy, uses CRISPR/Cas-9 to edit the patient’s own blood (bone-marrow) stem cells. By disrupting the unhealthy gene that gives red blood cells their “sickle” shape, the aim is to produce red blood cells with a healthy spherical shape.
Although the treatment uses the patient’s own cells, the same underlying principle applies to recent clinical xenotransplants: unsuitable cellular materials may be edited to make them therapeutically beneficial in the patient.
CRISPR technology is aiming to restore diseased red blood cells to their healthy round shape. Sebastian Kaulitzki/Shutterstock We’ll be talking more about gene-editing
Medicine and gene technology regulators are increasingly asked to approve new experimental trials using gene editing and CRISPR.
However, neither xenotransplantation nor the therapeutic applications of this technology lead to changes to the genome that can be inherited.
For this to occur, CRISPR edits would need to be applied to the cells at the earliest stages of their life, such as to early-stage embryonic cells in vitro (in the lab).
In Australia, intentionally creating heritable alterations to the human genome is a criminal offence carrying 15 years’ imprisonment.
No jurisdiction in the world has laws that expressly permits heritable human genome editing. However, some countries lack specific regulations about the procedure.
Is this the future?
Even without creating inheritable gene changes, however, xenotransplantation using CRISPR is in its infancy.
For all the promise of the headlines, there is not yet one example of a stable xenotransplantation in a living human lasting beyond seven months.
While authorisation for this recent US transplant has been granted under the so-called “compassionate use” exemption, conventional clinical trials of pig-human xenotransplantation have yet to commence.
But the prospect of such trials would likely require significant improvements in current outcomes to gain regulatory approval in the US or elsewhere.
By the same token, regulatory approval of any “off-the-shelf” xenotransplantation organs, including gene-edited kidneys, would seem some way off.
Christopher Rudge, Law lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Unlimited Memory – by Kevin Horsley
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Premise: there are easily learnable techniques to rapidly (and greatly) improve one’s memory. We’ve touched on some of these methods before at 10almonds, but being a newsletter rather than a book, we’ve not been able to go as deeply into it as Horsley!
Your memory is far, far, far more powerful than you might realize, and this book will help unlock that. To illustrate…
Some of the book is given over to what are for most purposes “party tricks”, such as remembering pi to 10,000 places. Those things are fun, even if not as practical in today’s world of rarely needing to even know the actual digits of a phone number. However, they do also serve as a good example of just how much of “super memory” isn’t a matter of hard work, so much as being better organized about it.
Most of the book is focused on practical methods to improve the useful aspects of memory—including common mistakes!
If the book has any flaw it’s that the first chapter or so is spent persuading the reader of things we presumably already believe, given that we bought the book. For example, that remembering things is a learnable skill and that memory is functionally limitless. However, we still advise to not skip those chapters as they do contain some useful reframes as well.
Bottom line: if you read this book you will be astonished by how much you just learned—because you’ll be able to recall whole sections in detail! And then you can go apply that whatever areas of your life you wanted to when you bought the book.
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ADHD For Smart Ass Women – by Tracy Otsuka
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We’ve reviewed books about ADHD in adults before, what makes this one different? It’s the wholly female focus. Which is not to say some things won’t apply to men too, they will.
But while most books assume a male default unless it’s “bikini zone” health issues, this one is written by a woman for women focusing on the (biological and social) differences in ADHD for us.
A strength of the book is that it neither seeks to:
- over-medicalize things in a way that any deviation from the norm is inherently bad and must be fixed, nor
- pretend that everything’s a bonus, that we are superpowered and beautiful and perfect and capable and have no faults that might ever need addressing actually
…instead, it gives a good explanation of the ins and outs of ADHD in women, the strengths and weaknesses that this brings, and good solid advice on how to play to the strengths and reduce (or at least work around) the weaknesses.
Bottom line: this book has been described as “ADHD 2.0 (a very popular book that we’ve reviewed previously), but for women”, and it deserves that.
Click here to check out ADHD for Smart Ass Women, and fall in love with your neurodivergent brain!
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Longans vs Lychees – Which is Healthier?
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Our Verdict
When comparing longans to lychees, we picked the lychees.
Why?
These two fruits are more closely related than they look from the outside, both being members of the soapberry family. However, there are some differences:
In terms of macros, longans have more protein while lychees have more carbs, and they are equal on fiber, giving longans the lower glycemic index. They’re both good, but longans nominally take the win on this one.
When it comes to vitamins, longans have more of vitamins B1, B2, and C, while lychees have more of vitamins B3, B6, B9, E, K, and choline, making for a respectable win for lychees in this category.
In the category of minerals, longans have more copper and potassium, while lychees have more calcium, iron, manganese phosphorus, and zinc. Thus, a win for lychees here too.
It’s worth looking at polyphenols too—lychees have around 10x more, which is notable.
Adding up the categories makes for an overall win for lychees, but by all means enjoy either or both! Diversity is good.
Want to learn more?
You might like to read:
Replacing Sugar: Top 10 Anti-Inflammatory Sweet Foods ← longans and lychees both make the list
Take care!
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