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Fall Prevention in Later Life

As one of the leading causes of hospitalisation among older people, fall-related injuries are a threat to the functional independence that is vital for healthy ageing. According to the World Health Organization, adults older than 60 years of age suffer the greatest number of fatal falls. The physical and cognitive changes that occur with advancing age and frailty increase the risk of a fall-related injury. Fast becoming a major global public health problem, with over 80% of fall-related fatalities occurring in low-and middle-income countries, there is an urgent need to implement prevention strategies and institute policies that minimise risk and create safe communities that enhance quality of life. In the ageing population, falls have multifactorial causes ranging from pharmacologic, behavioural, environmental, and activity-related actions. Effective prevention programs and strategies are most often based on modifiable risk factors such as vitamin D insufficiency, gait and balance problems, vision impairment, medications linked to falls or home hazards such as improper use of an assistive device, poor lighting, lack of bathroom grab bars, or slippery surfaces. Preventing falls requires not just a comprehensive assessment of all the factors involved, but also a multidisciplinary approach that draws on the expertise and skill set of each team member. The National Council on Aging’s Center for Healthy Aging for Professionals publishes expert content on evidence-based programs for professionals. In a recent article, the Center highlighted the work of CAPABLE programs. CAPABLE (Community Aging in Place – Advancing Better Living for Elders) is a program developed at the Johns Hopkins School of Nursing for low-income older people to safely age in place. The approach teams a registered nurse, an occupational therapist, and a handy worker to address both the environmental factors in homes as well as the strengths of older people themselves to improve safety and independence. The in-person at home program studied over a period of five months resulted in improved health outcomes resulting in better function, lower hospitalisation rates, decreased nursing home admissions, lower disability, and decreased depression. Effective prevention strategies first and foremost should address not only the reduction of falls but also the reduction of injuries and other consequences of falls. “A fall” is the product of a sequence of risks, including the probability of falling, learned protective responses, environmental surfaces, and the strength and resiliency of bones, tissues, and organs1. Designing an integrated care pathway for fall prevention that addresses the entire sequence is of vital importance. The National Institute for Health and Care Excellence (NICE) guidelines to identify, assess, and treat those at risk for falls cover the areas of identification and assessment of older people at risk; exercise; podiatry; vision; home assessment; medical review; and pharmacological review. The UN Decade of Healthy Ageing focuses on changing how we think, feel and act towards age and ageing, developing communities that foster the abilities of older people, delivering integrated care, and providing older people with access to long-term care. Policies that take into consideration a cross-sectoral approach towards fall prevention services and implement them at-country level, with connections to community-based services, including physiotherapy and occupational therapy; as well as closer collaboration between governments, academia, industry, and civil society will go a long way towards reducing the rate and severity of falls and fall-related injuries. To learn more about preventing falls to ensure healthy ageing, please contact Prof. Jean Woo, Emeritus Professor of Medicine and Director, CUHK Jockey Club Institute of Ageing | University of Hong Kong, at the IFA Expert Centre, which is a unique resource for those interested or involved in the areas of ageing, vision health, human rights, vaccination and more. To learn more about how to contribute to the critical dialogue on vision health, healthy ageing, and fall prevention, join the DR Barometer community, and connect with Dr. Supriya Venigalla (svenigalla@ifa.ngo). 1 Institute of Medicine (US) Division of Health Promotion and Disease Prevention; Berg RL, Cassells JS, editors. The Second Fifty Years: Promoting Health and Preventing Disability. Washington (DC): National Academies Press (US); 1992. 15, Falls in Older Persons: Risk Factors and Prevention. Available from: https://www.ncbi.nlm.nih.gov/books/NBK235613/

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A Vision of the Evolving Ophthalmology Landscape

Vision Health Month is the annual opportunity for raising awareness of and supporting initiatives to address the significant burden of vision loss to individuals and nations. According to the World Health Organization (WHO) World Report on Vision, roughly 2.2 billion people live with vision loss, with the heaviest burden borne by older people and marginalized populations. Globally, experts have repeatedly called for universal access to comprehensive eye care services and integrated person-centred eye care, however access and equity of vision care remains a challenge in many parts of the world. Vision loss impacts the quality of life throughout the life course, and most severely in later life by contributing to lower participation in the workforce and community, higher rates of social isolation and depression, increased likelihood of falls and fractures, loss of independence and autonomy, and cognitive decline. Moreover, the financial and economic burden of vision loss on the national scale is immense, in Canada amounting to $32.9 B annually in direct health care costs (hospital stays, services provided by vision professionals, cost of medicines), indirect health care costs (reduced workforce participation/productivity, premature loss of function and income), and the cost to well-being (disability care and equipment and other out-of-pocket expenses).1 The Canadian Ophthalmological Society draws attention to the urgent need to prioritize eye care through a National Vision Health Plan that would improve access to care for the over 8 million Canadians at risk for blindness. Studies have indicated that early screening can treat or prevent 75 per cent of vision loss cases, allowing patients and their families the opportunity to regain function, autonomy and improve their quality of life. A comprehensive eye exam is essential to early detection of blinding eye diseases, and to thoroughly discussing treatment options, particularly as new treatments emerge in the rapidly evolving field of biosimilars. Of concern is the fact that a recent article from the American Academy of Ophthalmology has suggested there remains a high degree of uncertainty among patients and professionals when it comes to the 25 ophthalmic biosimilars in development in 2020. “Given the rapidly expanding pipeline of biosimilars, physicians will be challenged to stay up to date—and to do so, they will need evidence from well-designed studies. ‘That’s why it’s critical for federal and foundation funding to do these objective comparative studies,’” says Dr. Jennifer K. Sun, Associate professor of ophthalmology at Harvard Medical School and chief of the Center for Clinical Eye Research and Trials at the Joslin Diabetes Center in Boston. Aligned with the calls of vision health experts and advocates for universal and integrated person-centred eye care, the UN Decade of Healthy Ageing provides a framework for action through four action areas, including integrated primary care for older people. The IFA’s 15th Global Conference on Ageing represents a critical point of connection for all those advocating for the rights of older people to access eye care, through a Presidential Symposium on Vision Health entitled “The Future of Person-centred Vision Care” taking place virtually and in-person on 11th November 2021. If you are a journalist covering this topic – then let the experts help with your stories. Ms. Helen Louise Gillis, President, Canadian Council of the Blind Mr. Doug Earle, President and Chief Executive Officer, Fighting Blindness Canada Dr. Walter Wittich, Associate Professor, School of Optometry, University of Montreal Experts are available to speak with media about the impact of vision loss, vision health research, and healthy ageing – simply click on either expert’s icon to arrange an interview today.1 Canadian Council of the Blind. (2021). The Cost of Vision Loss and Blindness in Canada. Retrieved online at https://bit.ly/3f6ljMP

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The call to invest in heathy ageing

It is no secret that people are increasingly living longer lives due to remarkable advances in health, technology and development. Increased longevity combined with decreasing fertility rates is resulting in changing demographics and an ageing population. By 2050, the global population of people over 60 will have doubled, representing over 2 billion people. With the goal of fostering longer and healthier lives, the United Nations (UN) Decade of Health Ageing (2021-2030) brings together government, civil society, academia and the private sector to improve the lives of older people and rethink the roles of older people in society. Fostering healthy ageing, defined as “developing and maintaining functional ability that enables well-being in older age,” throughout the life-course is at the centre of the Decade of Healthy Ageing. A recent article from the World Economic Forum, written by John Ataguba, David E. Bloom and Andrew J. Scott, highlights the need for investment in preventative healthcare to prioritize healthy ageing. As highlighted in the article, with an ageing population comes an increase in non-communicable diseases (NCDs) such as dementia, cardiovascular diseases, cancer, diabetes, and chronic respiratory disorders. The authors indicate that it is necessary to prepare for a “global pandemic of age-related diseases which is even larger than COVID-19 in scale, as well as made worse by the pandemic.” Indeed, NCDs cause significant mortality, killing 41 million people each year, according to the World Health Organization. Older people and adults experiencing NCDs are also at a greater risk of experiencing morbidity and mortality from vaccine-preventable diseases (VPDs), such as influenza, pneumococcal pneumonia, shingles and pertussis. The increasing prevalence of NCDs and age-related waning of the immune system, known as immunosenescence, leaves older adults more vulnerable to VPDs. To promote healthy ageing, there is a need to shift from a curative disease model to one that focuses on prevention of disease. Vaccination is an important strategy for shifting resources toward prevention and achieving healthy ageing. Vaccination throughout the life-course is a key prevention effort and investment in healthy ageing, which should be prioritized. Prevention efforts, like vaccination and promotion of healthy ageing, are worth the investment for many reasons, one being the economic benefits. The article from the World Economic Forum indicates the economic benefits of healthy ageing, since older people drive employment growth and often comprise a large portion of the labour force. Investing in the health of the population allows for greater economic productivity in society, making the case for global action towards prevention and healthy ageing. Importantly, investment in healthy ageing and prevention extends beyond economics. The authors of the article amplify the intrinsic value of good health and well-being throughout life. Healthy ageing strengthens the societal contributions of older people and investing in healthy ageing is an important priority in reducing inequalities in the long-term. The authors state that inequality “tends to rise with age, multiplying disadvantages over a lifetime and magnifying the impact of health shocks.” Indeed, ageism is often compounded by other social complexities, such as gender, education and ethnicity, leaving older adults most vulnerable to poor health and well-being. A focus on healthy ageing throughout life recognizes the valuable contributions of older people in society and aims to prevent the accumulation of disadvantages over the lifetime. There is a need to change policy and perceptions on ageing, uphold the rights of older people and combat ageism. Aligned with these goals, the International Federation on Ageing (IFA) is hosting its 15th Global Conference on Ageing entitled “Rights Matter”, which champions healthy ageing and provides a global point of connection for those fighting for the rights of older people. The conference program centers around the four action areas of the Decade of Healthy Ageing: ageism, age-friendly cities and communities, primary health care, and long-term care. In the days prior to the conference, IFA will host the pre-conference Vaccines 4 Life Summit which features sessions based on the principles of prevention, access and equity in adult vaccination, and the Master Class “Campaigning to combat ageism”. Visit the conference website to explore the events and further engage in fostering healthy ageing. To learn more about prevention, investment in healthy ageing and fighting for the rights of older people, contact these experts. Ms. Alana Officer, Unit Head, Demographic Change and Healthy Ageing, World Health Organization Dr. John Beard, Former Director of Ageing and Life Course with the World Health Organization Prof. Raina MacIntyre, Head of the School of Public Health and Community Medicine, and Professor of Infectious Diseases Epidemiology, University of New South Wales

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Working Together to Defeat Invasive Meningococcal Disease

April 24 is World Meningitis Day, and on this day, the International Federation on Ageing (IFA) together with the Confederation of Meningitis Organisations (CoMO) and Immunize Canada want to remind you that meningococcal disease is a health risk you should not take.

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The IFA has a long established and wide-ranging network of member organizations around the world. The network extends to over 75 countries covering every region. Together these organizations represent over 80 million older people.

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