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We tend to underestimate our future expenses – here’s one way to prevent that

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ray-charles-chuck-howard-1361224">Ray Charles "Chuck" Howard</a>, <a href="https://theconversation.com/institutions/texas-aandm-university-1672">Texas A&M University</a>; <a href="https://theconversation.com/profiles/abigail-sussman-227057">Abigail Sussman</a>, <a href="https://theconversation.com/institutions/university-of-chicago-952">University of Chicago</a>; <a href="https://theconversation.com/profiles/david-j-hardisty-753777">David J. Hardisty</a>, <a href="https://theconversation.com/institutions/university-of-british-columbia-946">University of British Columbia</a>, and <a href="https://theconversation.com/profiles/marcel-lukas-1236384">Marcel Lukas</a>, <a href="https://theconversation.com/institutions/university-of-st-andrews-1280">University of St Andrews</a> <h2>The big idea</h2> When asked to estimate how much money they would spend in the future, people underpredicted the total amount by more than C$400 per month. However, when prompted to think about unexpected spending in addition to typical expenses, people made much more accurate predictions. These are the main findings of a series of <a href="https://doi.org/10.1177%2F00222437211068025">studies and experiments that we conducted</a> and which have just been published in the <a href="https://journals.sagepub.com/home/mrj">Journal of Marketing Research</a>. In our first study, we began by asking 187 members of a Canadian credit union to predict their weekly spending for the next five weeks. Then, at the end of each week, we asked them how much they actually spent. For the first four weeks, people underpredicted their weekly spending by about $100 per week or $400 for the month. In the study’s fifth and final week, we ran an experiment to see if we could improve people’s prediction accuracy. Specifically, we randomly assigned participants to one of two groups. In group one, participants estimated their spending for the next week just as they had done in previous weeks. These folks once again significantly underpredicted their spending. In group two, participants were asked to think of three reasons why their spending for the next week might be different than usual before making their estimate. This led them to make higher and much more accurate predictions – coming within just $7 of what they actually spent. Importantly, participants in each group spent roughly the same amount of money that week, on average. The only difference between the two groups was whether they accurately predicted that amount. <iframe id="WlDv3" class="tc-infographic-datawrapper" style="border: 0;" src="https://datawrapper.dwcdn.net/WlDv3/3/" width="100%" height="400px" frameborder="0" scrolling="no"></iframe> Next, we conducted nine experiments to better understand why people underpredict their spending and whether being prompted to think of unusual expenses helps improve accuracy. In all, over 5,800 people participated in these experiments, including a representative sample of U.S. residents. These experiments revealed two important insights. First, people primarily base their spending predictions on typical expenses like groceries, gasoline and rent. They usually fail to account for irregular – though still common – expenses like car repairs, last-minute concert tickets or one-off health care bills. This is what leads to underprediction. Second, prompting people to think of irregular expenses in addition to typical expenses helps them to make more accurate spending predictions. In our studies, people did not factor in atypical expenses unless we asked them to do so. <h2>Why it matters</h2> Helping people improve the accuracy of their spending predictions could help them improve their financial well-being. Underpredicting expenses can be costly. For example, 12 million Americans <a href="https://www.pewtrusts.org/en/research-and-analysis/reports/2012/07/19/who-borrows-where-they-borrow-and-why">borrow a total of more than $7 billion</a> in payday loans each year because they can’t meet their monthly expenses. These loans typically have extremely high interest rates – <a href="https://www.pewtrusts.org/en/research-and-analysis/data-visualizations/2022/how-well-does-your-state-protect-payday-loan-borrowers">more than 250% in some states</a>. Payday loans also come due in full so quickly that around three in four borrowers <a href="https://www.pewtrusts.org/en/research-and-analysis/reports/2012/07/19/who-borrows-where-they-borrow-and-why">end up borrowing again</a> to pay off the original loan. If consumers could better anticipate how much money they will spend in the future, it might help motivate them to spend less and save more in the present. In fact, one of our studies shows that our suggested prediction strategy <a href="https://doi.org/10.1177/0022243721106802">not only boosted spending estimates</a>, it also increased intentions to save. <h2>What’s next</h2> Members of our research team are currently investigating if, when and why underpredicting one’s expenses may be beneficial. For example, if a person sets an optimistically low budget and actively tracks their spending against it, does that help them reduce their spending? We are also investigating whether people who work in the gig economy show a corresponding tendency to mispredict their future income.<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/189100/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ray-charles-chuck-howard-1361224">Ray Charles "Chuck" Howard</a>, Assistant Professor of Marketing, <a href="https://theconversation.com/institutions/texas-aandm-university-1672">Texas A&M University</a>; <a href="https://theconversation.com/profiles/abigail-sussman-227057">Abigail Sussman</a>, Professor of Marketing, <a href="https://theconversation.com/institutions/university-of-chicago-952">University of Chicago</a>; <a href="https://theconversation.com/profiles/david-j-hardisty-753777">David J. Hardisty</a>, Assistant Professor of Marketing & Behavioral Science, <a href="https://theconversation.com/institutions/university-of-british-columbia-946">University of British Columbia</a>, and <a href="https://theconversation.com/profiles/marcel-lukas-1236384">Marcel Lukas</a>, Lecturer in Banking and Finance, <a href="https://theconversation.com/institutions/university-of-st-andrews-1280">University of St Andrews</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/we-tend-to-underestimate-our-future-expenses-heres-one-way-to-prevent-that-189100">original article</a>. </div>

Money & Banking

Arrests made after woman ends her life in "suicide pod"

Police in Switzerland have made several arrests in connection with a woman's death in the Australian-made "suicide pod". The 'Sarco' capsule was used for the first time by a 64-year-old American woman who was “immune compromised” and had been in “severe pain” for “at least two years”. The pod is designed for the user to push a button that injects nitrogen gas into the sealed chamber, with the person inside then supposed to fall asleep and die of suffocation in a few minutes. The Sarco machine (short for sarcophagus) was invented by Australian Dr Philip Nitschke, who has been nicknamed “Dr Death”, said the machine had performed exactly as it had been designed", with the woman's death occurring as "expected". “It looked exactly as we expected it to look. My guess is that she lost consciousness within two minutes and that she died after five minutes,” Dr Nitschke told Dutch media. “We saw sudden, small contractions and movements of the muscles in her arms, but she was probably already unconscious by then.” Dr Nitschke claimed the woman “almost immediately” pressed the button, adding, “She didn’t say anything. She really wanted to die.” However, despite the woman's wishes to take her own life, Swiss police announced that several people were taken into custody over the woman's death and are now facing criminal charges, suspected of “inducement and aiding and abetting suicide.” The arrests took place despite the fact that Dr Nitschke had previously told AP that his organisation received advice from lawyers in Switzerland that the use of the Sarco would be legal in the country, where active euthanasia is banned but assisted dying has been legal for decades. Need to talk to someone? Don't go it alone. Call Lifeline on 13 11 14 or visit lifeline.org.au Beyond Blue: 1300 224 636 SANE: 1800 187 263; saneforums.org Image credits: Exit International

Caring

"We won't recover": Grieving parents speak out ahead of daughter's funeral

Warning: This article contains discussions about suicide that some readers may find distressing. The grieving stepfather of 12-year-old Charlotte who died by suicide has spoken about the young girl's struggles with bullying as he prepares for her funeral. On Monday, Matthew remembered his stepdaughter as the “kindest, most caring little girl” whose death had followed “toxic” issues at school. “To lose a little girl at the age of 12 is something we won’t recover from,” he told 2GB’s Ben Fordham. Charlotte was a student at Santa Sabina College in Sydney’s inner west, with the Catholic school being forced to defend their handling of bullying in the wake of the 12-year-old's death. Matthew said he believed some of the responses from the school had been “unnecessary”, and claimed he had no direct communication from officials despite their public statements. “I think outside of the response from the broader community of the school I have to say I’ve been disappointed to say the least, with the response that’s come from the school,” he said. “Some of the responses that have gone into the media, I think the first response was around that there’s inconsistencies in their records and I thought that comment to go out at that time when we were grieving was unnecessary." “And since then, comments like the school’s been overwhelmed with support from other parents coming forward and saying how well they deal with these types of issues. And I’m sure they’ve had some communication and some support, Ben." “But those mothers that have given that school support, no doubt they will be planning on picking their daughter up from school today, and we are not.” Matthew went on to confirm that Charlotte's mother had repeatedly asked her daughter's school to do something about the bullying, and break up the friendship that put Charlotte through a "roller coaster". “I would not allow this behaviour to happen in my home,” he said. “I am not after any retribution for these girls … but I’m looking for the schools to step in … to act when these things are raised for the first time, not the second or third time.” Matthew said it was time school “friendship issues” were called out for what they really were, saying, “It’s not called a friendship issue in the workplace.” The year 7 student took her own life on September 9th, leaving a note to her parents that included names of those she wanted at her funeral and others who had made “life too hard”. It also instructed her mother, Kelly, to “tell the school please”, with the note reading, “Mama, please share my story to raise awareness.” The family are preparing to farewell her at a funeral on Friday, and have asked those who wish to send flowers to instead make a donation to the <a href="https://inmemoryofcharlotte.raiselysite.com" target="_blank" rel="noopener">Kids Helpline</a>. Need to talk to someone? Don't go it alone. Call Lifeline on 13 11 14 or visit lifeline.org.au Beyond Blue: 1300 224 636 SANE: 1800 187 263; saneforums.org Image credits: 2GB / Kids Helpline <p style="box-sizing: inherit; border: 0px; font-stretch: inherit; line-height: inherit; font-family: 'Helvetica Neue', HelveticaNeue, Helvetica, Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; font-size: 18px; margin: 0px 0px 24px; padding: 0px; vertical-align: baseline;">

Caring

"I don't call that a life": Couple sign up to die in double suicide pod

Warning: This article contains sensitive content that some readers may find distressing. A couple from the UK has signed up to be the first to die in a double suicide pod, invented by an Australian doctor, after 46 years of marriage. Peter and Christine Scott, from Suffolk in England’s east, have shared their plans to travel to Switzerland to die together after Ms Scott, a former nurse, was diagnosed with early-stage vascular dementia. After meeting at a jazz club, the pair married 46 years ago, and shared that they have opted out of potentially years of hospital treatment and the crippling costs of care which could eat into their life savings. “We have had long, happy, healthy, fulfilled lives but here we are in old age and it does not do nice things to you,” Mr Scott, 86, told<a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html"> The Daily Mail</a>. “The idea of watching the slow degradation of Chris’s mental abilities in parallel to my own physical decline is horrific to me,” the former Royal Air Force pilot added. “Obviously I would care for her to the point I could not, but she has nursed enough people with dementia during her career to be adamant she wants to remain in control of herself and her life”. “I would not want to go on living without her,” he said of his 80-year-old wife. “I don’t want to go into care, to be lying in bed dribbling and incontinent – I don’t call that a life”. As English law does not allow for euthanasia, the couple have planned their trip to Switzerland for the procedure, where Ms Scott has planned out her final days with her husband. “I’d like to go walking with Peter in the Swiss Alps, by a river. I’d have a beautiful plate of fish for my last supper, and enjoy a great bottle of Merlot,” she said. “I’d make a playlist including Wild Cat Blues and The Young Ones by Cliff Richard and I’ve found a poem called Miss Me But Let Me Go, which sums up exactly how I feel”. The suicide pod, known as Sarco, can be turned on with a simple flick of a switch from inside the futuristic capsule that resembles a modern car. The machine was invented by Australian Dr Philip Nitschke, who has long been behind a number of initiatives to allow legal euthanasia in Australia. The 3D printed Sarco capsule ends the lives of those inside by pumping the pod with nitrogen which replaces the oxygen in the pod, which renders the occupants unconscious within about a minute without, its claimed, any panic or distress. With falling oxygen, the person eventually suffocates. Dr Nitschke said the machine is activated by a button from inside the pod. “The capsule for two people works exactly the same as the single Sarco but there is only one button so they will decide between them who will push it,” he told <a title="www.dailymail.co.uk" href="https://www.dailymail.co.uk/news/article-13825105/Former-RAF-engineer-nurse-wife-sign-British-couple-use-double-suicide-pod-Switzerland-dementia.html">The Daily Mail</a>. “Then they’ll be able to hold each other”. Image credits: Courtesy of Exit International

Legal

New study links Ozempic and Wegovy to suicidal thoughts

A new study has found a link between weight reduction drugs and reports of suicidal thoughts. Semaglutide, the drug sold under the brand names Ozempic and Wegovy, has been widely used for weight loss despite only being approved for the treatment of diabetes. An analysis of data on the adverse drug reactions database of the World Health Organisation found a disproportionate number of people reporting suicidal thoughts while using semaglutide. The research published in JAMA Network also found that the effect was "significant" compared to other diabetes medication, and that people with anxiety and depression were more likely to report suicidal thoughts when taking the drug. The researches have called for "urgent clarification" and larger studies around how semaglutide medications impact the brain. "The study raises key questions about whether additional precautions are needed when prescribing semaglutide," Trevor Steward, a neurobiology researcher from the University of Melbourne said. However, there are a few limitations with the study as there were a lack of information about the dosages, and did not adjust for things like alcohol and substance misuse and off-label use. While the study did not find a direct cause between suicidal thoughts and the use of semaglutide, it is important to raise concerns, especially for those who may want to use these drugs based on information they found on social media, and therefore do not fully understand the risks. The use of semaglutide for weight loss in Australia is considered 'off label', meaning that it has been prescribed for purposes outside of its approved use. The Therapeutic Goods Administration (TGA) believes that these prescriptions have been driving shortages, which they are trying to address and believe will last until 2025. Images: Shutterstock

Caring

Shocking theory behind grandma's broad daylight murder-suicide

Warning: This article contains distressing content that some readers may find upsetting. Court papers have revealed the sinister reason behind why a grandmother allegedly killed her daughter-in-law before killing herself. Terminally ill ex-probation officer Kathleen Leigh, 65, fatally shot 45-year-old Marisa Galloway, who shares a child with Leigh’s son, Zachariah Reed, on a New York street before taking her own life. Now Ms Galloway’s grieving parents, Nancy and John, have filed an emergency court petition claiming Mr Reed has run off to his “multimillion-dollar home” in Chicago with their grandchild Lili under the pretext of “mourning” his mother’s death. He has also barred the Galloways from any contact, either in person or via technology, with the child. “Clearly, [Mr Reed’s] mother had a deliberate plan to kill Marisa in order to provide custody for her son,” the court papers charge, according to an exclusive report by the <a title="nypost.com" href="https://nypost.com/2024/08/18/us-news/killer-nyc-granny-carried-out-slay-suicide-to-give-son-full-custody-of-child-heartbreaking-suit/" target="_blank" rel="noopener">New York Post</a>. “Unfortunately, [Mr Reed] has demonstrated an absolute intention to further those same goals of his mother as he has refused to provide us with any access to Lili at all in almost 3 weeks.” According to legal papers filed on Friday, the grandparents, who live a 12 hour drive away in New Jersey, are asking a Manhattan Supreme Court judge to pass on Marisa’s parenting time, hashed out in a 2022 custody agreement with Mr Reed. They are also asking that Mr Reed be forced to live in the New York until Lili is 18 so that she can keep a close relationship with her grandparents and with her half-sister, Mariel, the 1-year-old daughter Marisa had with a sperm donor who currently lives with the grandparents. “While Marisa was always the best mother, we would love to be involved with all aspects of taking care of an infant, toddler, and ultimately the little girl that Lili currently is,” Nancy wrote. Nancy said she is “extremely uncomfortable” being forced to file the petition but worried Lili would become estranged from her mum’s side of the family if they didn’t intervene. The grandmother laid out the history of Marisa and Mr Reed’s “tumultuous relationship” since the pair split and their “contentious” custody battle while she also claimed the pair dated before Marisa became pregnant but said their relationship ended “driven by the interference of [Mr Reed’s] mother.” On the day of the heinous crime on July 26th 2024, Marisa was loading her car and had put Mariel in her seat with plans to visit her parents for a few days. She was approached by Leigh while she was putting something in the boot, and shot her once in the back of the head and again in the back before taking her own life. Before her heinous crime, Leigh scrawled a seven-page letter “For Police” describing how she felt Marisa was trying to alienate Lili from her dad and saying she suspected Marisa of abusing Lili, despite child services clearing Marisa in two probes launched by Mr Reed. “She took away the child’s mother in order to make her son happy … it’s shocking,” a law-enforcement source had told the New York Post of Leigh right after the alleged murder-suicide. Image credits: Manhattan Supreme Court

Legal

Walking can prevent low back pain, a new study shows

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</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>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Do you suffer from low back pain that recurs regularly? If you do, you’re not alone. Roughly <a href="https://pubmed.ncbi.nlm.nih.gov/31208917/">70% of people</a> who recover from an episode of low back pain will experience a new episode in the following year. The recurrent nature of low back pain is a major contributor to the <a href="https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(23)00098-X/fulltext">enormous burden</a> low back pain places on individuals and the health-care system. In our new study, published today in <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)00755-4/fulltext">The Lancet</a>, we found that a program combining walking and education can effectively reduce the recurrence of low back pain. <h2>The WalkBack trial</h2> We randomly assigned 701 adults who had recently recovered from an episode of low back pain to receive an individualised walking program and education (intervention), or to a no treatment group (control). Participants in the intervention group were guided by physiotherapists across six sessions, over a six-month period. In the first, third and fifth sessions, the physiotherapist helped each participant to develop a personalised and progressive walking program that was realistic and tailored to their specific needs and preferences. The remaining sessions were short check-ins (typically less than 15 minutes) to monitor progress and troubleshoot any potential barriers to engagement with the walking program. Due to the COVID pandemic, most participants received the entire intervention via telehealth, using video consultations and phone calls. The program was designed to be manageable, with a target of five walks per week of roughly 30 minutes daily by the end of the six-month program. Participants were also encouraged to continue walking independently after the program. Importantly, the walking program was combined with education provided by the physiotherapists during the six sessions. This education aimed to give people a better understanding of pain, reduce fear associated with exercise and movement, and give people the confidence to self-manage any minor recurrences if they occurred. People in the control group received no preventative treatment or education. This reflects what <a href="https://www.sciencedirect.com/science/article/abs/pii/S2468781222001308?via%3Dihub">typically occurs</a> after people recover from an episode of low back pain and are discharged from care. <h2>What the results showed</h2> We monitored the participants monthly from the time they were enrolled in the study, for up to three years, to collect information about any new recurrences of low back pain they may have experienced. We also asked participants to report on any costs related to their back pain, including time off work and the use of health-care services. The intervention reduced the risk of a recurrence of low back pain that limited daily activity by 28%, while the recurrence of low back pain leading participants to seek care from a health professional decreased by 43%. Participants who received the intervention had a longer average period before they had a recurrence, with a median of 208 days pain-free, compared to 112 days in the control group. Overall, we also found this intervention to be cost-effective. The biggest savings came from less work absenteeism and less health service use (such as physiotherapy and massage) among the intervention group. This trial, like all studies, had some limitations to consider. Although we tried to recruit a wide sample, we found that most participants were female, aged between 43 and 66, and were generally well educated. This may limit the extent to which we can generalise our findings. Also, in this trial, we used physiotherapists who were up-skilled in health coaching. So we don’t know whether the intervention would achieve the same impact if it were to be delivered by other clinicians. <h2>Walking has multiple benefits</h2> We’ve all heard the saying that “prevention is better than a cure” – and it’s true. But this approach has been largely neglected when it comes to low back pain. Almost all <a href="https://www.sciencedirect.com/science/article/pii/S0140673618304896?via%3Dihub">previous studies</a> have focused on treating episodes of pain, not preventing future back pain. A limited number of <a href="https://pubmed.ncbi.nlm.nih.gov/26752509/">small studies</a> have shown that exercise and education can help prevent low back pain. However, most of these studies focused on exercises that are not accessible to everyone due to factors such as high cost, complexity, and the need for supervision from health-care or fitness professionals. On the other hand, walking is a free, accessible way to exercise, including for people in rural and remote areas with limited access to health care. Walking also delivers many other <a href="https://www.vichealth.vic.gov.au/sites/default/files/VH_Benefits-of-Walking-Summary2020.pdf">health benefits</a>, including better heart health, improved mood and sleep quality, and reduced risk of several chronic diseases. While walking is not everyone’s favourite form of exercise, the intervention was well-received by most people in our study. Participants <a href="https://pubmed.ncbi.nlm.nih.gov/37271689/">reported</a> that the additional general health benefits contributed to their ongoing motivation to continue the walking program independently. <h2>Why is walking helpful for low back pain?</h2> We don’t know exactly why walking is effective for preventing back pain, but <a href="https://www.e-jer.org/journal/view.php?number=2013600295">possible reasons</a> could include the combination of gentle movements, loading and strengthening of the spinal structures and muscles. It also could be related to relaxation and stress relief, and the release of “feel-good” endorphins, which <a href="https://my.clevelandclinic.org/health/body/23040-endorphins">block pain signals</a> between your body and brain – essentially turning down the dial on pain. It’s possible that other accessible and low-cost forms of exercise, such as swimming, may also be effective in preventing back pain, but surprisingly, <a href="https://pubmed.ncbi.nlm.nih.gov/34783263/">no studies</a> have investigated this. Preventing low back pain is not easy. But these findings give us hope that we are getting closer to a solution, one step at a time.<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/231682/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/tash-pocovi-1293184">Tash Pocovi</a>, Postdoctoral research fellow, Department of Health Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>; <a href="https://theconversation.com/profiles/christine-lin-346821">Christine Lin</a>, Professor, Institute for Musculoskeletal Health, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</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>; <a href="https://theconversation.com/profiles/petra-graham-892602">Petra Graham</a>, Associate Professor, School of Mathematical and Physical Sciences, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a>, and <a href="https://theconversation.com/profiles/simon-french-713564">Simon French</a>, Professor of Musculoskeletal Disorders, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie 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/walking-can-prevent-low-back-pain-a-new-study-shows-231682">original article</a>. </div>

Body

"The most gorgeous family": Tributes flow for slain mother and daughter

Police are continuing their investigation into the tragic deaths of Jennifer Petelczyc and her daughter Gretel, who were shot dead in their own home by a 63-year-old man. The mother and daughter were killed on Friday, when the man was allegedly searching for his ex-partner before he fatally shot the pair in their home at Floreat, north-west of the Perth CBD. Since their tragic deaths, loved ones and members of the community have come out in droves to pay their respects. "They're the most gorgeous family and it's absolutely just heartbreaking that this has happened," said family friend Imogen Harrris. She added the slain mum, 59, and her 18-year-old daughter were the "kindest, most light-hearted, beautiful people". Neighbour Claire Andrews remembered them as people who "always gave back to the community". Jennifer Petelczyc was known to be a caring and generous member of the community, as she installed a $5,000 defibrillator to be installed outside her home for local people to use in a health emergency. According to police, the man who allegedly killed the mother and daughter, Mark Bombara, was a licensed firearms owner who possessed at least 13 guns and took multiple firearms to the Floreat home as he searched for his ex-wife, who detectives say was a friend of Jennifer. It is understood that Bombara’s wife left him weeks ago and had been staying with Ms Petelczyc. Officers confirmed the man's former partner was not at the home but the two women were tragically killed. WA's Premier Roger Cook has described the murders as "chilling and horrific", saying, "This is a circumstance in which a woman has sought refuge from a friend. It would appear that as a result of that, that friend and her daughter have come to harm." "They're innocent people ... simply doing what we'd all want someone to do when we're facing difficult circumstances. By every measure it looks senseless, chilling and absolutely horrific." "I think we need to take the opportunity today ... to reflect on it and think about how we can all continue to make the world a safer place." Image credits: 9News

Caring

Independent you: preventing, and recovering from, elder abuse

From implementing safeguards to stop it from beginning to taking back control if it does, there is a lot of power in your hands to avoid elder abuse. Previously, we explored the warning signs of elder abuse and how <a href="https://www.oversixty.com.au/finance/retirement-income/are-you-a-victim-of-elder-abuse-without-even-realising-it">it is possible to be a victim without even realising it</a>. And with more wealth owned by people over 60 now than ever before, the potential for abuse only continues to grow. So, how can you prevent elder abuse happening to you? And if you are already experiencing it, what can you do to regain control over your finances, independence and wellbeing? Prevention better than cure The best way to avoid the impacts of elder abuse is to protect yourself against it beginning in the first place. Awareness is the first step, so having <a href="https://www.oversixty.com.au/finance/retirement-income/are-you-a-victim-of-elder-abuse-without-even-realising-it">read this article and knowing the warning signs</a>, you’re already ahead of the game! Other preventative actions include: <ul> <li>Maintaining contact: social interactions are important not just for warding off loneliness but providing access to other points of view and avenues for support. </li> <li>External advisers: engage your own advisers – don’t simply employ who someone tells you to. They should be an impartial, qualified set of eyes to monitor things for you and point out anything that doesn’t seem right. This includes a financial advisor, lawyer, accountant, doctor and so on. A support person attending appointments with you may give you extra assurance.</li> <li>Power of attorney/guardianship: nominate multiple people, so that no one individual has all the say. It can be useful to include someone who is not a relative for impartiality, such as a trusted friend or your lawyer. </li> <li>Superannuation beneficiaries: super is separate from your will, but beneficiary nominations can only be spouse, child, dependent or interdependent otherwise it will go to you Will. In your Will you can direct to other people or charities. Some beneficiaries lapse, so will need to be renewed.</li> <li>Wills: review your will to ensure it reflects YOUR wishes, not someone else’s. People can jostle over not only their own inheritance but may try to influence you to leave others out. </li> <li>Documenting everything: keep a written record, especially where money is concerned – such as acting as Bank of Mum and Dad for adult kids to purchase property. Outline how much is given, what if any interest/repayments are expected and when, and what happens if their relationship subsequently breaks down.</li> <li>Encouraging independence: people who have come to expect handouts can become abusive if those handouts stop or requests for more are denied. Support and encourage others, especially your kids, to be financially independent and self-sufficient.</li> </ul> Taking back control Sadly, prevention is no longer an option for an <a href="https://www.aihw.gov.au/family-domestic-and-sexual-violence/population-groups/older-people?xd_co_f=YjAzZDU4YTUtYzA5YS00YTNkLWJkNDQtNjdiZTM5ZmY5ZjQx#abuse">estimated 598,000 Australians</a> already experiencing elder abuse. However, it is still possible to break the cycle. Don’t be embarrassed or stick your head in the sand hoping things will improve. You have done nothing wrong. You are entitled to enjoy your retirement years. To take back control over your affairs, your wellbeing and your independence: <ul> <li>Ensure your physical safety first and foremost.</li> <li>Seek medical attention for your physical and mental health (the latter is crucial for making good decisions around the other points on this list).</li> <li>Get support from another relative, close friend, neighbour, or other trusted person. Don’t be alone.</li> <li>Secure a roof over your head. Having a stable place to live gives you the security and focus to tackle other concerns.</li> <li>Freeze access to your money – bank accounts, credit cards etc. This will stop (further) unauthorised withdrawals or purchases being charged to you.</li> <li>Seek professional advice. Your financial adviser, tax accountant and lawyer will be able to guide you through protecting your home, money, guardianship and estate planning matters.</li> <li>Make informed changes. Don’t do anything rashly – make necessary changes once you have sought independent advice and considered your options. This may involve making changes to your power of attorney, will, superannuation, bank accounts, even your phone number in extreme cases.</li> <li>Consider counselling. Your abuser may not realise the severity of their actions. An independent counsellor may be able to help them see this and change their ways, and ultimately salvage your relationship.</li> </ul> If you or someone you know is experiencing elder abuse, seek help straight away. Speak to a trusted relative or friend. Seek independent legal and financial advice about your affairs. Or call the government’s free elder abuse line on 1800 353 374. And if your life is in danger, call triple zero (000) immediately. Helen Baker is a licensed Australian financial adviser and author of On Your Own Two Feet: The Essential Guide to Financial Independence for all Women. Helen is among the 1% of financial planners who hold a master’s degree in the field. Proceeds from book sales are donated to charities supporting disadvantaged women and children. Find out more at <a href="http://www.onyourowntwofeet.com.au/">www.onyourowntwofeet.com.au</a> Disclaimer: The information in this article is of a general nature only and does not constitute personal financial or product advice. Any opinions or views expressed are those of the authors and do not represent those of people, institutions or organisations the owner may be associated with in a professional or personal capacity unless explicitly stated. Helen Baker is an authorised representative of BPW Partners Pty Ltd AFSL 548754. Image credits: Getty Images

Caring

Kate Middleton is having ‘preventive chemotherapy’ for cancer. What does this mean?

<a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</a> Catherine, Princess of Wales, is undergoing treatment for cancer. In a video thanking followers for their messages of support after her major abdominal surgery, the Princess of Wales explained, “tests after the operation found cancer had been present.” “My medical team therefore advised that I should undergo a course of preventative chemotherapy and I am now in the early stages of that treatment,” she said in the two-minute video. No further details have been released about the Princess of Wales’ treatment. But many have been asking what preventive chemotherapy is and how effective it can be. Here’s what we know about this type of treatment. <h2>It’s not the same as preventing cancer</h2> To <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">prevent cancer developing</a>, lifestyle changes such as diet, exercise and sun protection are <a href="https://www.cancer.org.au/about-us/how-we-help/prevention">recommended</a>. Tamoxifen, a hormone therapy drug can be used to reduce the risk of cancer for some patients at <a href="https://www.mayoclinic.org/diseases-conditions/breast-cancer/in-depth/breast-cancer/art-20045353">high risk of breast cancer</a>. Aspirin <a href="https://www.cancer.gov/about-cancer/causes-prevention/research/aspirin-cancer-risk">can also be used</a> for those at high risk of bowel and other cancers. <h2>How can chemotherapy be used as preventive therapy?</h2> In terms of treating cancer, prevention refers to giving chemotherapy after the cancer has been removed, to prevent the cancer from returning. If a cancer is localised (limited to a certain part of the body) with no evidence on scans of it spreading to distant sites, local treatments such as surgery or radiotherapy can remove all of the cancer. If, however, cancer is first detected after it has spread to distant parts of the body at diagnosis, clinicians use treatments such as chemotherapy (anti-cancer drugs), hormones or immunotherapy, which circulate <a href="https://www.healthline.com/health/cancer/metastatic-cancer">around the body</a> . The other use for chemotherapy is to add it before or after surgery or radiotherapy, to prevent the primary cancer <a href="https://www.verywellhealth.com/adjuvant-therapy-5198903">coming back</a>. The surgery may have cured the cancer. However, in some cases, undetectable microscopic cells may have spread into the bloodstream to distant sites. This will result in the cancer returning, months or years later. With some cancers, treatment with chemotherapy, given before or after the local surgery or radiotherapy, can kill those cells and prevent the cancer coming back. If we can’t see these cells, how do we know that giving additional chemotherapy to prevent recurrence is effective? We’ve learnt this from clinical trials. Researchers have compared patients who had surgery only with those whose surgery was followed by additional (or often called adjuvant) chemotherapy. The additional therapy resulted in patients not relapsing and surviving longer. <h2>How effective is preventive therapy?</h2> The effectiveness of preventive therapy depends on the type of cancer and the type of chemotherapy. Let’s consider the common example of bowel cancer, which is at high risk of returning after surgery because of its size or spread to local lymph glands. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7564362/">first chemotherapy tested</a> improved survival by 15%. With more intense chemotherapy, the chance of surviving six years is approaching 80%. Preventive chemotherapy is usually given for three to six months. <h2>How does chemotherapy work?</h2> Many of the chemotherapy drugs stop cancer cells dividing by disrupting the DNA (genetic material) in the centre of the cells. To improve efficacy, drugs which work at different sites in the cell are given in combinations. Chemotherapy is not selective for cancer cells. It kills any dividing cells. But cancers consist of a higher proportion of dividing cells than the normal body cells. A <a href="https://www.canceraustralia.gov.au/cancer-types/breast-cancer/treatment/chemotherapy/how-does-chemotherapy-work#:%7E:text=Chemotherapy%20works%20by%20killing%20cells%20that%20are%20rapidly,cells%20can%20repair%20the%20damage%20and%20can%20recover.">greater proportion of the cancer is killed</a> with each course of chemotherapy. Normal cells can recover between courses, which are usually given three to four weeks apart. <h2>What are the side effects?</h2> The side effects of chemotherapy are usually reversible and are seen in parts of the body where there is normally a high turnover of cells. The production of blood cells, for example, is temporarily disrupted. When your white blood cell count is low, there is an increased risk of infection. Cell death in the lining of the gut leads to mouth ulcers, nausea and vomiting and bowel disturbance. Certain drugs sometimes given during chemotherapy can attack other organs, such as causing numbness in the hands and feet. There are also generalised symptoms such as <a href="https://www.cancervic.org.au/cancer-information/treatments/treatments-types/chemotherapy/side_effects_of_chemotherapy.html">fatigue</a>. Given that preventive chemotherapy given after surgery starts when there is no evidence of any cancer remaining after local surgery, patients can usually resume normal activities within weeks of completing the courses of chemotherapy.<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/226461/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ian-olver-1047">Ian Olver</a>, Adjunct Professsor, School of Psychology, Faculty of Health and Medical Sciences, <a href="https://theconversation.com/institutions/university-of-adelaide-1119">University of Adelaide</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/kate-middleton-is-having-preventive-chemotherapy-for-cancer-what-does-this-mean-226461">original article</a>.

Body

What happens to teeth as you age? And how can you extend the life of your smile?

<a href="https://theconversation.com/profiles/arosha-weerakoon-792707">Arosha Weerakoon</a>, <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</a> A healthy smile <a href="https://pubmed.ncbi.nlm.nih.gov/37314011/">helps us</a> live long, well and happy lives. But just <a href="https://pubmed.ncbi.nlm.nih.gov/37436910/">like our bodies</a>, our teeth succumb to age-related changes. So what happens to teeth as you age? And what can you do to ensure your smile lasts the distance? <h2>First, what are teeth made of?</h2> The tooth crown is covered by a hard enamel coat that surrounds softer, brown dentine, which protects a centrally located pulp. Enamel is a complex weave of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2584618/">brittle</a>, honeycomb-clustered strands that interact with light to make teeth appear opalescent (a pearly, milky iridescence). <a href="https://onlinelibrary.wiley.com/doi/10.1111/j.1601-1546.2012.00269.x">Dentine under enamel</a> forms most of the tooth crown and root, and is made of collagen, mineral, water and proteins. Collagen strands are <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">woven</a> to stretch and spring back, to <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib12">prevent teeth</a> from cracking and breaking when we grind and chew. The pulp has blood vessels and nerves that communicate with the rest of your body. Enmeshed in the dentine mineral and collagen are small, <a href="https://pubmed.ncbi.nlm.nih.gov/8809302/">interconnected tubules</a> formed by specialised cells called <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847799940960">odontoblasts</a> that settle around the pulp, once our teeth completely form. Each tooth contains a <a href="https://pubmed.ncbi.nlm.nih.gov/23803461/">finite number of odontoblasts</a>, unlike the constantly replenished special bone cells that renew. <h2>How do our teeth change as we age?</h2> Unable to renew, our teeth <a href="https://www.sciencedirect.com/science/article/pii/S0003996922002102?via%3Dihub#bib19">become brittle</a>, and prone to fracture as dentine loses its spring. This is <a href="https://www.sciencedirect.com/science/article/pii/S0002817714613532?casa_token=1K9Y6CJXmsAAAAAA:t6y_b_Iy02AWpUGaiz4H8Fk0Kdfx6z1ypHiGOEjFqFNlU1jvSRCVjfYOyysgIErJvgCzh33c2hfX">more common</a> in teeth with existing crack lines, large fillings or root canal treatments. With time, the outer surface of enamel <a href="https://www.sciencedirect.com/science/article/abs/pii/S0022391305004348?casa_token=xXfdecXrLaoAAAAA:YE_0swAFtT3RyCUeJmPwciixQ0hwL-foLyC2RGtnlyUSJ9O-pPLQz0B8XNd4Gq1AMtCN2BgnCrqo">thins</a> to reveal the relatively opaque dentine that darkens as we age. The dentine darkens because the collagen weave <a href="https://www.sciencedirect.com/science/article/abs/pii/S1047847722000697">stiffens and shrinks</a>, and the fluid in the tubules <a href="https://www.sciencedirect.com/science/article/pii/S2590152422000010?via%3Dihub">fills with mineral</a>. The odontoblasts continue to form dentine inside the tooth to reduce the translucent pulp space. The increase in dentine makes our teeth appear <a href="https://www.sciencedirect.com/science/article/abs/pii/S0003996913003294">opaque</a> and insulates from hot and cold sensations. This is why <a href="https://www.sciencedirect.com/science/article/pii/S0300571215000494?casa_token=iiLtoxOZOYQAAAAA:RfaGR7lrq9dgWuO_nh6hLETzVUiIWdu-mB-Ev019vZH5t6meVyAHs3YpZzcu9FNrDBYQL6OExu6j">X-rays</a> are useful to detect cavities we may not feel. Food and drink particles fill micro-gaps and age-related fine crack lines that run up and down enamel to <a href="https://www.researchgate.net/profile/Yash-Kapadia/publication/322509199_Tooth_staining_A_review_of_etiology_and_treatment_modalities/links/5b4cd922a6fdcc8dae245b7d/Tooth-staining-A-review-of-etiology-and-treatment-modalities.pdf">discolour and stain</a>. These stains are easily managed by <a href="https://www.sciencedirect.com/science/article/pii/S2772559622000207">tooth whitening</a>. How else can you extend the life of your teeth and brighten your smile? Here are seven tips to avoid dental decline: <h2>1. Avoid unnecessary forces</h2> Avoid <a href="https://www.nature.com/articles/sj.bdj.2012.722">using</a> your teeth to hold things such as working tools or to open packaging. Take measures to avoid forces such as <a href="https://www.sciencedirect.com/science/article/pii/S1882761622000059">grinding or clenching</a> by wearing a night guard. If you have <a href="https://www.sciencedirect.com/science/article/pii/S0109564122002421">large fillings</a> or <a href="https://www.sciencedirect.com/science/article/pii/S0109564122001579?casa_token=kQPjGNgU2iQAAAAA:ytMnT5MLV8aRehNyyWD7qC7FXSBE5xpPCxnzZ2ryKsuyJePq1jHisue1udtN0Cs6NDYJ37xYHy_5">root canal-treated</a> teeth, speak to your dentist about <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/aej.12002?casa_token=RwMhhwmgjwwAAAAA%3AGCWVA9vjFX68S2DdKbCFl4jwTAjMeqVDoT3GtXTSjA7SMEc3ksktOMCUSz9ArikD4XhBM5v08nGCvmVF0g">specific filling materials or crowns</a> that can protect your teeth from cracking or breaking. <h2>2. Share the load</h2> If you are missing molars or premolars, distribute chewing forces evenly to prevent overloading your remaining teeth. Replace missing teeth with <a href="https://www.sciencedirect.com/science/article/pii/S010956411100858X?casa_token=4vrj3ssj0PEAAAAA:UODaFxNDCKmQ_lQs1faL6lh0xIeIfSFrRQBq-s0KF1ZvUJd6ytbXX37TVaiHLRzJPJaSDF_2aVmL">bridges</a>, <a href="https://aap.onlinelibrary.wiley.com/doi/full/10.1902/jop.2008.080188?casa_token=uA0r7imcRbUAAAAA%3AeXGszI5-Dcu4oKi33FCrRRviiAj0uyoP7V5wApIRQD1-1Zu-rkLAcoLhKMAJYVnC9tEnxj33UdNJIndEBA">implants</a> or well-fitted <a href="https://www.mdpi.com/1660-4601/18/13/6776">dentures</a> to support your bite. Get your dentures <a href="https://www.sciencedirect.com/science/article/pii/S0022391320301554">checked regularly</a> to ensure they fit and support adequately, and replace them at least every ten years. <h2>3. Preserve your enamel</h2> Reduce <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jcpe.12330?casa_token=W2Ib34A77-QAAAAA%3AnLZtwwqZuueyHf1CMX0K9MERSW_Pvc3w0KlpArFT1KNusuopjEUcWmGd8pDUA7fQcj6DMkcS-JnXISFV1w">further enamel and dentine loss</a> by selecting soft-bristled <a href="https://www.tandfonline.com/doi/full/10.1080/00016350802195041?casa_token=E-ErdP543QUAAAAA%3A0Wz5AWwQxntBIc3UndFX_5nVbAYoPDx-PX1tg7Umxjr_QepX3CSIFVXYcrrxWV9iTx99Afk8c_zff-o">tooth brushes and non-abrasive toothpastes</a>. Certain whitening toothpastes can be abrasive, which can <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874033/">roughen and wear</a> the tooth surfaces. If you are unsure, stick with toothpastes that are labelled “sensitive”. Reduce your exposure to <a href="https://www.nature.com/articles/sj.bdj.2012.722">acid</a> in food (think lemons or apple cider vinegar) or illness (reflux or vomiting) where possible to maintain enamel and prevent erosion. <h2>4. Enhance your saliva</h2> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jtxs.12356?casa_token=1moXbwnrDQIAAAAA%3AHz3Im9lmR3h75TmG8FSUQH-8_0UGnQ9TNkgaPL79LlrCmwC3kzZZJaAB2mSZHf4X7PX5y3GKaVoY5cm5JA">Saliva</a> protects against acid attacks, flushes our teeth, and has antibacterial properties to reduce erosion and decay (holes forming). Saliva is also important to help us chew, swallow and speak. But our saliva quality and quantity reduces because of age-related changes to our salivary glands as well as certain medications prescribed to <a href="https://pubmed.ncbi.nlm.nih.gov/19392837/">manage chronic illnesses</a> such as depression and high blood pressure. Speak to your doctor about other medication options to improve your saliva or manage reflux disease to prevent erosion. <h2>5. Treat gum disease</h2> Aesthetically, <a href="https://pubmed.ncbi.nlm.nih.gov/37358230/">treating gum disease (periodontitis)</a> reduces gum shrinkage (recession) that typically exposes the relatively darker tooth roots that are more <a href="https://journals.sagepub.com/doi/abs/10.1177/00220345231166294">prone to developing holes</a>. <h2>6. Manage and prevent senescence</h2> <a href="https://pubmed.ncbi.nlm.nih.gov/36908187/">Cellular senescence</a> is the process that changes DNA in our cells to reduce our ability to withstand physical, chemical or biological damage. Cellular senescence enhances new cancer formation, the spread of existing cancers and the onset of chronic illnesses such as Alzheimer’s disease, diabetes, osteoporosis and heart disease. You can prevent cell damage by managing lifestyle factors such as smoking, uncontrolled diabetes and chronic infections such as gum disease. <h2>7. Adapt and ask for help</h2> <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15769?casa_token=SC-LouFQThsAAAAA%3A4jcvLRuJ56dGEm7ttvMad65hvUoZ7V5nvILg5sLFVZo8jxyQGR6YFeTcfM8sByTbdVrCWR1O5ytI3Z_crA">Ageing</a> can affect our cognition, hand dexterity and eyesight to prevent us from cleaning our teeth and gums as effectively as we once could. If this describes you, talk to your dental care team. They can help clean your teeth, and <a href="https://www.magonlinelibrary.com/doi/full/10.12968/bjon.2020.29.9.520?casa_token=_rol0NXx9c8AAAAA%3Aq8zgxiMSASwF1MRQZnZzfzmttn2x7FfGwsiIv71C_s_PTTmGD9JOIbqqtLNXa0oF9ogOjOCZwwpwB94">recommend products and tools</a> to fit your situation and abilities.<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/215786/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/arosha-weerakoon-792707">Arosha Weerakoon</a>, Senior Lecturer, School of Dentistry, The University of Queensland and General Dentist., <a href="https://theconversation.com/institutions/the-university-of-queensland-805">The University of Queensland</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-happens-to-teeth-as-you-age-and-how-can-you-extend-the-life-of-your-smile-215786">original article</a>.

Body

Taking more than 5 pills a day? ‘Deprescribing’ can prevent harm – especially for older people

<a href="https://theconversation.com/profiles/emily-reeve-1461339">Emily Reeve</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L Johnson</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/janet-sluggett-146318">Janet Sluggett</a>, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>, and <a href="https://theconversation.com/profiles/kate-ohara-1462183">Kate O'Hara</a>, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</a> People are living longer and with more <a href="https://www.aihw.gov.au/reports/older-people/older-australia-at-a-glance/contents/health-functioning/health-disability-status">chronic health conditions</a> – including heart disease, diabetes, arthritis and dementia – than ever before. As societies continue to grow older, one pressing concern is the use of multiple medications, a phenomenon known as <a href="https://www.who.int/docs/default-source/patient-safety/who-uhc-sds-2019-11-eng.pdf">polypharmacy</a>. About <a href="https://onlinelibrary.wiley.com/doi/full/10.5694/mja2.50244">1 million older Australians</a> experience polypharmacy and this group is increasing. They may wake up in the morning and pop a pill for their heart, then another one or two to control blood pressure, a couple more if they have diabetes, a vitamin pill and maybe one for joint pain. Polypharmacy is usually <a href="https://www.safetyandquality.gov.au/sites/default/files/2021-04/fourth_atlas_2021_-_6.1_polypharmacy_75_years_and_over.pdf">defined</a> as taking five or more different medications daily. In aged care homes, <a href="https://doi.org/10.1016/j.archger.2022.104849">90% of residents</a> take at least five regular medications every single day. That can put their health at risk with increased costs for them and the health system. <h2>Adding up over time</h2> As people age, the effects of medications can change. Some medications, which were once beneficial, might start to do more harm than good or might not be needed anymore. About <a href="https://www.psa.org.au/wp-content/uploads/2020/02/Medicine-Safety-Aged-Care-WEB-RES1.pdf">half of older Australians</a> are taking a medication where the likely harms outweigh the potential benefits. While polypharmacy is sometimes necessary and helpful in managing multiple health conditions, it can lead to unintended consequences. <a href="https://www.nps.org.au/living-with-multiple-medicines/costs">Prescription costs</a> can quickly add up. Taking multiple medications can be difficult to manage particularly when there are specific instructions to crush them or take them with food, or when extra monitoring is needed. There is also a risk of <a href="https://www.nps.org.au/consumers/understanding-drug-interactions">drug interactions</a>. Medications bought “over the counter” without a prescription, such as vitamins, herbal medications or pain relievers, can also cause <a href="https://onlinelibrary.wiley.com/doi/abs/10.5694/mja11.10698">problems</a>. Some people might take an over-the-counter medication each day due to previous advice, but they might not need it anymore. Just like prescription medications, over-the-counter medications add to the overall burden and cost of polypharmacy as well as drug interactions and side effects. Unfortunately, the more medications you take, the more likely you are to have <a href="https://www.nps.org.au/consumers/managing-your-medicines#risks-of-taking-multiple-medicines">problems with your medications</a>, a reduced quality of life and increased risk of falls, hospitalisation and death. Each year, <a href="https://www.psa.org.au/wp-content/uploads/2019/01/PSA-Medicine-Safety-Report.pdf">250,000 Australians</a> are admitted to hospital due to medication-related harms, many of which are preventable. For example, use of multiple medications like sleeping pills, strong pain relievers and some blood pressure medications can cause drowsiness and dizziness, potentially resulting in a <a href="https://betterhealthwhileaging.net/preventing-falls-10-types-of-medications-to-review/">fall</a> and broken bones. <h2>Prescribing and deprescribing are both important</h2> Ensuring safe and effective use of medications involves both prescribing, and <a href="https://www.racgp.org.au/clinical-resources/clinical-guidelines/key-racgp-guidelines/view-all-racgp-guidelines/silver-book/part-a/deprescribing">deprescribing</a> them. <a href="https://www.australiandeprescribingnetwork.com.au/474-2/">Deprescribing</a> is a process of stopping (or reducing the dose of) medications that are no longer required, or for which the risk of harm outweighs the benefits for the person taking them. The process involves reviewing all the medications a person takes with a health-care professional to identify medications that should be stopped. Think of deprescribing as spring cleaning your medicine cabinet. Just like how you tidy up your house and get rid of objects that are causing clutter without being useful, deprescribing tidies up your medication list to keep only the ones truly required. <h2>But care is needed</h2> The process of deprescribing requires close monitoring and, for many medications, slow reductions in dose (tapering). This helps the body adjust gradually and can prevent sudden, unpleasant changes. Deprescribing is often done on a trial basis and medication can be restarted if symptoms come back. Alternatively, a safer medication, or non-drug treatment may be started in its place. Studies show deprescribing is a safe process when managed by a health-care professional, both for people living at <a href="https://link.springer.com/article/10.1007/s11606-020-06089-2">home</a> and those in <a href="https://doi.org/10.1016/j.jamda.2018.10.026">residential aged care</a>. You should always talk with your care team before stopping any medications. Deprescribing needs to be a team effort involving the person, their health-care team and possibly family or other carers. Shared decision-making throughout the process empowers the person taking medications to have a say in their health care. The team can work together to clarify treatment goals and decide which medications are still serving the person well and which can be safely discontinued. If you or a loved one take multiple medications you might be eligible for a free visit from a pharmacist (<a href="https://www.nps.org.au/assets/NPS/pdf/NPSMW2390_Anticholinergics_HMR_Factsheet.pdf">a Home Medicines Review</a>) to help you get the best out of your medications. <h2>What’s next?</h2> Health care has traditionally focused on prescribing medications, with little focus on when to stop them. Deprescribing is not happening as often as it should. <a href="https://www.australiandeprescribingnetwork.com.au/">Researchers</a> are working hard to develop tools, resources and service models to support deprescribing in the community. Health-care professionals may think older adults are not open to deprescribing, but about <a href="https://academic.oup.com/biomedgerontology/article/77/5/1020/6352400">eight out of ten people</a> are willing to stop one or more of their medications. That said, of course some people may have concerns. If you have been taking a medication for a long time, you might wonder why you should stop or whether your health could get worse if you do. These are important questions to ask a doctor or pharmacist. We need more <a href="https://shpa.org.au/news-advocacy/MedsAware">public awareness</a> about polypharmacy and deprescribing to turn the tide of increasing medication use and related harms. <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/211424/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/emily-reeve-1461339">Emily Reeve</a>, Senior Research Fellow in the Centre for Medicine Use and Safety , <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a>; <a href="https://theconversation.com/profiles/jacinta-l-johnson-1441348">Jacinta L Johnson</a>, Senior Lecturer in Pharmacy Practice, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>; <a href="https://theconversation.com/profiles/janet-sluggett-146318">Janet Sluggett</a>, Enterprise Fellow, <a href="https://theconversation.com/institutions/university-of-south-australia-1180">University of South Australia</a>, and <a href="https://theconversation.com/profiles/kate-ohara-1462183">Kate O'Hara</a>, PhD student, Clinical Pharmacology and Toxicology, <a href="https://theconversation.com/institutions/university-of-newcastle-1060">University of Newcastle</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/taking-more-than-5-pills-a-day-deprescribing-can-prevent-harm-especially-for-older-people-211424">original article</a>.

Body

Daily aspirin doesn’t prevent strokes in older, healthy people after all

<a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> The daily use of <a href="https://www.nps.org.au/australian-prescriber/articles/drugs-in-secondary-stroke-prevention">low dose aspirin</a> has been a mainstay of preventing strokes for decades. While there has always been a risk of bleeding associated with aspirin use, the benefits were thought to outweigh the risk. Now <a href="https://dx.doi.org/10.1001/jamanetworkopen.2023.25803">new research</a> led by Monash University has shown daily, low-dose aspirin doesn’t prevent strokes in relatively healthy people aged over 70. And it increases their risk of bleeding on the brain after falls or other injuries. But if you’re taking aspirin, it doesn’t mean you should abruptly stop. It may still have a role to play in treating people at high risk of stroke. Or, after talking to your doctor, there might be better options available. <h2>Why has aspirin been used to prevent strokes?</h2> Aspirin is an anti-platelet medicine, which is commonly known as a blood-thinner. <a href="https://www.lifeblood.com.au/blood/learn-about-blood/platelets">Platelets</a> are the component of blood primarily responsible for its clotting action. They are what stop you from continuously bleeding any time you have a cut or scrape on your skin. A <a href="https://strokefoundation.org.au/about-stroke/learn/what-is-a-stroke">stroke</a> is when oxygen can’t get into the brain because of a burst or blocked blood vessel. A blockage can occur when platelets in the bloodstream form a clot and it gets stuck in the artery. Because aspirin acts on platelets, it can help prevent the clots that can lead to a stroke. But because aspirin acts on platelets, it can also increase the risk of <a href="https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/daily-aspirin-therapy/art-20046797#:%7E:text=While%20daily%20aspirin%20can%20help,of%20developing%20a%20stomach%20ulcer.">unwanted bleeding</a>, usually in the stomach. It can also increase your risk of bleeding more when you have another injury, like hitting your head. Aspirin isn’t just used for the prevention of strokes. It is also the first aid treatment for someone undergoing a <a href="https://www.nps.org.au/australian-prescriber/articles/acute-myocardial-infarction-early-treatment">heart attack</a>. <h2>Findings of the Monash trial</h2> New <a href="https://dx.doi.org/10.1001/jamanetworkopen.2023.25803">research from Australia and the United States</a> reports results from the Aspirin in Reducing Events in the Elderly (ASPREE) trial. The researchers examined the protective use of daily low-dose aspirin (100 mg) in nearly 2,000 people who were aged 70 years and older and had no history of heart disease or stroke and whose blood pressure and cholesterol were well managed. When compared with placebo, aspirin didn’t reduce or increase the risk of stroke. Of the participants who took the aspirin, 195 or 4.6% had a stroke. Of those who took the placebo, 203 people or 4.7% had a stroke. But it did statistically increase the rate of non-stroke bleeding in the participants’ brains, for example when they injured their head. Those on aspirin showed a rate of bleeding in the brain of 1.1% (108 participants) compared with 0.8% (79 people) for those on placebo. This is a relatively, low but serious, risk. These findings are not entirely new. <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1800722?query=featured_home">Research</a> published five years ago based on the same ASPREE trial showed a similar result: a higher rate of bleeding among those taking low-dose aspirin compared with placebo. However as the study authors note, aspirin continues to be widely used for the prevention of stroke. <h2>What are the study’s limitations?</h2> The researchers examined aspirin in mostly people of white European heritage. So we don’t know whether the results are translatable to people with different ethnic backgrounds. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2594139/">Genetics and ethnicity</a> can significantly impact the efficacy and safety of some drugs. The clinical trial only included people who were not significantly at risk of a stroke, and had no history of heart disease. Younger age groups were not studied either, so we cannot make any conclusions about their use of low dose aspirin to prevent stroke. It’s also possible the potential benefits and risks are different for those who have underlying heart problems or who have previously had a stroke and are therefore at higher risk of another stroke. <h2>I’m taking aspirin, what should I do?</h2> If you’re taking daily low-dose aspirin and are concerned by the results of the study, it’s important you don’t just stop taking your medicine. Speak to your doctor or pharmacist. For people who are at high risk of having a stroke, or have previously had one, low-dose aspirin may remain their treatment of choice despite the slight bleeding risk. If you’re at high risk of bleeding, for example because of falls and other accidents due to advanced age, frailty, or another underlying condition, your doctor may be able to reduce the amount of aspirin you take by adding in <a href="https://www.nps.org.au/australian-prescriber/articles/dipyridamole">dipyridamole</a> or prescribing a different medicine completely, such as <a href="https://www.nps.org.au/australian-prescriber/articles/clopidogrel">clopidogrel</a>.<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/210388/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/nial-wheate-96839">Nial Wheate</a>, Associate Professor of the Sydney Pharmacy School, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</a> and <a href="https://theconversation.com/profiles/tina-hinton-329706">Tina Hinton</a>, Associate Professor of Pharmacology, <a href="https://theconversation.com/institutions/university-of-sydney-841">University of Sydney</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/daily-aspirin-doesnt-prevent-strokes-in-older-healthy-people-after-all-210388">original article</a>.

Body

How to prevent travel-related deep vein thrombosis

No matter your transportation of choice, sitting motionless for long periods of time puts people at increased risk of deep vein thrombosis (DVT). DVT refers to blood clots that form deep in your veins, usually in the calf or leg, and results in the sensation of a swollen, painful limb. If you’ve been susceptible to DVT in your past travels, there are a few simple things to do to combat the problem. <ul> <li>Stand up and walk around at least every hour to keep blood flowing</li> <li>Exercise your calf muscles by standing on tip-toes a few times</li> <li>If you can’t walk around, exercise legs by stretching them, flexing feet and curling or pressing toes frequently</li> <li>Drink lots of fluids, especially water, to prevent dehydration</li> <li>Reduce alcohol and coffee consumption, which contributes to dehydration</li> <li>Avoid crossing your legs when seated or at least for long periods of time</li> <li>Wear compression stockings that put on gentle pressure on leg muscles.</li> <li>Don’t wear regular socks that are right or have tight elastic bands at top</li> <li>Skip the aspirin; there’s no evidence that it’s effective as a preventative measure</li> </ul> Image credits: Getty Images

Travel Tips

New details surrounding Emma Pattison’s prior arrest

Warning: This article contains distressing content that some readers may find confronting. It is now known that Emma Pattison, the headmistress at a private school in the UK who police believe was shot dead by her husband, <a href="https://oversixty.com.au/news/news/disturbing-new-details-emerge-in-death-of-head-teacher-husband-and-daughter" target="_blank" rel="noopener">made a distress call</a> to a family member just hours before she was discovered. Further to that, new details have emerged that reveal that Mrs Pattison was arrested by Surrey police following a domestic row with her husband, George, seven years ago. Mr Pattison telephoned police one evening just prior to midnight, claiming that Mrs Pattison had slapped him around the face in their home. Only a short time later – two minutes or so – Mr Pattison then called the station back to ask the police officers not to come, saying that the matter was inconsequential and that he had overreacted. However, Surrey police decided to proceed with the home visit to investigate the complaint, and arrested Mrs Pattison on suspicion of common assault. Mrs Pattison was then questioned in the presence of a solicitor, and was subsequently released without charge. While a full investigation <a href="https://oversixty.com.au/news/news/headmistress-husband-and-daughter-found-dead-on-school-grounds" target="_blank" rel="noopener">into their deaths</a> has commenced, Surrey police are currently refusing to discuss Mrs Pattison’s arrest seven years ago in 2016, stating instead that autopsy results on the bodies of all three of the deceased are expected by the end of the week. Police have yet to disclose the official cause of death, but are confident no one else was involved in the "isolated" incident. Detectives confirmed a firearm registered to George, of which he had a license for, was found at the scene and they are treating the tragedy as a double murder and suicide. Detectives suspect George killed his wife Emma, 45, and little Lettie before taking his own life. Detective Chief Inspector Kimball Edey, senior investigating officer on the case, said, “This is an incredibly traumatic incident and we are working around the clock to investigate and understand the exact circumstances which led to this point." Don't go it alone. Please reach out for help. Lifeline: 13 11 14 or lifeline.org.au Beyond Blue: 1300 22 4636 or beyondblue.org.au Headspace: 1800 650 890 or headspace.org.au Image credits: epsomcollege.org.uk

News

Disturbing new details emerge in death of head teacher, husband and daughter

Warning: This article contains distressing content that some readers may find confronting. A headmistress at a private school in the UK made a distress call to a family member just hours before she was found dead, a report has claimed. School principal Emma Pattison, the head teacher of private school Epsom College in Surrey, England, was <a href="https://oversixty.com.au/news/news/headmistress-husband-and-daughter-found-dead-on-school-grounds" target="_blank" rel="noopener">found dead</a> alongside her 39-year-old husband, George, and seven-year-old daughter Lettie on the school grounds earlier this week. As an investigation into their deaths has commenced, the BBC has reported that Emma made a frantic phone call to a relative with concerns about her partner. By the time the worried relative arrived at the house, which is surrounded by other properties occupied by college staff and is close to the prestigious school’s rifle range, all three were dead. Police have yet to disclose the official cause of their deaths, but are confident no one else was involved in the "isolated" incident. Detectives confirmed a firearm registered to George, of which he had a license for, was found at the scene and they are treating the tragedy as a double murder and suicide. Detectives suspect George killed his wife Emma, 45, and little Lettie before taking his own life. Detective Chief Inspector Kimball Edey, senior investigating officer on the case, said, “This is an incredibly traumatic incident and we are working around the clock to investigate and understand the exact circumstances which led to this point." “We understand the public concern and upset, and we will clarify what we can, when we can, while respecting the right to a level of privacy for the families of those who have lost their lives." The community is reeling from the tragedy, as devastated neighbours who knew the "lovely" family shared how "heartbroken" they are. One person said, “It is just shocking and unimaginable.” Chloe Rathbone, a nursery worker who looked after Lettie, told The Times, “I am utterly so heartbroken over this awful news." “They were such a lovely family and Lettie was perfect in every way, everything you could have wished for in a little girl.” <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">Don't go it alone. Please reach out for help. <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">Lifeline: 13 11 14 or lifeline.org.au <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">Beyond Blue: 1300 22 4636 or beyondblue.org.au <p style="font-size: 16px; box-sizing: border-box; margin-top: 0px; margin-bottom: 1rem; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">Headspace: 1800 650 890 or headspace.org.au Image credits: Getty Images / <em style="font-size: 16px; box-sizing: border-box; caret-color: #212529; color: #212529; font-family: -apple-system, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif, 'Apple Color Emoji', 'Segoe UI Emoji', 'Segoe UI Symbol', 'Noto Color Emoji';">epsomcollege.org.uk

News

13 things neurologists do to help prevent Alzheimer’s disease

Understand Alzheimer's disease Alzheimer’s disease is the leading cause of dementia. But all dementia is not Alzheimer’s, says Dr David Knopman, a neurologist at the Mayo Clinic in Minnesota. Dementia is a general term used to describe a set of symptoms that may include memory loss and difficulties with thinking, problem-solving or language. Alzheimer’s is a physical disease that targets the brain, causing problems with memory, thinking and behaviour. It is also age-related (symptoms usually start at age 65) and progressive, as symptoms usually worsen over time. Research shows that plaques and tangles two proteins that build up and block connections between nerve cells and eventually kill nerve cells in the brain, cause Alzheimer’s symptoms. Get enough sleep When you toss and turn all night, levels of brain-damaging proteins in the cerebrospinal fluid can rise: A 2017 study in Brain suggests that those with chronic sleep problems during middle age may increase their risk of Alzheimer’s later in life. “You have to commit to the importance of sleep,” says neurologist Dr Gayatri Devi. “I prioritise sleep as one of the most important activities I do – I will leave a party early in order to get a good night’s sleep.” Stay socially active Say yes to those social invitations! A 2019 study published in PLOS Medicine found that social activity with friends in your 60s could lower your risk of dementia by 12%. “There is something intrinsically valuable about social engagement,” says Dr Knopman. “It makes sense that those who are more engaged, especially socially, will think more positively and have a better outlook on life.” Keep learning People with advanced degrees have a lower risk of Alzheimer’s, according to 2017 research published in the BMJ. Education seems to build a ‘cognitive reserve’, which enables the brain to better resist neurological damage. “Higher education has a powerful effect,” says Dr Knopman. It’s never too late, check out the continuing education courses offered online or near you. Learn a second language Speaking more than one language can protect against Alzheimer’s disease and other types of dementia, according to 2017 research published in Clinical Interventions in Aging. While no one is sure why a second language helps so much, Dr Knopman theorises that the effort to communicate bilingually is like a workout for the brain, helping preserve grey matter and neurons. Do it yourself Challenging your brain in new ways can enhance memory as you age. Dr Devi has her own take on this: “If there is a problem with the phone or the plumbing, I will try to fix it,” she says. “If I try to figure out how to fix this on my own, it is good for my brain.” Right now she’s designing and building a window seat. “It is a way to keep different parts of my brain thriving.” Stay active Exercise is crucial to your wellness and your brain. Research published in Cureus in 2020, found that people who exercise regularly can slow cognitive decline. According to the Alzheimer’s Society, the combined results of 11 studies indicate that regular exercise can reduce the risk of developing dementia by about 30%; it drops the risk of Alzheimer’s by 45%. “When you are physically active, you burn more calories and you’re less likely to be obese,” explains Dr Knopman. “You’ll have better cardiovascular health because you are pushing your heart rate.” Take care of your heart “What is good for the heart is good for the brain,” says Dr Devi. Conditions such as high blood pressure, diabetes and high cholesterol, which increase the risk of cardiovascular disease, may also increase the risk of developing Alzheimer’s, and a 2017 study in JAMA found that middle-aged people with risk factors for heart attacks and stroke are also more likely to develop changes in the brain that can lead to the disease. “Anything that keeps the heart healthy is directly related to brain health,” Dr Devi says. It also reduces the risk of stroke, which can cause its own kind of dementia – vascular dementia. Lower your stress levels Persistent stress can take a toll on the brain, and 2018 research published in Neurobiology of Stress indicates that chronic stress can accelerate Alzheimer’s disease. When you’re stressed, your body releases cortisol, a hormone linked to memory trouble. In addition, experts have found that stress can lead to conditions such as depression and anxiety, which also increases the risk for dementia, according to research in Current Opinion in Psychiatry. “Eliminating stress helps reduce the amount of cortisol and optimises glucose utilisation, which your brain needs for food,” says Dr Devi. Try the MIND diet A combination of the Mediterranean diet and the DASH (Dietary Approaches to Stop Hypertension) diet, the MIND diet is designed specifically for brain health. (MIND is short for Mediterranean-DASH Diet Intervention for Neurodegenerative Delay.) The diet is pretty pleasant: you eat at least three servings of whole grains a day, two portions of vegetables (one of which must be a leafy green), snack on nuts, eat lean proteins like chicken and fish, berries, and have a glass of wine a day. According to research in Alzheimer’s & Dementia, those who adhered to the diet rigorously were able to lower their risk of cognitive decline later in life. You can’t trust all diets, warns Dr Knopman, but he likes this approach: “I tell my patients that if you follow a reasonable diet with lots of fresh fruits and vegetable that balances different food groups, and avoid obesity, you will be okay.” Get your snoring checked out Another way to wreck your sleep without realising it is with sleep apnea. According to the US National Institutes of Health, sleep apnoea occurs when a person’s upper airway becomes blocked repeatedly during sleep, reducing or completely stopping airflow. Many factors – from obesity to large tonsils to neuromuscular disorders – can cause sleep apnoea. Sleep apnoea not only prevents restful sleep, but untreated it can increase the risk of developing certain health conditions. “If left untreated, sleep apnoea has significant cardiovascular consequences and consequences of mental function,” says Dr Knopman. Protect your head According to the Alzheimer’s Association, there is a strong link between serious head trauma and developing Alzheimer’s later in life, especially if the injury involves loss of consciousness. A 2017 review of research in PLOS One suggests head injuries that require medical attention may increase the risk of dementia and Alzheimer’s disease. Wear a helmet while cycling, make your home fall-proof, and always use a seat belt to help protect your noggin. Drink a cup of tea Green tea has loads of health benefits – including some for your brain. A 2019 systematic review in Nutrients found that green tea might reduce the risk of dementia. And research in the Journal of the American Chemical Society found that it’s a compound in the beverage that can disrupt the formation of toxic plaques that contribute to Alzheimer’s disease. Image credits: Getty Images This article originally appeared on <a href="https://www.readersdigest.com.au/healthsmart/conditions/13-things-neurologists-do-to-help-prevent-alzheimers-disease?pages=1" target="_blank" rel="noopener">Reader's Digest</a>.

Mind

Ellen devastated after death of beloved show's DJ

Stephen "tWitch" Boss has died at the age of 40. The entertainer is most commonly known for his role as the DJ on the Ellen DeGeneres Show, where he has been a staple since 2014. His death was announced by his wife of nine years Allison Holker just days after marking their wedding anniversary, as she shared a touching statement about his lasting legacy. “It is with the heaviest of hearts that I have to share my husband Stephen has left us,” she said in a statement received by The Post. “Stephen lit up every room he stepped into. He valued family, friends and community above all else and leading with love and light was everything to him. He was the backbone of our family, the best husband and father, and an inspiration to his fans.” Ellen DeGeneres was among the first to pay tribute to her friend and colleagues, sharing a photo of the two in an emotional embrace. She wrote, “I’m heartbroken. tWitch was pure love and light. He was my family, and I loved him with all my heart. I will miss him." "Please send your love and support to Allison and his beautiful children — Weslie, Maddox, and Zaia.” When Allison Holker discovered her husband has left home without his car, she reportedly ran frantically into an LAPD station, saying the behaviour was unlike him, according to law enforcement sources. Police later got a call about an incident at an LA hotel, where they found Boss. <div id="indie-campaign-rHsIzpAmAj7xkA4llYlH-2" data-campaign-name="NCA ENTERTAINMENT newsletter" data-campaign-indie="newsletter-signup" data-jira="TSN-268" data-from="1640955600000" data-to="1677502800000"></div> “To say he left a legacy would be an understatement, and his positive impact will continue to be felt,” Holker continued in her statement. “I am certain there won’t be a day that goes by that we won’t honour his memory. We ask for privacy during this difficult time for myself and especially for our three children. “Stephen, we love you, we miss you, and I will always save the last dance for you.” Image credits: Instagram

Caring

COVID nasal sprays may one day prevent and treat infection

We have vaccines to boost our immune response to SARS-CoV-2, the virus that causes COVID. We have medicines you can take at home (and in hospital) to treat COVID. Now researchers are trialling something new. They want to develop drugs that stop the virus getting into the body in the first place. That includes nasal sprays that stop the virus attaching to cells in the nose. Other researchers are looking at the potential for nasal sprays to stop the virus replicating in the nose, or to make the nose a hostile place to enter the body. Here’s where the science is up to and what we can expect next. <h2>How could we block the virus?</h2> “Viral blockade”, as the name suggests, is a simple premise based on blocking SARS-CoV-2. In other words, if something gets in its way, the virus cannot attach to a cell and it can’t infect you. As SARS-CoV-2 is a respiratory virus, it makes sense to deliver this type of medicine where the virus mainly enters the body – via the nose, in a nasal spray. There are various groups around the world working on this concept. Some research is still being conducted in the lab. Some agents have progressed to preliminary human trials. None are yet available for widespread use. Heparin Heparin is a common medicine that’s been used for decades to thin the blood. Studies in mice show that when heparin is delivered via the nose, <a href="https://link.springer.com/article/10.1007/s11095-022-03191-4" target="_blank" rel="noopener">it’s safe</a> and <a href="https://journals.asm.org/doi/10.1128/JVI.01987-20" target="_blank" rel="noopener">effective</a> in preventing the virus binding to nose cells. Researchers believe heparin binds to the virus itself and stops the virus attaching to the cells it’s trying to infect. A <a href="https://clinicaltrials.gov/ct2/show/NCT05204550" target="_blank" rel="noopener">clinical trial</a> is being <a href="https://www.premier.vic.gov.au/covid-nasal-spray-treatment-clinical-trials-begin" target="_blank" rel="noopener">conducted in Victoria</a> in collaboration between multiple Melbourne-based research centres and the University of Oxford. Covixyl-V Covixyl-V (ethyl lauroyl arginine hydrochloride) is another nasal spray <a href="https://assets.researchsquare.com/files/rs-911449/v1/0577f1f1-56f8-476f-97f6-d27d332ea9ca.pdf?c=1643375660" target="_blank" rel="noopener">under development</a>. It aims to prevent COVID by blocking or modifying the cell surface to prevent the virus from infecting. This compound has been explored for use in various viral infections, and <a href="https://assets.researchsquare.com/files/rs-911449/v1/0577f1f1-56f8-476f-97f6-d27d332ea9ca.pdf?c=1643375660" target="_blank" rel="noopener">early studies</a> in cells and small animals has shown it can prevent attachment of SARS-CoV-2 and reduce the overall viral load. Iota-carrageenan This molecule, which is extracted from seaweed, acts by blocking virus entry into <a href="https://www.frontiersin.org/articles/10.3389/fviro.2021.746824/full" target="_blank" rel="noopener">airway cells</a>. One study of about 400 health-care workers suggests a nasal spray may reduce the incidence of COVID <a href="https://www.dovepress.com/efficacy-of-a-nasal-spray-containing-iota-carrageenan-in-the-postexpos-peer-reviewed-fulltext-article-IJGM" target="_blank" rel="noopener">by up to 80%</a>. IGM-6268 This is <a href="https://www.nature.com/articles/s41586-021-03673-2" target="_blank" rel="noopener">an engineered antibody</a> that binds to SARS-CoV-2, <a href="https://www.sciencedaily.com/releases/2021/06/210603171306.htm" target="_blank" rel="noopener">blocking</a> the virus from attaching to cells in the nose. A nasal and oral (mouth) spray are in a clinical trial <a href="https://clinicaltrials.gov/ct2/show/NCT05184218?term=IGM-6268&draw=2&rank=2" target="_blank" rel="noopener">to assess safety</a>. Cold atmospheric plasma This is a gas that contains charged particles. At cold temperatures, it can <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0165322" target="_blank" rel="noopener">alter the surface</a> of a cell. A <a href="https://www.thno.org/v12p2811.htm" target="_blank" rel="noopener">lab-based study</a> shows the gas changes expression of receptors on the skin that would normally allow the virus to attach. This results in less SARS-CoV-2 attachment and infection. Scientists now think this technology could be adapted to a nasal spray to prevent SARS-CoV-2 infection. <h2>How could we stop the virus replicating?</h2> Another tactic is to develop nasal sprays that stop the virus replicating in the nose. Researchers are designing genetic fragments that bind to the viral RNA. These fragments – known as “<a href="https://www.nature.com/articles/s41467-022-32216-0" target="_blank" rel="noopener">locked nucleic acid antisense oligonucleotides</a>” (or LNA ASOs for short) – put a proverbial spanner in the works and stop the virus from replicating. A spray of these genetic fragments delivered into the nose <a href="https://www.nature.com/articles/s41467-022-32216-0" target="_blank" rel="noopener">reduced virus replication in the nose</a> and prevented disease in small animals. <h2>How could we change the nose?</h2> A third strategy is to change the nose environment to make it less hospitable for the virus. That could be by using a nasal spray to change moisture levels (with saline), alter the pH (making the nose more acidic or alkaline), or adding a virus-killing agent (iodine). Saline can reduce the amount of <a href="https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2768627" target="_blank" rel="noopener">SARS-CoV-2 in the nose</a> by simply washing away the virus. One study has even found that saline nasal irrigation <a href="https://journals.sagepub.com/doi/10.1177/01455613221123737" target="_blank" rel="noopener">can lessen COVID disease</a> severity. But we would need further research into saline sprays. An Australian-led study has found that an iodine-based nasal spray <a href="https://www.theajo.com/article/view/4466/html" target="_blank" rel="noopener">reduced the viral load</a> in the nose. Further <a href="https://www.uwa.edu.au/news/Article/2022/February/Study-finds-nasal-spray-could-aid-battle-against-COVID" target="_blank" rel="noopener">clinical trials</a> are planned. <a href="https://www.sciencedirect.com/science/article/pii/S1386653222001809#!" target="_blank" rel="noopener">One study</a> used a test spray – containing ingredients including eucalyptus and clove oils, potassium chloride and glycerol. The aim was to kill the virus and change the acidity of the nose to prevent the virus attaching. This novel formulation has been tested in the lab and in a <a href="https://www.sciencedirect.com/science/article/pii/S1386653222001809#!" target="_blank" rel="noopener">clinical trial</a> showing it to be safe and to reduce infection rate from about 34% to 13% when compared to placebo controls. <h2>Barriers ahead</h2> Despite promising data so far on nasal sprays for COVID, one of the <a href="https://www.nature.com/articles/d41586-022-03341-z" target="_blank" rel="noopener">major barriers</a> is keeping the sprays in the nose. To overcome this, most sprays need multiple applications a day, sometimes every few hours. So based on what we know so far, nasal sprays will not singlehandedly beat COVID. But if they are shown to be safe and effective in clinical trials, and receive regulatory approval, they might be another tool to help prevent it. This article originally appeared on <a href="https://theconversation.com/covid-nasal-sprays-may-one-day-prevent-and-treat-infection-heres-where-the-science-is-up-to-193840" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

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Sounds great: Scientists are manipulating dreams to prevent nightmares

It’s estimated that at any given time, around 4% of adults suffer <a href="https://cosmosmagazine.com/health/one-side-of-your-brain-might-be-giving-you-nightmares/" target="_blank" rel="noreferrer noopener">chronic nightmares</a> but researchers in Switzerland have a new approach which will be music to the ears of night-terror-sufferers. Basing their study on the relationship between the types of <a href="https://cosmosmagazine.com/science/biology/nightmares-and-night-terrors-in-kids-when-do-they-stop-being-normal/" target="_blank" rel="noreferrer noopener">emotions experienced in dreams</a> and our emotional well-being, researchers have investigated how to help people by manipulating emotions in their dreams. Traditional methods to help chronic nightmare patients involves ‘imagery rehearsal therapy’, during which they are coached to rehearse the dream scenario during the day and redirect it towards a more positive ending. A <a href="https://link.springer.com/article/10.1007/s11818-021-00320-w" target="_blank" rel="noreferrer noopener">2021 study</a> of 28 participants showed 3 in 5 patients benefitted from this approach, however, it doesn’t work for everyone. <div class="newsletter-box"> <div id="wpcf7-f6-p220659-o1" class="wpcf7" dir="ltr" lang="en-US" role="form"> <form class="wpcf7-form mailchimp-ext-0.5.62 spai-bg-prepared init" action="/health/sounds-great-preventing-nightmares/#wpcf7-f6-p220659-o1" method="post" novalidate="novalidate" data-status="init"> <input class="wpcf7-form-control wpcf7-text referer-page" name="referer-page" type="hidden" value="https://cosmosmagazine.com/health/" data-value="https://cosmosmagazine.com/health/" aria-invalid="false" /> </form> </div> </div> In a <a href="https://www.cell.com/current-biology/fulltext/S0960-9822(22)01477-4" target="_blank" rel="noreferrer noopener">study from Geneva University</a>, over a two-week period, researchers asked a group of 18 patients to create an association between the positively redirected version of their dream and a sound during an imagination exercise. The patients then wore wireless headbands during night which would play the specific sound during the REM (Rapid Eye Movement) stage of sleep – when <a href="https://www.mayoclinic.org/diseases-conditions/nightmare-disorder/symptoms-causes/syc-20353515" target="_blank" rel="noreferrer noopener">nightmares typically occur</a>. When compared to 18 patients who undertook only the image rehearsal therapy, those who received the combined rehearsal and sound therapy had fewer nightmares. This trend continued even after three months post-intervention, with those receiving combination therapy also reporting experiencing more positive emotions such as ‘joy’ in their dreams. “We were positively surprised by how well the participants respected and tolerated the study procedures, for example performing imagery rehearsal therapy every day and wearing the sleep headband during the night,” says Lampros Perogamvros, senior author of the study and a psychiatrist at the Sleep Laboratory of the Geneva University Hospitals and the University of Geneva. “We observed a fast decrease of nightmares, together with dreams becoming emotionally more positive. For us, researchers and clinicians, these findings are very promising both for the study of emotional processing during sleep and for the development of new therapies.”  <img id="cosmos-post-tracker" style="opacity: 0; height: 1px!important; width: 1px!important; border: 0!important; position: absolute!important; z-index: -1!important;" src="https://syndication.cosmosmagazine.com/?id=220659&title=Sounds+great%3A+Scientists+are+manipulating+dreams+to+prevent+nightmares" width="1" height="1" />  <div id="contributors"> <a href="https://cosmosmagazine.com/health/sounds-great-preventing-nightmares/" target="_blank" rel="noopener">This article</a> was originally published on Cosmos Magazine and was written by Clare Kenyon. Image: Getty Images </div>

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