Study shows older men feel 'excluded, overlooked and cut-off'

by University of Bristol

Credit: CC0 Public Domain

With increasing numbers of older men experiencing loneliness, a new report published April 29 calls for a better understanding of how to tackle the growing public health challenge.

29 april 2019--A two-year study, led by the University of Bristol in collaboration with Age UK, highlights the issues faced by older men, many of whom describe feeling socially excluded, overlooked, cut-off and feeling 'left out of things'—all of which have a range of negative impacts on day-to-day life.

These feelings were triggered by a variety of life events, including loss of a partner, retirement or relocation.

To combat the problem, researchers at the University are calling for changes to the focus of adult social care services – urging for greater priority to be given to the running of groups rather than focusing primarily on care and support for individuals. There should also be more inclusive, tailored groups for older men in marginalised groups.

It follows a report from Age UK which shows the number of over 50s suffering from loneliness is set to reach two million by 2025/6 due to a rising number of older people. This compares to around 1.4 million in 2016/7 – a 49 per cent increase in 10 years.

Unfortunately, older men who live alone are more likely to be socially isolated than their female counterparts, having less regular contact with family and friends, and this can exacerbate feelings of loneliness.

The circumstances and experiences that increase the risk of loneliness and isolation appears to rise with age, and among those with long-term health problems and/or disability.

To date, little research has been undertaken into older men's experiences of loneliness and isolation. Researchers at the University of Bristol interviewed 111 men, aged between 65 and 95 and living in the West and South West of England, to identify new ways in which social care and voluntary services could help alleviate the problem.

There was generally a reluctance to speak to others and seek help, often due to a perception that people wouldn't be interested, or the potential stigma attached to loneliness. Men with adult children avoided speaking to their children as they didn't want to worry them, or it was not in keeping with their role as the father-type figurehead.

The report highlights the 'critical role' voluntary and independent services play in promoting social wellbeing and loneliness. However, those involved in leading and running these groups say funding cuts are placing a strain on resources and insufficient staff numbers.

A key finding, which researchers hope will influence policy makers, was that men valued mixed-age groups which mirror social interactions in everyday life, as opposed to groups specifically targeting older people. Equally, men valued groups that facilitated emotional and social ties with other men.

Dr. Paul Willis, from the University of Bristol's School for Policy Studies, led the research. He said: "For a growing number of people, particularly those in later life, loneliness can define their lives and have a significant impact on their wellbeing.

"Because loneliness occurs when people's ability to engage with others is inhibited, helping people cope with and overcome these feelings is vital.

"Our research has shown the importance of groups and networks in older men's lives, especially those run by voluntary and third sector organisations. Support for such groups needs to be given greater priority by local authorities, both in terms of support from social workers and long-term funding."

The project focused on older men from seldom-heard groups, including men who were single or living alone in rural and urban areas, men who were carers for loved ones, men living with hearing loss, and gay men who were single or living alone.

While loneliness and isolation impacted negatively on men's lives across the groups, there were important differences identified. For example, men with hearing loss were often isolated from family and friends in social gatherings and events because of their hearing loss and challenges in keeping up with conversations around them in noisy environments, such as pubs.

For older gay men, experiences of loneliness and isolation were entangled with earlier life-experiences of being reluctant to come out to others in fear of social censure or hostility from family or work colleagues.

For male carers, the companionship of the person they cared for routinely inhibited feelings of loneliness however the caring experience isolated them from others, such as diminished time spent with friends.

There are clear reasons behind the high numbers of lonely older people, according to Age UK. The risk of being lonely is dramatically higher among older people who have financial difficulties, are in poor health or have a disability, are carers or have recently been bereaved.

Loneliness occurs when people do not have someone to open up to and their ability to have meaningful conversations and interactions is inhibited.

Caroline Abrahams, Charity Director at Age UK, said: "This study helps further our understanding about how older men experience loneliness and how best to help.

"Loneliness is a problem among many older people, especially for those who are in poor health or have a disability, who are carers for loved ones, who have been bereaved, have financial difficulties or who don't have family and friends nearby.

"This study highlights specific issues and challenges for men, who can find it difficult to talk about feeling lonely.

"As more older men live longer we need to appreciate that the numbers who are chronically lonely are likely to increase too—unless we act which we can and we must do. The study also gives service providers, like Age UK, useful tips on how to help older men overcome loneliness, and things to consider when engaging with those from seldom-heard groups."

Based on this new research, Age UK has produced good practice guidance for service providers, tips for older men themselves and information for families or friends who are worried that an older man close to them might be lonely.

More information: Addressing older men's experiences of loneliness and social isolation in later life. www.bristol.ac.uk/policybristo … licy-briefings/omam/

Provided by University of Bristol 

Pain during sex? Incontinence or constipation? You might benefit from pelvic floor physiotherapy

by Claudia Brown, The Conversation

"How did I not know this was a pelvic floor issue? Why didn't my doctor send me here sooner? Do you have other patients with problems like mine?"

28 april 2019--As a physiotherapist, I hear these questions again and again, from people of all ages and genders, who are struggling with issues related to the urinary system, sexual function and the lower digestive tract.

Adrian is one example. A 35 year-old active cyclist and successful professional, he has a nagging pain in the private parts that just won't go away. It is interfering with his sporting activities and ruining his sex life. Pressure from the bicycle seat, the ambitious effort to cycle 100 kilometres in record time, and the stress from a crazy week at work have all resulted in pelvic floor muscle tension and chronic pelvic pain.

Then there's Lisa, a 63 year-old woman who is ready to become involved in a new relationship. In her search for a companion, she explores online dating and begins to realize that sex may be involved sooner than later. She worries that she may not be ready, physically, not having had sex for quite a few years, and wonders what she could do to improve her vaginal comfort and physical confidence.

These patients, and many others, did not know that a physiotherapist could help them. In my role as a clinician and as course co-ordinator for pelvic floor rehabilitation at McGill University's School of Physical and Occupational Therapy, I see a huge lack of awareness of the impact that physiotherapy can have on the lives of people suffering these very personal conditions.

From pain during sexual intercourse to urinary incontinence after surgery for prostate cancer, to anal incontinence after pregnancy, physiotherapy can help.

Pain during sexual intercourse

Up to 20 per cent of women have pain during sexual intercourse. This is a surprising statistic, especially when it predominantly includes active women in their twenties and thirties, who may believe that there is something psychologically wrong with them when all of the gynaecological tests come up negative.

Vestibulodynia, an invisible hypersensitivity at the entrance to the vagina, is considered the most common cause of sexual pain in pre-menopausal women. It can be treated in physiotherapy.

The pelvic floor muscles span the private area under the pelvis. They are responsible not only for helping to control the passage of urine, stool and gas, but also for allowing comfort and pleasure during sex.

These muscles also support the pelvic organs and help with balance and stability. It is important to be able to contract and to relax these muscles. Pelvic floor exercises train the muscles for the desired result, and are sometimes referred to as "targeted" Kegels.

In pelvic floor physiotherapy, patients learn exercises, and they may receive manual treatments, biofeedback and/or electrical stimulation. Biofeedback displays pelvic floor activity on a computer screen, making it easier to contract and relax muscles that are usually hidden from view. Electrical stimulation causes a pain-free muscle contraction, with the goal of improving the ability to contract and relax naturally.

Research supports the use of physiotherapy in the treatment of a variety of pelvic disorders. A team approach is ideal, and, depending upon the condition, may involve collaboration with general practitioners, urologists, gynaecologists, sex therapists and others.

Prostate, pregnancy and potty

After surgery for prostate cancer, up to 40 per cent of men experience problems with urinary incontinence. Pelvic floor physiotherapy teaches men different strategies to control leakage. Men can even consult prior to surgery, in order to prepare.

Women experience an array of pelvic floor issues during and after pregnancy. It is important to mention that many women who have had a third or fourth degree tear during delivery will experience issues with anal incontinence later in life.

Some countries systematically refer these patients for preventative physiotherapy and some centres in Canada are now beginning to follow suit.

More than 40 per cent of women also have issues with bladder control. Patients with stress urinary incontinence and those with an overactive bladder can experience significant improvement in physiotherapy.

Physiotherapy is considered first-line intervention for both types of incontinence by the International Continence Society, the Canadian Urological Association and the European Association of Urology.

Constipation is another issue that may be caused by the inability to relax the muscles of the pelvic floor and anal sphincter at the appropriate time. Physiotherapists can work to improve "defecation dynamics" and provide suggestions for lifestyle changes.

In children, constipation may lead to soiling or overflow incontinence. Children may also be seen for urinary disorders.

A co-ordinated physiotherapy plan

The internet has been instrumental in enabling patients to learn about embarrassing or taboo subjects in the privacy of their own homes, and has led many to seek out physiotherapy as a viable treatment option for pelvic conditions.

Patients consulting for pelvic floor issues learn how the bladder functions, how the pelvic floor muscles can be involved in constipation, what causes the muscles to be such culprits in pelvic pain and how new brain research supports a bio-psycho-social approach for the management of their problems. They find an ally in the physiotherapist, who supports them and directs them towards the improvement of their condition.

A step-by-step coordinated physiotherapy plan is a key element in the interdisciplinary management of patients with disorders related to the pelvic floor.

Provided by The Conversation 

Doctors face a dilemma when seeking mental health assistance for themselves

by Ellen Goldbaum, University at Buffalo

Credit: CC0 Public Domain

It's no secret that physicians have stressful jobs. Figuring out how to mitigate and deal with that stress can be a key part of a successful medical career. But while individual physicians seek and find help for their mental health issues privately, the prevailing public perception among physicians is that it just isn't done.

26 april 2019--Sourav Sengupta, a University at Buffalo faculty member, knows all about it. An assistant professor of psychiatry and pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB, who also treats patients, he reached a point a few years back where he knew that escalating professional and personal demands were impacting his effectiveness.

Last month, JAMA Network online published his essay, "Rebuilding more of me," about how he worked through his issues with the help of a therapist. He wasn't sure how it would be received, but in the few weeks since its publication, he has received personal email messages from dozens of physicians from across the U.S. who reached out to share perspectives and their experiences.

Since publication, Altmetric rated the essay in the top 5% of publications; it has been viewed more than 6,500 times and downloaded more than 500 times. Sengupta has received emails from physicians at every career stage, who tell him it was a relief to read it, to know that others have also gone through this and have succeeded.

'I am an attending physician in the field from which I seek support'

The essay describes the difficulty Sengupta felt in figuring out how to access the help he needed. "I am an attending physician in the field from which I need support," he wrote. "Many of the best clinicians and treatment setting are not options. I know them too well."

Once he found a psychotherapist he could work with confidentially, who wasn't a colleague, he began to open up. Sengupta wrote: "His willingness to acknowledge that clinical work is stressful and can become toxic establishes a life raft upon which I can hoist myself, build new strategies, and shape a different perspective."

That struggle is behind Sengupta now and he was ready to move on. Besides occasionally discussing his experience with others who might be going through something similar, he didn't consider sharing it more widely.

He changed his mind this past winter, when the Jacobs School held an event on National Physician Suicide Awareness Day. Faculty members who direct UB residencies decided to screen a provocative documentary called "Do No Harm: Exposing the Hippocratic Hoax." The movie and a panel discussion that followed took on the issue of physician mental health and suicide. Alarming statistics were discussed, for example, that among physicians ages 25 to 39, suicide accounts for 26% of deaths compared to 11% in the same age group in the general population.

The event struck a chord. More than 200 of UB's 800-plus medical residents and fellows attended. As Sengupta listened to the discussion that followed the screening, he realized he needed to share his story.

"One of the most distressing themes in the discussion afterwards was how scared or resistant or hesitant the trainees were about seeking any therapeutic support," he recalled. "I had the chance to share a little of my experience and a number of residents wondered aloud if it might be helpful for more attendings and medical education leaders to open up a bit more about these kinds of things.

"I wrote the essay for a very particular reason," he said. "There were hundreds of trainees in the room but the vibe around seeking support was quite negative. It wasn't that people thought physicians shouldn't get help, but that there were lots of factors that would probably keep them from seeking help, such as stigma, having enough time, concern for how it might impact their careers.

"I wrote the essay in the hope that I could convey to other physicians what actually happens when you work with a therapist, that it's a collaborative process that can lead to really positive outcomes."

Sengupta, who directs UB's child and adolescent psychiatry fellowship program, also has a close-up view of the difficulties that students and especially medical residents undergo.

"I do see them struggling sometimes," said Sengupta. "Medicine is such a challenging field to be in in this day and age. Trainees are such a critical part of the system and at the same time, they probably need far more support than they are getting. It can be a tough system to work in. You can lose track of what brought you into the field."

Self-stigmatization

Among the factors contributing to physicians' reluctance to seek help are the traits that led them to medicine in the first place, Sengupta said.

"Who is the type of person that ends up wanting to be a physician and then succeeding?" Sengupta asked. "We are pretty intelligent and we're hard-working but we are probably not talking about the struggles we're having. We're internalizers."

At the same time, the nature of medical training itself also contributes. "The training values toughness and grit and perseverance. That shouldn't be to the exclusion of getting help and support but somehow it can be translated into that. Taking care of oneself can seem to represent weakness or incompetence. Sometimes it's the message that is given or sometimes it's a message that trainees perceive.

"Doctors are supposed to be larger than life figures, take in everything, be wise and be helpful," he continued. "We do a really good job of stigmatizing ourselves. When really, getting support when needed could help us get back on track to finding meaning in helping others."

He knows, however, that the challenges to changing the culture are significant. For one thing, he said, trying to find someone who can help is complicated and sensitive. "How interesting would it be if we created some sort of way for physicians who are struggling to communicate with each other… a support group of sorts?"

In the essay, he describes how he shared his experience with his trainees; it came up in the context of a broader conversation about self-care. Afterward, he noticed a change in the way they interacted with him. "I sense a subtle shift in the way some of them approach me. A bit more willing to discuss challenges and vulnerabilities. More open to reflection and self-improvement. A few clinicians even ask for help in finding therapists for themselves, allowing me to transform my process of seeking help into a way to help others."

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More information: Sourav Sengupta. Rebuilding More of Me, JAMA (2019). DOI: 10.1001/jama.2019.2137

Journal information: Journal of the American Medical Association 

Provided by University at Buffalo 

When psychiatric medications are abruptly discontinued, withdrawal symptoms may be mistaken for relapse

by Stan Paul, University of California, Los Angeles

Credit: CC0 Public Domain

Withdrawal symptoms following the practice of discontinuation, or abruptly "coming off," of psychiatric drugs in randomized clinical trials may be mistaken for relapse and bolster the case for continued use of medication, according to two new studies by UCLA researchers published in the journal Psychotherapy and Psychosomatics.

25 april 2019--Principal investigator David Cohen, professor of social welfare in the UCLA Luskin School of Public Affairs, said that clinical trialsemploying a drug discontinuation procedure had not previously been studied systematically.

"For years, observers have asked whether people getting more symptoms when they came off their medication was their disorder returning or the withdrawal effects from drugs that could be reduced by more gradual, patient-centered discontinuation," Cohen said.

In light of the difficulties that people have in discontinuing psychiatric medications, Cohen sought to answer that question, joined by co-author Alexander Récalt, a doctoral student in social welfare at UCLA Luskin who is also pursuing a master's degree at the UCLA Fielding School of Public Health.

They looked at how and why antidepressants, antipsychotics and stimulants were deliberately discontinued from trial subjects in more than 80 randomized controlled trials from 2000–2017. The study also included benzodiazepines, a class of drugs such as Valium, upon which long-term users may become dependent and experience withdrawal symptoms.

In the first study, the researchers found:

• In 67 percent of studies, no justification was given for a particular discontinuation strategy, which was abrupt or lasted less than two weeks in most cases (60 percent).
• In 44 percent of studies that related to antidepressants, stimulants and antipsychotics, researchers used mainly abrupt discontinuation to test whether the drugs prevented relapse. Yet, researchers in most studies did not indicate that misclassifying a withdrawal reaction could occur.
• Most studies incorporating benzodiazepines used discontinuation differently. These studies recognized that withdrawal symptoms were common, and they employed longer drug-tapering periods (more than eight weeks in most cases) to help people successfully come off and stay off these drugs.

The pharmaceutical industry was involved in 70 percent of the 80 studies; in most of the relapse-prevention studies; but in few of the benzodiazepines studies with longer tapering periods, according to the researchers. Cohen, who also serves as associate dean for research and faculty development at UCLA Luskin, observed across the 80 studies that, in addition to testing relapse prevention, drug discontinuation was employed to chart withdrawal effects and to compare different methods of managing older and frail residents in institutions, given the known damaging effects of drugs taken over the long term.

But only a single study out of the 80 actually employed the discontinuation procedure in order to distinguish clearly between "relapse" and "withdrawal symptoms," the researchers noted.

"This suggests to us that sponsors or researchers of discontinuation studies are really uninterested in exploring this crucial question," Cohen said.

"Distinguishing between them requires careful history taking, an open mindset from the clinician and a degree of suspicion that the discontinuation process itself may be contributing."

In many first-person accounts, patients have complained that they were not warned about these effects or told how slowly they should come off, Cohen said. Instead, their prescriber told them that the effects confirmed that the patients were better off taking the medication and therefore should continue to take it.

"The disconnect continues to drive a wedge between patients and their prescribers and is increasingly discussed in the media, as about one in six adult Americans take—increasingly for years—psychiatric drugs," Cohen said.

"Our findings, if confirmed by other researchers looking at this literature, contribute to helping decide whether industry-funded drug trials in psychiatry are—as critics have maintained for years—infomercials for drugs or credible scientific investigations," he said.

In their second study, Cohen and Récalt focused on whether they could detect evidence in the relapse-prevention randomized control trials that an actual misclassification—a confound—of relapse with withdrawal was occurring.

"Most publications do not raise the issue openly, so they do not provide the data to examine this issue directly," said Cohen, explaining that an indirect method to test their hunch was used. Because withdrawal symptoms are known to begin to occur within an interval of time after drug discontinuation, the researchers focused on the timing of symptoms for drug-continued vs. drug-discontinued participants. They looked for evidence that end-of-study symptoms might already have been present during the study at set discontinuation times. A 50 percent rate of occurrence was chosen to indicate a substantial, non-trivial possible misclassification, Cohen said.

Few studies provided the data to actually test the hypothesis, even indirectly. Among the 14 studies that did provide the necessary data, about three-quarters showed evidence that withdrawal may be mistaken for relapse.

Relapse prevention trials that use psychiatric drug discontinuation commonly conclude that drugs work because they help prevent relapse, Cohen pointed out.

In line with a stream of previous warnings in the literature, the two studies show that more justifications are needed for why and how these discontinuation trials are conducted. Clinicians and consumers should not accept conventional interpretations of what is actually occurring to deliberately drug-discontinued participants in the trials, Cohen said, "and what this could mean for long-term use of psychiatric medications by ordinary people around the world."

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More information: David Cohen et al. Discontinuing Psychotropic Drugs from Participants in Randomized Controlled Trials: A Systematic Review, Psychotherapy and Psychosomatics (2019). DOI: 10.1159/000496733

Alexander M. Récalt et al. Withdrawal Confounding in Randomized Controlled Trials of Antipsychotic, Antidepressant, and Stimulant Drugs, 2000–2017, Psychotherapy and Psychosomatics (2019). DOI: 10.1159/000496734

Journal information: Psychotherapy and Psychosomatics 

Provided by University of California, Los Angeles 

High-dose, immune-boosting or four-strain? A guide to flu vaccines for over-65s

by Allen Cheng And Christopher Blyth, The Conversation

There are three types of flu vaccine available in Australia. Credit: Image Point Fr/Shutterstock

Flu vaccines work by exposing the body to a component of the virus so it can "practise" fighting it off, without risking infection. The immune system can then mount a more rapid and effective response when faced with a "real" virus.

22 april 2019--Three types of influenza vaccines are available in Australia:

• "standard" vaccines that contains four different strains of influenza
• a "high-dose" vaccine (Fluzone High Dose) that contains three strains of influenza at a higher dose than standard vaccines
• an "adjuvanted" vaccine (Fluad) that contains the standard dose of three strains of influenza, along with MF59, an immune stimulant designed to encourage a stronger immune response to the vaccine.

The high-dose and adjuvanted vaccines are designed for use only in people aged 65 and over because they can stimulate a better immune response than the standard vaccine. Standard vaccines should be used those younger than 65 years.

This year, the Australian government is offering the adjuvanted vaccine for free for over-65s. The standard vaccine is available for free for some groups under 65 under national and state programs. The high-dose vaccine will only be available to buy through pharmacies and general practices on prescription.

Is the high-dose vaccine better?

Clinical trials have compared the high-dose vaccine with older forms of the standard vaccine that contained three strains.

One US study in over-65s found 1.4% of recipients who were given the high-dose vaccine were diagnosed with influenza, compared with 1.9% of those who received the standard vaccine.

Subsequent studies also found people who got the high-dose vaccine were less likely to be hospitalised with influenza-related complications. A similar trial in nursing home residents also found a reduced risk of hospitalisation.

Although clinical trials are generally regarded as the gold standard when testing vaccines, it's also important to consider data from other studies, where different flu strains circulate and where the vaccine may be used in groups that were excluded from clinical trials.

These studies have generally found that the high-dose vaccine is better than the standard vaccine. However, some studies have shown a lesser degree of benefit.

What about the adjuvanted vaccine?

Clinical trials have not been designed to show the different rates of flu infection after taking the adjuvanted vaccine compared with the standard vaccine. But studies have examined the effectiveness of this vaccine in preventing hospitalisations with influenza.

One trial found a small decrease in influenza infection in people who had been given adjuvanted vaccine, compared with standard vaccine, but this difference was not statistically significant.

A flu vaccination doesn’t completely eliminate the risk of getting the flu, but it’s likely to make the illness less severe. Credit: shutterstock.com

Another recent trial has been performed in nursing home residents. Preliminary results suggest a very small reduction in hospitalisations compared with those who took the standard vaccine.

Despite a lack of clinical trial data, several observational studies have found getting the adjuvanated vaccine means you're less likely to be hospitalised with influenza than if you receive the standard vaccine.

As with the studies of the high-dose vaccine, the estimated degree of protection varies between studies, reflecting differences in circulating strains, study types, and populations.

Which is better?

There is not yet sufficient data to know whether one enhanced vaccine is better than the other.

One observational study suggests the high-dose vaccine is more effective than the adjuvanted vaccine at preventing hospital admissions with influenza. But this study was not designed to address this question specifically, and the differences observed were small.

Both enhanced vaccines are safe. Although a higher proportion of patients who receive enhanced vaccines report a sore arm, compared to those who receive the standard vaccine, this is generally mild and rarely requires medical attention.

Immunisation expert groups in Australia, the United States, Canada and the United Kingdom have not recommended either enhanced vaccine over the other.

Can you get two for better coverage?

The currently available enhanced vaccines protect against three flu strains, whereas the standard vaccine protects against four.

But for most people, there is no evidence that receiving multiple doses of different vaccines in any one year is any better than getting a single dose of vaccine.

In theory, the four-strain vaccines protect against one more strain than the enhanced three-strain vaccines. But in most seasons, few infections are caused by the fourth strain.

There are some specific groups of people for whom two doses may be recommended, including young children receiving the vaccine for the first time, and some people with bone marrow or organ transplants. Seek advice from your doctor if this describes you or your children's situation.

It's important to note that none of the standard or enhanced flu vaccines are completely protective; they reduce, but don't completely eliminate, the risk of getting influenza.

A single dose of any influenza vaccine in each season is the most effective strategy to reduce your chance of getting influenza.

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Provided by The Conversation 

Dementia more preventable in Asia and Latin America

by University College London

Credit: CC0 Public Domain

Close to one in two cases of dementia could be preventable in low- to middle-income countries, finds a new UCL study.

16 april 2019--The findings, published in The Lancet Global Health, found how improving childhood education and other health outcomesthroughout life could reduce the risk of dementia."After our previous research finding that one in three cases of dementia could be preventable, we realised that the evidence was skewed towards higher-income countries," said the study's lead author, Dr. Naaheed Mukadam (UCL Psychiatry).

"We have now found that in low- to middle-income countries in Asia and Latin America, dementia may be even more preventable than it is in more wealthy countries. If life-course risk factors such as low levels of education in early life and hearing loss, obesity and low physical activity in mid-life to old age are addressed, these countries could see large improvements in their dementia rates."

While the number of people with dementia is increasing globally, particularly in low- to middle-income countries, there have been modest reductions in age-specific dementia rates in many high-income countries over the last two decades. The researchers say this could be due to improvements in health outcomes throughout life that affect dementia risk.

The research team built on their previous work for the Lancet Commission on dementia prevention, intervention, and care, published in 2017, which found that 35% of dementia is attributable to nine risk factors: low levels of childhood education, hearing loss, smoking, hypertension, obesity, physical inactivity, social isolation, depression, and diabetes.

To understand whether the commission's findings would apply equally to global regions that were underrepresented in the report, a team of UCL researchers sought out data from China, India and Latin America. They drew from the research collective 10/66 Dementia Research Group's data, which used similar methodology to gauge prevalence of the nine risk factors in those countries, with sample sizes of 1,000 to 3,000 in each country.

The researchers found even more potential for preventing dementia across the globe, as the proportion of dementia linked to the nine modifiable risk factors was 40% in China, 41% in India and 56% in Latin America.

A major factor in that difference is the lower levels of educational attainment in low- to middle-income countries, which the researchers say signals hope for the future, as education levels rise.

"People growing up in Asia and Latin America today are more likely to have completed schooling than their parents and grandparents were, meaning they should be less at risk of dementia later in life than people who are already over 65. Continuing to improve access to education could reap great benefits for dementia rates in years to come," Dr. Mukadam said.

On the other hand, social isolation is a major risk factor of dementia in higher income countries, but much less so in China and Latin America. The researchers say that public health officials in countries such as the UK could learn from China and Latin America in efforts to build more connected communities to buffer against the dementia risk tied to social isolation.

Obesity and hearing loss in mid-life, and physical activity in later life, were also strongly linked to dementia risk in the study area, as well as mid-life hypertension in China and Latin America and smoking in later-life in India.

"Reducing the prevalence of all of these risk factors clearly has numerous health benefits, so here we've identified an added incentive to support public health interventions that could also reduce dementia rates. The growing global health burden of dementia is an urgent priority, so anything that could reduce dementia risk could have immense social and economic benefit," Dr. Mukadam said.

Senior author Professor Gill Livingston (UCL Psychiatry) added: "A lot of the findings of health and medical research derive primarily from higher income countries such as in Western Europe and North America, so ensuring that research is inclusive is vital to the development of global public health strategies."

"While we don't expect these risk factors to be eliminated entirely, even modest improvements could have immense impact on dementia rates. Delaying the onset of dementia by just five years would halve its prevalence," she said.

Provided by University College London 

Electric bikes can boost older people's mental performance and their well-being

by Louise-Ann Leyland, Ben Spencer, Carien Van Reekum And Tim Jones, The Conversation

Credit: shutterstock

Getting on your bicycle can give you an enormous sense of freedom and enjoyment. It can increase your independence and knowledge of the local area, and improve your access to the natural (or urban) environment. It can also be highly nostalgic – reminding you of your childhood cycle rides and the joy of being young.

14 april 2019--But beyond the feel-good factor, can cycling actually make any difference to mental abilities and well-being? This was something our new study aimed to investigate – specifically looking at cycling among older adults.

While most studies incorporate exercise in a gym situation, our study wanted to examine the impact of cycling in the real world – outside a controlled environment. So older adults, aged 50 and above, were asked to cycle for at least an hour and a half each week for an eight-week period.

Participants either cycled on a conventional pedal bike, on an electrically assisted "e-bike" or were instructed to maintain their regular non-cycling exercise routine as a comparison group. Mental abilities, mental health and well-being were measured before and after the eight-week cycling period.

Mental boost

Exercise is thought to improve mental functioning through increased blood flow to the brain – as well as encouraging regrowth of cells, specifically in the hippocampus. This is known to be an area associated with memory. So it was expected that the greater physical exertion required for pedal cycling, compared to cycling an e-bike with a motor, would result in greater benefits to mental functioning.

Having a bike can open up new places of adventure. Credit: Shutterstock

One of the tasks we used to measure mental ability is the "Stroop test". The task involves participants being shown the name of a colour printed on a card in a different colour script – imagine the word "blue" printed in red ink. Participants are asked to saying the colour of the ink that the word is printed in, rather than reading the name of the colour. The Stroop test measures how accurately someone is able to minimise distraction from the written word when reporting the ink colour.

We found that after eight weeks of cycling, both pedal and e-bike cycling groups were better at ignoring the written word, indicating that their mental function had improved. This was not the case for non-cycling control participants.

Pedal power

Aside from the benefits found to some mental abilities, we also saw a trend for mental health improving for the e-bike cyclists, but pedal cyclists did not change on this measure. This could be because e-bikes may be more enjoyable and easier to ride than normal pedal bikes – helping to improve mental well-being.

We also found e-bike cyclists spent more time cycling on average each week than the pedal cyclists. Many of the participants commented that they felt they could go further on the e-bike as they could rely on the motor to get them home if they could not manage it by themselves.

This research, to some extent, provides support for many bike-related motivation quotes, including the following from Sir Arthur Conan Doyle: "When the spirits are low, when the day appears dark, when work becomes monotonous, when hope hardly seems worth having, just mount a bicycle and go out for a spin down the road, without thought on anything but the ride you are taking."

It seems then that e-bikes have the potential to re-engage older adults with cyclingand provide a great opportunity to increase physical activity and engagement with the outdoor environment. So given that more than three million older people in the UK live alone, of whom more than two million are older than 75, it might just be that the use of an electric bicycle could help to improve older people's lives by increasing independence and mobility – all of which can have a significant impact on their well-being.

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Provided by The Conversation 

Is 75 the new 65? Wealthy countries need to rethink what it means to be old

by Warren Sanderson And Sergei Scherbov, The Conversation

Living longer and loving it. Credit: oneinchpunch/shutterstock.com

In 1950, men and women at age 65 could expect to live about 11 years more on average.

12 april 2019--Today, that number has gone up to 17, and the United Nations forecasts that it will increase by about five more years by the end of the century.

One consequence of the increase in life expectancy is that the proportion of the population above age 65 has increased, too. In policy analyses and in the media, increases in these proportions are frequently taken to mean that the population will keep getting older. This is often interpreted as warning of a forthcoming crisis.

As researchers who study aging, we believe that it's better to think about older people not in terms of their chronological ages, but in terms of their remaining life expectancy.

In our study, published on Feb. 26, we explored the implications of this alternative view for assessing the likely future of population aging. We found that, using this new perspective, population aging in high-income countries will likely come to an end shortly after the middle of the century.

Age inflation

Sixty-five-year-olds today are not like 65-year-olds in 1900. Today's older people on average live longer, are healthier and score higher on cognitive tests.

There are two different ways that demographers can think about older people. They can define older people by the number of years they've already lived, or they can define older people based on how many more years they are expected to live. In our research, we subscribe to the second view.

Credit: The Conversation

We think about aging the way economists think about price inflation. Say US$75 today would buy the same amount as $65 in the past. In essence, $75 is the new $65, because $75 today and $65 in the past had the same purchasing power.

When we say that 75 is the new 65, we mean something similar – that 75-year-olds now have the same remaining life expectancy as 65-year-olds in the past. Adjusting age for changes in remaining life expectancy is called adjustment for "age inflation." It's just like adjusting the value of the dollar for changes in purchasing power.

Measuring future aging

In our study, we explored the future of population aging, measured with and without age inflation.

We wanted to understand whether population aging will come to an end in the foreseeable future, particularly in wealthier countries, where public concern about population aging is most acute. We looked at countries with a gross national income per capita at or above $4,000, including Barbados, Croatia, the U.S., China, Russia and South Africa.

Using the U.N.'s forecasts of population sizes and age structures, a computer program generated 1,000 random possible future populations for these countries.

We computed the likelihood that population aging would come to an end this century using two measures. First, we looked at the proportion of the the population above a certain age. The unadjusted measures uses a cutoff of 65. The adjusted measure uses an age that changes from year to year based on a remaining life expectancy of 15 years.

Second, we looked at the median age of the population: the age that divides the population into two equally sized groups.

Credit: The Conversation

We found that, when unadjusted measures are used, population aging generally continues through the end of the century. But, when adjusted measures are used, population aging generally comes to an end well before the end of the century.

When exactly will population aging end? It depends on whether you're looking at the adjusted proportion of people who are counted as old is used or the adjusted median age. By the second measure, in over 95% of our 1,000 simulated futures, populations stopped growing older by 2050.

Two views of aging and public policy

In 1950, the average monthly U.S. Social Security benefit was $29.

The people of 1950 could have envisioned two scenarios for future Social Security payments. In one future, the average monthly Social Security benefit would have stayed unadjusted for expected wage and price increases. In that scenario, the average monthly benefit would still be $29. In the second, Social Security benefits would be adjusted for expected wage increases and inflation.

Of course, although it is possible, no one would ever forecast future Social Security payments assuming a fixed dollar monthly payment. It's too unrealistic. Forecasts are always made using adjusted benefit levels.

In demography, however, forecasts of population aging are still often made on the basis of ages unadjusted for life expectancy change. We believe these are equally unrealistic.

For example, today in the U.S., people are not allowed to contribute to certain retirement savings plans after age 70 and a half. As life expectancy increases, an increasing proportion of the population may wish to continue contributing to their saving plans after age 70 and a half but be unable to do so.

As people continue to live longer, governments will need to rethink similar policies around health care, employment and more. Eventually, as conditions change, we worry that policies based on fixed chronological ages will become as dysfunctional as a $29 monthly Social Security benefit would be today.

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Provided by The Conversation