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How long will you live? New evidence says it’s much more about your choices than your genes

<div class="theconversation-article-body"> One of the most enduring questions humans have is how long we’re going to live. With this comes the question of how much of our lifespan is shaped by our environment and choices, and how much is predetermined by our genes. A study recently published in the prestigious journal <a href="https://www.nature.com/articles/s41591-024-03483-9">Nature Medicine</a> has attempted for the first time to quantify the relative contributions of our environment and lifestyle versus our genetics in how we age and how long we live. The findings were striking, suggesting our environment and lifestyle play a much greater role than our genes in determining our longevity. <h2>What the researchers did</h2> This study used data from the <a href="https://www.ukbiobank.ac.uk/">UK Biobank</a>, a large database in the United Kingdom that contains in-depth health and lifestyle data from roughly 500,000 people. The data available include genetic information, medical records, imaging and information about lifestyle. A separate part of the study used data from a subset of more than 45,000 participants whose blood samples underwent something called “<a href="https://www.nature.com/articles/s41576-022-00511-7">proteomic profiling</a>”. Proteomic profiling is a relatively new technique that looks at how proteins in the body change over time to identify a person’s age at a molecular level. By using this method researchers were able to estimate how quickly an individual’s body was actually ageing. This is called their biological age, as opposed to their chronological age (or years lived). The researchers assessed 164 environmental exposures as well as participants’ genetic markers for disease. Environmental exposures included lifestyle choices (for example, smoking, physical activity), social factors (for example, living conditions, household income, employment status) and early life factors, such as body weight in childhood. They then looked for associations between genetics and environment and 22 major age-related diseases (such as coronary artery disease and type 2 diabetes), mortality and biological ageing (as determined by the proteomic profiling). These analyses allowed the researchers to estimate the relative contributions of environmental factors and genetics to ageing and dying prematurely. <h2>What did they find?</h2> When it came to disease-related mortality, as we would expect, age and sex explained a significant amount (about half) of the variation in how long people lived. The key finding, however, was environmental factors collectively accounted for around 17% of the variation in lifespan, while genetic factors contributed less than 2%. This finding comes down very clearly on the nurture side in the “nature versus nurture” debate. It suggests environmental factors influence health and longevity to a far greater extent than genetics. Not unexpectedly, the study showed a different mix of environmental and genetic influences for different diseases. Environmental factors had the greatest impact on lung, heart and liver disease, while genetics played the biggest role in determining a person’s risk of breast, ovarian and prostate cancers, and dementia. The environmental factors that had the most influence on earlier death and biological ageing included smoking, socioeconomic status, physical activity levels and living conditions. Interestingly, being taller at age ten was found to be associated with a shorter lifespan. Although this may seem surprising, and the reasons are not entirely clear, this aligns with <a href="https://www.sciencedaily.com/releases/2014/05/140509110756.htm">previous research</a> finding taller people are more likely to die earlier. Carrying more weight at age ten and maternal smoking (if your mother smoked in late pregnancy or when you were a newborn) were also found to shorten lifespan. Probably the most surprising finding in this study was a lack of association between diet and markers of biological ageing, as determined by the proteomic profiling. This flies in the face of the extensive body of evidence showing the crucial role of <a href="https://www.nature.com/articles/s43016-023-00868-w">dietary patterns</a> in chronic disease risk and longevity. But there are a number of plausible explanations for this. The first could be a lack of statistical power in the part of the study looking at biological ageing. That is, the number of people studied may have been too small to allow the researchers to see the true impact of diet on ageing. Second, the dietary data in this study, which was self-reported and only measured at one time point, is likely to have been of relatively poor quality, limiting the researchers’ ability to see associations. And third, as the relationship between diet and longevity is likely to be complex, disentangling dietary effects from other lifestyle factors may be difficult. So despite this finding, it’s still safe to say the food we eat is one of the most important pillars of health and longevity. <h2>What other limitations do we need to consider?</h2> Key exposures (such as diet) in this study were only measured at a single point in time, and not tracked over time, introducing potential errors into the results. Also, as this was an observational study, we can’t assume associations found represent causal relationships. For example, just because living with a partner correlated with a longer lifespan, it doesn’t mean this caused a person to live longer. There may be other factors which explain this association. Finally, it’s possible this study may have underestimated the role of genetics in longevity. It’s important to recognise genetics and environment don’t operate in isolation. Rather, health outcomes are shaped by their interplay, and this study may not have fully captured the complexity of these interactions. <h2>The future is (largely) in your hands</h2> It’s worth noting there were a number of factors such as household income, home ownership and employment status associated with diseases of ageing in this study that are not necessarily within a person’s control. This highlights the crucial role of addressing the social determinants of health to ensure everyone has the best possible chance of living a long and healthy life. At the same time, the results offer an empowering message that longevity is largely shaped by the choices we make. This is great news, unless you have good genes and were hoping they would do the heavy lifting. Ultimately, the results of this study reinforce the notion that while we may inherit certain genetic risks, how we eat, move and engage with the world seems to be more important in determining how healthy we are and how long we live.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/251054/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/hassan-vally-202904">Hassan Vally</a>, Associate Professor, Epidemiology, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-long-will-you-live-new-evidence-says-its-much-more-about-your-choices-than-your-genes-251054">original article</a>. Image: Shutterstock </div>

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Bruce Willis' wife issues amazing reflection on Gene Hackman's passing

As Bruce Willis continues to live with frontotemporal dementia, his wife, Emma Heming Willis, has emerged as a vocal advocate for those who support loved ones with long-term care needs. This week, she reflected on the tragic <a href="https://www.oversixty.com.au/health/caring/gene-hackman-s-cause-of-death-revealed" target="_blank" rel="noopener">deaths of legendary actor Gene Hackman and his wife</a> and caregiver, Betsy Arakawa, in a heartfelt video shared on Instagram. "So this is not something I would normally comment on, but I do really believe that there is some learning in this story," Heming Willis said of Hackman and Arakawa. The couple was found dead in their New Mexico home in late February. According to the New Mexico medical investigator’s office, Arakawa, 65, succumbed to hantavirus, a rare and often fatal disease, while Hackman, 95, passed away days later due to heart disease. Authorities revealed that Hackman had been living with Alzheimer’s disease and may not have realised he was alone after his wife's passing. Heming Willis used the heartbreaking story to highlight a crucial issue: the well-being of caregivers themselves. "It's just made me think of this broader story, and that is that caregivers need care too and that they are vital, and that it is so important that we show up for them so that they can continue to show up for their person," she stated. She further addressed a common misconception about caregivers, saying that many assume they "have it all figured out". "They've got it covered, they're good," she said before clarifying, "I don't subscribe to that. We need to be showing up for them so they can continue to show up for their person." In the caption of her video, Heming Willis reinforced her message: "Caregivers need care too. Period. Full stop. #supportcaregivers." The flood of responses to her post was immediate and heartfelt, as fans and followers shared their experiences for caring for loved ones. "I had the same terrified reaction to Gene Hackman," wrote one reader. "What must he have suffered those last days? And his wife? It’s unfathomable. My father was a dedicated caregiver to my mom. Realising that dementia takes every ounce of patience and energy, my two sisters and I were honoured to take one full day each per week (in addition to afternoon nurses two alternate days) to support my dad’s decision to keep mama at home. She’s been gone three years now and I have never once regretted those special Fridays with her. Your message is so very important." "I’m so glad you said this," wrote another reader. "Because that’s exactly what I was thinking when this happened that his wife was so devoted to him that she didn’t take care of herself and this happens a lot with women a lot! She didn’t have any children, but I’m amazed that no friends checked in on her." Heming Willis speaks from personal experience, having taken on the role of primary caregiver for her husband since his diagnosis. It was announced in 2022 that Bruce Willis would step away from his acting career due to cognitive issues, <a href="https://www.oversixty.com.au/health/caring/cruel-disease-bruce-willis-given-heartbreaking-new-diagnosis" target="_blank" rel="noopener">which were later identified as frontotemporal dementia</a> (FTD), a progressive brain disorder. The couple, who married in 2009, share two daughters, Mabel and Evelyn. Through her platform, Heming Willis remains committed to raising awareness and fostering support for those navigating the complexities of long-term care. Images: Instagram

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Gene Hackman's cause of death revealed

The cause of death of legendary actor Gene Hackman, 95, and his wife Betsy Arakawa, 65, has finally been confirmed, more than a week after they were <a href="https://www.oversixty.com.au/health/caring/sad-new-details-emerge-in-gene-hackman-case" target="_blank" rel="noopener">discovered in their Santa Fe home</a>. The couple was found deceased in their residence on February 26, prompting an investigation by authorities. Dr Heather Jarrell, Chief Medical Examiner for New Mexico, disclosed at a press conference that Hackman succumbed to cardiovascular disease, with advanced Alzheimer’s disease being a significant contributing factor. His wife, Betsy Arakawa, died around seven days earlier from hantavirus pulmonary syndrome, a rare infectious disease contracted through exposure to rodents and their excrement. Authorities found evidence of rodent intrusion in the couple’s home, believed to be the source of Arakawa’s infection. Based on her movements and email communications, Dr Jarrell determined that Arakawa likely passed away on February 11, while Hackman is believed to have died on February 18. Santa Fe County Sheriff Adan Mendoza confirmed that Hackman was likely at home with his deceased wife for seven days before his own death. Dr Jarrell noted that Hackman was in "very poor health", and it was unclear how he managed in his final days without his wife's assistance. Given his advanced Alzheimer’s, Jarrell suggested that it was possible he was unaware that his wife had passed away. “There was no food in his stomach, which means he had not eaten recently, but he had no evidence of dehydration,” she stated. Hantavirus pulmonary syndrome is a severe and often fatal respiratory disease. According to the Mayo Clinic, it begins with flu-like symptoms and rapidly progresses to serious lung and heart complications. The best prevention is avoiding contact with rodents and properly managing rodent-prone areas. Dr Jarrell’s findings confirmed that Hackman had severe heart disease, with evidence of multiple prior heart attacks and chronic high blood pressure. A full-body post-mortem examination showed no signs of trauma. He tested negative for COVID-19, influenza and other respiratory illnesses, as well as hantavirus and carbon monoxide poisoning. Similarly, Arakawa’s autopsy revealed no external or internal trauma. Laboratory tests confirmed the presence of hantavirus, ruling it as the cause of her death. Other tests for respiratory viruses and toxins returned negative results. Dr Jarrell said that there were “no other significant natural disease findings” in either case, and that all medications found in the home were taken as prescribed and did not contribute to their deaths. The tragic passing of Gene Hackman and Betsy Arakawa marks the end of an era for Hollywood, with fans mourning the loss of the two-time Academy Award-winning actor. Hackman, known for his roles in The French Connection, Unforgiven and The Royal Tenenbaums, retired from acting in 2004. The couple had been residing in Santa Fe for many years, enjoying a quiet life away from the public eye. Image: Instagram

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Experts debunk dominant theory in Hackman deaths

It's been a week since acting legend Gene Hackman and his wife Betsy were both <a href="https://www.oversixty.com.au/health/caring/sad-new-details-emerge-in-gene-hackman-case" target="_blank" rel="noopener">found dead</a> in their Santa Fe home. Gene, 95, was found dead in the home's mudroom, with his cane nearby, while his 65-year-old wife was found in the bathroom, near an open bottle of prescription pills. Preliminary autopsies have ruled out carbon monoxide poisoning as a cause of death, and Santa Fe Sheriff Adan Mendoza confirmed the actor had likely died about nine days before the bodies were discovered. While there's been speculation that the death could have been a "companion suicide", experts have casted their doubts on this theory. James Gill, Chief Medical Examiner with the Connecticut Office of the Chief Medical Examiner, told <a href="https://people.com/gene-hackman-wife-betsy-suicide-less-likely-says-expert-exclusive-11690593" target="_blank" rel="noopener">People </a>that it is unlikely the couple decided to end their lives together, as their bodies were found in different locations. While he is not working on the case, he offered his expert opinion, saying: “I’ve seen cases like that — usually they’re together in bed,” “The fact that they’re in two separate locations tells me that I think that’s less likely.” One of the couple's three dogs was also found dead inside the home, adding to the mystery. “From the initial kind of circumstances, it seems like he may have collapsed — he’s got a history of heart disease. He’s got a pacemaker. So that would not be unusual,” Gill told People. He also ruled out the theory that he had died after Betty because she was not around to take care of him. “Sometimes we’ll see instances where someone is bedridden and maybe they have dementia and then their caregiver dies from a natural event, and then there’s no one there to take care of them, and then they can die from dehydration or what have you. I don’t think that’s the case in this,” he said. Forensic pathologist Dr. Michael Baden believes that the couple's death could be the result of a tragic accident, suggesting that Hackman's pacemaker could provide clues as to what happened. “That event would have been a cardiac arrest caused by an abnormal pulse rate,” he said. “The pacemaker keeps track of the pulse, and when it gets down too low, it discharges. And that’s all in the record.” “So the autopsy showed he didn’t have any injury,” Baden continued. “There was no carbon monoxide. And he had — the most common cause of death in this country — severe heart disease, coronary artery disease and high blood pressure perhaps, from what’s been released. So that would cause him, having cardiac arrest in the mudroom, to collapse right there.” Dr. Baden suggested that Hackman's wife Betsy could have died while trying to help him. “She may have struck her head on the way down and had some internal injury to the brain that doesn’t show up on the outside or bleeding in the inside of the brain,” he said. “Or that she may also, at 65, had severe heart disease and excitement can cause a trigger to the cardiac rhythm causing death under those circumstances. I think the first, that striking her head would be more common.” A criminal investigation was launched this week after New Mexico authorities deemed the circumstances around the couple’s deaths “suspicious.” Image: Dave Lewis/ Shutterstock Editorial <p style="box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; color: #212529; font-family: -apple-system, 'system-ui', 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 16px; background-color: #ffffff;">Need to talk to someone? Don't go it alone. <p style="box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; color: #212529; font-family: -apple-system, 'system-ui', 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 16px; background-color: #ffffff;">Call Lifeline on 13 11 14 or visit lifeline.org.au <p style="box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; color: #212529; font-family: -apple-system, 'system-ui', 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 16px; background-color: #ffffff;">Beyond Blue: 1300 224 636 <p style="box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; color: #212529; font-family: -apple-system, 'system-ui', 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji'; font-size: 16px; background-color: #ffffff;">SANE: 1800 187 263; saneforums.org

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Sad new details emerge in Gene Hackman case

Authorities in New Mexico have shared a grim new update on the shocking deaths of Gene Hackman and his wife. New information has suggested that the Hollywood actor, 95, and his wife, 63, had passed away in their home nine days before their bodies were found. The bodies of the deceased couple, who were married for 24 years, were found by a maintenance worker who spotted their bodies through a window. Authorities are yet to determine a cause of death for both Hackman and Arakawa but have repeatedly ruled out foul play. In an investigation update on Friday, Santa Fe County Sheriff Adan Mendoza said a pathologist had advised that tests for carbon monoxide poisoning were negative. Mendoza also said the pathologist was given an insight into Hackman's last moments due to the activity in his pacemaker. "An initial interrogation was conducted of Mr Hackman's pacemaker. This revealed that his last event was recorded on February 17th, 2025," he told reporters. "It is a good assumption that was his last day of life." However it remains unclear whether Hackman, who was found in the kitchen of the home, or Arakawa, who was located in a bathroom, died first. One of the couple's dogs was also located deceased in the bathroom, while two other dogs were found alive at the property. Alongside Arakawa's body, police found an orange prescription pill bottle in the bathroom and pills scattered across the floor. While a toxicology report has been requested on the pills, as well as other medications found inside the house, the report could take months to be completed. The discovery of the pills was described as "something of concern", with Mendoza telling NBC News: "That's obviously very important evidence at the scene". Hackman appeared in more than 80 films throughout his career, as well as on television and the stage after his breakout role as the brother of bank robber Clyde Barrow in 1967's Bonnie and Clyde, earning him his first Oscar nomination. He won an Oscar for best actor in 1972 for his portrayal of detective Popeye Doyle in The French Connection, and in 1993 won an Oscar for best supporting actor for Unforgiven. Image credits: MediaPunch/Shutterstock Editorial

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Does menopause hormone therapy increase or decrease your risk of dementia?

<div class="theconversation-article-body"> <figure>By <a style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;" href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;" href="https://theconversation.com/profiles/rachel-furey-2274695">Rachel Furey</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a style="font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, Oxygen, Ubuntu, Cantarell, 'Open Sans', 'Helvetica Neue', sans-serif;" href="https://theconversation.com/profiles/samantha-loi-2274698">Samantha Loi</a>, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a></figure> By 2050, <a href="https://www.alzint.org/u/2020/08/GlobalImpactDementia2013.pdf">around 135 million people</a> worldwide will be living with dementia. The most common cause of dementia is Alzheimer’s disease. Women are more likely than men to develop Alzheimer’s disease, even after accounting for women living longer. The symptoms of Alzheimer’s disease most commonly occur after the age of 65. However, changes in the brain begin decades before symptoms start. For women, this typically coincides with their transition to menopause. Menopause results from the body decreasing production of two hormones made by the ovaries: oestrogen and progesterone. These hormonal changes are associated with a wide range of symptoms, including hot flushes, night sweats, difficulties sleeping, reduced libido, mood changes and brain fog. Menopause hormonal therapy (also called hormone replacement therapy or HRT), including oestrogen alone or oestrogen combined with a progesterone, has been prescribed to help with menopausal symptoms for decades. But how does menopause hormone therapy affect the risk of dementia? And why do some studies say the therapy increases the risk, while others say it reduces it? <h2>Hormones and the brain</h2> A large body of pre-clinical (animal based) research shows oestrogen helps protect the brain. It reduces any damage to nerve cells and supports overall brain health. Receptors that respond to oestrogen are in areas of the brain related to reproductive functions. But they’re also in <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC4491541/">areas of the brain</a> important for learning, memory and higher-order cognitive abilities such as planning, organisation and decision making. <figure class="align-right "><figcaption></figcaption></figure> The loss of the “neuroprotective” effects of oestrogen after menopause is thought to contribute to more cases of Alzheimer’s disease in women than men. <a href="https://pubmed.ncbi.nlm.nih.gov/30928686/">Clinical studies</a> have also shown women who have a medical or surgical menopause before the age of natural menopause have a higher lifelong risk of dementia and cognitive impairment. This risk <a href="https://pubmed.ncbi.nlm.nih.gov/17761551/">appears to be reduced</a> in women who take oestrogen therapy after their surgery. This has led researchers to hypothesise that adding oestrogen back – via menopause hormone therapy – might protect and maintain women’s cognitive health. However, the research findings have not been consistent. <h2>Could menopause hormone therapy impact dementia risk?</h2> Concern about dementia risk and menopause hormone therapy have been partially driven by the unexpected findings from a landmark study conducted more than two decades ago. The <a href="https://jamanetwork.com/journals/jama/fullarticle/198994">findings showed</a> hormone therapy use in post-menopausal women, 65 years and older, was associated with an increased risk for dementia. However, these studies have some key limitations: 1) most of the women were aged over 65 and more than ten years post-menopause 2) the type of oestrogen and progestogen (a synthetic form of progesterone) used may have less benefit on brain health. The most recently published <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10625913/">systematic review and meta-analysis</a> of scientific data linking hormone therapy to the risk of Alzheimer’s disease included findings from 51 different reports that were published up to 2023. The results showed if hormone therapy was initiated in midlife, or more generally within ten years of the final menstrual period, there was a decreased risk of later-life Alzheimer’s disease compared to women not using any hormone therapy. The greatest reduction in risk was associated with oestrogen-only hormone therapy. In contrast, when considering using hormone therapy in late-life, or more than ten years after menopause, oestrogen-only therapy had a neutral effects on Alzheimer’s disease risk. However, oestrogen-progestogen therapy was associated with a risk increase. Only <a href="https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1004435">one clinical trial</a> has been published since this meta-analysis. This study examined the long-term effects of menopause hormone therapy use initiated in early menopause. Women were on average aged 52.8 years and 1.5 years post-menopause when they entered this trial. They were randomly assigned to an oestrogen (with or without progestogen) or placebo for four years. Researchers followed 275 women up ten years later. They found no cognitive effects (no harm nor any benefit) based on whether women were exposed to 48 months of hormone therapy or a placebo. <h2>What affects your risk?</h2> It appears the effects of menopause hormone therapy on dementia risk are influenced by several factors. These include when someone starts taking it, how long they take it for, the type of hormones used, and the person’s genetic and health background. 1. When therapy starts: the critical window hypothesis One key factor in determining the effect of menopause hormone therapy on cognitive function and the risk of dementia appears to be when therapy starts relative to menopause. This is called the “critical window hypothesis”. According to this hypothesis, oestrogen may help protect neurons in the brain only if started early in the menopause transition, particularly within a few years of menopause, when the brain may still be more responsive to hormones. 2. Type of menopause hormone therapy and the role of progesterone The type of hormones included in hormone therapy can <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC9964432/#sec6-ijms-24-03205">vary widely</a> in their molecular structure as well as their physiological actions. Different types of oestrogens (such as estradiol or conjugated oestrogen) and the inclusion of a progestogen (needed for women who have not undergone a hysterectomy) may have different impacts on brain health and dementia risk. <a href="https://www.sciencedirect.com/science/article/pii/S0091302224000402#s0055">Some studies</a> suggest adding a progestogen to oestrogen therapy could counteract some of the cognitive benefits of oestrogen alone, possibly by blocking oestrogen receptors in the brain. 3. The role of vasomotor symptoms Vasomotor symptoms, such as hot flushes and night sweats, are the hallmark of menopause. Experiencing more vasomotor symptoms has been <a href="https://journals.lww.com/menopausejournal/abstract/2008/15050/objective_hot_flashes_are_negatively_related_to.9.aspx">linked to poorer memory</a> as well as an <a href="https://pubmed.ncbi.nlm.nih.gov/37577812/">increase in biological markers</a> associated with dementia risk. Therefore, one possible pathway by which menopause hormone therapy may moderate Alzheimer’s disease risk is via their effects on reducing vasomotor symptoms. 4. An person’s genetic and health background The greatest genetic risk factor for older-onset Alzheimer’s disease is carrying one or more copies of a specific version of the APOE gene, called APOE e4. There is an <a href="https://pubmed.ncbi.nlm.nih.gov/36218064/">emerging hypothesis</a> that women who have this genetic risk for Alzheimer’s disease may show the greatest benefit from using hormone therapy. <h2>What does this mean for you?</h2> The clinical and scientific community are still debating whether menopause hormone therapy may play a role in Alzheimer’s disease risk. Overall, the decision to use hormone therapy should be individualised, taking into account your age and timing of menopause, health status and specific menopause symptoms. We need more research before we can make clear decisions about the role of hormone therapy and dementia risk, but based on the current evidence, hormone therapy may be beneficial if started early in the menopause transition, particularly for women at genetic risk of Alzheimer’s disease.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/242111/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/caroline-gurvich-473295">Caroline Gurvich</a>, Associate Professor and Clinical Neuropsychologist, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/rachel-furey-2274695">Rachel Furey</a>, Teaching Associate, Neuropsychology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>, and <a href="https://theconversation.com/profiles/samantha-loi-2274698">Samantha Loi</a>, Associate Professor and Neuropsychiatrist, Department of Psychiatry and Royal Melbourne Hospital, <a href="https://theconversation.com/institutions/the-university-of-melbourne-722">The University of Melbourne</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/does-menopause-hormone-therapy-increase-or-decrease-your-risk-of-dementia-heres-the-science-242111">original article</a>. Image: Shutterstock </div>

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What is ‘doll therapy’ for people with dementia? And is it backed by science?

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> The way people living with dementia <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/how-dementia-changes-perception">experience the world</a> can change as the disease progresses. Their sense of reality or place in time can become distorted, which can cause <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/restlessness">agitation and distress</a>. One of the best ways to support people experiencing changes in perception and behaviour is to <a href="https://www.dementia.org.au/professionals/designing-dementia-friendly-care-environments">manage their environment</a>. This can have profound benefits including <a href="https://www.agedcarequality.gov.au/resource-library/reducing-use-sedatives-aged-care-video">reducing the need for sedatives</a>. One such strategy is the use of dolls as comfort aids. <h2>What is ‘doll therapy’?</h2> More appropriately referred to as “<a href="https://www.dementia.com.au/resource-hub/the-use-of-dolls-in-dementia-care">child representation</a>”, lifelike dolls (also known as empathy dolls) can provide comfort for some people with dementia. Memories from the <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/symptoms/memory-loss#:%7E:text=Older%20memories%20%E2%80%93%20which%20have%20been,detailed%20memories%20from%20earlier%20life.">distant past</a> are often more salient than more recent events in dementia. This means that past experiences of parenthood and caring for young children may feel more “real” to a person with dementia than where they are now. <a href="https://www.alzheimers.org.uk/about-dementia/symptoms-and-diagnosis/hallucinations#:%7E:text=Visual%20hallucinations%20are%20more%20common,hallucinating%20and%20how%20others%20respond.">Hallucinations or delusions</a> may also occur, where a person hears a baby crying or fears they have lost their baby. Providing a doll can be a tangible way of reducing distress without invalidating the experience of the person with dementia. <h2>Some people believe the doll is real</h2> A recent case involving <a href="https://www.theguardian.com/australia-news/2024/nov/06/deplorable-nurse-slammed-therapy-doll-dementia-patient-believed-was-real-baby-on-table-nsw-tribunal-hears">an aged care nurse mistreating a dementia patient’s therapy doll</a> highlights the importance of appropriate training and support for care workers in this area. For those who do become attached to a therapeutic doll, they will treat the doll as a real baby needing care and may therefore have a profound emotional response if the doll is mishandled. It’s important to be guided by the person with dementia and only act as if it’s a real baby if the person themselves believes that is the case. <h2>What does the evidence say about their use?</h2> Evidence shows the use of empathy dolls may help <a href="https://www.sciencedirect.com/science/article/pii/S0197457223002677">reduce agitation and anxiety</a> and <a href="https://www.mdpi.com/2039-4403/14/4/200">improve overall quality of life</a> in people living with dementia. Child representation therapy falls under the banner of <a href="https://www.sciencedirect.com/science/article/pii/S0149763423004761">non-pharmacological approaches to dementia care</a>. More specifically, the attachment to the doll may act as a form of <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC6494367/">reminiscence therapy</a>, which involves using prompts to reconnect with past experiences. Interacting with the dolls may also act as a form of <a href="https://www.health.vic.gov.au/dementia-friendly-environments/sensory-stimulation">sensory stimulation</a>, where the person with dementia may gain comfort from touching and holding the doll. Sensory stimulation may <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.13169?casa_token=ro96fxe2VPoAAAAA%3AKOS10VkTdcrf0yTI_F9p6cI5Kpbj85ZTFq13PQ56YHxi0i3-5BOnFQfW1WFWqiCZ8-mk5sp_EGkGtKM">support emotional well-being and aid commnication</a>. However, not all people living with dementia will respond to an empathy doll. The <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">introduction of a therapeutic doll</a> needs to be done in conjunction with careful observation and consideration of the person’s background. Empathy dolls may be inappropriate or less effective for those who have not previously cared for children or who may have experienced past birth trauma or the loss of a child. Be guided by the person with dementia and how they respond to the doll. <h2>Are there downsides?</h2> The approach has <a href="https://pubmed.ncbi.nlm.nih.gov/33125455/">attracted some controversy</a>. It has been suggested that child representation therapy “infantilises” people living with dementia and may increase negative stigma. Further, the attachment may become so strong that the person with dementia will <a href="https://www.dementiauk.org/information-and-support/living-with-dementia/doll-therapy/">become upset if someone else picks the doll up</a>. This may create some difficulties in the presence of grandchildren or when cleaning the doll. The introduction of child representation therapy may also require additional staff training and time. Non-pharmacological interventions such as child representation, however, have been shown to be <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC10180718/">cost-effective</a>. <h2>Could robots be the future?</h2> The use of more <a href="https://pmc.ncbi.nlm.nih.gov/articles/PMC8247474/#:%7E:text=Therefore%2C%20an%20interactive%20baby%20robot,mental%20support%20for%20older%20adults.">interactive empathy dolls</a> and <a href="https://journals.sagepub.com/doi/full/10.1177/14713012231155985">pet-like robots</a> is also gaining popularity. While robots have been shown to be <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">feasible and acceptable in dementia care</a>, there remains some contention about their benefits. While some studies have shown <a href="https://academic.oup.com/innovateage/article/5/2/igab013/6249558?login=false">positive outcomes</a>, including reduced agitation, others show <a href="https://www.sciencedirect.com/science/article/pii/S1568163722000757">no improvement</a> in cognition, behaviour or quality of life among people with dementia. Advances in artificial intelligence are also being used to help support people living with dementia and <a href="https://journals.sagepub.com/doi/full/10.1177/1471301221998888">inform</a> the community. <a href="https://feel-lab.org/research_projects/ai-viv-and-friends/">Viv and Friends</a>, for example, are AI companions who appear on a screen and can interact with the person with dementia in real time. The AI character Viv has dementia and was co-created with women living with dementia using verbatim scripts of their words, insights and experiences. While Viv can share her experience of living with dementia, she can also be programmed to talk about common interests, such as gardening. These companions are currently being trialled in some residential aged care facilities and to help educate people on the lived experience of dementia. <h2>How should you respond to your loved one’s empathy doll?</h2> While child representation can be a useful adjunct in dementia care, it requires sensitivity and appropriate consideration of the person’s needs. People living with dementia <a href="https://pubmed.ncbi.nlm.nih.gov/38325063/">may not perceive the social world the same way</a> as a person without dementia. But a person living with dementia is not a child and should never be treated as one. Ensure all family, friends and care workers are <a href="https://www.alzheimerswa.org.au/wp-content/uploads/2017/07/2.00-Guidlines-for-Use-of-Dolls-and-Mechanized-Pets-as-a-Therapeutic-Tool-4-pages.pdf">informed about the attachment to the empathy doll</a> to help avoid unintentionally causing distress from inappropriate handling of the doll. If using an interactive doll, ensure spare batteries are on hand. Finally, it is important to reassess the attachment over time as the person’s response to the empathy doll may change.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/243589/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nikki-anne-wilson-342631">Nikki-Anne Wilson</a>, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), <a href="https://theconversation.com/institutions/unsw-sydney-1414">UNSW Sydney</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-doll-therapy-for-people-with-dementia-and-is-it-backed-by-science-243589">original article</a>. </div>

Mind

Doctor defies terminal cancer diagnosis with breakthrough therapy

Dr Tina Willits was told she had just 24 months to live after being diagnosed with breast cancer, but against all odds she is now in remission. The mother-of-five's disease was "everywhere" with three golf-ball sized tumors in her breast and cancerous masses in her ribs, spine, lymph nodes and legs. "When my cancer was detected, it was pretty past a stage four diagnosis and I was too far gone for a mastectomy," she told the Daily Mail. She was placed on end-of-care chemotherapy and was told to "enjoy the time you have left". That was nearly three years ago. Now, the 53-year-old US mum is in remission thanks to a breakthrough cancer therapy that uses cold gases and the body's own cells to freeze and fight tumors. "I was devastated, but I was also like no, I was not ok with that diagnosis. I felt I had to do something," she recalled. "I was just really determined that I did not want to live my life with this cancer, even if they could stop it progressing, I didn't want that, I just wanted it gone." Dr Willits' cancer was HER2 positive, which account for about 20 percent of all diagnoses, and she had no family history of the disease. She underwent four rounds of chemotherapy before she sought alternative treatment at the Williams Cancer Institute. The institute sent her a list of supplements to begin taking and advised her to avoid sugar, which some researchers believe can help reduce inflammation and slow down the growth of cancer cells. She then underwent a treatment regimen that is not yet fully approved in the US, with cryoablation as the first step. Cryoablation is the process where doctors insert a small metal probe through the skin and into the tumor, extremely cold gasses are then released directly into the mass to kill its cells. In the second phase of her treatment, she received immunotherapy, where eight drugs were administered directly into her tumor, which doctors say can prompt the immune system to recognise cancer cells as a threat and trigger an immune response. Dr Willits told the Dailymail that she was shocked when she got the results from her six-week scan after the treatment. "There were none, no tumors. They were just completely gone," she said. "All the metastasis (cancerous growths outside the breast) had completely healed, and the cancer in my lymph nodes was no longer there." After the treatment she had another four rounds of chemotherapy, and still undergoes PET scans every six months. So far the cancer has not been detected in her body since the treatment, and will need to wait for five years of clear results before she can be declared cancer free. Dr Williams, the founder of the institute, developed the treatment regimen over several years, and believes it could offer a better way to treat cancer. He is currently running a trial of the treatment in hard-to-treat prostate cancer patients, although he did not reveal how long the study had been going on for or how many rounds of treatment the patients had received. Since going into remission Dr Willits has travelled to Honduras and Colorado, tried mountain biking and is training for a 5k marathon for breast cancer awareness. "I wouldn't appreciate life like this if I had not gone through the cancer," she said. "No one on their deathbed says I wish I had worked more or got that job, you all say I wish I had spent more time with my parents and kids or gone to that place I had always wanted to." Images: DailyMail

Caring

How to know when it’s time to start therapy

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/simon-sherry-557487">Simon Sherry</a>, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a> People go to therapy for many reasons. A challenging life event, trauma, volatile emotions, relationship problems, poor mental health: all can prompt someone to seek it out. Whatever the reason, it can be difficult to decide when and if therapy is right for you. If you’re reading this, now’s probably the right time. If you’re considering therapy, something is likely bothering you and you want help. Consider this your sign to reach out. If you’re still unsure, keep reading. <h2>Why therapy?</h2> Sometimes, our minds work against us. Therapy can help you understand why you think, feel, or act how you do and give you the skills you need to think, feel, or act in healthier ways. This includes helping you: <ul> <li> identify, understand, and overcome internal obstacles </li> <li> identify and challenge thought patterns and beliefs that are holding you back </li> <li> improve your mental health </li> <li> cope with mental illness </li> <li> and create lasting changes to your thoughts and behaviour that can improve all areas of your life. </li> </ul> <h2>When your mental health is suffering</h2> Everyone experiences negative emotions in difficult situations — like sadness after a breakup or anxiety before a big life event. But when do these feelings become problematic? When you have <a href="https://www.canada.ca/en/public-health/services/about-mental-health.html">poor mental health</a>. Mental health and mental illness <a href="https://cmha.ca/news/mental-health-what-is-it-really/">are distinct</a>, but related, concepts. <a href="https://dictionary.apa.org/mental-health">Mental health</a> refers to the inner resources you have to handle life’s ups and downs. You have good mental health if you enjoy life; feel connected to others; cope well with stress; and have a sense of purpose, a sense of self and strong relationships. If you have poor mental health, it can be hard to adapt to changes like a breakup, move, loss or parenthood. Therapy can help you improve your mental health, develop resilience and maintain a state of well-being. <a href="https://www.canada.ca/en/public-health/services/about-mental-illness.html">Mental illness</a> refers to distressing disturbances in thoughts, feelings and perceptions that interfere with daily life. There are <a href="https://cmha.ca/brochure/mental-illnesses/">different kinds</a> of mental illness, each characterized by different thoughts, feelings and behaviours. Mental illness may feel like: <ul> <li> Hopelessness — feeling stuck, unmotivated or helpless. </li> <li> Apathy — feeling uninterested in things that used to give you satisfaction or pleasure. </li> <li> Anger — feeling rage or resentment, especially frequently or disproportionately. </li> <li> Stress — feeling overwhelmed, unable to cope, unwilling to rest or like everything is hard (even if you know it shouldn’t be). </li> <li> Guilt — feeling ashamed, undeserving of good things or deserving of bad things. </li> <li> Anxiety — worrying about what has or might happen or having disturbing intrusive thoughts. </li> <li> Exhaustion — sleeping more than usual, having difficulty getting out of bed or lacking energy during the day. </li> <li> <a href="https://doi.org/10.1016/S2215-0366(20)30136-X">Insomnia</a> — having difficulty falling or staying asleep. </li> </ul> Both poor mental health and mental illness are equally good reasons to seek therapy. Ask yourself: Am I having trouble dealing with life challenges? If the answer is yes, therapy might be for you. People often cope with the feelings listed above in different ways. <a href="https://www.nami.org/wp-content/uploads/2023/11/NAMI-Warning-Signs-FINAL.pdf">Some gain or lose a lot of weight</a>. Others might seek out or do things that are unhealthy for them, like entering a toxic relationship, engaging in dangerous activities, developing an unhealthy habit or procrastinating. Others might isolate themselves from friends and family, or catastrophize and <a href="https://pubmed.ncbi.nlm.nih.gov/22468242">ruminate on negative experiences</a>. However it manifests, <a href="https://namica.org/what-is-mental-illness/">mental illness often gets worse if left untreated</a>. It can have very real impacts on your life, potentially leading to unemployment, broken relationships, poor physical health, substance abuse, homelessness, incarceration or even suicide. Ask yourself: Is mental illness negatively affecting my functioning or well-being? If the answer is yes, therapy might be for you. <h2>What if therapy didn’t work before?</h2> Many people put off going to therapy because they don’t think their problems are serious enough, but you don’t need a big, deep reason to start therapy. Some people go to therapy to learn more about themselves. Some, to improve their skills, relationships or productivity. Others go for help reaching their goals or because they aren’t happy and don’t know why. Any of these are good reasons to start therapy, even if they don’t seem like “problems” in a traditional sense. You can go to therapy just because there’s something about yourself or your life you’d like to explore. Therapy is a process. Whether psychotherapy works for you depends on many factors, such as time, effort and your psychologist. There’s no quick fix for mental health. Symptoms can take weeks, months or even years to improve. Although this can be frustrating or disheartening, for therapy to work, you have to give it time. Sometimes people go to therapy, but are skeptical or resistant. Therapy won’t work if you aren’t invested in it. For therapy to work, you have to put in the work. Therapy is a vulnerable process, so finding a psychologist you trust and relate well with is crucial. Psychologists also have different specialities and approaches. For therapy to work, you have to find the right therapist for you. <h2>What if I’m not ready?</h2> There are several reasons why now might not be the right time for you to start therapy. Maybe therapy isn’t in the budget. Maybe you have other priorities. Maybe you’re scared to relive trauma. That’s okay. Therapy can be expensive and difficult, but also rewarding. Just because now isn’t a good time, doesn’t mean there will never be a good time. If you don’t want to start therapy, don’t. However, it can be helpful to determine why you don’t want to. Maybe you don’t want to go to therapy because you’re worried what others might think. If so, remember that people are often <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">more understanding</a> than we anticipate, and there is nothing wrong with investing in your health or happiness. If you’re struggling with your mental health, know that you’re not alone. Mental health issues are common. Having them or attending therapy does not mean there is something “wrong” with you. Mental illness affects <a href="https://www.who.int/news-room/fact-sheets/detail/mental-disorders">970 million people</a> and is the leading cause of disability worldwide. <a href="https://www.camh.ca/en/driving-change/the-crisis-is-real/mental-health-statistics">One in five</a> <a href="https://www.nami.org/about-mental-illness/mental-health-by-the-numbers/">adults</a> and more than <a href="https://doi.org/10.1001/jamapsychiatry.2023.5051">one in 10 children and youths</a> have mental illness. About <a href="https://health-infobase.canada.ca/datalab/mental-illness-blog.html">15 per cent of Canadians</a> use mental health services each year. Don’t let stigma keep you from bettering your life and well-being. Everyone deserves to live a healthy, fulfilling life. Therapy can help you get there.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/234078/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/simon-sherry-557487">Simon Sherry</a>, Clinical Psychologist and Professor in the Department of Psychology and Neuroscience, <a href="https://theconversation.com/institutions/dalhousie-university-1329">Dalhousie University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/how-to-know-when-its-time-to-start-therapy-234078">original article</a>. </div>

Mind

Exercise, therapy and diet can all improve life during cancer treatment and boost survival. Here’s how

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> With so many high-profile people <a href="https://www.theguardian.com/uk-news/2024/mar/23/cancer-charities-princess-of-wales-speaking-about-diagnosis">diagnosed with cancer</a> we are confronted with the stark reality the disease can strike any of us at any time. There are also reports certain cancers are <a href="https://www.cancer.org/research/acs-research-news/facts-and-figures-2024.html">increasing among younger people</a> in their 30s and 40s. On the positive side, medical treatments for cancer are advancing very rapidly. Survival rates are <a href="https://acsjournals.onlinelibrary.wiley.com/doi/10.3322/caac.21763">improving greatly</a> and some cancers are now being managed more as <a href="https://www.cancer.org/cancer/survivorship/long-term-health-concerns/cancer-as-a-chronic-illness.html">long-term chronic diseases</a> rather than illnesses that will rapidly claim a patient’s life. The <a href="https://www.cancer.org/cancer/managing-cancer/treatment-types.html">mainstays of cancer treatment</a> remain surgery, chemotherapy, radiation therapy, immunotherapy, targeted therapy and hormone therapy. But there are other treatments and strategies – “adjunct” or supportive cancer care – that can have a powerful impact on a patient’s quality of life, survival and experience during cancer treatment. <h2>Keep moving if you can</h2> Physical exercise is now recognised as a <a href="https://www.exerciseismedicine.org/">medicine</a>. It can be tailored to the patient and their health issues to stimulate the body and build an internal environment where <a href="https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.884">cancer is less likely to flourish</a>. It does this in a number of ways. Exercise provides a strong stimulus to our immune system, increasing the number of cancer-fighting immune cells in our blood circulation and infusing these into the tumour tissue <a href="https://jitc.bmj.com/content/9/7/e001872">to identify and kill cancer cells</a>. Our skeletal muscles (those attached to bone for movement) release signalling molecules called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7288608/">myokines</a>. The larger the muscle mass, the more myokines are released – even when a person is at rest. However, during and immediately after bouts of exercise, a further surge of myokines is secreted into the bloodstream. Myokines attach to immune cells, stimulating them to be better “hunter-killers”. Myokines also signal directly to cancer cells <a href="https://www.sciencedirect.com/science/article/pii/S2095254623001175">slowing their growth and causing cell death</a>. Exercise can also greatly <a href="https://wchh.onlinelibrary.wiley.com/doi/full/10.1002/tre.884">reduce the side effects of cancer treatment</a> such as fatigue, muscle and bone loss, and fat gain. And it reduces the risk of <a href="https://doi.org/10.2337/diacare.27.7.1812">developing other chronic diseases</a> such as heart disease and type 2 diabetes. Exercise can maintain or improve quality of life and mental health <a href="https://www.hindawi.com/journals/tbj/2022/9921575/">for patients with cancer</a>. Emerging research evidence indicates exercise might increase the effectiveness of mainstream treatments such as <a href="https://aacrjournals.org/cancerres/article/81/19/4889/670308/Effects-of-Exercise-on-Cancer-Treatment-Efficacy-A">chemotherapy</a> and <a href="https://www.nature.com/articles/s41391-020-0245-z">radiation therapy</a>. Exercise is certainly essential for preparing the patient for any surgery to increase cardio-respiratory fitness, reduce systemic inflammation, and increase muscle mass, strength and physical function, and then <a href="https://www.jsams.org/article/S1440-2440(18)31270-2/fulltext">rehabilitating them after surgery</a>. These mechanisms explain why cancer patients who are physically active have much <a href="https://journals.lww.com/acsm-msse/fulltext/2019/06000/physical_activity_in_cancer_prevention_and.20.aspx">better survival outcomes</a> with the relative risk of death from cancer <a href="https://journals.lww.com/acsm-msse/fulltext/2019/06000/physical_activity_in_cancer_prevention_and.20.aspx">reduced by as much as 40–50%</a>. <h2>Mental health helps</h2> The second “tool” which has a major role in cancer management is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016045/">psycho-oncology</a>. It involves the psychological, social, behavioural and emotional aspects of cancer for not only the patient but also their carers and family. The aim is to maintain or improve quality of life and mental health aspects such as emotional distress, anxiety, depression, sexual health, coping strategies, personal identity and relationships. Supporting quality of life and happiness is important on their own, but these barometers <a href="https://www.frontiersin.org/journals/psychology/articles/10.3389/fpsyg.2024.1349880/full">can also impact</a> a patient’s physical health, response to exercise medicine, resilience to disease and to treatments. If a patient is highly distressed or anxious, their body can enter a flight or fight response. This creates an internal environment that is actually supportive of cancer progression <a href="https://www.cancer.gov/about-cancer/coping/feelings/stress-fact-sheet">through hormonal and inflammatory mechanisms</a>. So it’s essential their mental health is supported. <h2>Putting the good things in: diet</h2> A third therapy in the supportive cancer care toolbox is diet. A healthy diet <a href="https://www.cancer.org/cancer/survivorship/coping/nutrition/benefits.html">can support the body</a> to fight cancer and help it tolerate and recover from medical or surgical treatments. Inflammation provides a more fertile environment <a href="https://www.cancer.gov/news-events/cancer-currents-blog/2022/reducing-inflammation-to-treat-cancer">for cancer cells</a>. If a patient is overweight with excessive fat tissue then a diet to reduce fat which is also anti-inflammatory can be very helpful. This <a href="https://www.frontiersin.org/articles/10.3389/fnut.2021.709435/full">generally means</a> avoiding processed foods and eating predominantly fresh food, locally sourced and mostly plant based. Muscle loss is <a href="https://onlinelibrary.wiley.com/doi/10.1002/rco2.56">a side effect of all cancer treatments</a>. Resistance training exercise can help but people may need protein supplements or diet changes to make sure they get enough protein to build muscle. Older age and cancer treatments may reduce both the intake of protein and compromise absorption so <a href="https://www.sciencedirect.com/science/article/pii/S0261561421005422">supplementation may be indicated</a>. Depending on the cancer and treatment, some patients may require highly specialised diet therapy. Some cancers such as pancreatic, stomach, esophageal, and lung cancer can cause rapid and uncontrolled drops in body weight. This is called <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8233663/">cachexia and needs careful management</a>. Other cancers and treatments such as hormone therapy can cause rapid weight gain. This also needs careful monitoring and guidance so that, when a patient is clear of cancer, they are not left with higher risks of other health problems such as cardiovascular disease and metabolic syndrome (a cluster of conditions that boost your risk of heart disease, stroke and type 2 diabetes). <h2>Working as a team</h2> These are three of the most powerful tools in the supportive care toolbox for people with cancer. None of them are “cures” for cancer, alone or together. But they can work in tandem with medical treatments to greatly improve outcomes for patients. If you or someone you care about has cancer, national and state cancer councils and cancer-specific organisations can provide support. For exercise medicine support it is best to consult with an <a href="https://www.essa.org.au/Public/Public/Consumer_Information/What_is_an_Accredited_Exercise_Physiologist_.aspx">accredited exercise physiologist</a>, for diet therapy an <a href="https://dietitiansaustralia.org.au/working-dietetics/standards-and-scope/role-accredited-practising-dietitian">accredited practising dietitian</a> and mental health support with a <a href="https://psychology.org.au/psychology/about-psychology/what-is-psychology">registered psychologist</a>. Some of these services are supported through Medicare on referral from a general practitioner. <hr /> For free and confidential cancer support call the <a href="https://www.cancer.org.au/support-and-services/cancer-council-13-11-20">Cancer Council</a> on 13 11 20.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/226720/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/rob-newton-12124">Rob Newton</a>, Professor of Exercise Medicine, <a href="https://theconversation.com/institutions/edith-cowan-university-720">Edith Cowan University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/exercise-therapy-and-diet-can-all-improve-life-during-cancer-treatment-and-boost-survival-heres-how-226720">original article</a>. </div>

Caring

5 reasons art therapy is great for your mental health as you age

We know how important it is to look after our <a style="color: blue;" href="https://www.betterhealth.vic.gov.au/health/servicesandsupport/healthy-and-active-ageing">physical health</a> as we age, but our mental health is equally important. <a style="color: blue;" href="https://aifs.gov.au/resources/short-articles/normalising-mental-illness-older-adults-barrier-care">Studies have shown</a> that besides the immediate impact on wellbeing, older people with untreated mental ill health are at risk of poorer overall health, increased hospital admissions, and an earlier transition into aged care. Art therapy is an excellent way to boost our mental wellbeing. In a nutshell, this type of therapy is when visual art, such as drawing, sculpting, or collage, is used in a <a style="color: blue;" href="https://www.rtor.org/2018/07/10/benefits-of-art-therapy/">therapeutic context</a>. And don’t be put off if you haven’t picked up a paintbrush since you were a kid. Art therapy is not about creating works of beauty but about the process. It’s a completely <a style="color: blue;" href="https://cata.org.au/faqs-myth-busters/#:~:text=The%20focus%20of%20Creative%20Art,%2C%20growth%20and%20self%2Dawareness.&text=Reality%3A%20Creative%20Art%20Therapy%20does,to%20affect%20change%20and%20growth.">judgement free zone</a>! Emotional release: Growing up, many of us were never taught that it was okay to express how we’re feeling, especially emotions like anger and sadness. In that way, art therapy can be ideal us older folks who often feel stuck when it comes to expressing ourselves. Art therapy provides the opportunity to express our <a style="color: blue;" href="https://creativityintherapy.com/2017/06/expressing-emotions-creativity-6-step-art-process/">inner experiences</a> in a visual way. Through the act of creation, we can release pent-up feelings, reduce stress, and experience emotional release. Another challenging emotion that art therapy can help with is grief. As we age, we are more likely to experience the <a style="color: blue;" href="https://www.nari.net.au/the-impact-of-prolonged-grief-in-older-people">loss of a loved one</a> and we don’t get ‘used to it’. The hole it leaves in our hearts is just as dark. Through <a style="color: blue;" href="https://www.vivianpaans.com.au/blog/healing-through-art-how-art-therapy-can-help-with-grief-and-wellbeing">creating art</a> we can explore the feelings of grief and sadness in a safe, judgement-free space. It can also foster a sense of self-compassion and when we have more compassion for ourselves, it becomes easier to accept our emotions. Stress relief: <a style="color: blue;" href="https://www.sane.org/information-and-resources/facts-and-guides/facts-mental-health-issues">Anxiety, depression, and past traumas</a> can heavily impact on our daily lives. Risk factors over our lifespans may change but they don’t magically disappear once we hit a certain age. Illness, grief, financial stress, social isolation, and life transitions such as menopause can all be <a style="color: blue;" href="https://www.healthdirect.gov.au/older-people-and-mental-health">contributing factors</a> of poor mental health for older adults. Creating art can ease symptoms as we refocus on what we’re creating and move thoughts away from overthinking and worry. Creating art releases <a style="color: blue;" href="https://www.rtor.org/2018/07/10/benefits-of-art-therapy/">dopamine,</a> the chemical responsible for allowing us to feel pleasure and satisfaction. This further reduces bothersome symptoms of anxiety and depression. Also, participating in art therapy leads to a more creative brain. A creative brain is better equipped to create stress-relieving techniques for other areas of our lives. Through creating art, we draw the fears that are inside our minds. This takes them out of our heads and places them away from us, helping us feel more in control. Recovering from <a style="color: blue;" href="https://www.interrelate.org.au/news-media/blogs/november-2021/how-art-can-heal-trauma">trauma</a> can be a lifelong process for many, and it’s important for someone dealing with it to find tools that will help this process. Art therapy can be one of those as it can give a sense of agency and self-understanding through the ability to express feelings symbolically. This can give <a style="color: blue;" href="https://anzacata.org/About-CAT">new perspectives</a> of ourselves and our worldview which is essential in the recovery process. It can also help connect with deeply stored emotions and help process them. Self-discovery: When we are younger we are often so busy working, socialising, and raising a family many of us never get a chance to take the time out for <a style="color: blue;" href="https://www.visionpsychology.com/starting-the-process-of-self-discovery/">self-discovery</a>. Self-discovery is important in our lives as it gives us a clearer sense of purpose and direction in life. In turn, this leads to making better decisions that lead to our overall happiness. Some of us see our kids leave home and suddenly we’re left wondering, who am I when I don’t have a family to care for? Creating art can help us acknowledge and recognise feelings that have been suppressed in our subconscious. Through learning to use different techniques of art our minds open up to thinking more freely. Self-discovery comes from both the finished product we create as well as the process of making it. Self-esteem: As we age, it’s easy to look in the mirror and struggle to recognise the person we see. Our bodies are changing, and it can often feel like society doesn’t value us as much as when we were young. It can be a major shift in the way we view ourselves and lead to poor self-esteem. Art therapy teaches us how to use a variety of media to create something new. We can develop talents and see strengths as we master new materials and see the completion of projects. This sense of accomplishment can be a big leg up to our <a style="color: blue;" href="https://artbusinessnews.com/2022/01/benefits-of-art-therapy/">self-esteem.</a> A sense of community: <a style="color: blue;" href="https://likefamily.com.au/blog/what-is-loneliness-and-how-does-it-affect-someone/">Loneliness</a> is a big contributor to poor mental health. <a style="color: blue;" href="https://www.psychiatrist.com/news/study-why-older-people-feel-so-lonely/">Studies</a> show two groups of people are most at risk: young adults and older people. With factors at our age such as children leaving home, not working as much or at all, living alone, and chronic illness, it’s easy to see how loneliness can creep into our lives. Group art therapy is a wonderful way to connect with others. We share a space with those who have similar interests, and it gives us a sense of belonging. For those who can't make a session in person due to distance or illness, some therapists offer <a style="color: blue;" href="https://www.artandplaytherapytraining.com.au/art_therapy">online group art therapy</a>. You don’t need to see an art therapist to get the mental health benefits of creating art. But the advantage of that is they have the skills to work out what best suits your needs. They’ll also work with you through any tough emotions that may arise from your art therapy. So maybe it’s time to hide those new coloured pencils from the little ones, crack them open, and enjoy them yourself! If you’d like to find out more about art therapy sessions, the links below are helpful. They offer online, in person and group sessions. <a style="color: blue;" href="https://www.zevaarttherapy.com/" target="_blank" rel="noopener">https://www.zevaarttherapy.com/</a> <a style="color: blue;" href="https://www.alliedarttherapy.com.au/" target="_blank" rel="noopener">https://www.alliedarttherapy.com.au/</a> <a style="color: blue;" href="https://www.solacecreativetherapies.com.au/" target="_blank" rel="noopener">https://www.solacecreativetherapies.com.au/</a> <a style="color: blue;" href="https://cata.org.au/programs-ndis/online-creative-art-therapy/" target="_blank" rel="noopener">https://cata.org.au/programs-ndis/online-creative-art-therapy/</a> And for some more ideas on dabbling in art therapy on your own (or with a friend), check out Shelley Klammer’s amazing resources. She is US-based but has some online workshops that are also amazing: <a style="color: blue;" href="https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/" target="_blank" rel="noopener">https://www.expressiveartworkshops.com/expressive-art-resources/100-art-therapy-exercises/</a> Article written by Kylie Carberry Image: Shutterstock

Mind

What are the most common symptoms of menopause? And which can hormone therapy treat?

<a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Despite decades of research, navigating menopause seems to have become harder – with conflicting information on the internet, in the media, and from health care providers and researchers. Adding to the uncertainty, a recent <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">series in the Lancet</a> medical journal challenged some beliefs about the symptoms of menopause and which ones menopausal hormone therapy (also known as hormone replacement therapy) can realistically alleviate. So what symptoms reliably indicate the start of perimenopause or menopause? And which symptoms can menopause hormone therapy help with? Here’s what the evidence says. <h2>Remind me, what exactly is menopause?</h2> Menopause, simply put, is complete loss of female fertility. Menopause is traditionally defined as the final menstrual period of a woman (or person female at birth) who previously menstruated. Menopause is diagnosed after 12 months of no further bleeding (unless you’ve had your ovaries removed, which is surgically induced menopause). Perimenopause starts when menstrual cycles first vary in length by seven or more days, and ends when there has been no bleeding for 12 months. Both perimenopause and menopause are hard to identify if a person has had a hysterectomy but their ovaries remain, or if natural menstruation is suppressed by a treatment (such as hormonal contraception) or a health condition (such as an eating disorder). <h2>What are the most common symptoms of menopause?</h2> <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">Our study</a> of the highest quality menopause-care guidelines found the internationally recognised symptoms of the perimenopause and menopause are: <ul> <li>hot flushes and night sweats (known as vasomotor symptoms)</li> <li>disturbed sleep</li> <li>musculoskeletal pain</li> <li>decreased sexual function or desire</li> <li>vaginal dryness and irritation</li> <li>mood disturbance (low mood, mood changes or depressive symptoms) but not clinical depression.</li> </ul> However, none of these symptoms are menopause-specific, meaning they could have other causes. In <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">our study of Australian women</a>, 38% of pre-menopausal women, 67% of perimenopausal women and 74% of post-menopausal women aged under 55 experienced hot flushes and/or night sweats. But the severity of these symptoms <a href="https://journals.lww.com/menopausejournal/abstract/2015/07000/moderate_to_severe_vasomotor_and_sexual_symptoms.6.aspx">varies greatly</a>. Only 2.8% of pre-menopausal women reported moderate to severely bothersome hot flushes and night sweats symptoms, compared with 17.1% of perimenopausal women and 28.5% of post-menopausal women aged under 55. So bothersome hot flushes and night sweats appear a reliable indicator of perimenopause and menopause – but they’re not the only symptoms. Nor are hot flushes and night sweats a western society phenomenon, as has been suggested. Women in Asian countries are <a href="https://journals.lww.com/menopausejournal/fulltext/2022/05000/prevalence,_severity,_and_associated_factors_in.9.aspx">similarly affected</a>. Depressive symptoms and anxiety are also often linked to menopause but they’re less menopause-specific than hot flushes and night sweats, as they’re common across the entire adult life span. The <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">most robust guidelines</a> do not stipulate women must have hot flushes or night sweats to be considered as having perimenopausal or post-menopausal symptoms. They acknowledge that new mood disturbances may be a primary manifestation of <a href="https://www.cell.com/cell/abstract/S0092-8674(23)00905-4?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0092867423009054%3Fshowall%3Dtrue">menopausal hormonal changes</a>. The extent to which menopausal hormone changes impact memory, concentration and problem solving (frequently talked about as “brain fog”) is uncertain. <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">Some studies</a> suggest perimenopause may impair verbal memory and resolve as women transition through menopause. But strategic thinking and planning (executive brain function) <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2022.2122792">have not been shown to change</a>. <h2>Who might benefit from hormone therapy?</h2> The Lancet papers <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00462-8/fulltext">suggest</a> menopause hormone therapy <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)02799-X/fulltext">alleviates</a> hot flushes and night sweats, but the likelihood of it improving sleep, mood or “brain fog” is limited to those bothered by vasomotor symptoms (hot flushes and night sweats). In contrast, the highest quality <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">clinical guidelines</a> consistently identify both vasomotor symptoms and mood disturbances associated with menopause as reasons for menopause hormone therapy. In other words, you don’t need to have hot flushes or night sweats to be prescribed menopause hormone therapy. Often, menopause hormone therapy is prescribed alongside a topical vaginal oestrogen to treat vaginal symptoms (dryness, irritation or urinary frequency). However, none of these guidelines recommend menopause hormone therapy for cognitive symptoms often talked about as “brain fog”. Despite musculoskeletal pain being the most common menopausal symptom in <a href="https://journals.lww.com/menopausejournal/abstract/2016/07000/prevalence_and_severity_of_vasomotor_symptoms_and.6.aspx">some populations</a>, the effectiveness of menopause hormone therapy for this specific symptoms still needs to be studied. Some guidelines, such as an <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Australian endorsed guideline</a>, support menopause hormone therapy for the prevention of osteoporosis and fracture, but not for the prevention of any other disease. <h2>What are the risks?</h2> The greatest concerns about menopause hormone therapy have been about breast cancer and an increased risk of a deep vein clot which might cause a lung clot. Oestrogen-only menopause hormone therapy is <a href="https://www.nice.org.uk/guidance/ng23">consistently considered</a> to cause little or no change in breast cancer risk. Oestrogen taken with a progestogen, which is required for women who have not had a hysterectomy, <a href="https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Women%20Health/CPG_Management_of_Menopause_2022_e-version-1.pdf">has been associated with a small increase</a> in the risk of breast cancer, although any <a href="https://www.bmj.com/content/bmj/371/bmj.m3873.full.pdf">risk appears to vary</a> according to the type of therapy used, the dose and duration of use. Oestrogen taken orally has also been associated with an increased risk of a deep vein clot, although the risk varies according to the formulation used. This risk is avoided by using estrogen patches or gels <a href="https://www.bmj.com/content/bmj/364/bmj.k4810.full.pdf">prescribed at standard doses</a> <h2>What if I don’t want hormone therapy?</h2> If you can’t or don’t want to take menopause hormone therapy, there are also effective non-hormonal prescription therapies available for troublesome hot flushes and night sweats. In Australia, most of these options are “off-label”, although the new medication <a href="https://australianprescriber.tg.org.au/articles/management-of-menopause.html">fezolinetant</a> has just been <a href="https://www.tga.gov.au/resources/artg/401401">approved</a> in Australia for postmenopausal hot flushes and night sweats, and is expected to be available by mid-year. Fezolinetant, taken as a tablet, acts in the brain to stop the chemical neurokinin 3 triggering an inappropriate body heat response (flush and/or sweat). Unfortunately, most over-the-counter treatments promoted for menopause are either <a href="https://srh.bmj.com/content/early/2024/02/21/bmjsrh-2023-202099.long">ineffective or unproven</a>. However, cognitive behaviour therapy and hypnosis <a href="https://journals.lww.com/menopausejournal/abstract/2023/06000/the_2023_nonhormone_therapy_position_statement_of.4.aspx">may provide symptom relief</a>. The Australasian Menopause Society has useful <a href="https://www.menopause.org.au/health-info/fact-sheets">menopause fact sheets</a> and a <a href="https://www.menopause.org.au/health-info/find-an-ams-doctor">find-a-doctor</a> page. The <a href="https://www.tandfonline.com/doi/full/10.1080/13697137.2023.2258783">Practitioner Toolkit for Managing Menopause</a> is also freely available.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/225174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/susan-davis-10376">Susan Davis</a>, Chair of Women's Health, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-are-the-most-common-symptoms-of-menopause-and-which-can-hormone-therapy-treat-225174">original article</a>.

Body

What is cognitive functional therapy? How can it reduce low back pain and get you moving?

<a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a> If you haven’t had lower back pain, it’s likely you know someone who has. It affects <a href="https://pubmed.ncbi.nlm.nih.gov/22231424/">around 40% of adults</a> in any year, ranging from adolescents to those in later life. While most people recover, <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">around 20%</a> go on to develop chronic low back pain (lasting more than three months). There is a <a href="https://bjsm.bmj.com/content/54/12/698">common view</a> that chronic low back pain is caused by permanent tissue damage including “wear and tear”, disc degeneration, disc bulges and arthritis of the spine. This “damage” is often described as resulting from injury and loading of the spine (such as bending and lifting), ageing, poor posture and weak “core” muscles. We’re often told to “protect” our back by sitting tall, bracing the core, keeping a straight back when bending and lifting, and avoiding movement and activities that are painful. Health practitioners often <a href="https://theconversation.com/having-good-posture-doesnt-prevent-back-pain-and-bad-posture-doesnt-cause-it-183732">promote and reinforce these messages</a>. But this is <a href="https://bjsm.bmj.com/content/54/12/698">not based on evidence</a>. An emerging treatment known as <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">cognitive functional therapy</a> aims to help patients undo some of these unhelpful and restrictive practices, and learn to trust and move their body again. <h2>People are often given the wrong advice</h2> People with chronic back pain are often referred for imaging scans to detect things like disc degeneration, disc bulges and arthritis. But these findings are very common in people without low back pain and research shows they <a href="https://pubmed.ncbi.nlm.nih.gov/24276945/">don’t accurately predict</a> a person’s current or future experience of pain. Once serious causes of back pain have been ruled out (such as cancer, infection, fracture and nerve compression), there is <a href="https://pubmed.ncbi.nlm.nih.gov/27745712/">little evidence</a> scan findings help guide or improve the care for people with chronic low back pain. In fact, scanning people and telling them they have arthritis and disc degeneration can <a href="https://pubmed.ncbi.nlm.nih.gov/33748882/">frighten them</a>, resulting in them avoiding activity, worsening their pain and distress. It can also lead to potentially harmful treatments such as <a href="https://pubmed.ncbi.nlm.nih.gov/27213267/">opioid</a> pain medications, and invasive treatments such as spine <a href="https://pubmed.ncbi.nlm.nih.gov/19127161/">injections</a>, spine <a href="https://pubmed.ncbi.nlm.nih.gov/12709856/">surgery</a> and battery-powered electrical stimulation of spinal nerves. <h2>So how should low back pain be treated?</h2> A complex range of factors <a href="https://pubmed.ncbi.nlm.nih.gov/29112007/">typically contribute</a> to a person developing chronic low back pain. This includes over-protecting the back by avoiding movement and activity, the belief that pain is related to damage, and negative emotions such as pain-related fear and anxiety. Addressing these factors in an individualised way is <a href="https://pubmed.ncbi.nlm.nih.gov/29573871/">now considered</a> best practice. <a href="https://pubmed.ncbi.nlm.nih.gov/15936976/">Best practice care</a> also needs to be person-centred. People suffering from chronic low back pain want to be heard and validated. They <a href="https://pubmed.ncbi.nlm.nih.gov/35384928/">want</a> to understand why they have pain in simple language. They want care that considers their preferences and gives a safe and affordable pathway to pain relief, restoring function and getting back to their usual physical, social and work-related activities. An example of this type of care is cognitive functional therapy. <h2>What is cognitive functional therapy?</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/29669082/">Cognitive functional therapy</a> is about putting the person in the drivers’ seat of their back care, while the clinician takes the time to guide them to develop the skills needed to do this. It’s led by physiotherapists and can be used once serious causes of back pain have been ruled out. The therapy helps the person understand the unique contributing factors related to their condition, and that pain is usually not an accurate sign of damage. It guides patients to relearn how to move and build confidence in their back, without over-protecting it. It also addresses other factors such as sleep, relaxation, work restrictions and engaging in physical activity based on the <a href="https://www.restorebackpain.com/patient-journey">person’s preferences</a>. Cognitive functional therapy usually involves longer physiotherapy sessions than usual (60 minutes initially and 30-45 minute follow-ups) with up to seven to eight sessions over three months and booster sessions when required. <h2>What’s the evidence for this type of therapy?</h2> Our recent clinical trial of cognitive functional therapy, published in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00441-5/fulltext">The Lancet</a>, included 492 people with chronic low back pain. The participants had pain for an average of four years and had tried many other treatments. We first trained 18 physiotherapists to competently deliver cognitive functional therapy across Perth and Sydney over six months. We compared the therapy to the patient’s “usual care”. We found large and sustained improvements in function and reductions in pain intensity levels for people who underwent the therapy, compared with those receiving usual care. The effects remained at 12 months, which is unusual in low back pain trials. The effects of most recommended interventions such as exercise or psychological therapies are <a href="https://pubmed.ncbi.nlm.nih.gov/34580864/">modest in size</a> and tend to be of <a href="https://pubmed.ncbi.nlm.nih.gov/32794606/">short duration</a>. People who underwent cognitive functional therapy were also more confident, less fearful and had a more positive mindset about their back pain at 12 months. They also liked it, with 80% of participants satisfied or highly satisfied with the treatment, compared with 19% in the usual care group. The treatment was as safe as usual care and was also cost-effective. It saved more than A$5,000 per person over a year, largely due to increased participation at work. <h2>What does this mean for you?</h2> This trial shows there are safe, relatively cheap and effective treatments options for people living with chronic pain, even if you’ve tried other treatments without success. <a href="https://www.restorebackpain.com/cft-clinicians">Access to clinicians</a> trained in cognitive functional therapy is currently limited but will expand as training is scaled up. The costs depend on how many sessions you have. Our studies show some people improve a lot within two to three sessions, but most people had seven to eight sessions, which would cost around A$1,000 (aside from any Medicare or private health insurance rebates). <img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207009/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/peter-osullivan-48973">Peter O'Sullivan</a>, Professor of Musculoskeletal Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/jp-caneiro-1463060">JP Caneiro</a>, Research Fellow in physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a>; <a href="https://theconversation.com/profiles/mark-hancock-1463059">Mark Hancock</a>, Professor of Physiotherapy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/peter-kent-1433302">Peter Kent</a>, Adjunct Associate Professor of Physiotherapy, <a href="https://theconversation.com/institutions/curtin-university-873">Curtin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-is-cognitive-functional-therapy-how-can-it-reduce-low-back-pain-and-get-you-moving-207009">original article</a>.

Body

Got no COVID-19 symptoms? A gene mutation might be the reason

<div> <div class="copy"> A global study has unearthed a possible genetic reason why some people infected with the virus that causes COVID-19 show no symptoms. Human leukocyte antigens – or HLAs – are important genes that support immune function in the human body, particularly in identifying viral pathogens. And a particular variation in the HLA-B complex has been found to at least double the likelihood that a person infected with SARS-CoV-2 will be asymptomatic. For people who inherit a copy of the HLA-B15 variant from one parent, there was a 2.4 times greater chance of avoiding symptoms. Homozygous carriers — born with copies of the variant from each parent — were 8.5 times more likely to avoid symptoms. It’s a somewhat common variant among certain ethnicities – about 1 in 10 people with European ancestry are potential carriers – but having the gene is not a guaranteed protector against coronavirus symptoms. The findings, <a href="https://doi.org/10.1038/s41586-023-06331-x" target="_blank" rel="noreferrer noopener" data-type="URL" data-id="https://doi.org/10.1038/s41586-023-06331-x">published</a> in Nature, have emerged from a joint study between researchers at the University of California San Fransisco and Australian institutions including Latrobe University, Monash University and the QIMR Berghofer Centre. The research came about almost by accident. <div class="in-content-area content-third content-right"><a href="https://cosmosmagazine.com/health/covid/link-between-blood-type-and-risk-of-covid-19-infection/"> </a></div> Co-lead authors Professor Stephanie Gras from Latrobe and Jill Hollenbach from UCSF first met at a research conference in May 2022 and pooled their resources to track the association of possible gene variations with COVID-19 symptoms. Their teams narrowed a group of 30,000 people with high-quality HLA data to a cohort of about 1,500 unvaccinated people who tested positive for the virus. They then focussed on five locations of interest in the HLA genes while monitoring the emergence of symptoms to determine which variants, if any, might have a greater linkage to being COVID asymptomatic. “The [SARS-CoV-2] virus gets inside cells and ‘presents’ some small part of the virus on the surface via the HLA molecule,” Gras explains. “Those act as a red flag for T cells. The cell sends the signal to the T cell that it has been infected with the virus, and the T cells get activated and kill that [infected] cell. “HLA-B15 can actually present a small part of the spike protein that is very similar between SARS-CoV-2 and seasonal coronaviruses… [that] circulate every year in the population and give us the common cold during winter most of the time. They share some similarities.” The understanding provides a possible application for future treatments. Now an association between the variant and asymptomatic cases has been identified, the Gras and Hollenbach teams have begun to study the interaction between HLA-B15 and the SARS-CoV-2 spike protein at the atomic level. That research is already underway, including at the Australian Synchrotron at the Australian Nuclear Science and Technology Organisation. “We’re doing atomic-level models of proteins to understand the interaction,” Gras says. “We want to compare the T cells within people who are asymptomatic with HLA-B15 and people who are not asymptomatic with HLA-B15. Actually, HLA-B15 is not a magic bullet, you can have it and still have severe COVID.” Image credits: Getty Images </div> <div id="contributors"> <a href="https://cosmosmagazine.com/health/covid/got-no-covid-19-symptoms-a-gene-mutation-might-be-the-reason/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/matthew-agius">Matthew Ward Agius</a>. </div> </div>

Body

“Irwin genes are strong”: Bindi shares adorable candid snap

Bindi Irwin has delighted fans after sharing a sweet snap of her two-year-old daughter, Grace Warrior cuddling a giant tortoise. The wildlife warrior took to Instagram to share the sweet snap with a comparison photo of herself hugging a giant tortoise when she was around Grace’s age. “Holding my newborn daughter wondering if she’ll love wildlife like I did” she captioned one of the photos in the Reel. The next two photos showed comparison photos of the mother-daughter duo which showed that the apple doesn’t fall far from the tree. “Our Grace Warrior, the Wildlife Warrior," she captioned the post. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-captioned="" data-instgrm-permalink="https://www.instagram.com/reel/Cs4wPGzBjZZ/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/Cs4wPGzBjZZ/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by Bindi Irwin (@bindisueirwin)</a> </div> </blockquote> The adorable photo has been praised by fans who commented how proud Steve Irwin would be of his daughter and granddaughter. "It’s in the Irwin blood! You guys have the most beautiful connection with wildlife and each other! Steve Irwin genes are strong!” wrote one fan. "Your dad is probably so so proud looking down,” commented a second person. "This gives me happy goosebumps babe,” wrote a third. Images: Instagram

Family & Pets

Fun ways to boost memory in seniors

Memory issues can seriously deteriorate the quality of life for seniors. To reverse the typically progressive process of memory loss, many solutions have been put forward. These include creative leisure activities aimed to work on the senior’s brain while providing relaxation. To work on a senior’s memory, it’s optimal to have them work on a project, focusing and seeing the work being done. There are plenty of games and activities available to help memory. Paint by Numbers Paint by Numbers is a creative art form that involves painting a pre-drawn sketch on a linen canvas with reference numbers. It helps stimulate the intellect and senses. They’re available in colour books as well, you can find them at your local Kmart and select supermarkets. Diamond painting Diamond painting is a manual activity where the senior creates beautiful pictures using rhinestones to stick onto a self-adhesive canvas. It calls for concentration, reflection, memorisation, and patience from the practitioner, which is beneficial for working on memory. Scratch painting Scratch painting is a fun activity that involves scratching a picture with a coin or stylus, like a lottery scratch-off. It requires interest and concentration from the individual, who will enjoy the final picture and benefit their memory. Music therapy Music therapy is used to treat and alleviate disorders, such as relational, behavioural, and communication difficulties. It also has benefits for seniors with memory problems, as it allows them to mobilise concentration, emotions, and memory in a playful way. Image credit: Shutterstock

Mind

Aussie patient given new drug worth $5 million per dose

A potential cure for a rare genetic disease is being trialled, and it comes with a hefty price tag. Sydney’s Royal Prince Alfred Hospital is part of a groundbreaking new trial aimed at potentially curing haemophilia B – a hereditary bleeding disorder. Patients with haemophilia B have a mutation on the F9 gene, which causes excessive bleeding and damage to joins as they lack the protein that helps blood to clot. A mere 40 patients worldwide will be infused with the gene therapy, with each dose the equivalent of $5 million, or over $1,000 a drop. A safe virus carrying the F9 gene is infused into the body, sending it to the liver cells, where doctors hope the protein is made for the rest of the patient’s life. Professor John Rasko, Head of Cell and Molecular Therapies at RPA, said the process is a “thrilling moment in the history of gene therapy” "We are pushing the boundaries of medical technology hoping to bring cures to individuals," he said. "It's a massive international effort that takes time and money and ultimately the manufacturing alone costs millions and millions of dollars." Haemophilia B patients currently require three injections a week. This revolutionary treatment could mean just one infusion in a lifetime. The infusion on May 22 was the culmination of more than two decades of work. Image credit: Shutterstock

Caring

KISS concert halted as Gene Simmons falls ill on stage

KISS singer Gene Simmons gave fans - and bandmates - a fright when dehydration got the better of him live on stage, and the group were forced to bring their entire concert to a halt. In a video from the event, KISS’ Paul Stanley can be seen addressing the crowd, telling them that “we’re gonna have to stop to take care of him. Because we love him, right?” He goes on to call for a cheer for Simmons, with the 73-year-old catching his breath on a chair on stage - the same chair that he remained in for the rest of the show, after a five minute break to assure he was well enough to continue. <blockquote class="twitter-tweet"> Gene Simmons, baixista e vocalista do Kiss, passa mal e show é brevemente interrompido na Arena da Amazônia. <a href="https://t.co/nphJEj1PQo">pic.twitter.com/nphJEj1PQo</a> — A Crítica (@ACritica) <a href="https://twitter.com/ACritica/status/1646372105523478529?ref_src=twsrc%5Etfw">April 13, 2023</a></blockquote> And while fans were concerned for the singer, he later took to social media to assure them that he was “fine” and looking forward to the band’s next stadium performance. “I’m fine. Yesterday at Manaus Stadium in Brazil, [I] experienced weakness because of dehydration,” he explained. “We stopped for about five minutes, I drank some water, and then all was well. Nothing serious.” “Brazil is hotter than hell!!” one fan responded, “so glad you're okay and I can't wait to see you in São Paulo! Take care, god of thunder!!” “Even the God of Thunder needs hydration,” another agreed. “Good to hear you're doing well.” <blockquote class="twitter-tweet"> Hey everybody, thanks for the good wishes. I’m fine. Yesterday at Manaus Stadium in Brazil, experienced weakness because of dehydration. We stopped for about five minutes, I drank some water, and then all was well. Nothing serious. Tomorrow, Bogota Stadium. See you there! — Gene Simmons (@genesimmons) <a href="https://twitter.com/genesimmons/status/1646530305791266818?ref_src=twsrc%5Etfw">April 13, 2023</a></blockquote> And as news broke around the world of what had gone down in Brazil, Simmons returned with another round of assurances, writing that it was “not a big deal” while again thanking everyone for their well wishes. “Last night we played Amazon jungle Stadium/Brazil. Humidity and temperature were sky high. I was dehydrated and was forced to sit for a song,” he said. “We got back on stage in 5 minutes & finished the show.” It was enough for his fans, who were quick to share their delight that their star was okay, as well as voicing their excitement for upcoming shows - with a good portion of requests for the singer to take care of himself, and avoid a repeat performance. “Happy to hear you're doing better,” one wrote. “Even more happy it wasn’t anything serious.Ya'll take care.” “Frankly, I don’t know [how] you do it every night. You’re amazing!” another declared. Meanwhile, some could see the humour in it all now that their fears had been put to rest, with one joking “and who says playing music couldn't be dangerous”. Images: Twitter

Caring

Ed Sheeran shoots for the stars with daughter’s name reveal

When Ed Sheeran and his wife Cherry Seaborn announced the birth of their second child in May 2022, they kept things simple. In a post to social media, Sheeran shared a picture of socks on a crochet blanket, with a caption reading “Want to let you all know we’ve had another beautiful baby girl. We are both so in love with her, and over the moon to be a family of 4”. The couple shared no ‘face reveal’ - opting to keep their children far removed from the public eye - and did not share their youngest daughter’s name with Sheeran’s 42.8m followers. But in a March interview with Rolling Stone, the 32-year-old singer-songwriter took everyone by surprise, opening up about his family life, and revealing the out-of-this-world moniker bestowed upon their youngest, Jupiter. “Me and Cherry were talking earlier about how it’s so lovely,” he told the publication, opening up about the little things in life that he and his family cherish the most. “We had an entire day. We did nothing but this. It’s so nice and wholesome having family on tour. “On the last tour, I’d party till 7 am, sleep till 4 pm, get up, and do the gig. But I was like, 26. It’s very different.” Jupiter’s birth, and establishing their new “lovely” life, were no easy feats for the couple. In February 2022 - a month that was already proving determined to knock Sheeran down - when Cherry was six months along in her pregnancy, she was diagnosed with a tumour. Surgery was required, but couldn’t be performed until she had given birth. As Sheeran wrote in a post outlining plans for his album Subtract, “Within the space of a month, my pregnant wife got told she had a tumour, with no route to treatment until after the birth. My best friend Jamal, a brother to me, died suddenly, and I found myself standing in court defending my integrity and career as a songwriter. “I was spiralling through fear, depression and anxiety. I felt like I was drowning, head below the surface, looking up but not being able to break through for air.” “There’s nothing you can do about it,” he confessed to Rolling Stone. “You feel so powerless.” Over the course of his interview, Sheeran toyed with a chain bracelet - one gifted to him by his wife, with their daughters’ name engraved. “It felt symbolic,” he said of the swap to the silver from the rubber bands that had previously adorned his wrist, “to take off those bracelets and put on one for my family.” After the slew of tragedies to hit Sheeran in such a short span of time, it was Cherry who realised that he was in need of professional help, leading to the singer seeking out a therapist. “No one really talks about their feelings where I come from,” he said. “People think it’s weird getting a therapist in England … I think it’s very helpful to be able to speak with someone and just vent and not feel guilty about venting. Obviously, like, I’ve lived a very privileged life. So my friends would always look at me like, ‘Oh, it’s not that bad.’ ” “The help isn’t a button that is pressed, where you’re automatically okay,” he added. “It is something that will always be there and just has to be managed.” And as Sheeran himself <a href="https://www.oversixty.com.au/health/caring/writing-songs-is-my-therapy-ed-sheeran-reveals-further-heartbreak">wrote in his Subtract post</a>, “Writing songs is my therapy. It helps me make sense of my feelings … in just over a week I replaced a decade’s worth of work with my deepest darkest thoughts.” Images: Getty

Family & Pets

Super rare pic of unrecognisable Gene Hackman

For the first time in a long time, legendary actor Gene Hackman has been spotted out and about at the age of 93. The icon had been reclusive in recent years, and these are the first photos of him snapped in a very long time. The Superman star still seemed fit and looked quite healthy in the snaps taken in Santa Fe, New Mexico. The retired actor was spotted enjoying a fast food lunch at a parking lot after going through the Wendy’s drive-thru. He is still sporting his signature moustache in the rare sighting. <blockquote class="twitter-tweet"> New photos of Hollywood Legend Gene Hackman have been released. He is currently 93-years-old. These are the first photos of him in years. <a href="https://t.co/5pn1wXN81w">pic.twitter.com/5pn1wXN81w</a> — Daily Loud (@DailyLoud) <a href="https://twitter.com/DailyLoud/status/1633270131324223489?ref_src=twsrc%5Etfw">March 8, 2023</a></blockquote> Hackman’s last movie role was with Ray Romano and Christine Baranski in the 2004 comedy Welcome To Mooseport. In July 2004, Hackman was interviewed by Larry King, where he announced there were no new film projects lined-up and believed his acting career was over. Years later, the star confirmed his retirement while promoting his third novel Escape From Andersonville, back in 2008. In an interview with CQ in 2011, he was asked if he would ever come out of retirement to do another film, and he responded, “If I could do it in my own house, maybe, without them disturbing anything and just one or two people.” CQ also asked him, “how do you want to be remembered?" “As someone who tried to portray what was given to them in an honest fashion. I don't know, beyond that. I don't think about that often, to be honest. I'm at an age where I should think about it.” He said with a laugh. Hackman has long been one of the most highly regarded film actors of all time, leading his Mississippi Burning director Alan Parker to state that “he is incapable of bad work. Every director has a shortlist of actors he’d die to work with, and I’ll bet Gene’s on every one.” The thespian really made waves when he was nominated for an Oscar for the Best Supporting Actor category for the 1970s film I Never Sang For My Father. A year later, he became a leading man in incredible fashion, winning the Academy Award for Best Actor in his New York City Detective Jimmy 'Popeye' Doyle in The French Connection (1971). Hackman’s career only went up from there, with countless awards under his belt, including two Oscars, two BAFTA awards and two Golden Globes. Image credit: Getty

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What is cognitive functional therapy? How can it reduce low back pain and get you moving?

Got no COVID-19 symptoms? A gene mutation might be the reason

“Irwin genes are strong”: Bindi shares adorable candid snap

Fun ways to boost memory in seniors

Aussie patient given new drug worth $5 million per dose

KISS concert halted as Gene Simmons falls ill on stage

Ed Sheeran shoots for the stars with daughter’s name reveal

Super rare pic of unrecognisable Gene Hackman

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