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Spotlights

Prioritizing Pneumococcal Vaccination for Older Adults to Foster Healthy Ageing

Pneumonia is a leading cause of morbidity and mortality amongst older adults. In fact, deaths due to pneumonia are increasing in older adults. The Global Burden of Disease Study finds that deaths due to pneumonia in this age group have increased by approximately 60% over the last two decades. Additionally, pneumonia regularly results in hospitalization and significant morbidity, such as frailty, exacerbation of pre-existing comorbidities and overall decline in health. There remains a misconception that pneumonia is a disease only affecting old people, when in fact many forms of pneumonia are preventable via vaccination. The bacterial pathogen Streptococcus pneumoniae is a leading cause of pneumonia and does disproportionally result in greater morbidity and mortality in older populations. Two types of vaccines are available to protect against pneumonia due to Streptococcus pneumoniae, yet there remains very little awareness of these which can prevent serious disease and death in older adults. Pneumococcal vaccination is almost always in routine childhood immunization programs and are considered a critical action in preventing deaths in children under 5 years of age. In contrast, recommendations for older adults vary globally and are lacking overall. Some countries provide pneumococcal vaccination to all adults considered “high-risk” due to pre-existing comorbidities, such as those with immunocompromising conditions or non-communicable diseases. In many countries, vaccine recommendations for older adults are specified by arbitrary age cut-offs, such as 60 or 65 years and older. Even in countries where pneumococcal vaccination is recommended for older adults in national programs and free, uptake in this group is consistently below target and there is low awareness amongst the general public. Poor vaccination policy and low awareness amongst the general public is particularly concerning as we learn about the process of immune decline which occurs with ageing. This process, termed immunosenescence, is a normal function of ageing and makes older adults more susceptible to contracting and experiencing adverse health effects from infectious diseases. A newly published article, co-authored by the International Federation on Ageing’s (IFA) Secretary General, Dr. Jane Barratt, proposes changes to pneumococcal vaccine policy for older adults, considering the decline in immune function which occurs with age. The article suggests a new approach for pneumococcal vaccination in adults which firstly, recognizes older adults as an immunocompromised group and, secondly, prioritizes a life course approach to vaccination. The epidemiological, biological and clinical evidence, as outlined in the article, supports a re-framing of pneumococcal vaccination as a response to the medical needs of older adults due to their immunocompromising condition. Additionally, it is critically important to prioritize a life-course approach to vaccination and recognize it as a key component of healthy ageing. This approach involves expanding vaccination programs beyond childhood to support immunization for all ages. The WHO defines healthy ageing as “developing and maintaining the functional ability that enables well-being in older age”. In alignment with its Immunization Agenda 2030 and the United Nations Decade of Healthy Ageing, pneumococcal vaccination should be considered a key prevention effort which enables older people to maintain good health and well-being and continue to do what they have reason to value. The IFA’s 15th Global Conference on Ageing entitled “Rights Matter” provides a global platform to mobilize action and advocate for immunization policies and practices, which consider factors such as immunosenescence and prioritize vaccination as a key component of healthy ageing. Visit the conference website to register for the pre-conference Vaccines4Life Summit “Driving Policy to End Immunisation Inequity: The Future of Adult Vaccination and Lessons Learned from the Coronavirus Pandemic” and the Presidential Symposium on Adult Vaccination “Together Towards Tomorrow: Post-pandemic Action on Adult Vaccination”. Additionally, this World Pneumonia Day, taking place on November 12, IFA calls for the recognition of the high-burden of pneumonia in older adults and a life-course approach to pneumococcal vaccination. To learn more about vaccination policy for older people and a life-course approach to vaccination, contact these experts. • Dr. Luis M. Gutierrez Robledo, Director General, National Institute of Geriatrics,        National Institute of Health • Dr. Mine Durusu-Tanriover, Professor of Internal Medicine, Hacettepe University • Dr. Gaëtan Gavazzi, Professor, Faculty of Medicine, Grenoble-Alpes University

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Vaccination Equity as the Backdrop for Universal Health Coverage

Although many lessons have been learned through COVID-19, one of most crucial is the urgent need for universal health coverage to advance protection against the threats of infectious diseases and consequences to the population and economy. As vaccination policies and programs move towards implementing a life course approach, health disparities continue to be ever present in all countries around the world. To ensure no one is left behind, especially those most at-risk, governments need to prioritize increasing their investment in health promotion and prevention programs including immunization. In the recently published article entitled ‘South Korea’s Health-Centered Development Model’, author Lee Jong- Wha, shares the success of South Korea in developing and sustaining a well-functioning and resilient universal health coverage program. It is important to acknowledge the decade of this work and effort that has made medical and health-care services more accessible and cost-effective since the 1960’s. As a result of strong government commitment and investment to universal health care, evidence shows high vaccination uptake rates and effective containment of communicable diseases in South Korea. The commitment to universal health coverage and public health investment in vaccines in South Korea has resulted in the success of protecting population groups including older people and those with chronic health conditions against infectious diseases. This investment is also associated with robust social and economic systems that continue to prosper. Although the UN Sustainable Development Goals brings together a common agenda to work towards achieving universal health coverage including access to safe, and affordable vaccines, inequities around the world pose several challenges. Still to this day, most than half of the world’s population does not have access to health coverage and vaccines that are a crucial pillar of expanded prevention strategies. To combat vaccination inequity and ensure universal health coverage, join the Vaccines4Life World Coalition on Adult Vaccination (WCAV). The WCAV brings together experts of non-governmental organizations and academia, clinicians, and public health worldwide collaborating on a common agenda around a life course approach to vaccination. Follow the #Vaccine4Life platform on twitter to learn more about good practices in public health investment and worldwide case studies of inequities that contribute to low uptake rates. To engage with an expert on the value of universal health care, connect with Dr. Xenia Scheil-Adlung. She has published various research particularly on health coverage, and inequalities in access to services among older persons. To learn more about building a business case to improve public health investment for immunizations, connect with Dr. Bryan Patenaude, economist and Assistant Professor of Economic Evaluation in the Department of International Health at the Johns Hopkins Bloomberg School of Public Health. He has extensive expertise analyzing the cost-effectiveness of public health interventions including the economic impact of infection prevention policies and programs.

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Bone Health in Later Life

One of the structural changes that occurs as people age is the loss of bone tissue. As the skeleton provides structure, balance, and support to the body, the loss of bone mass or density can cause joints to become stiffer and less flexible. The interior structure of a bone resembles a honeycomb. When the tiny holes become larger, the bone becomes less dense and more porous. This weakens bones, making them fragile, and more susceptible to breakage. Age-related bone loss involves a steady and progressive decline with lower rates of calcium absorption leading to brittle bones that fracture easily. Over 80% of all fractures in people aged over 50 years are caused by osteoporosis.1 Often called the ‘silent thief’, osteoporosis is a skeletal disorder that can cause bone loss without symptoms. Postmenopausal women are especially susceptible as the condition is closely related to estrogen deficiency. Alarmingly, at least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture in their lifetime, and 28% of women who suffer a hip fracture will die within one year. Men who suffer a hip fracture tend to have poorer outcomes and are more likely to die from the complications. Protecting bone health requires not just behavioural and lifestyle modifications but also regular screening. The intake of calcium, vitamin D, weight-bearing exercises such as walking, and resistance training such as lifting weights, all contribute to bone health. Experts recommend screening for osteoporosis with bone measurement testing as a tool to help prevent fractures in women 65 years and older, and postmenopausal women younger than 65 years. Early detection has been found to reduce the rate of hip fractures among the ageing population2. Pharmacologic therapies are effective for people with low bone density (BMD) or those with a prior fragility fracture as well as reducing fractures in postmenopausal women. Medications appear to either reduce the rate of bone deterioration or are active in stimulating the bone-building process. From a policy standpoint, an important prevention measure is removing the barriers to healthy ageing such as fall prevention programs and building age-friendly communities. According to Dr. Kristine Ensrud, a physician-researcher who studies aging-related disorders at the University of Minnesota and Minneapolis VA Health Care System, “To reduce the societal burden of fracture, it’s going to take a combined approach of not only focusing on the skeleton but focusing on fall prevention.” The external environment is of great significance when considering the bone health of older people. Studies have shown that those over the age of 65 years face problems moving outdoors3. This impacts the health benefits of daily physical activity and hinders healthy ageing. The physical design of a space is a crucial element of preventing osteoporotic fractures. For example, the Netherlands is exploring the adaptation of street furniture like fences, benches, and lampposts into public gym equipment through minor modifications4. The protection of bone health in later life and prevention of age-related conditions such as osteoporosis are aligned with the key messages of the UN Decade of Healthy Ageing which emphasizes the development of communities that foster the abilities of older people through integrated person-centred care. A proactive approach towards the health of older people must go hand-in-hand with the implementation of policies at country level. To learn more about osteoporosis in later life and protecting bone health to ensure healthy ageing, please contact Dr. Edward Leung, Chief of Service of Department of Medicine and Geriatrics, United Christian Hospital, 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 contribute to the vital discourse on bone health and fall prevention, connect with Dr. Supriya Venigalla (svenigalla@ifa.ngo). 1 Fast facts: Osteoporosis Canada. Osteoporosis Canada. (2019, April 18). https://osteoporosis.ca/about-the-disease/fast-facts/ 2 US Preventive Services Task Force. Screening for Osteoporosis to Prevent Fractures: US Preventive Services Task Force Recommendation Statement. JAMA. 2018;319(24):2521–2531. doi:10.1001/jama.2018.7498 3 Kerr, J., Marshall, S., Godbole, S., Neukam, S., Crist, K., Wasilenko, K., Golshan, S., & Buchner, D. (2012). The relationship between outdoor activity and health in older adults using GPS. International journal of environmental research and public health, 9(12), 4615–4625. https://doi.org/10.3390/ijerph9124615 4 Morris, K. (2016). (rep.). Making Cities Better for Ageing: Lessons from U.K. Age-Friendly Cities. The German Marshall Fund of the United States. Retrieved from https://www.gmfus.org/publications/making-cities-better-aging-lessons-uk-age-friendly-cities

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Long-term caregivers are essential, whether formal or informal

The United Nations Economic Commission for Europe has reported women comprise 58 per cent of persons over the age of 65 years, and play valuable roles within their families and communities as caregivers, accounting for up to 95 per cent of all care needs1. While these are invaluable contributions to societies and nations, there are insufficient protections for caregivers working formally or informally to balance the emotional, financial, and physical impacts of caregiving. The Academy Award-nominated film, The Father, gives viewers the opportunity to explore and perhaps better understand the impact of cognitive decline on informal caregivers, oftentimes family members, and on those living with Alzheimer Disease. The movie, in which Sir Anthony Hopkins plays an octogenarian living with dementia, explores the difficulties in navigating familial impact of family caregiving, both on the father-daughter relationship, and on her “fraying marriage” as described in this New York Times review. However, it also sheds light on the difficulties in caring professionally for persons experiencing cognitive decline. Perhaps as a consequence of the COVID-19 pandemic, the long-standing under-appreciation of the caregiving profession is receiving well-deserved policy attention. In a recent CNN opinion piece, US Senator Elizabeth Warren, and Mary Kay Henry, President of the Service Employees International Union, report that “care jobs remain undervalued, understaffed, under protected and underpaid.” “Everyone who needs care deserves to live with dignity in the setting of their choice, supported by a workforce that is respected, protected and paid for the essential care they provide” This article argues that the under-valuing of caregiving work is directly linked to racism and sexism, with the vast majority of formal caregivers comprising women (86 per cent) and people of colour (59 per cent). The consequence of these forms of discrimination is low wages, a lack of benefits, insufficient training and inadequate funding for a workforce traditionally devalued as “unskilled labour.” The shameful and appalling impact of the coronavirus on the long-term care sector is often incorrectly characterized as taking place within institutional facilities. However, long-term care also includes services in the home and community, which deserves an equal consideration of standards of care, staffing, safety and investment by decision-makers, taking into account the essential contributions of family and staff. Within the context of the UN Decade of Healthy Ageing, long-term care is one of four action areas requiring concerted attention as population ageing, migration and urbanization converge. The IFA’s 15th Global Conference on Ageing represents a critical point of connection for all those advocating for the rights of older people, with a conference theme dedicated to deliberating issues within long-term care. If you are a journalist covering this topic – then let the experts help with your stories. Dr. Amy D’Aprix, Founder of Life Transitions by Dr. Amy Dr. Sytse Zuidema, Professor of Elderly Care Medicine and Dementia at the University Medical Center Groningen, the Netherlands Experts are available to speak with media about caregiving, long-term care, healthy ageing, and cognitive decline – simply click on either expert’s icon to arrange an interview today. 1United Nations Economic Commission for Europe. (2020). UNECE issues recommendations on gender equality in ageing ‎societies. Available at: https://bit.ly/3jjRr1l

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The G7 Pledge to Address Vaccine Inequity Globally and What This Means for Older Persons

COVID-19 has continuously shown the disproportionate impact of the pandemic between the Global North and Global South. Since March 2021 there have been 117 million cases and 3.83 million deaths globally with the majority of deaths occurring in those 65 years of age and older. The pandemic has also highlighted more broadly the inadequate systems and models of care for older persons globally. Most recently the attention has turned to the reality of global vaccination inequity with 75% of COVID-19 vaccines having been distributed among 10 countries. As the variants continue evolving and emerging so does the number of deaths in the Global South where now countries that previously had been able to control the pandemic are faced with mounting number of infections and deaths but not enough vaccine supply to curb the numbers and stop the spread of variants. The G7 Summit took place on 7th June 2021, where G7 leaders announced a pledge and commitment to provide 870 million COVID-19 vaccines to be shared internationally. The pledge also states that at least half of these vaccines are to be delivered by the end of 2021 through COVAX. COVAX is one of the pillars of the Access to COVID-19 Tools (ACT) Accelerator that was launched by the World Health Organization (WHO), the European Commission and France. COVAX is a global collaboration to ensure equitable global distribution of vaccines. The pledge is an attempt to support global equitable access and to help end the continued impact the pandemic is having in the Global South as well as the emergence of new strains. Although the pledge is a step towards addressing issues of vaccine scarcity and inequity, questions arise as to how the vaccines will be distributed and if older persons will be prioritized in vaccination roadmaps. COVID-19 has made clear the vulnerability of older persons. Older persons are an integral part of societies and carry the collective wisdom of society. The pandemic has meant the continued isolation of older persons and much of the media’s focus has served to dehumanize older persons, ignoring their importance within communities and nations. With the prospect of vaccines reaching the most vulnerable in the Global South now is the time to prioritize the needs and wellbeing of older persons. To ensure older persons are no longer ignored and healthy ageing is prioritized as a strategic goal globally there are a series of tools and frameworks in place like the United Nations (UN) Decade of Healthy Ageing and World Health Organization (WHO) Immunization Agenda 2030. Both reports envision a world in which vaccination is a pillar to healthy ageing and now with the prospect of being able to immunize older persons in the context of the pandemic it is important that this pillar is recognized and implemented by Member States globally. The International Federation of Ageing’s (IFA) Vaccines4Life similarly envisions a world through which vaccination is a pillar to healthy ageing and is a platform that serves as a point of connection on adult vaccination. Follow the #Vaccine4Life platform to learn more about the work of IFA and multisectoral partners that comprise the World Coalition on Adult Vaccination on ending immunization inequity and how to join the movement and collaborate with global experts on bridging the inequity gap. The IFA within its 15th Global Conference on Ageing will be hosting a Vaccines4Life Summit which will further emphasize the importance of adult vaccination by bringing together experts and leaders in immunization, ageing, public health, healthy policy, health economics, government to inspire change. To learn more about the importance of adult vaccination please contact: Prof Roman Prymula, Director of University Hospital, University of Defense Dr Ian Philp, Deputy Medical Director at the Heart of England NHS Foundation Dr Mine Durusu-Tanriover, Professor of Internal Medicine, Hacettepe University

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Pertussis in Adults: The Hidden Problem in Europe

Pertussis, more commonly known as whopping cough, is a highly infectious respiratory disease transmitted through airborne droplets. The Bordetella pertussis is the causative agent producing toxins that damage the mucous membrane, causing the most common symptom, severe coughing episodes that can last on average 44 days. Globally there were 150, 000 cases of pertussis in 2018, and in Europe the incidence of pertussis varies from 0.01 to 50 per 100, 000 person- years. Fortunately, pertussis is a vaccine preventable disease and since the introduction of pertussis vaccinations in national immunisation plans, outbreaks started to decrease yet in more recent time there is a need for caution and concern. A recent study conducted by the University of Turku in Finland found that cases of pertussis among adults aged 40 – 59 years is more common that originally thought. DTP antibodies (diphtheria, tetanus, and pertussis) were collected from participants in 18 European countries to determine vaccine-induced protection. Findings revealed tetanus protection was sufficient, however, data for diphtheria and pertussis indicated severe under protection. Of the 18 countries studied, pertussis was most commonly found in Norway, France, and Denmark, with the lowest cases in Finland and Hungary. According to Professor Qiushui He the low levels of antibodies indicate that “herd immunity in middle-aged adults is decreasing” and a problem that needs to be addressed by the entire European continent. Higher rates of pertussis among adults are concerning because pertussis tends to present in an atypical manner in adults and often with greater complications (hemoptysis, pneumonia, rib fractures, etc.), especially for those aged 65 years and over as well as those with chronic obstructive pulmonary disease (COPD). Traditionally pertussis is commonly referred to as a children’s disease, yet it is clear from emerging trends globally that adults are at risk of contracting this disease with dire consequences. Alarmingly, many countries do not include adult pertussis vaccines as part of national immunisation schedules despite evidence that vaccine-induced protection is not life long. In line with the Decade of Healthy Ageing, it is important countries introduce policies that work to protect the health of older persons underpinned through a life-course approach. As the findings of this study illustrate, pertussis in adults is a problem that cannot be ignored, and countries need to re-evaluate existing plans to prevent and protect all age groups against this preventable disease. To learn more about vaccine preventable diseases and adult vaccination please contact: • Dr Paolo Bonanni, Director of the Specialization School for MDs in Hygiene and Preventative Medicine • Dr Mine Durusu-Tanriover, Professor of Internal Medicine, Hacettepe University • Dr Ian Philip, Founder, Age Care Technologies

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Suffering in Silence - Older Adults and the Prevalence of Urinary Tract Infections

Considering the impact of urinary tract infections (UTIs) across the life course they are both underdiagnosed and under acknowledged particularly among older adults who are at an increased risk. With countries around the world experiencing unprecedented population ageing, it is important now more than ever to acknowledge and address the significant burden of urinary tract infections on older adults. In a recent article entitled “Urinary Tract Infections 101: Improving Well-Being with Knowledge & Supports” CanAge, a leading advocacy organization in Canada has examined in detail the effects of both incontinence and UTIs across 6 key areas; 1) Violence and Abuse Prevention, 2) Optimal Health and Wellness, 3) Infection Prevention and Disaster Response, 4) Caregiving, Long-term Care, Home Care and Housing Resources, 5) Economic Security and 6) Social Isolation. While UTIs affect people of all ages, older adults may experience more frequent serious complications such as sepsis leading to hospitalization. Understanding why older adults are at increased risk is crucial to determining opportunities to address this issue. Changes to hormonal, physical, and immunological responses to infections represent the broadest risk factors and can lead to changes in the function and structure of the bladder. Certain medical conditions often seen in older people such as stroke, diabetes, Parkinson’s disease and multiple sclerosis by their aetiology may also lead to changes in the normal functioning of muscles and nerves needed to control the bladder, leading to an increased risk for UTI development. Diagnosis of UTIs in older people impact timely management and treatment. Hallmark symptoms such as pain when urinating or the frequent/urgent need to urinate may not be present in older adults or communicated effectively due to other conditions such as cognitive changes. Equally important is that health care professionals (and families) either may not be listening or hearing the nuanced conversations about symptoms that may be evident. Not all people, and not all older people are comfortable talking about their bodily functions. The use and misuse of urinary catheters for older people is a growing concern in long term care facilities (LTCFs) and represents an additional risk factor. UTIs were the third most common reason for residents to be transferred to a hospital and across three surveys conducted in 18 Canadian hospitals, they were the most common healthcare-associated infection, with people aged 65 years and over consistently accounting for ~50% of these infections. Increasing awareness of UTIs and their causes is imperative in driving preventative efforts. A systematic review of interventions to reduce urinary tract infections in nursing home residents reported that measures such as proper hand hygiene, reduced catheter use and duration, infection surveillance, better staff training, and standardizing diagnoses may contribute to improve care and reduced rates in long term care facilities. For older adults living independently simple lifestyle decisions such as staying hydrated, avoiding foods and beverages that irritate the bladder, healthy voiding habits and keeping pelvic floor muscles strong can be powerful habits for fostering urinary health across the life course. For more information about the impact of urinary tract infections on older adults and strategies for prevention, diagnosis and treatment contact Ms Laura Tamblyn Watts, President and CEO of CanAge, and member of the IFA Expert Centre. Future articles in this invaluable CanAge UTI 101 series will explore prevention and treatment strategies, the stigma and social isolation associated with urinary incontinence, and the global health crisis of antibiotic resistance.

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Do Vaccines Really Bring All Older Adults Closer?

As populations age, chronic health conditions such as diabetes, lung and heart disease prevail and leave many older adults at risk for serious complications from vaccine preventable diseases such as influenza, pneumococcal pneumonia, pertussis and shingles. Vaccination throughout life signifies a life course approach to not only immunisation but also to healthy ageing. Intergovernmental agendas such as the UN Decade of Healthy Ageing and the WHO Immunization Agenda 2030 call on governments to implement comprehensive public health programs including immunisation to save lives and maintain functional ability. ‘Vaccines bring us closer’ was the 2021 theme for World Immunization Week, highlighting the value of immunizations beyond the COVID-19 agenda. Awareness of the serious consequences of infectious diseases is often a barrier to population coverage. A recent article written by Sofiat Akinola, Chris Hardesty, and Ada Wong shines light on the severely low adult immunization rates across the Asia Pacific as a result of poor awareness compared to the rates in the United States and the United Kingdom. While it is useful to consider rates in other countries, work by the International Federation on Ageing is cautious in benchmarking and comparison because not only are the health systems vastly different, as are cultural influences. Akinola et al stressed the need for clear and transparent communication on the effectiveness and benefits of vaccination to an ageing population, and this was seen to be insufficient and inconsistent. The recent expert discussion conducted by Sanofi and KPMG in the Asia-Pacific region, with the support of World Economic Forum, showed that many older adults faced uncertainties and a lack of knowledge on the efficacy of vaccination as a key component of healthy ageing. Three pillars were identified to drive sustainable action towards equitable life course immunization: 1. Adult immunization being integrated into national immunization strategies and healthy ageing policies, and regularly reviewed through robust data collection efforts. 2. Targeted and consistent communication strategies that reach those who are currently marginalized and often invisible. 3. Ensuring that nations are able to implement novel models of sustainable healthcare funding beyond the reliance of income taxes. In order to ensure vaccines do bring us closer across the globe, collaborative action that recognizes the pressing barriers faced in developing regions is vital to increasing uptake rates. Aligned with the Decade of Healthy Ageing (2020-2030) and the WHO Immunisation Agenda 2030, the IFA’s Vaccines4Life Program envisions a world in which vaccination throughout life is a pillar to healthy ageing, recognized through appropriate governmental investment in prevention and promotion. Follow the #Vaccine4Life platform to learn more about the upcoming project on Ending Immunization Inequity which will provide findings on the significant inequities that contribute to low uptake rates, and sign the pledge to engage in this movement. To connect with an expert on this topic, engage with Dr Tam Yat-Hung, Honorary Clinical Assistant Professor at The University of Hong Kong. His practice is mainly focused on epidemiological investigation of disease outbreak and implementation of control and preventive measures with expertise in public health education.

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The Epidemic of Loneliness Continues for Older People

Countries around the world have inadequately protected older people throughout the pandemic. The majority of COVID-19 deaths occurred in those over 65 years of age. It is now evident that older people will continue to struggle with isolation and diminished mental and physical health due to lack of health and social support systems before and during the pandemic. A recent report from the United Kingdom (UK) indicates that older people continue to be at-risk of loneliness despite the easing of COVID-19 lockdown measures. According to the article, by Amelia Hill, a million people over 65 in the UK are at-risk for experiencing chronic loneliness. Loneliness is indeed an epidemic with serious effects on mental and physical health. A 2020 report by the National Academies of Sciences, Engineering, and Medicine in the United States found that one in four adults over 65 years of age are socially isolated. This same report finds that social isolation increases the risk of premature death at similar rates to smoking, obesity and physical inactivity. Additionally, loneliness increases the risk of heart disease, stroke, dementia and poorer mental health effects. According to the Older People’s Task and Finish Group, part of the UK’s Department for Digital, Culture, Media and Sport Tackling Loneliness Network, support organizations which helped to combat loneliness amongst older people, closed during the pandemic and have not yet re-opened. Research by the Tackling Loneliness Network, reported that “only 7% of 96 support organisations questioned have returned to normal service after the pandemic.” Additionally, “Almost three-quarters of older people questioned in the network’s survey said they had no or significantly less support from the charities they had relied on before the pandemic.” Indeed, these results indicate that older people continue to be left behind in pandemic responses. Despite the delivery of vaccines to older people in many countries, this does not mean that ageism does not exist, it does as many government responses have failed to adequately protect the rights of older people. Additionally, the effects of pandemic isolation extend beyond loneliness. Organizations whose membership or representation are older people report a growing trend of those experiencing deterioration in physical health due to diminished activity, including feeling less steady on their feet, being unable to walk, diminished memory and decreased energy. Pandemic life has diminished the confidence of older people to return to their daily life, get out and about and increase their social interaction. Many older people feel fearful, anxious and unseen. These sentiments are a heartbreaking product of the ageism experienced by older people, only exacerbated by the pandemic. Now is the time to prioritize older people in a new stage of pandemic life. Aligned with the United Nations (UN) Decade of Healthy Ageing and the Global Report on Ageism, concerted policy actions are needed to respect the rights of older people and ensure no one is left behind. Each of the four action areas of the UN Decade of Healthy Ageing, age-friendly environments, combatting ageism, integrated care and long-term care, require immediate focus to combat social isolation and ensure older people can live healthy, active and productive lives. The International Federation on Ageing (IFA)’s 15th Global Conference on Ageing entitled “Rights Matter”, provides a global point of connection to fight for the rights of older people and ensure the prioritization and investment in creating an environment which allows older people to thrive. The conference program centers around the four action areas of the Decade of Healthy Ageing and will include a focus on older people and pandemics. Visit the conference website to explore these conference themes and further engage in fostering the social inclusion and health of older people. To learn more about social isolation and fighting for the rights of older people, contact these experts. • Dr. Mike Martin, Managing Director and Professor for Gerontopsychology and Gerontology, Institute of Gerontology and Dynamics of Healthy Aging, University of Zurich • Dr. Emily A. Greenfield, Associate Professor of Social Work at Rutgers, The State University of New Jersey • Linda Robinson, Chief Executive of AGE NI

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What is the impact of COVID-19 on Long-Term Care in Canada?

People living in long-term care (LTC) homes in across the globe have been far more likely to die of COVID-19 than the rest of the population. However, the effect of COVID-19 on residents in LTC has varied widely within countries. Here are some of the lessons that can be learned from Covid-19: The Government Needs to Reprioritize Long-Term Care Planning & Also Focus on Community-Based Home Care Services The lack of pandemic planning in the sector, outdated building standards, poor staffing practices and the reluctance by government to hold service providers accountable to ensure quality resident outcomes has contributed significantly to the high death rates in long term care. Government policy and funding support for long-term care needs to be reprioritised from the built environment to community-based supports into the homes or dwellings where people live. Adopting a planning framework based on population demographics and socio-economic status of people over the age of 70 in a defined geographical area should be adopted. For every 1000 people over the age of 70 there should be 65-70 residential care (nursing home) places and 75-80 community care (packaged care) places. This shifts the focus and priority to care at home. Building Standards and Living Arrangements Need to be Reimagined for Long-Term Care Facilities LTC residents in many countries are more likely to reside in shared rooms. In Ontario, Canada for example approximately 63% of residents are in shared rooms. Rates of infection associated with the LTC and the health care sectors are lower where facilities have single patient/resident rooms. Shared resident living arrangements have contributed significantly to the spread of Covid-19 and other outbreaks such as influenza in LTC. In Ontario, Canada for example, the maximum resident home area (RHA) caters to 32 residents, but the standards do not specify that all must be single rooms. It is not mandated that resident ensuites or shared washrooms have showering or bathing facilities, instead there must be a shower/bathroom within each RHA. Building standards for long-term care must provide for single resident rooms with a full ensuite to include showering facilities and resident home areas (RHA’s) should be no greater than 16 resident care places. Single rooms with ensuites should be 250 square feet as the minimum standard. Staffing Levels for Long-Term Care Need to be Addressed as Part of a Broader Quality of Care Standards Framework A high quality of nursing home care requires adequate levels of competent staff, but mandating staffing levels does not ensure quality resident outcomes. A sophisticated quality of care standards framework in itself can ensure appropriate staffing based on the resident care mix and measured against legislated resident outcome standards. Mandated staffing profiles or hours of direct care in long term care will never ensure quality of care. What is Long-term care? Long-term care (LTC) is a range of services that helps meet both the medical and non-medical care needs of people who need assistance with basic daily activities such as dressing, bathing and using the bathroom. Long-term care can be provided at home, in the community, in assisted living facilities or in residential care facility. Long-term care may be needed by people of any age, although it is a more common need for older people. Long-term care involves providing a level of medical care that requires the expertise of skilled practitioners to address the multiple chronic conditions associated with older populations. To learn more about the impact of COVID-19 in Long-Term care in Canada and across the globe please contact Mr. Greg Shaw, Director International and Corporate Relations for the International Federation on Ageing (IFA) 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.

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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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Forgetting Adult Immunization During Covid-19

Every day the COVID-19 pandemic continues to bring on new economic, social and health challenges for all members and especially those most at risk to severe consequences including older persons and those with chronic health conditions. Significant impacts have also been experienced in regular routine health care services including increasingly longer wait times, fear of in-person checkups, and a decline in routine immunizations such as influenza, pneumococcal pneumonia, measles, and shingles. The stark decline in routine adult immunizations as a consequence of the COVID-19 pandemic may not only impose serious implications to vulnerable groups at risk to life altering diseases but also to the health and safety of the general population. In a recent article published through the BioPharma- Reporter, Dr. Friedland, vice president, director scientific affairs and public health at GSK stresses attention to the decline in adult immunizations that may exacerbate serious strains on public health through increased exposure to non-COVID infectious diseases. Furthermore, Dr. Friedland points out that although there are a variety of barriers ‘in more normal times’ that can explain low adult vaccination rates including fear of adverse side effects and vaccine hesitancy, the pandemic has disrupted the vaccination pathway for routine vaccines. There is sustained need to increase knowledge and awareness of the safety, effectiveness and value of routine adult immunizations through the involvement of civil society advocates and public health experts. The International Federation on Ageing, through it is Vaccines4Life platform prioritizes bringing awareness on the safety and effectiveness of adult vaccinations to address vaccine hesitancy, build trust and improve equity among the most at risk groups including older adults. To learn more, check out the resources produced through IFA’s ’60 Second Fact Check: Vaccine Safety for Older Adults’ campaign. To engage in this campaign, contact Ms. Petek Yurt (pyurt@ifa.ngo). On 9 November, the IFA 15th Global Conference on Ageing will be hosting the first in person and virtual conference entitled ‘Rights Matter’ which aims to build global collective action to fight for the rights of older adults, under the four pillars aligned with the UN Decade of Ageing and WHO Immunization Agenda 2030: ageism, age-friendly cities and communities, primary health care, and long-term care alongside older people and pandemics. Delegates have the unique opportunity to engage, network, and learn from diverse experts from all around the world. To learn more and connect with an expert on this topic, contact Dr. Palle Valentiner-Branth, the Head of Vaccine-Preventable Disease Group of the Statens Serum Institute. He serves as the National Focal Point for vaccine preventable diseases in the European Center of Disease Prevention and Control (ECDC) and is the author/co-author of more than 70 peer reviewed publications with extensive research experience in vaccinology and infectious disease epidemiology.

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Technological advances to improve patient-centered care

As the social restrictions of the COVID-19 pandemic are forcing nations to live online, Zoom meetings have become the staple of 2020 and 2021. With the increased online presence, supporting technological advances goes hand-in-hand with improving quality-of-life and standards of living. In the realm of healthcare, technological advances offer a way to leverage patient data to improve care. For example, an alert to a physician can be done about a potential adverse reaction to a drug. Technology also contributes to improved patient-centered care by fostering communication between providers and patients via online portals, text messaging, and email correspondence. In an article in Fierce Healthcare titled, “Policies to support data liquidity: improving medication access” The importance of improved healthcare interoperability and transparency is noted by better enabling the sharing of patient data. This improved sharing allows providers to have access to all data for a patient being treated which results in a more effective management and treatment plan for patients. As the pandemic enforces strict social distancing measures, real-time information at the point of care can be critical to patients in understanding their options to afford, access, and adhere to their medication while reducing provider burdeni. Thus, improved data liquidity allows for more ways and choices for patients to own their computable health data and ultimately get help and advice. Proficient data liquidity allows providers and pharmacists to surface patient-specific, relevant health datai. While policies can focus on the socioeconomic aspects including improving equitable access to care, greater data enables patients to better manage their care. Pushing healthcare towards greater data is supported by an article in CIO (Chief Information Officer) as enabling patients with access to their own medical information as a giant step towards improved health outcomesi . While there will be associated challenges including data management on cloud, and ensuring veracity of parties involved, the value-add of better data liquidity goes without question. With the growing ageing population, there is an increased demand for caregivers, yet technology companies have been stepping up to fill this caregiver gap . Technology aids old persons to ‘age in place’ and helps ease the transition to old age by avoiding unnecessary visits to the emergencyii. Applications for medication adherence, and voice command can be particularly helpful for older personsii facing cognitive impairments. Technologies tailored to older persons must remain user-friendly, cost-effective, and simple enough to be easily learnt. To learn more about technological advances supporting older persons, contact Dr. Ad van Berlo, Research and Development Manager at Smart Homes from the IFA Expert Centre. For any questions or ideas to contribute to the conversation on technological advances improving patient care, connect with Ms. Jun Wang (jwang@ifa.ngo), Special Projects Officer at the IFA. i CIO. (2019). The great conundrum of data liquidity in healthcare. Retrieved from: https://www.cio.com/article/3346022/the-great-conundrum-of-data-liquidity-in-healthcare.html ii Health care dive. (2017). How technologies can help the elderly age at home. Retrieved from: https://www.healthcaredive.com/news/how-technologies-can-help-the-elderly-age-at-home/436386/

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Palliative Care: A Holistic Approach to Caring for Older People with Diabetes

As a result of the major achievements of modern civilization, people are now living longer than at any other time in history. In a pre-modern world, our ancestors lived for approximately 30 years. Since 1900, the global average life expectancy has more than doubled and is now above 70 years. Among the older population, life expectancy rates have been improving for many decades now.But does living longer equate to a better quality of life? What about older adults with chronic conditions who need care? Adding years to life is more meaningful when it is supplemented by adding life to years. An article published by Podiatry Today, entitled “When Patients with Diabetes Need Hospice Care” links the rising numbers of older people with diabetes to an increased need for end-of-life care. Contrary to popular opinion, people do not have to be actively dying to qualify for palliative or hospice care. Palliative care is an interdisciplinary speciality that focuses on preventing and alleviating suffering and supporting the best possible quality of life for patients who are facing a serious and/or life-threatening illness.As the older person with diabetes approaches the end of their life, there comes a time when rigorous glycemic control can not only prove to be of questionable benefit but also has the likelihood to cause harm. Many clinicians do not converse with their patients on advance care planning because they are either not familiar with palliative care or are reluctant to discuss the issue. However, comprehensive diabetes management includes palliative care and advance care planning. With comorbidities that shorten life-expectancy, the focus then expands from tight glucose control to encompass informed consent, comfort, religious and cultural values, mental, spiritual, and emotional needs.In a paper published in the American Diabetes Association journal Diabetes Spectrum, the authors explain that many older adults with diabetes experience frailty, and cognitive changes or dementia. They are prone to the unpleasant symptoms associated with these conditions, and consequently often have unmet psychological needs that compound pain and other symptoms. Advance care planning goes hand in hand with palliative care. It is essential that the older person with diabetes together with the diabetes health care team and family members share perspectives and options to enable informed decisions about future care. This brings value and control into the life of the older adult, where they feel seen and heard, and can make their priorities clear such as, dancing at a grandchild’s wedding or attending a graduation.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. Palliative care ensures a holistic approach to care that considers the older person’s wants and needs. Ensuring quality of life does not stop at a certain age, it continues until the end.To learn more about end-of-life care for older people with diabetes, contact Prof. Trisha Dunning, Chair in Nursing and Director Centre for Nursing and Allied health Research at Deakin University and Barwon Health in Victoria, Australia, and former Vice President of the International Diabetes Federation, at the IFA Expert Centre, which is an invaluable 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 vital conversation on diabetes and the older person, connect with Dr. Supriya Venigalla (svenigalla@ifa.ngo), and join the DR Barometer community.

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Brain Games: The Newest Addition to the Daily Workout Routine

Population ageing along with urbanisation and migration are the great demographic definers of our time. While healthy life expectancy is slowly increasing, between 10 to 20% of older people experience some cognitive impairment, and 47 million people live with cognitive impairment severe enough to limit their ability to function in society. Healthy ageing as defined by World Health Organization’s (WHO) is “the process of developing and maintaining the functional ability that enables older people to do what they value.” Cognition is one of the major predictors of day-to-day functional ability and so new strategies for protecting against cognitive decline and impairment are necessary. A recent article entitled “Mind Games: Brain Boosters for Older Adults” explores the evidence that engagement in mental activities, not just physical, can have a profound impact on cognitive health. Engaging in mentally rigorous activities such as board games, visual planning games (e.g., Chess), word games and socialization games can all help to build cognitive reserve and protect individuals from cognitive decline and the onset of Dementia and Alzheimer’s. At the 2019 Copenhagen Summit on Cognitive Reserve Prof Michael Valenzuela, leader of the Regenerative Neuroscience Group at the Brain and Mind Research Institute, University of Sydney referred to cognitive reserve as the “human capacity to decouple cognitive function from the accumulation of brain pathology that is so common as we age,” simply put, cognitive reserve is the brain’s ability to adapt and resist to damage associated with cognitive decline. As stated by Ms Beverly Sanborn, vice president of program development at Belmont Village Senior Living “in order to build this reserve, you must exercise your brain beyond your normal routine.” The potential for Cognitive Reserve to impact population health cannot be overvalued. A famous quote by George Bernard Shaw states that “We don't stop playing because we grow old; we grow old because we stop playing.” In the context of brain health this quote rings true, engaging in cognitively stimulating activities, such as games, as well as a variety of other lifestyle factors including, physical activity and diet can all help individuals build cognitive reserve and actively prevent cognitive decline, reducing the risk of Dementia and Alzheimer’s. The pervasive belief that cognitive impairment is inevitable in older age is simply untrue. Empowering people of all ages, and especially older people to actively invest in their brain health is crucial to reduce the global burden of dementia, especially as the greatest growth in dementia burden is yet to come and will occur in lower- and middle-income countries. As part of IFAs ongoing work to help influence and shape policy in cognitive reserve the Presidential Symposium on Brain Health at the IFAs 15th Global Conference entitled “The Treatment for Dementia is Prevention” presents the views of renowned experts in the field of cognitive reserve and neuroscience with clear arguments for an governmental and civil society investment in the conversation on healthy ageing. To learn more about cognitive reserve, contact IFA expert Prof Michael Valenzuela and register now for the IFA 15th Global Conference on Ageing where Prof Valenzuela will be a featured panelist at the Presential Symposium on Brain Health.

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Access to adult vaccination for older people in remote, rural and hard-to-reach communities

The United Nations (UN) has previously stressed the risk of COVID-19 for indigenous communities since they are among the most vulnerable, with higher rates of communicable and non-communicable diseases, poorer sanitation and inadequate access to healthcare. Additionally, indigenous peoples often experience stigma and discrimination in healthcare settings and distrust in government, resulting in difficulty with COVID-19 management and vaccine delivery.According to a recent report by the Thomas Reuters Foundation, Brazilian indigenous communities have been particularly devastated by COVID-19, with nearly a thousand deaths within this population due to the pandemic. Many of those who died were indigenous elders, over the age of 60. Like many indigenous peoples, elders transmit traditional knowledge, practices and languages to future generations. For Brazil’s indigenous communities, the loss of elders represents the death of traditions, culture and knowledge. COVID-19 destroyed a “library” of knowledge and identity held by community elders. As COVID-19 vaccination is well underway in many countries, it is important that the principles of prevention, access and equity are upheld throughout the rollout of vaccination strategies. These principles are detailed in the Immunization Agenda 2030, which outlines a global strategy to ensure equitable and community-centred delivery of immunization services to ensure good health and well-being for everyone. Exercising these principles means ensuring that hard-to-reach and vulnerable communities have access to vaccines and contextually appropriate information on vaccine preventable diseases. COVID-19 vaccination of remote and hard-to-reach populations is an opportunity to bolster adult immunization strategies, expand immunization infrastructure and establish adult vaccination policy for other vaccine preventable diseases, such as influenza, pneumonia and shingles. Implementation of vaccination policy for older people may help preserve the culture and traditions of communities, allowing libraries to remain intact longer.In Brazil, COVID-19 vaccination of indigenous communities is a priority, however some older people in the community oppose the vaccine. Glades Kokama, a leader of the Kokama indigenous community in the Amazon region, says, “Some (elders) believe in the vaccine, but some don’t. We try to explain it to them, but we have to respect our elders.” Combating vaccine hesitancy amongst older people is needed to improve healthy ageing through vaccination. It is important that communication is targeted and specific to the population context and needs. For indigenous and hard-to-reach communities, distribution of information and promotion of vaccination requires partnership with community leaders and culturally appropriate messaging.The International Federation on Ageing (IFA) is committed to addressing barriers to adult vaccination for older people by expanding knowledge and access to vaccination, and improving vaccination messaging. The 15th Global Conference on Ageing entitled “Rights Matter” provides a global platform to inspire, enquire, learn and advocate for immunization policies and practices that create an environment that enables older people to do what they value. Visit the conference website to learn about the pre-conference Vaccines 4 Life Summit “Beyond the Pandemic: Driving Policy to Improve Adult Immunization Rates” and the Presidential Symposium on Adult Vaccination “Together Towards Tomorrow: Post-pandemic Action on Adult Vaccination”. To learn more about adult vaccination for older people and combating vaccine hesitancy, contact these experts. • Lois Privor-Dumm, Director of Adult Vaccines, Senior Advisor, Policy Advocacy and Communications at the International Vaccine Access Center • Dr. José F. Parodi, Professor of Geriatrics and Public Health in the Faculty of Human Medicine at the Universidad de San Martin de Porres of Peru (FMH-USMP) and Director of Center for Ageing Research – CIEN of the FMH-USMP. • Dr. Holly Seale, Associate Professor at the School of Population Health, Faculty of Medicine and Health, University of New South Wales.

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Vaccine Hesitancy as a Consequence of Social Media Misinformation

The rise of mass media and exposure to diverse sources of information can impose both positive and negative implications to influence a view, opinion and attitude towards an issue, especially with regard to vaccines. Messages based upon fear, lack of evidence or even myths may impact the decisions individuals make in being vaccinated against infectious diseases such as influenza, pneumonia as well as COVID-19. A recent article written by Karen Nikos-Rose suggests that credible sources such as Universities and health institutions can generate positive attitudes toward vaccines rather than misinformation, especially with the help of fact check tags or when a post is verified. These simple actions can play a vital role in combating vaccine myths. Contrary to some beliefs it is vital that health experts respond to misinformation immediately. Prof. Jingwen Zhang, lead author from the University of California study states, “The most important thing I learned from this paper is that fact checking is effective…giving people a simple label can change their attitude. Secondly, I am calling for more researchers and scientists to engage in public health and science communications. We need to be more proactive. We are not using our power right now.” Facts about the effectiveness of vaccines in protecting and maintaining the health and well-being of at-risk populations including older persons and those with chronic conditions is available yet the risk of misinformation continues to influence behavior towards vaccines. Combating misinformation on vaccines through social media is a tested action to prevent the growth of vaccine hesitancy and encourage positive messages towards vaccines to reduce the spread of diseases that burden global public health. It is also imperative to understand the perspectives, views and opinions of at-risk populations towards vaccines to better respond to knowledge gaps and ensure messages are not only evidence based but tailored to answer health concerns and needs. As a proud member of the Vaccine Safety Net, the IFA is committed to building awareness, knowledge and improving messaging on vaccine safety through a collaborative effort between physicians, public health professionals, policy makers, and civil society to ensure older persons, including those with complex health needs, are confident to access safe and affordable vaccines to live healthily. To join this global movement of combating vaccine hesitancy and building trust and confidence in vaccines that will enable protection against life altering diseases, connect with experts and learn more in our monthly newsletter. Dr. Gaëtan Gavazzi is a Professor at Grenoble-Alpes University and expert specializing in Geriatrics, Internal Medicine, Vaccines and Healthy Aging. He has published more than 120 peer reviewed papers and participated in nearly 500 events at national and international levels. His research related to this topic includes communicating the benefits of vaccines and analyzing vaccine hesitancy and acceptance. Mr. Gary Finnegan is Editor of Vaccines Today, an online platform that facilitates an informed discussion on vaccinations. The content of Vaccines Today is produced through interviews with experts from academia, patient groups, and industry experts, along with reports based on scientific literature and conferences. Gary is also the author of the Vaccine Misinformation Management Field Guide, which provides strategic guidance and coordinated action to rapidly counter vaccine misinformation. IFA is always looking to expand resources on vaccine safety for older adults and those with chronic conditions and welcomes you to submit it to VacciNet.

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The Link Between COVID-19 and Vision Health: Blood Vessels

As the novel coronavirus pandemic evolves, new information is constantly coming to light. Rapidly accumulating global data has shone a spotlight on inequities in social determinants of health, such as healthcare access and utilization. These same inequities contribute to higher rates of medical conditions such as diabetes, an underlying disease for which people are at great risk of severe complications and even death from COVID-19. Individuals with diabetes are at a heightened risk for eye complications like glaucoma, cataracts, and microvascular complications such as retinopathy, neuropathy, and nephropathy. An article published by National Public Radio (NPR), entitled “Clots, Strokes And Rashes. Is COVID-19 A Disease Of The Blood Vessels?” explains that the virus warps a vital piece of our vascular infrastructure. Dr. William Li, a vascular biologist and founder of the Angiogenesis Foundation, compares the lining of blood vessels to a freshly resurfaced ice-skating rink before a hockey game. "When the virus damages the inside of the blood vessel and shreds the lining, that's like the ice after a hockey game, you wind up with a situation that is really untenable for blood flow,” says Li. Intensive care units are being filled with patients who have large body mass indexes (BMIs), those with diabetes and with high blood pressure. Over time, these conditions damage the lining of blood vessels, which is then exacerbated by COVID-19. The fact that the virus is associated with microvascular alterations led a team of researchers at the Eye Clinic, Luigi Sacco Hospital, ASST Fatebenefratelli-Sacco, and the Department of Infectious Diseases in Italy to determine if the COVID-19 disease affects the retina of the eye and its blood vessels. The team’s findings were published in the Lancet journal EClinicalMedicine. The team screened the fundus (the interior surface of the eye) of patients with COVID-19 to detect alterations to the retina and found ruptured and/or twisted blood vessels. Furthermore, the diameters of arteries and veins were higher in those with COVID-19 when compared to those without. The researchers have stated unequivocally that “COVID-19 can affect the retina. Retinal veins' diameter seems directly correlated with the disease severity. Its assessment could have possible applications in the management of COVID-19.” The World Report on Vision seeks to contribute to Sustainable Development Goal 3.8 which is to “achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.” Ensuring universal health coverage requires a global movement that involves civil society, governments, non-governmental organizations, academia, and industry in order to promote equity and reduce disparities in healthcare access and utilization. The International Federation on Ageing (IFA) works tirelessly with partners and members to achieve the vision of universal health coverage. On 11 November 2021 as part of IFA’s 15th Global Conference on Ageing taking place both virtually and in-person in Niagara Falls, Canada, a Presidential Symposium on Vision Health will bring together a global network of peers in the aim of conveying the importance of integrated care. Register now to learn about the latest global evidence in vision health, emerging policy issues, and the role of civil society in improving health care outcomes for all. To learn more about COVID-19’s effects on the retina, contact Dr Serge Resnikoff, Professor at the School of Optometry and Vision Science, University of New South Wales from the IFA Expert Centre, which offers a point of contact to specialists in the fields of ageing, vision health, human rights and more. To learn more about how to contribute to the critical conversation on diabetes and vision health, connect with Dr Supriya Venigalla (svenigalla@ifa.ngo), and join the DR Barometer community.

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COVID-19 | Supporting patients with hearing and/or speaking challenges

The COVID-19 pandemic has overwhelmed healthcare systems around the world. Eye care services were put on hold or in-person appointments were limited as countries locked down, affecting those who needed these services the most. The impact of delaying eye care, especially in cases of degenerative eye conditions such as diabetic retinopathy, glaucoma, cataracts, is simply too high a cost when it comes to saving sight. The pandemic has also highlighted significant communication barriers for patients with hearing or speech impairments. The use of personal protective equipment (PPE) has placed these individuals at a great disadvantage for being able to communicate and receive appropriate care. The Vision Academy, comprising an international group of more than 80 experts in the field of vision and ageing, in partnership with the International Federation on Ageing (IFA) and Bayer AG, have developed an infographic on ways to support patients with hearing and/or speaking challenges during the COVID-19 pandemic. The infographic provides guidance for ophthalmologists on how to communicate clearly to deliver effective care, while minimizing the risk of infection. Best practices include establishing clear sight lines, good lighting, a quiet space, using hands and body language for better understanding, and having written information ready to enhance clarity. For further information on best practices for effective communication with hearing and/or speech impaired patients during COVID-19, please contact IFA experts Dr. Jane Barratt, Secretary General of the IFA, who played a key role in developing a guidance document on the topic, and Helen Louise Gillis, National President of the Canadian Council of the Blind and leading advocate for accessibility for blind/vision impaired Canadians. As a valued member of the DR Barometer community, please register for the IFA 15th Global Conference on Ageing which will feature experts from around the world discussing the importance of healthy ageing.

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Amplifying the Potential of Healthy Ageing for Sustainable Development

The World Health Organization (WHO) reports that by 2050, 80% of older people will be living in low- and middle-income countries. In the context of the UN Decade of Healthy Ageing 2021-2030 (the Decade) and the 2030 Agenda for Sustainable Development the time to invest in healthy ageing to support a sustainable future is now, according to a recent World Economic Forum article: Mr. Antonio Guterres, Secretary-General of the United Nations, has stated, “the potential of older persons is a powerful basis for sustainable development.” However, data on development assistance for health and health burden in 2017 indicate that investment is much higher in the first half of life, despite a higher prevalence of disease and need for care in later life, with an emphasis on treatment over prevention. The ongoing COVID-19 pandemic has demonstrated the tragic effects of chronic underfunding and undervaluing programs and services to support the needs of older people. The pandemic response has highlighted the pervasive nature of ageism locally, nationally, and internationally. It is a fundamental obstacle to the development of effective health policies. An example of this is the impact of COVID-19 on the long-term care sector, where the high mortality rate is an indicator of the lack of preparedness according to the World Economic Forum article. COVID-19 may have an irreversible impact on global health and development alike unless there is significant momentum towards advancing universal health coverage and investing in proven, effective preventive interventions such as life course immunization strategies. Healthy ageing can not only add years to life, but it adds life to years. By providing a framework for action across four action areas, the Decade represents an unprecedented opportunity for "concerted, catalytic and collaborative action to improve the lives of older people, their families, and the communities in which they live." To that end, global leaders and civil society must invest in the potential of healthy older people. Combating ageism requires a whole-of-society approach comprising citizens, governments, civil society, academia, and industry in order to transform attitudes and actions across generations. The International Federation on Ageing (IFA), as a non-state actor at the WHO and having general consultative status at the UN, is a proud ambassador for the Decade across sectors and disciplines. If you are a journalist covering this topic – let the experts help with your stories.  Dr. Alexandre Kalache, President of the International Longevity Centre - Brazil Ms. Alana Officer, Unit Head of Demographic Change and Healthy Ageing at   the World Health Organization Dr. Jesús Felipe González Roldán, Director General of the National Center for   Preventive Programs and Disease Control, Mexico Dr. Jane Barratt, Secretary General of the International Federation on Ageing These experts are available to speak with media about the Decade, healthy ageing, sustainable development and the importance of preventive health policies – simply click on either expert’s icon to arrange an interview today.

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Walking the Talk: Equity in the COVID-19 Vaccine Rollout

As the world enters its second year living with COVID-19, much of the public attention and investment has shifted to large scale vaccination efforts. Scientists around the world have been called upon to dedicate unprecedented time, resources and energy to the development of a COVID-19 vaccine. The urgency is unquestionable, yet in the rush to vaccinate and be vaccinated personal and global ethics are on the line. We must avoid repeating the same mistakes that have been so starkly illuminated across the global response to the pandemic, namely increasing health disparities and health inequities in many marginalized populations. In a recent article published in the Atlantic entitled “The Vaccine Line Is Illogical” author, Epidemiologist and Professor at the Yale School of Public Health, Dr Gregg Gonsalves reflects on his own experience with the COVID-19 vaccine rollout and the implications of exciting strategies for vaccine distribution both nationally (in the United States) and internationally. While equity has been at the forefront of preliminary discussions regarding vaccine distribution, Dr Tedros Adhanom Ghebreyesus, Director General of the WHO has stated that while many countries “speak the language of equitable access, some countries and companies continue to prioritize bilateral deals, going around COVAX, driving up prices and attempting to jump to the front of the queue.” Dr Tedros warns that “the world is on the brink of a catastrophic moral failure – and the price of this failure will be paid with lives and livelihoods in the world’s poorest countries and the world’s poorest people.” Unfortunately, the reality of these disparities are already present. More than 39 million vaccine doses had been distributed across 49 rich countries, while one poorer nation—Guinea—has received just 25 doses. These trends not only exist between high-income and low-income countries, but these disparities are also mirrored within countries. Despite efforts to ensure that those in greatest need of vaccination receive it first, fundamental issues regarding barriers to access have been all but ignored. A recent article entitled “Older adults without family or friends lag in race to get coronavirus vaccines” illustrates that despite the “prioritization” of vaccinating older adults (a population that has been disproportionately affected by COVID-19) many of this population face significant barriers in accessing vaccination gateways and services. Those living alone or with limited mobility may be unable to travel to vaccination sites while others may not have access to the internet, or the digital literacy required to register online for appointments or receive notifications when vaccines become available. Dr. XinQi Dong, Director, Institute for Health, Health Policy and Aging Research at Rutgers University has expressed increasing concern that “barriers to getting vaccines are having unequal impacts on our older population.” Those with limited resources and social supports, the very individuals most in need and at risk of COVID-19, the least likely to receive timely access to vaccination are being left behind. This situation is painfully ironic when leave no one behind (LNOB) is the central, transformative promise of the 2030 Agenda for Sustainable Development and its Sustainable Development Goals. Initial reporting has indicated that Black and Hispanic individuals in the United States are two to three times less likely than Caucasians to have been vaccinated as of now. These trends extend beyond the United States and beyond even discussions specific to a COVID-19 vaccine. While COVID-19 has shone an unflattering light on public health shortcomings in addressing equity it also provides an opportunity to examine these issues more broadly. Issues of accessibility be it transportation, language or even time are all factors that impact access to other lifesaving vaccinations such as influenza, pneumococcal and shingles. It is imperative that global leaders in public health continue to refine strategies for the equitable distribution of a COVID-19 vaccine, and these lessons learned, and policies developed extend beyond this time of crisis and become foundational to future discussions towards ending immunization inequity. To learn more about the COVID-19 vaccine and immunisation amongst at-risk populations, contact Dr Holly Seale, Senior Lecturer at the School of Public Health and Community Medicine (SPHMC), University of New South Wales from the IFA Expert Centre. If you are an individual who works with older adults, IFA wants to hear from you to better understand how equity is conceptualized and operationalized within your organizations and countries of origin. To learn more about how to contribute to this important dialogue connect with Ms Anna Sangster (asangster@ifa.ngo), and sign the IFA pledge to End Immunization Inequity. 

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Older aged and all alone. What is the impact of being childless in the time of COVID-19?

The coronavirus pandemic has impressed upon the world the dreadful impact of isolation on mental health and overall health and wellbeing on populations of all ages, and especially older people. While many have taken this as an opportunity to better support one another within their families, some older women are facing a different reality with staggering unmet care needs, discrimination and without children who may have provided support. A recent article in The Guardian explores an uncommon perspective: What does it mean to be childless in later life? Given that in some societies there is a reliance on adult children to provide care for their parents, support programs and services may not be available to meet the care needs of older people . Women also experience pervasive criticism for the divergence from societal expectations of child bearing whereas data on men without children is not collected.“It’s somehow their own fault if there is no one to look after them.” - Jody Day, founder of Gateway Women Is there a care crisis now and in the future that we are not seeing? A report from the United Kingdom’s Office for National Statistics suggests an increasing need for formal caregiving services, in light of a decreasing kinship (informal) caregiving: Forty-one percent of those aged 80 years and over are not receiving help and support needed. By 2045 there will be a threefold increase in the number of women who reach the age of 80 and do not have children. Older adults who do not have children are 25% more likely to go into residential care than those with children. While these statistics are revealing, a broader conversation must be had to bring attention the care needs of older women who have had children and are no longer alive, or children who do not live in close proximity or children who choose not to be involved in their parent’s care. Many residential facilities are undervalued, underfunded and struggling to cope with the current demand let alone the future. Civil society in many countries is calling for a substantial overhaul to meet the rising demand in coming years. The International Federation on Ageing (IFA) believes that governments must develop integrated systems that support long-term care provision based on need, and which reflect the inherent diversity of ageing populations. The upcoming 15th Global Conference on Ageing will explore new and innovative models of long-term care systems needed to respond to changing demographics and societal norms. If you are a journalist covering this topic – the let the experts help with your stories. - Dr. Sytse Zuidema, Professor of Elderly Care Medicine and Dementia in the Netherlands - Prof. Ariela Lowenstein, Head of the Social Gerontology Center for Research in Israel These experts are available to speak with media about the need to improve formal and informal caregiving frameworks – simply click on either expert’s icon to arrange an interview today.

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Rates of undiagnosed hearing and vision loss are striking. Let IFA's newest expert explain the impact this is having on older adults.

Unaddressed hearing and vision loss among older adults is a major health concern yet does not receive the attention it deserves. Striking findings from new research based on older adults in England found that one third of people aged 50 and older with hearing loss are not diagnosed. Principle investigator, Dr. Dalia Tsimpida says, "It is crucial that those with hearing loss are detected in a timely way, referred to ear specialists and given access to hearing aids. The early identification of hearing difficulties in primary care may be the key to tackling this major public health issue." Low rates of diagnosis are also found among older adults with vision loss, with two in ten older people in the United Kingdom experiencing vision loss, yet a third of this same group had not received an eye test in the last 12 months (Lliffe et al., 2013). These findings are critical considering the impact of sensory decline on various modes of functional ability among older adults – including cognition. IFA’s newest expert Dr. Heather Whitson explains: "If you’re ageing without good vision, not only are you giving your brain less stimulation, you might be altering your brain at a structural level." Dr. Heather E. Whitson, MD, MHS, is an internist, geriatrician and clinical investigator. Dr. Whitson is the Director of the Duke Center for the Study of Aging and Human Development (Duke Aging Center), where her research seeks to improve health and resilience for older adults with multiple chronic conditions. She has particular interest and expertise related to the interface between age-related changes in sensory and cognitive health. Dr. Whitson is available to speak with media, and recently spoke with Reuters and was featured in a variety of articles regarding this critical topic, including: Look after your eyes to protect your brain, new study claims Maintaining healthy vision may help keep brain in shape, too Clinical Research Day highlights the role of new technologies in building partnerships Simply click on her expert icon to arrange an interview today.

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Equity under pressure: Does the burden of COVID-19 threaten progress made?

By Anna Sangster - Program Manager, International Federation on AgeingThe COVID-19 pandemic is a global crisis touching the lives of everyone around the world. In times such as these people often take solace in collective experience, they take comfort in the notion that everyone, as the expression goes, is in the same boat… but is this really true? In a recent article entitled “Help for the money anxieties of older LGBT Adults” the impact and disproportionate burden of COVID-19 on the lives and particularly the financial security of LGBT Americans is illustrated. John C. Williams, President and CEO of the Federal Reserve Bank of New York, said in June that “the unemployment rate for lesbian, gay, bisexual and transgender people was nearly double the national average during the pandemic.” Understanding what drives this stark difference requires a closer inspection of the everyday lived experience of LGBT individuals. LGBT folks especially older LGBT, often experience higher rates of: Discrimination Higher instances of health conditions Increased social isolation when compared to non-LGBT people. This combined with the fact that LGBT individuals rely more heavily on the informal economy and industries that have been heavily affected by COVID-19 restrictions such as the service and entertainment industries, has had devastating impacts within this community. The vulnerability of older LGBT adults during the pandemic, is but one salient example that illustrates the urgent need to formally acknowledge and incorporate an equity lens into pandemic responses. The importance of the role of equity cannot be overstated, UN Secretary General António Guterres said in a recent virtual town hall that “the global pandemic has already reversed decades of limited and fragile progress on gender equality and women’s rights” adding that “Without a concerned response, we risk losing a generation or more of gains.” As is the case with the LGBT community, women globally have been disproportionally impacted with respect to not only labour force participation but also increased domestic violence. Compounded with the reality that there are fewer resources and support services available, the mental and physical health implications are dire. The COVID-19 pandemic has undoubtedly led to a collective experience but in that collective experience there is a collective responsibility. While individuals around the world have been weathering the same storm, our protections against the storm have been vastly different. Recognizing these differences and working actively to mitigate the impacts within our marginalized communities is a crucial step to not only protecting the rights and needs of all individuals, but in preserving hard earned progress and shaping a future where addressing inequity is a priority.If you are a journalist looking to report on the impact of COVID-19 on older LGBT individuals and older women – then let our experts help.• Michael Adams is currently the Chief Executive Officer of SAGE (Advocacy and Services for LGBT Elders), the oldest and largest organization in the United States dedicated to improving the lives of LGBT older adults. In partnership with SAGE affiliates countrywide, SAGE serves countless LGBT older people nationally via technical assistance, trainings and services as well as advocacy at every level of government. • Dr Pat Armstrong is a Distinguished Research Professor of Sociology at York University in Toronto. She held a CHSRF/CIHR Chair in Health Services and Nursing Research and has published on a wide variety of issues related to long-term care, health care policy, and women’s health.Both experts are available to speak with media about this important topic – simply click on either expert’s icon to arrange an interview today!

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Dangerous delays – What will a slowdown in the postal service mean for the health of older adults?

By Yifan Zheng - Project Officer, International Federation on AgeingIt’s like a perfect storm – the combination of the rapid expansion of online shopping and the implementation of new COVID-19 safety protocols within postal processing facilities has led to a backlog of mail and an increasing surge of postal delays in many countries. And, for the older adults who rely on the postal service to access medications, these delays place them in serious peril. In fact, a 2017 National Poll on Healthy Aging in the United States shows that about 25% of Americans 50 to 80 years of age receive at least one medication by mail and nearly 17% receive all their medications via mail. In the midst of the coronavirus pandemic and lockdown policies, vulnerable persons including older people and those with chronic conditions are now depending on mail-ordered medications more than ever. Some of these people actually rely on medications to stay well and stay alive, and missing even a few days of a prescription may have significant and lasting negative health outcomes. Dr Ramzi Yacoub, Chief Pharmacy Officer at SingleCare recommend groups at higher risk for severe complications from the coronavirus stock up on their prescriptions in advance."If you're facing any barriers, I recommend speaking with your pharmacist to help you navigate through this process. You may also have to call your doctor or health insurance provider to get approval on lifting refill restrictions, but your pharmacist should be able to help you through that process." The rights of older people to access timely and safe drug services should be prioritized. If you are a journalist looking to report on the impact of delayed medication delivery on the health of older people – then let our experts help.• Dr. Samir Sinha currently serves as the Director of Geriatrics at the Sinai Health System and the University Health Network in Toronto, with expertise in caregiving, ageing in place, public policy, and frailty. Dr. Sinha's breadth of international training and expertise in health policy and the delivery of services related to the care of the elderly have made him a highly regarded expert in the care of older adults. • Dr. Lale Ozisik is an expert in the area of general internal medicine, with expertise in medicine, vaccination, and medical education.Both experts are available to speak with media about this important topic – simply click on either expert’s icon to arrange an interview today.

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Ageism in the COVID-19 Workplace: Walking the Fine Line between Protection and Discrimination of Older Employees

By Andra Stancu - Project Officer, International Federation on AgeingAs businesses and workplaces start re-opening and operating during the new normal that is COVID-19, there is concern that efforts to protect older employees might actually be violating the rights of older workers. An article published in Forbes magazine recently suggested that certain operational changes may not only be singling out older people unfairly - but may in fact constitute illegal discrimination. In the United States, should an employee experience age discrimination, provisions in the Age Discrimination in Employment Act 1967 (ADEA) may provide some protections. The following workplace policies may be crossing the line from protection to discrimination: Moving an older worker from the front office to the back office, away from contact with the general public and substantially altering the worker’s job duties Furloughing only older workers and allowing younger workers to continue working Only mandating that older employees wear personal protective equipment, such as face shields or face masks Firing older workers due to the belief that they will be more expensive to keep on as employees due to potentially higher insurance or paid time off costs If an employee feels unsafe in their workplace, Tom Spiggle, Senior Contributor at Forbes suggests that accommodations could be based on underlying medical risk factors rather than age though the Americans with Disabilities Act 1990 (ADA). “One of the rights not present in the ADEA is the right to reasonable accommodations because of age. But given how many older workers tend to have medical conditions, it’s possible that an older worker can ask for an accommodation if they have an ADA recognized disability.” Although older employees are considered at-risk for the coronavirus, there are reasonable accommodations that may ensure a safe return to the workplace for all. It is incumbent upon employers to review recommendations made by public health authorities such as the Centers for Disease Control and Prevention (CDC) in order to adapt workplaces to protect employees from COVID-19 while steering away from discriminatory practices. If you are a journalist covering this topic – let the experts help with your stories. Dr. Anne Martin-Matthews is a Professor of Ageing and Lifecourse at the University of British Columbia. She is an expert in the areas of public policy and the the sociology of aging. Dr. Debra Whitman is the Chief Public Policy Officer with AARP and is an authority on aging issues with extensive experience in policymaking, research and the political process. Both experts are available to speak with media about the rights of older adults in the workplace and this emerging issue – simply click on either expert’s icon to arrange an interview today. Given the heightened awareness of the devastating effects of COVID-19 on older people, this is an opportune moment to advocate for equitable treatment of older employees in the workforce. The rich experience and resilience of older workers through this period of unparalleled workplace pressures should not be undermined by workplace discrimination such as ageism. Combating age discrimination requires a whole-of-society approach comprising citizens, governments, civil society, academia, and industry in order to transform attitudes and actions across generations.

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New research suggests influenza and pneumonia vaccines can reduce the risk of Alzheimer’s disease. Talk to our IFA experts to learn more

By Megan Acton - Program Manager, International Federation on AgeingNew research suggests that the same vaccines that protect older adults against influenza and pneumonia may also reduce the risk of Alzheimer’s disease.Researchers at the University of Texas searched through medical records of around 9,000 people 60 years old and older, and found that those who had at least one flu shot were 17% less likely to have Alzheimer’s disease, and those who had regular influenza vaccination reduced their risk by an additional 13%.Researchers at Duke University and the University of North Carolina also examined medical records of close to 5,000 people aged 65 years and older and found that those who received vaccination against pneumonia before the age of 75 had a 25% less chance of being diagnosed with Alzheimer’s.Experts in the field of cognition found these research findings surprising, with Dr. Paul Schulz, Director of the Neurocognitive Disorders Center at McGovern stating, "To have these guys come out and say, well it looks like getting the vaccine is associated with less [Alzheimer's] was totally the opposite of what any of us thought." Further research has demonstrated that vaccine preventable diseases such as influenza may other have secondary protective effects, especially for adults with chronic disease, that information can be found in the IFA’s report, The Secondary Benefits of Influenza Vaccination. This is a fascinating development and if you are a journalist covering this subject – then let our experts help. • Dr. Mine Durusu-Tanriover is a professor of internal medicine in Hacettepe University School of Medicine (Ankara, Turkey) and the author of more than 40 peer-reviewed articles, with expertise in adult vaccination. • Dr. Samir Sinha is a passionate and respected advocate for the needs of older adults, with expertise in adult vaccination, public policy, quality of care, and frailty. Dr. Sinha's breadth of international training and expertise in health policy and the delivery of services related to the care of the elderly have made him a highly regarded expert in the care of older adults.Dr. Durusu-Tanriover and Dr. Sinha are available to speak with media. Simply click on either expert’s icon to arrange an interview today.

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The Rise of Multigenerational Living

By Anna Sangster - Program Manager, International Federation on AgeingIn southern Europe, many parts of Asia and the Middle East, it’s perfectly normal for extended families to live together, however for many people in western society, the notion of intergenerational living can be overwhelming and unappealing. The sacrifice of privacy and independence is often a driving force behind this distaste. Despite the stigma often associated with this type of living arrangement, intergenerational living is undoubtedly on the rise in western society. Such appears to be the case in Canada, where the latest data from a 2016 census illustrates a significant spike in the growth rate of multigenerational households showing a 37.5 per cent increase since 2001 with approximately 2.2 million people (6.3 per cent of the population) living in private households with at least three generations under one roof. Similar trends can be seen in the United States, the United Kingdom and Australia. As discussed in a recent article entitled “Family embrace: the rise of multi-generational living in Australia”, with affordable housing becoming increasingly difficult to find, and the precariousness often associated with balancing dual careers and child rearing, more and more young people are rethinking the idea of intergenerational living. This, combined with the reality that approximately 25% of older adults live alone, many of which struggle with issues of social isolation and apprehension about having to leave their homes and enter residential facilities, intergenerational living has become not only a viable option but an appealing one. Happy home: children Manning and Audrey with mother Zoe Flanagan-Field, Zoe’s parents, Robin and Warwick Mosman, and father Craig Field, outside the home they share in the Blue Mountains. Credit: Jennifer Soo Family embrace: the rise of multi-generational living in Australia This is not to say that multigenerational living is completely straightforward. In an article entitled “Multigenerational living is on the rise – here's how to get the balance right” many factors and considerations underlying successful multigenerational living are explored. These considerations range from the physical building design and construction where architects building generational homes stress the importance of ensuring mobility and autonomy for older adults. This can include prioritizing main floor living arrangements for older adults and independent living space where possible to encourage socialization.Other considerations include developing social contracts, which can be crucial in mitigating tensions around boundaries and independence. As Robert Wilson, architectural director of Granit architects, explains “It’s easier to navigate these dynamics if you’ve discussed arrangements in advance.” Zoning the space, sorting out technology and even investing in plenty of chairs are all additional considerations to help further support success. While intergenerational living may not be everyone’s cup of tea, to many it represents a new reality which not only allows for a future that may otherwise have been out of reach, and an opportunity to foster meaningful intergenerational relationships. To learn more about intergenerational living and connections contact IFA expert Donna Butts, Executive Director of Generations United and don’t forget to register here or the IFA 15th Global Conference on Ageing where age-friendly environments will be featured prominently.Family embrace: the rise of multi-generational living in Australia Multigenerational living is on the rise – here's how to get the balance right IFA Expert Profile

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Combating loneliness in the “caged” life

Although the rapid implementation of physical distancing and self-imposed quarantine is necessary to contain the spread of coronavirus, it has left many people, and particularly older people, feeling more alone than ever before. A recent study conducted from Bar-Ilan University and the University of Haifa has linked COVID-19-based loneliness in older adults with elevated psychiatric symptoms of anxiety, depression, and trauma. However, the association is only evident among those who felt subjectively older than their biological age but not in those who felt younger. "The way older adults perceive old age and their own aging may be more important to their coping and wellbeing than their chronological age," said the principal investigator, Prof. Amit Shrira. The findings suggest that lowering perception of age is a gateway to mitigate the negative impact of loneliness in older adults.The profound effects of social isolation and loneliness on the health and functional ability of older people are also astounding. The report “Social Isolation and Loneliness in Older Adults” by the National Academies of Sciences revealed that social isolation has been associated with a significantly increased risk of premature mortality from all causes, including a 50% increased risk of developing dementia, a 29% increased risk of incident coronary heart disease, a 25% increased risk for cancer mortality, a 59% increased risk of functional decline, and a 32% increased risk of stroke. Given the mental and health risks of social isolation, which have been starkly portrayed during the current pandemic for all ages, but most especially older people separated from loved ones and community actions and activities, it is essential that innovative ways to connect become the norm rather than a novelty. Also important is to encourage a positive thinking on isolation to relieve the emotional burden of physical distancing and prevent or reverse loneliness in a time of self-quarantine among older adults."We should take this opportunity to learn again what it really means to be social and find new forms of social connection. Older adults, in fact, have a wisdom that can be protective against loneliness because they tend to value the quality of their relationships over the quantity." said Stephanie Cacioppo, director of the Brain Dynamics Laboratory at the University of Chicago’s Pritzker School of Medicine, in a recent interview with ABC News. To learn more about how to keep a positive attitude under the emotional stress of social isolation during the pandemic, please contact IFA Expert Dr Emily A. Greenfield, Associate Professor of Social Work at the State University of New Jersey.COVID-19 loneliness linked to elevated psychiatric symptoms in older adults Social Isolation and Loneliness in Older Adults The unspoken COVID-19 toll on the elderly: Loneliness IFA Expert Profile

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When COVID-19 meets Flu Season

Coronavirus disproportionally affects vulnerable populations including older people and those with chronic diseases such as diabetes, and heart and lung disease. Every year, these same individuals are most impacted by seasonal influenza, with CDC estimates suggesting that 70-85% of influenza related deaths have occurred among people aged 65 years and older. Where death is not the result, influenza can lead to hospitalizations, long standing diminished function as well as acute or long-term complications. A recent Vaccines Today article written by IFA Expert Mr. Gary Finnegan, Editor of Vaccines Today, explains that although a coronavirus vaccine will not be available for the winter of 2020/2021, vaccines are available that protect against influenza. Mr Finnegan goes on to explain that despite this “every year, huge numbers of people who should be vaccinated are not.” The public often underestimates the impact of influenza on the individual and their family; as well as health and social care systems.Vaccinations against diseases such as influenza have been proven to effectively reduce the risk of adverse consequences for adults with chronic diseases and prevent decline in functional ability of older people. A life course approach to vaccination is therefore critical to healthy ageing. Secretary General of IFA, Dr Jane Barratt adds to this point: “We need to look at flu vaccination rates, but also immunization against pneumococcal disease and shingles. Many of the same people suffering the worst of the COVID-19 outbreak are also those who would benefit from these vaccines.”It is for these reasons that IFA, for over 9 years now, has been advocating for a life course approach to vaccination, with focus on at-risk groups. IFA’s work on vaccination, Vaccines4Life, is set within the context of the WHO Decade of Healthy Ageing, and is aligned with the WHO Immunization Agenda 2030. Under this portfolio of work, IFA envisions a world of healthy older people whose rights to safe and appropriate vaccines are respected through programs that hold high the principles of prevention, access and equity. Removing barriers impeding access to vaccination such as cost and complex vaccination pathways are critical to ensuring people of all ages are protected and no one is left behind. One way influenza vaccination rates could be improved is through pharmacists as a vaccinator gateway. In countries such as Portugal, Switzerland, Norway and the United Kingdom, pharmacists are able to administer vaccinations if they complete the required training. This can allow for greater reach to at-risk groups such as older people who may not typically go out of their way to be vaccinated by their doctor. The pharmacist-vaccinator gateway is important for not only influenza season, but also could be useful when a COVID-19 vaccine is released. Do you have an interesting article, video, webinar or podcast that speaks to improving vaccination rates for at-risk groups? Submit your document to the new IFA VacciNet database to share this important knowledge, and reach out to IFA experts Mr Finnegan and Dr Barratt for further comments on the topic area. To learn more on the interrelationship between COVID-19 and other age-related matters (including grandparenting, technology and ageism) visit IFA’s COVID-19 resource library.

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Biosimilar Initiatives: Discounting Cost, Not Education

Biologic medicines (biologics) are made using living cells and are the most advanced therapy available for numerous conditions. As patents expire on branded biologics, biosimilar medicines (biosimilars) made to be like their biologic reference product enter the market driven by their cost-saving potential.  Biosimilars are used in the field of rheumatology, oncology, gastroenterology, dermatology and endocrinology, with ophthalmology on the horizon. Increasingly studies emphasize that appropriate implementation of biosimilar policies is contingent upon comprehensive patient education, as their beliefs and behaviours can have considerable effects on treatment adherence.[1] In fact, negative perceptions of biosimilars may produce a nocebo effect, which contributes to the intentional non-adherence to treatments and can result in poor patient outcomes.A recent article by The Centre for Biosimilars expands on the importance of providing reliable patient education about biosimilars to rheumatology patients undergoing biologic therapies in New Zealand: Patients with reported negative perceptions about biosimilars are concerned with safety and ultimately fear adverse effects of switching treatments. Fears and uncertainties about biosimilars often lead patients to seek information online. However, according to the Centre for Biosimilars, on-line information is not always consistent with professional evidence-based guidelines. “By assessing patients’ preferences […] healthcare professionals can provide educational interventions to address misconceptions toward medicines”[2] reported Tony Hagen, Senior Editor at the Centre. As exclusivity periods for biologics expire, biosimilars may be considered in the treatment of retinal diseases such as diabetic retinopathy (DR), diabetic macular edema (DME) and age-related macular degeneration (AMD).[3] According to the DR Barometer Study undertaken by the International Federation on Ageing (IFA), the International Diabetes Federation (IDF), and the International Agency for the Prevention of Blindness (IAPB), some 93 million adults suffer from DR worldwide. With the increasing prevalence of diabetes alongside the growing global ageing population, there is a real and urgent need for patients and their families to have access to education, screening and safe and effective treatment. Given the functional changes that accompany vision loss, a patient-centered approach to education about biosimilars must be a priority to overcome negative perspectives, facilitate the clinical consultation and inform decision-making. The World Health Organization’s (WHO) World Report On Ageing and Health further emphasizes the prerequisite of the patient-centered lens in crafting effective policies and plans to support the global ageing population: “This will require focusing on their unique needs and preferences and including them as active participants in care planning and in managing their health states.” For ophthalmology patients, reliable information and educational resources about biosimilars are severely lacking unlike the rheumatology field. While biosimilars may offer a decrease in public expenditure compared with biologics, the importance of investing in patient and health care professional education cannot be discounted. While biosimilar policies in ophthalmology remain in development now is the time for concerted efforts to raise awareness of this new trend in order to effectively respond to patient fears and concerns about treatment options. The IFA Expert Centre provides a point of contact to international specialists in retinal diseases and patient advocacy including Prof. Hans-Peter Hammes, Head of Endocrinology at the University Medical Center Mannheim of University of Heidelberg, Germany; or Dr. Jane Barratt, Secretary General of IFA. [1] Kristensen L. E., et al. (2018). Non-pharmacological Effects in Switching Medication: The Nocebo Effect in Switching from Originator to Biosimilar Agent. BioDrugs, 32, 5, 397‐404. doi:10.1007/s40259-018-0306-1 [2] Gasteiger, C., et al. (2020). Patients’ beliefs and behaviours are associated with perceptions of safety and concerns in a hypothetical biosimilar switch. Rheumatology International, 10.1007/s00296-020-04576-7. doi:10.1007/s00296-020-04576-7 [3] Sharma, A., et al. (2018). Biosimilars in ophthalmology: "Is there a big change on the horizon?" Clinical ophthalmology, 12, 2137-2143, doi:10.2147/OPTH.S180393

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Poor Oral Health and Diabetes: A Mutual Relationship

The importance of oral hygiene has been impressed upon us since childhood. As children the discomfort of sitting in a dentist’s chair is adequate motivation to maintain good (enough) personal oral hygiene behaviours; as adults, social protocols are equally incessant in guiding our oral hygiene practices. Could there be a more poignant reason for us to make sure we are brushing our teeth twice a day? A recent study conducted by clinical professor and neurologist Dr Yoonkyung Chan suggests there is. Want to Help Keep Diabetes at Bay? Brush & Floss - https://bit.ly/3ftL5Jo A close but complex relationship exists between oral health and diabetes mellitus. Both diabetes and oral diseases share many risk factors including alcohol, smoking, and high sugar diets, and is the reason both dentists and physicians caution against their use. Diabetes also shares a more direct link with poor oral health. High blood sugar, a trait characteristic of diabetes, increases the supply of sugar and starch to our teeth causing a buildup of plaque (a sticky film) to occur. The acids in plaque can damage the protective coating around teeth and reduce our ability to fight dental bacteria and infection, eventually leading to the development of cavities and gum diseases. More recently, however, researchers have looked at whether the reverse is also true; can poor oral health lead to diabetes? Inflammation of the gums and gum diseases are known to create space in the gum where bacteria can collect. This bacterium, according to researcher Dr Chan, can then travel into the body’s circulatory system and trigger immune responses that reduce the body’s ability to control blood sugar levels. While difficult to prove because many factors involved in poor oral health are also associated with diabetes, Dr Chan and his colleagues were able to control for these factors and reveal a link between having oral diseases and developing new-onset diabetes. In effect, the study found that people with gum disease and moderate tooth loss (edentulism) were more likely develop diabetes than those without.   For older adults who are at increased risk for edentulism and dental caries, this link between oral diseases and new-onset diabetes could create a double burden. Oral diseases have a profound bearing on general health and well-being through their influence on nutrition.  While the development of diabetes in later life can have more severe implications for physiological and cognitive health due to the interplay between the vascular complications associated with the disease and coexisting morbidities.In recognition of the high prevalence of oral diseases in older adults and the close connection poor oral health has with chronic diseases such as diabetes, the World Health Organization (WHO) has made oral health a global health priority. The WHO Report on Ageing and Health recognizes oral health as a crucial and often neglected area of healthy ageing and outlines broader strategies for reducing the burden of oral diseases and non-communicable diseases in older populations through prevention strategies that target the modifiable risk factors shared between them.   IFA believes improving and sustaining health in older age also requires the close collaboration of, and strategic alignment between, all stakeholders with vested interest in this population. As such, IFA is proud to play its role as a unifying agent and provide an important point of contact among experts through the IFA Expert Centre. To learn more about the critical work being done in the fields of gerontology and diabetes, please contact: Professor Alan J. Sinclair, WHO Expert in Diabetes and Frailty, Clinical Scientist and Diabetes Specialist, Prof. Dr Hans-Peter Hammes, Professor of Internal Medicine at the University of Heidelberg, Germany, and Head of Endocrinology at the 5th Medical Division and Prof. Leocadio Rodriguez Mañas, Head of the Department of Geriatrics at Hospital Universitario de Getafe (Madrid), and President of the Research Committee at Hospital Universitario de Getafe.

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Older Adults and Technology in the time of COVID-19

The COVID-19 pandemic has had an unprecedented impact on daily life for older adults. While security measures put in place have been crucial in battling the spread of the virus, they have also led to challenges in the acquisition of basic needs, social support and the management of preexisting conditions. With countries around the world implementing various lock down and shelter in place policies, the use and reliance on digital technologies has increased significantly. While these technologies have been crucial in maintaining access to information, services and social connection during the COVID-19 outbreak, it is imperative that those who are most in need of these interventions are able and confident in their abilities to use them. Despite the growing need for digital literacy and reliance on digital solutions, a recent article entitled “Designing software to include older people in the digital world” indicated that only 76% of adults over the age of 65 in the UK had accessed the internet in the past three months, compared to 99% of individuals aged 16-44. This issue is further exacerbated by the fact that older adults have and continue to be disproportionately affected by COVID-19 and the associated physical distancing measures. As organizations around the world mobilize to respond to this abrupt uptick in the use of technologies it is imperative to recognize the opportunity and responsibility to design and redesign these software solutions to maximize inclusivity and accessibility. One such example would be simply to limit changes made during software updates. Retaining familiarity can be crucial in ensuring continued use and engagement with technology, and therefore large changes to software interfaces can prove frustrating and prohibitive to many older adults. Another growing concern is the exploitation of older adults from various internet scams and fraud. The United States FBI Internet Crime Complaint Center reported that over $835 million in losses among adults over the age of 60 in 2019. The increasing sophistication of the schemes and the exploitation of the fear and anxiety related to the COVID-19 outbreak has dramatically increased the susceptibility of older adults. In fact, according to the Canadian Federal Government, older adults are more likely to experience fraud than any other form of crime. While governments, individuals and businesses are increasingly innovating and collaborating to help reduce fraud and financial abuse, the role of education cannot be overstated. IFA believes that increasing the digital literacy and accessibility of older adults is crucial not only in being able to identify and prevent fraud or accessing digital supports but in ensuring that this population have the same rights and opportunity to engage and contribute within an increasingly digital world.To learn more about the creation of technologies and services that benefit older adults and caregivers connect with IFA expert Dr Alex Mihailidis, Principal Investigator and a joint Scientific Director of AGE-WELL, Canada’s leading technology and ageing network.  

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A Tricky Combination: Face Masks and Hearing Loss

As the COVID-19 pandemic continues to affect millions of people around the world, issues in other sectors that may at first seem unrelated surface. One example is the interplay between hearing loss and face masks. During the COVID-19 pandemic, many global leaders encourage individuals to wear face masks to prevent the spread of the virus, however for people with hearing loss, this may present several additional challenges and barriers. In a recent Healthy Hearing article, Managing Editor Joy Victory explains that face masks may muffle the voice of the individual wearing the mask, and also prevent the ability for an individual with hearing loss to read facial expressions or lip read – making communication near impossible. This is especially true when face masks are used in medical settings such as hospitals, where loud background noise is common. These barriers to communication may result in frustration from both the person with hearing loss and the health care professional.   There are several steps that health care providers can take to improve communication in medical settings, including: ask how the patient prefers to communicate; speak slowly and clearly; avoid shouting; rephrase remarks if not understood; reduce the noise in the room; and if possible, use a clear plastic mask to make lip reading easier. The second challenge people with hearing loss endure in relation to face masks is for those who wear hearing aids. When wearing a face mask, the ear loops may tug at or pull out the hearing aid, especially when removing the face mask. Some solutions to preventing this issue include wearing a mask with soft fabric ties instead of elastic; using a mask extender that connects at the back of the head instead of the ears; and being sure to remove the mask slowly. IFA believes the ability to improve hearing and communication of older people cannot solely be done through hearing technology, but also must involve training for health care professionals and education for older people on how to create optimal listening environments. These factors especially need to be taken into consideration when barriers such as increased use of face masks are presented. For more information on the importance of hearing solutions for older people, contact IFA Expert Dr. Frank Lin, who emphasizes the importance of communication in all settings in a video by Johns Hopkins Medicine: “Our ability to communicate really defines our life and our ability to engage with everyone around us. For hearing and communication, it means not just using a device. It’s about being able to effectively communicate in all settings.”  In addition, join the IFA 15th Global Conference on Ageing “Rights Matter” on 3-5 March 2020 to learn more on the interplay between hearing loss, older people and communication under the conference sub-theme “Maximizing Senses”, and submit an abstract today!

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Social Isolation and COVID-19: The potential benefits of ICT

Social isolation in older populations is a growing concern. The prevalence of loneliness in community-dwelling adults is estimated to be 43%, and both loneliness and social isolation are strongly associated with adverse health outcomes in older adults including functional impairments and mortality.[i] The current pandemic contributes significantly to the burden of isolation experienced by older adults. It has in many ways also brought attention to the role technology can play in reducing and ameliorating some of the negative health consequences associated with isolation through enabling social connectedness. Social isolation can be defined as absent or weakened social interactions with family, friends, and neighbors and with society at large. The loss or absence of social support networks has a significant impact on mental and physical health irrespective of age. However, older adults, those without children and individuals who live alone are at increased risk for social isolation. Facilitators of social connectedness such as information and communication technology (ICT) can have immense benefits for older adults including improved health and well-being and protective effects on functional ability. Despite the potential benefits of technology in improving health outcomes for some adults, and despite being ubiquitous, ICTs are not widely used or relevant in many people lives. Limited use of technology among older persons can be attributed to lack of access to devices or training, the usability of devices, and motivation. In his Think-Piece “Technology and Care” IFA Expert David Sinclair explains that some people will inevitably be more excited about technology than others, but motivating and inspiring older people to talk about and use technology is important. It also has important implications for more personalized social care services.[ii] In a recent article “OK Zoomer: how seniors are learning to lead more digital lives”, researcher Dr Torgeir Alti expands on the newfound appreciation for technology some adults have gained in the era of physical distancing, and the implications this may have for socialization and communication preferences going forward.  Social distancing restrictions have in many ways tipped the balance of communications in favour of virtual social interactions. Adults who otherwise had no interest in ICTs and communication applications are increasingly finding use in online platforms that help them to stay connected and access essential services. As an example, learning to navigate various online platforms has become part of the new norm for Jillian Cheetham who uses Zoom to host her book club, an activity that has been part of her life for the past 10 years. Other platforms such as Facebook are used to “check-in” with community members and arrange for grocery drop-offs. Online communication platforms are also used regularly and routinely in many long-term care facilities to connect residents with their loved ones. ICTs such as touchpads are being used to facilitate daily or weekly conversations with families to help overcome the social disconnect created by the physical distancing measures.   The IFA encourages those with a keen interest in the interplay between technology, ageing and innovation to attend the IFA 15th Global Conference on Ageing, March 3-5th 2021, where technological advances that have improved quality of life and life expectancy and reduced social isolation will be discussed is depth.  Those interested in presenting their research are welcome to submit their abstracts here: [i] Perissinotto, C., Holt‐Lunstad, J., Periyakoil, V. S., & Covinsky, K. (2019). A practical approach to assessing and mitigating loneliness and isolation in older adults.Journal of the American Geriatrics Society, 67(4), 657-662. [ii] Sinclair D. (2010). Technology and Care Can the web transform social care? Think-Piece. https://ilcuk.org.uk/wp-content/uploads/2018/10/WebTransformSocialCare.pdf

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Vision Health Month - Guidance Note for Eye Care during COVID-19

The COVID-19 pandemic has bought with unprecedented challenges to those with vision impairment. Physical distancing and lockdown measures to curb the spread of infection poses unique challenges to routine ophthalmic care and time sensitive treatment. The Vision Academy, representing leading international experts in ophthalmology and ageing in its commitment to supporting ophthalmologists caring for patients with retinal disease recently published Guidance for anti-VEGF intravitreal injections during the COVID-19 pandemic. The article provides guidance for ophthalmologists on how to optimize care for patients while minimizing the risk of infection at this time. Measures include the use of personal protective equipment (PPE), scrupulous adherence to personal, facility, and instrument hygiene and disinfection protocols, pre-screening to identify symptomatic patients, and reducing the number of people in waiting rooms. Triaging patients according to medical needs and prioritizing of treatment over monitoring visits are also considerations. The Vision Academy stressed the importance of communication with patients via letters or phone calls, in order to provide clear instructions on how to minimize exposure whilst undertaking crucial eye care services. According to the published guidelines clinicians must reassure patients and their families that safety and eye health are top priorities during the pandemic by explaining infection prevention protocols and safeguards of the clinic. More important is the instruction on how to reduce the risk of exposure during and between clinic visits, and advice on what to do should patients become aware of COVID-19 symptoms or deterioration of their vision.The adaption and adjustment of clinical practice at this time is imperative to protect both patients and staff from potential exposure during this time of uncertainty. While the delivery of eye care has been changing amid the ongoing pandemic, patients with retinal disease should not neglect their vision health.  Be sure to visit the Vision Academy website where patient education materials supporting the communication on eye health during the COVID-19 pandemic are available including adaptable communication templates, infographic and video. Please contact IFA expert Dr. Juan Carlos Silva, a key contributor to the WHO World Report on Vision and a valued member of the DR Barometer Community for further information and recommendations in Vision Health Month. 

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A Silver Lining to Self Isolation

As frontline workers, essential workers and governments work tirelessly to control the spread of the novel coronavirus, the vast majority of people find themselves with one important task - to stay at home. With malls, restaurants and theatres closed, people are turning to new hobbies to tackle the boredom of lockdown and social isolation.  While the monotony can be undoubtedly challenging for many, it has also provided a silver lining in an otherwise bleak time.  In a recent article entitled “Why those boredom-busting isolation hobbies might actually be boosting your brainpower”, author Francesca Wallace explores how the resurgence of retro activities and new hobbies may actually be encouraging the development of cognitive reserve. https://www.vogue.com.au/beauty/wellbeing/why-those-boredombusting-isolation-hobbies-might-actually-be-boosting-your-brainpower/news-story/99b8cb2e717ca0321da98dbe352ba3f2 Increases in the sale of puzzles, yarn and language learning software all indicate that people are finding new ways to keep busy and these new activities may be boosting their brain health!  Learning a new language, for example is particularly impactful, encouraging learners to “look for patterns, think critically and retrieve newly learned information from their memory.” Furthermore, an article by Better Ageing entitled “Can Online Learning Help With Cognitive Improvement?” indicates that increases in online learning are not exclusive to language.  Many other online courses have seen a surge in registration and attendance, such as courses in Nutrition and Health, the Science of Wellbeing or the Science of Happiness.  This is particularly encouraging as leading experts believe that engaging in learning can help the brain adapt and “compensate for age-related brain changes and health conditions that affect the brain” and ultimately protect against cognitive decline in the future. It is important to note that “humans are inherently social creatures” and therefore no amount of puzzles or knitting will make up for a lack of social engagement.  That being said, the new hobbies and skills that people are forging during this time may be tremendously useful to hang onto even after we can revisit our favourite restaurants, as those who learn new skills see higher increases in cognitive improvement than those who engage in exclusively social activities. To learn more about brain health including how to foster cognitive reserve and prevent cognitive decline, contact IFA expert Dr Michael Valenzuela.  The IFA is also pleased to announce the upcoming launch of a consensus statement from the Copenhagen Summit on Cognitive Reserve, of which Dr Valenzuela is a lead author. Make sure to keep an eye on the IFA website and follow @IntFedAgeing on twitter where accessible links to the document will be provided!

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Enriching Immunization Strategies Post-COVID-19

The recovery of health systems around the world post-pandemic will depend upon a re-evaluation and re-orientation of national health priorities and investment strategies. Faced with the unprecedented impact of the COVID-19 pandemic on the most vulnerable including older people and those of all ages with underlying conditions, a thoughtful evidence-based approach to priority-setting must commence now. A reliable framework to improve the health of older people and reduce the health system burden of many infectious diseases is a strong immunization strategy founded upon a life course approach. The WHO Immunization Agenda 2030 in the context of the Decade of Healthy Ageing provides evidence-based guidance to Member States to pursue the benefits of vaccines through four core principles:1.      Placing people in the centre of strategic priorities 2. Securing national leadership of immunization strategies 3. Establishing broad partnerships for implementation 4. Using data as the driving force of national policies A recent article by Devex describes how adoption  of and adherence to strategic priorities outlined in the WHO Immunization Agenda 2030 can be a game-changer in the field of global health.This is a critical time for concerted focus and solidarity around strengthening immunization policies that leave no one behind. The momentum around vaccine development and promotion in light of COVID-19 can build upon existing immunization policies and focus attention on increasing access to vaccines across all ages and socio-economic backgrounds.The link between uptake of existing vaccines against diseases such as influenza or pneumonia and the health system burden of the COVID-19 pandemic is increasingly evident.  As adult vaccination uptake increases, three benefits emerge: 1. Older adults experience fewer complications and outcomes from influenza and pneumonia such as hospitalizations; 2.  Fewer hospitalizations for vaccine-preventable disease complications means that more health care resources, including health professionals, are available to treat COVID-19 patients; and 3.  A long-term reduction in the burden to health systems can result in greater workforce productivity and economic benefits for communities and countries.World Immunization Week (WIW), taking place 24-30 April 2020, is an opportunity for the global community to reflect upon the social and economic benefits of standing-up for the WHO Immunization Agenda 2030. #VaccinesWork for All, the theme of WIW further emphasizes the need to improve access to vaccines globally in an equitable manner that leaves no one behind. The International Federation on Ageing’s (IFA) World Coalition on Adult Vaccination serves as a platform for connecting thought leaders in the field of life course vaccination. The IFA Expert Centre provides a point of contact to specialists in the fields of epidemiology, vaccination and more. For more information on immunization strategies as they relate to older people, contact Prof. Raina MacIntyre, Head of Public Health and Community Medicine in Sydney, Australia or Dr. Isabella Ballalai, President of the Brazilian Immunization Society in Rio de Janeiro, Brazil.The IFA 15th Global Conference on Ageing “Rights Matter” in Niagara Falls, Canada 3-5 March 2021 is an international forum for knowledge exchange among global thought leaders in the field of vaccination throughout life. The Vaccines4Life Summit and the IFA Presidential Symposium on Vaccination will feature presentations and interactive workshops from leading experts. Registration is open; visit www.ifa2021.ngo.

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For the Hard of Hearing, COVID-19 Poses Special Challenges

The impact of COVID-19 is widespread, and has impacted every individual and sector around the world in different ways. Professors are having to transition to virtual platforms of teaching, a surge of employers are now working from home, dentists have had to close their clinics, and children are staying home from school.   A recent article by hear-it.org explains that people with hearing loss are no exception. During the COVID-19 pandemic, people increasingly rely on their hearing for communications through channels such as the internet or television to catch the latest updates from their country and around the world on COVID-19, including critical advice from public health advisors and pandemic status updates from their region. In addition, many older adults, who are at higher risk to the virus, are told to stay home and practice social distancing, leaving them to rely on virtual methods of communication. In all of these forms of communication, hearing plays a vital role. If an older adult is unable to hear, it could lead to difficulties accessing the news, and can also exacerbate social isolation. For these reasons, it is important that hearing issues are addressed. Audiologists have been considered an essential service throughout the COVID-19 pandemic in many countries. Audiologists should follow guidelines made by the European Association of Hearing Professionals, which aim to allow hearing specialists to continue to deliver their vital hearing services, while at the same time avoiding the spread of the COVID-19. In addition, it is crucial that older adults who use hearing instruments practice proper hygiene, by always washing their hands before touching their hearing instruments, and by ensuring they are disinfected when taking them off. For further information, contact IFA Expert Dr Frank Lin, a cochlear implant surgeon who specializes in hearing solutions for older persons. His epidemiologic research has established the impact of hearing loss on the risk of cognitive decline and dementia in older adults and served as the basis of the 2017 Lancet Commission on dementia conclusion that hearing loss was the single largest potentially modifiable risk factor for dementia. In addition, consider attending the IFA 15th Global Conference on Ageing “Rights Matter”, where presentations will be made on the importance of hearing in later life from leading experts under the key sub-theme “maximizing senses”. For further information related to COVID-19 and older people, check out IFA’s COVID-19 Resource Library, which aims to inform and drive policy discussions through highlighting views of thought leaders on the rights of older people in the context of COVID-19. 

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Stop the “dreaded duo” of influenza and COVID-19

While many are focusing on the COVID-19 pandemic and its serious global and local impacts, we should not ignore the concurrent threat of seasonal influenza. According to the US CDC (Center for Disease Control and Prevention), there were an estimated 39 million cases of influenza illness; 400,000 hospitalizations and 24,000 deaths have been linked to influenza during the 2019-2020 season. Flu season in the US is still going strong and could actually last through late May.   Australia and other countries of the south are heading for similar trouble as the oncoming flu season could add further strain to an already overwhelmed health system.There are currently no licensed vaccines or therapeutics for COVID-19. In contrast, vaccines are available for influenza and remain the most effective way to protect against the infection and related life-threating complications.  In line with the most recent WHO guidance for immunization activities during the COVID-19 pandemic, influenza and pneumococcal vaccines are advised for people who are at greatest risk of developing respiratory illness, including health workers, older adults, and pregnant women.  Australia is proactive in its action to advance the annual flu vaccination period to April, which usually started from May. Health authorities are urging Australians to have their flu shot as soon as possible amid concerns that influenza and COVID-19 can be a quite deadly combination. "This year, because we have a vulnerable population from COVID-19, it's super important that those people get protected from the normal flu”, says Dr Antonio DiDio, the Australian Medical Association ACT branch president. However, visiting vaccination clinics at a time of pandemic might be problematic for people at risk. Contact IFA expert Prof. Ross Andrews for best practice for immunizations in the context of COVID-19, who used to be the Chair of the Australian Technical Advisory Group on Immunisation (ATAGI), Australia's peak ministerial immunisation advisory committee. Also consider register for IFA “Vaccines4Life Summit” and the IFA Presidential Symposium on Vaccination at www.ifa2021.ngo. You will have opportunity to network with professionals from various fields, understand the burden of vaccine preventable diseases, and share proven best practices and resources to catalyze action. 

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Inequality to Illness

The relationship between structural inequalities and negative health outcomes has long been established. However, the most vulnerable populations remain unprotected by policies and unaccounted for in national strategies and plans. It is only at times of a global pandemic, when morbidity and mortality rates for older people reach unprecedented numbers,[1] that the consequences of poor social policies and structural barriers become inadmissible. In societies with higher rates of inequality, the lack of affordable housing and increased costs for living means that those on limited, fixed or no income sometimes have to make the difficult decision between eating healthy or having a safe space for the night. In a recent New York Times article, the feedback loop between social inequality and risk for infections was explored.  Max Fisher and Emma Bubola, argue that inequalities exacerbate the risk for infections such as COVID-19, which in turn widens social and economic divisions.In many countries the lack of recognition of the needs and rights of older people in economic policies means that older people are often left financially vulnerable. In Ghana, for example, a contributory pension scheme that was introduced to promote financial security in later life, remains inaccessible for the many adults who have never worked in formal employment.[2][3] Even stakeholder pension systems, as seen in India, that allow people to make regular payments over the span of several years, does not account for the economic reality of so many older adults who experienced life-time poverty.[4][5] The impacts of poverty can accelerate the physiological and psychological decline experienced with age, placing older people who are economically vulnerable at disproportionately higher risk for infectious diseases.During the COVID-19 pandemic- where death rates are highest among those with poor immunity and underlying chronic conditions - immediate short-term interventions are necessary to stave off the worst of the negative health impacts.   IFA Regional Vice President, Dr Vinod Shah, recently reported on the strategies currently in place to protect older people in Maharashtra, India, amidst the COVID crisis.  The state of Maharashtra has the highest reported cases of COVID in the country (162), and as such is taking the appropriate preventative measures to protect those at greatest risk. While the State has issued curfews for the population, food and other provisions are being distributed to older persons living by themselves. To protect older homeless people, state authorities and local ageing organizations such as the Janaseva Foundations are working together to coordinate volunteers from the social sectors to distribute food and health supplies, provide shelter for those still on the streets, and secure resources to ensure medical needs are met for all those infected. Older people who experience poverty are not often considered high priority in many nations, however, the disproportionate impacts of large-scale pandemics such as COVID-19 should draw attention to the cumulative effects of inequalities experienced across the life course. Policies that focus on strengthening preventative health measures throughout life are key to building healthier societies and provide the greatest protection against larger-scale pandemics.[1] Lloyd-Sherlock, P., Ebrahim, S., Geffen, L., & McKee, M. (2020). Bearing the brunt of covid-19: older people in low and middle income countries. [2] Schmitt, C. (2020). The coverage of social protection in the Global South. International Journal of Social Wefare,29(1)6-19 [3] Kpessa, M. W. (2011). A comparative analysis of pension reforms and challenges in Ghana and Nigeria.International Social Security Review 64(2),91-109 [4] Siefert, S. (2018). Chinese and Indian Public Pension Systems and Universal Oldage Security in Times of Rapid Demographic Changes. Contemporary Chinese Political Economy and Strategic Relations, 4(3), 941-XIII. [5] Gorman, M., & Heslop, A. (2002). Poverty, policy, reciprocity and older people in the South. The Journal of the Development Studies Association, 14(8), 1143-1151.

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Older adults and COVID-19. Does the WHO need to prioritize those most vulnerable to the virus?

COVID-19 has gone global – no border, wall or body of water seem to be able to stop it’s spread as it has now reached virtually every corner of the planet.Though all segments of the population need to be deeply concerned about catching COVID-19, and no one is immune nor should feel invincible, it’s older adults, who seem to be in the virus’ crosshairs.A recent article from VOX took a look at four global where the virus has spread:Seniors (70 years old and older) The important stats on older individuals: In Spain, out of 6,152 cases from this group, 3,388 people have been hospitalized, a 55 percent hospitalization rate; 199 went to the ICU, a 3.2 percent rate; and 705 people ages 70 and older have died, a 11.4 percent fatality rate. Italy, China, and South Korea have reported fatality rates from 6.2 percent up to 20.2 percent for people in this age range. I’ll use the 75-and-older numbers from the CDC: For ages 75 to 84, hospitalizations (30.5 percent), ICU stays (10.5 percent), and deaths (4.3 percent) are already high, and the key metrics go up even higher for people 85 and older; 31.3 percent hospitalized, 6.3 percent in the ICU, 10.4 percent fatality rate. One note: The ICU stays could be lower for the oldest people if the disease progresses so quickly that they don’t even have an opportunity for intensive care. Bottom line: There is no need to belabor the point, as I think one thing most people know about Covid-19 is it hurts older people the most. The data bears this out: People in this age group are the most likely to be hospitalized and to ultimately die during this pandemic. March 23 - Vox And recently, Dr. Jane Barratt, Secretary General of the IFA recently published a response in the British Medical Journal (BMJ) demanding the prioritise the needs of older people in its response to the Covid-19 pandemic. In response to the Open Letter, we request the following specific actions by WHO. 1) Its main webpage for Country and Technical Guidance - Coronavirus disease (COVID-19) must include a specific tab leading to guidance of specific relevance to older people. This would lead to the WHO guidance on long-term-care facilities and will also include information about other guidelines for other older people that will be published as a matter of urgency. 2) WHO must immediately appoint a senior member (ADG Level) to lead on older people issues across WHO. Since WHO’s regrettable decision to close its Department of Ageing and Life Course in 2018, it does not contain a senior member with an exclusive responsibility for older people. The newly appointed leader on older people’s health should be provided with a budget, staff and authority to take lead on this issue. 3) WHO must urgently mainstream awareness of older people's specific needs and vulnerabilities across all departments and activities dealing with COVID-19. If you are a journalist looking to cover how COVID-19 is impacting older adults and why that demographic needs to be the focus of governments and healthcare officials – then let our experts who are monitoring this situation around the world help.   Each expert is available to speak with media, simply click on any of their respective icons to arrange an interview today.   Dr. Mine Durusu-Tanriover is the author of more than 40 peer-reviewed articles, Dr. Durusu-Tanriover's research area mainly consists of acute care and adult vaccination. Dr. Jean-Pierre Michel is a full Professor of Medicine at Geneva University Medical School and head of the geriatric ward – 124 acute care beds including an intensive care unit of 4 beds at the Geneva University Hospitals - Switzerland.Professor Mañas is the Head of the Department of Geriatrics at Hospital Universitario de Getafe (Madrid), President of the Research Committee at Hospital Universitario de Getafe and Professor "ad honorem" of the Department of Medicine of the School of Medicine, Facultad de Medicina de la Universidad Autonoma de Madrid, Spain. Dr. César Misael Gómez Altamirano is Deputy Director of Coordination and Operation of CONAVA. Dr. Jane Barratt is the Secretary General of the International Federation on Ageing comprising government and non government members in 62 countries and representing some 50 million older people.

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Ageing in a Pandemic

In the last few weeks the world has seen incredible change. As the COVID-19 pandemic spreads to the far reaches of the globe, cities and countries that have operated as well-oiled machines now find themselves grinding to a halt.  Strict measures to control the spread of the novel coronavirus such as social distancing and the closure of non-essential services means that daily life as we know it has drastically changed. In an article recently published by Forbes entitled “COVID-19 Now We All Know What It’s Like To Be Old & Alone” author Joseph Coughlin illustrates how many of the challenges individuals find themselves having to quickly acclimate to, social isolation, acquiring groceries and basic necessities, and stress associated with ensuring access to medication and treatment, are commonplace for many older adults in our society. Mandatory social isolation, for example, has left many younger people scrambling for ways to cope, using everything from self-help books and guided meditation to board games and face-time group chats.  Whereas for many older individuals, social isolation is a normal part of their everyday life. Coughlin, founder of the Technology AgeLab, believes that this time alone can serve an invaluable opportunity to empathize with the mental and emotional struggle that older adults regularly face.  Taking this empathy exercise one step further, Coughlin shines a light on another often-overlooked transition for many older people, the move from work to home life.  As businesses have scrambled in the last few days to set up work from home options, many employees have found themselves in a jarring new reality.  This is in fact the reality that many older adults face once they reach the age of mandatory retirement.  One day they’re working and the next they are retired, with their workplace, clients, coworkers and routine simply gone. While this opportunity for empathy training may be a silver lining in this otherwise bleak time, it is important to recognize that while many people are just now experiencing what an average day in the life of some older adults may look like, COVID-19 has greatly exacerbated many of these preexisting challenges facing older adults.  Beyond just the clinical perspective which sees older adults being disproportionally affected by the virus, ageism is larger than life itself.  A recent article in the New York Times highlights a resurgence in the use of outdated language and even the emergence of cruel hashtags such as “#BoomerRemover”. Furthermore, while many individuals may now be able to understand the frustration of shopping for basic supplies amidst panic buying, it is imperative to remember that for older adults these challenges are often compounded by pre-existing issues, limited mobility, transportation and increased risk can make tasks which are already difficult at this time, virtually impossible. Use this time to practice more than empathy, practice action, reach out to loved ones and neighbors, check in and lend a hand where able.  It is our combined responsibility to ensure that the rights and needs of older adults are a priority during this transformative time.  For more information on COVID-19 and the impact on older people, contact IFA expert in combatting ageism and age-related discrimination, Liat Ayalon.  

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Combating Systemic Ageism in Emergency Preparedness Responses

Upgraded to pandemic status by the World Health Organization (WHO) on 11 March 2020, COVID-19 virus cases have increased exponentially around the globe. Decreased immune response among older people and those with pre-existing medical conditions (including high blood pressure, heart disease, lung disease, cancer or diabetes) means that the virus is more likely to cause severe complications leading to hospitalization and potentially death. Emergency preparedness responses are developed to respond to the needs of all vulnerable populations including older people. Yet, we now know in this pandemic that health systems are generally under-prepared for the rapidly growing wave of new cases including older people with chronic co-morbid conditions. Many front-line health professionals are experiencing every single day the ethical dilemma of whose life to save with the limited equipment, hospital beds and treatments. In Italy, an overwhelming surge of COVID-19 cases has pushed the public health system to capacity. Hospitals are facing the impossible choice of triaging people based on age and implied likelihood of survival. According to this recent article, that’s what hospital guidelines dictate doctors do. The WHO describes ageism as the discrimination of people on the basis of age, which has negative impacts on health and well-being. In the case of COVID-19 emergency responses, is it ageism that is driving decision about denying ventilation and other treatment to older people, and / or is it about survival and quality of life post infection. Will we ever know?Policies that discriminate based on age are out of touch with the global reality that the ageing population is a powerful and positive demographic force.  In these instances, thoughtful reflection is required on the nature of discriminatory practices, the investment in prevention and the language of humanity. While Italy may be the first country confronted with this choice, chances are that they will not be the last. This begs the question, in a country that is said to have one of the oldest populations in the world, what public health policies and guidelines are in place to protect vulnerable populations including older people? Combating ageism requires a global movement that involves citizens, governments, non-governments, academia, and industry in order to transform attitudes and actions across generations and civilization.  The International Federation on Ageing (IFA) works relentlessly alongside members and supporters to bring attention to the rights of older people. On 31 October 2020 as part of IFA’s 15th Global Conference on Ageing taking place in Niagara Falls, Canada, a Master Class on Ageism will bring together a global network of peers in the aim of combating ageism at scale. Register now to learn about the latest global evidence on ageism; gain knowledge and skills to develop evidence-based interventions to tackle ageism; and develop a plan to implement interventions to tackle ageism in your context. In the meantime, the IFA Expert Centre provides a point of contact to specialists in the fields of ageing, immunology, human rights and more. For more information on population ageing and the rights of older persons, contact Prof. Andrew Byrnes, Professor of International Law and Human Rights in Sydney, Australia; Dr. Isabella Aboderin, Head of the Program on Aging and Development in Nairobi, Kenya; or Dr. Laura Mosqueda, Dean of the Department of Family Medicine and Geriatrics at the Keck School of Medicine in California, United States.

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Less Shingles, Less Stroke

Shingles (herpes zoster) is a viral infection that causes a painful rash and blisters, instigated by the same virus that causes chickenpox. Older people are at higher risk of shingles, with one in three adults in the US developing the disease. Fortunately, vaccination can reduce risk of shingles by nearly 50%. A recent WebMD news article highlights the importance of being vaccinated against shingles, and the surprising other benefit vaccination against the disease can bring – reduced risk of stroke. The article explains that the risk of having a stroke was reduced by 20% for people under 80 years old who received the shingles vaccine. Why? Researchers suggest the answer may be related to inflammation. When people develop shingles, there is an increased inflammatory response which can increase risk for heart attack and stroke. Avoiding shingles through vaccination then, can reduce the inflammatory response and therefore reduce risk of stroke. IFA strongly believes vaccination against infectious diseases such as shingles, pneumonia and influenza brings many more benefits than just protecting against the disease for older adults. Vaccination can help to prevent functional decline, hospitalizations and complications resulting from the disease. To learn more about the protective effects of vaccination for other diseases such as influenza, read the IFA Report “The Secondary Benefits of Influenza Vaccination”, and consider contacting IFA Experts Dr Serhat Unal, Chair of Department of Infectious Disease, Hacettepe University (Turkey), and Prof Raina MacIntyre, international expert in infectious diseases and vaccinology among older adults. The IFA will host the 15th Global Conference on Ageing “Rights Matter” in November, where the Presidential Symposium on Vaccination “The Social and Economic Value of Adult Vaccination: Why Prevention is Wealth” will be held. One day prior to the conference (31 October) the IFA will convene the “Vaccines4Life Summit” a full day program that aims to inform the global agenda for a life course approach to vaccination, serving as an opportunity to network with professionals from various fields, understand the burden of vaccine preventable diseases, and share proven best practices and resources to catalyze action.

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Towards an Age-friendly World

Despite the significant attention given to dementia, brain health and ways to improve cognition little attention has been given until now on environmental exposure as a modifiable factor that can affect brain’s process of ageing. Results of a first known study on this matter, published in Journal Health & Place, suggest a joint impact of genetic makeup and physical environment on the cognitive health of older adults. Researchers found that living in neighborhood with greater access to social, walking and retail destinations is associated with better cognitive function and the relationship is strongest among those who are at the lowest genetic risk for Alzheimer's disease. Given the fact that age-related cognitive disorders are on the rise, researchers across the healthcare system are seeking innovative ways to prevent and treat these conditions.  Many are by gene therapy and precision medicine, but little or no consideration appears to be given to the effect of the environment where people are born and live throughout the life course. "Research on the potential influences of the neighborhood environment on cognition and brain aging can help inform recommendations for neighborhood improvements to simultaneously address population growth and healthy brain aging," said Lilah M. Besser, leading author of the study and an assistant professor from Florida Atlantic University. Since older people spend less time outside, the neighborhood environment increases in importance with age.  According to the World Health Organization (WHO), a key strategy to promote healthy ageing and prevent or delay the onset of disease and functional decline is to build age-friendly environments which are accessible, equitable, inclusive, safe and secure, and supportive. Contact IFA Expert Mr Rodd Bond, expert on age-friendly environments, for further information. The IFA, with general consultative status with the United Nations and in official relations with the WHO, is committed to driving the creation of age-friendly environments globally and acting as both the secretariat and as an affiliate for the WHO Global Network of Age Friendly Cities and Communities.  This year on 31 October, the IFA Age-Friendly Environments Summit will be held at Niagara Falls, Canada to raise critical importance of age-friendly environments on health and wellbeing of ageing populations. In addition, a unique Age Friendly Village will be on display throughout the IFA 15th Global Conference on Ageing from 1-3 November to showcase services, products, and devices that offer beneficial outcomes in the care and support of older people. Register for both events at www.ifa2020.org.

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Making the link: Rheumatoid Arthritis and Vaccines

The connection between rheumatoid arthritis (RA) and functional ability has been well documented in media and scientific literature. RA is an autoimmune disorder characterized by an overactive immune system that attacks the body’s tissues and joints.  The associated inflammation and pain can often lead to debilitating outcomes, including reduced functional ability and decline in quality of life.  Less often discussed in media outlets, however, is the thread linking rheumatoid arthritis, vaccine preventable diseases and functional decline. The population of people with RA represents a sizable percentage of the population at serious risk for infections due primarily to the nature of their condition and the immunosuppressive therapies used in treatment. While most individuals with RA are at risk for communicable diseases, older adults with RA in particular are more vulnerable to infectious diseases such as pneumonia and influenza.  The natural advancement of immunosenescence, in conjunction with a weakened immune system and the use of RA immunosuppressive therapies, makes it even more difficult for the ageing body to resist viral antigens.  Immunization, then, is not only an important mediatory intervention for this population but plays a critical and potentially lifesaving role. The importance of high-dose vaccinations for older adults with RA was highlighted in a recent article published by the Rheumatology Network.  The argument for high-dose influenza vaccines was made based on a recent Canadian study that showed high dose-trivalent inactivate influenza vaccine (HD-TIV) was 2-3 times more likely to generate antibodies against the influenza strains than the standard-dose vaccine. This is an important finding given that the annual incidence of influenza globally, as reported by WHO, is around 5-10%, and that this rate is even higher for adults with RA. In fact, two US studies found that people with rheumatoid arthritis were 1.4 times more likely to be diagnosed with influenza than controls.[1] Despite the myriad of evidence supporting vaccines as crucial health intervention for this population, the vaccine-uptake rates for adults with RA remains low.[2] IFA expert Dr Marla Shapiro has identified some key factors leading to this generally low trend in vaccination rates and found vaccine hesitancy to be a common perpetrator.  To combat this, Dr Shapiro recommends improving communication of vaccine designs and concepts of protection.[3] Global events such as the IFA Vaccines4Life Summit are an important platform for critical conversations around vaccine hesitancy and barriers to access.  The upcoming Vaccines4Life Summit held Oct 31, 2020 will facilitate cross sectoral and cross disciplinary collaborations around best practices, and promote the exchange of knowledge building resources. To learn more about this event visit www.ifa2020.org. [1] Somes MP, Turner RM, Dwyer LJ, et al. Estimating the annual attack rate of seasonal influenza among unvaccinated individuals: a systematic review and meta-analysis. Vaccine 2018;36:3199–207. [2] Gosselin Boucher, V., Colmegna, I., Gemme, C., Labbe, S., Pelaez, S., & Lavoie, K. L. (2019). Interventions to improve vaccine acceptance among rheumatoid arthritis patients: a systematic review. Clinical rheumatology, 38(6), 1537–1544. https://doi.org/10.1007/s10067-019-04430-7 [3] Volker Vetter, Gülhan Denizer, Leonard R. Friedland, Jyothsna Krishnan & Marla Shapiro (2018) Understanding modern-day vaccines: what you need to know, Annals of Medicine, 50:2, 110-120, DOI: 10.1080/07853890.2017.1407035

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The Case for Strength Training After Age 45

Strength training is an important safeguard against muscle loss in later life, and recent studies suggest that maintaining muscle mass may also reduce the risk of cardiovascular disease. While muscle loss can begin around the age of 30,[i] physical inactivity and metabolic changes can accelerate the rate of muscle mass decline in later life. If left unchecked, it can lead to a condition called sarcopenia, largely characterized by physical impairment and functional decline to the point of disability.[i] A New York Times article highlights the interconnected pathways through which muscle health affects cardiovascular health. The findings underscore the value of maintaining (and building) muscle mass through middle age as a means of preventing heart disease in later life by as much as 81% among male participants studied.The article points to the need for early non-pharmacological measures in order to promote cardiovascular health. A low risk and high reward option to preventing muscle mass decline is ensuring strength training is part of a regular exercise regimen, in order to maintain and build muscle mass beginning in middle age and into later life.  Although the general benefits of exercise towards healthy ageing are far from novel, advances in research techniques are allowing scientists to explain the metabolic links associated with muscle composition and cardiovascular disease (CVD) risk. On one hand, skeletal muscle has been shown to play a role in insulin regulation, which is significant when considering the association of CVD with insulin resistance.[i] On another hand, CVD-associated inflammatory markers are inversely related to skeletal muscle mass, indicating that higher muscle mass is linked to reduced inflammation.[i] Increasing muscle mass can not only reduce CVD risk, but also enable older individuals to maintain the intrinsic capacity (IC) to fulfill daily activities. As described by the World Health Organization (WHO) in their 2015 World Report on Ageing and Health, IC is comprised of an individual’s physical and mental attributes. Though genetics play a role, life course behaviours and social environment are much more powerful influences on the changes in IC observed in older age. These measures are strong predictors of positive outcomes when compared to traditional disease-focused assessments. Good practices in creating positive environments for active and healthy ageing can be found in the WHO’s Global Network for Age-Friendly Cities and Communities. A shift towards a more holistic health focus on person-centred functional ability may be possible by bringing awareness to the impact of non-pharmacological preventive interventions, such as strength training to retain muscle mass. To learn more about sarcopenia, CVD, and functional ability, contact IFA Experts Dr. Manuel Carrageta, President of the Portuguese Society of Geriatrics and Gerontology; Dr. Mark S. Lachs, Professor of Medicine and Co-Chief of the Division of Geriatrics and Gerontology at Cornell University’s Weill Medical College; or Prof. Alan J. Sinclair, Director of the Foundation for Diabetes Research in Older People. In addition, consider registering for the IFA 15th Global Conference on Ageing, now accepting abstracts related to preserving muscle mass in older age under the conference sub-theme “Enabling Functional Ability.” [1] Tyrovolas, S.,. (2020). Skeletal muscle mass in relation to 10 year cardiovascular disease incidence among middle aged and older adults: the ATTICA study. J Epidemiol Community Health, 74, 26-31.

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Ageism and Societal Responses to Population Ageing

A recent systematic review published in PLOS ONE has explored just how deleterious the impact of ageism can be on an older person’s health. The article entitled “Global reach of ageism on older persons’ health: A systematic review” found that 95.5% of all studies included illustrated that ageism led to significantly worse health outcomes for older adults, and perhaps most strikingly, highlighted just how pervasive and insidious ageism is worldwide. The effects of ageism can even be seen in many of the social responses to population ageing.  While responses to population ageing in general are a positive sign that ageing is being prioritized within political agendas, upon further inspection ageism is still very much at play.  The provision of social protection schemes provides an interesting example.  While crucial, the provision of social security to older adults sidesteps some of the underlying factors contributing to lower income in older adults.  While increased longevity has undoubtedly created a need for social security it can also mask the reality that many older adults while wanting to work, are excluded from the labor market due to ageism.  This is also seen in the seemingly arbitrary age-cut offs which dictate access to many services and resources including social security. Age does not discriminate, for example, someone at the age of 60 may have similar needs to someone else at the age of 70, and yet the former may not be able to access much needed services simply because they fall outside of a chronological age-cut off. Universal healthcare is another interesting example which for many countries enables their citizens to access basic services. As with social security, ageism (prejudice, stereotyping and discrimination) is ever present in this system.  Older adults may face limits in the access to certain services based on their age.  Rehabilitation services may not be available to individuals over the age of 80 years.  This is deeply concerning as recovering functional ability post fall or accident can significantly impact the overall health outcomes for older adults.   Furthermore, many services such as routine eye exams and hearing tests essential to the well-being of older people are not funded within “universal coverage” which often leads to the misperception that they are not important. Equally older people are more likely to be prudent with limited funds and not prepared to invest in prevention for fear that it may result in the need for costly eyeglasses or hearing aids.   In fact, the said study found that ageism was related to poorer health for older adults in 11 different measures, some of which were structural and some individual, including decreased longevity, poorer quality of life and even higher risk for cognitive impairment and physical illness.  What is unequivocal is that societal responses to ageing are for the most part just that, responses.  The solutions, be it social security or universal healthcare in this case, are based on, and “respond to”, the identified problem which then often ignores the underlying factors contributing / exacerbating the problem, in this case ageism.  In order to maximize the success of current and future approaches to population ageing, the underlying issue of ageism must be more adequately explored and addressed. To learn more about ageism including how to combat ageism connect with IFA expert Prof Liat Ayalon, Ilan University.  Also register for the Master Class on Ageism at the IFA’s 15th Global Conference on Ageing and be part of the conversation (and action)!

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The Hidden Universe of Sexuality in Later Life

In modern society, sexuality and intimacy are considered a central and meaningful part of life, however, the topic in relation to older people largely remains taboo. Media plays a key role in shaping the public’s views, often influencing what is deemed “socially acceptable” and what is not. Older people in general are largely under-represented in the media and especially regarding their sexuality. This cultivates a myriad of challenges, including but not limited the reluctance of older people to discuss sexual health with their care provider due to fear of judgement. A recent LifeGate article leaves these ageist views behind to shine a light on sexuality in later life.  The article features photographs by Arianne Clement, a Canadian photographer well-known for her “work exploring the hidden universe of beauty, sexuality and desire in old age.” The photographer notes that two of society’s prevailing taboos surround nudity and the sexuality of older people.  Arianne hopes her photographs, which have now gone viral, help to combat these ageist beliefs.  Ariane explains: “In a society that associates beauty with youth, there’s a pervasive fear that comes with the idea of ageing. (…) I knew I wanted to put these incredible women, discarded due to the social and cultural norms of mainstream society, under the spotlight.” Research on sexual activity in later life is limited, however the WHO World Report on Ageing and Health notes that despite stereotypes, older people continue to remain sexually active well into later life, with one longitudinal study noting that 53% of people aged 65 to 74 remained sexually active. Contact IFA Expert Dr John Beard, former Director of the WHO Ageing and Lifecourse Department, for further information. Also consider contacting Dr Debra Whitman, Chief Public Policy Officer of AARP, who released a 2018 Report which found that older adults who engaged in sexual activity are less likely to be lonely.  Under the key theme “Combating Ageism” at the IFA 15th Global Conference on Ageing, abstracts are currently being accepted on how to tackle social issues such as isolation, loneliness and abuse in later life.  Check out www.ifa2020.org for more information. 

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Senior substance use disorders: A silent epidemic

Substance misuse and dependency among older adults is a growing but mostly overlooked threat to healthy ageing. While the use of illicit drugs and alcohol are generally lower among older adults compared with younger cohorts, ageing itself presents greater risks for substance use disorders (SUD) due to the combination of biopsychosocial changes and complicated medication use, which provokes substance-abusing behavior in older age.  Alcohol, cannabis and medications that are used to manage pain, anxiety, sleeplessness and depression can be particularly dangerous for older people, even if they are not addicted. The adverse effects of such substance on the cognition, emotional and physical health of old adults puts them also at a higher risk for falls, fractures, car accidents and other such emergencies. Substance use disorders among older adults are mostly underdiagnosed and undertreated due to a lack of awareness among health care professionals. The Canadian Coalition for Seniors Mental Health (CCSMH) are leaders in bringing voice and actions to this growing trend. CCSMH recently launched 4 sets of evidence-based Clinical Guidelines on Substance Use Disorders in Older Adults which included educational tools and clinical practice recommendations on the use of alcohol, Benzodiazepine, Cannabis and opioid among seniors. “We are very hopeful these Guidelines will lead to the prevention of substance-related problems as well as to improved services for older adults who have developed a substance use disorder” says Dr. David Conn, project lead, Co-Chair of the CCSMH and Vice-President of Education at Baycrest. Ensuring that older adults have access to better treatment for Substance use disorders across the country is aligned with the IFA’s advocacy position of fostering healthy ageing.  Join the conversation with IFA experts and Dr David Conn today to learn about the first-ever National Clinical Guidelines detailing the evidence and best practice recommendations for the prevention, assessment and treatment of SUD among older adults. Original press release: https://ccsmh.ca/wp-content/uploads/2020/01/CCSMH-SUD-guidelines-Press-release-FINAL.pdf

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Looking Ageism in the Mirror

A robust older population is in many cases the hallmark of a highly developed society. Reflected in a healthy ageing population is society’s dedication to push boundaries and reframe what is probable. Our consumer industries, however, paint a very different narrative. The fashion and beauty industries have long excluded older people from runways, magazines and campaigns, perpetuating negative stereotypes about ageing and harmful standards of beauty.  Although industry giants such as Gucci have taken steps towards age-inclusivity in their campaigning, older models remain vastly underrepresented in beauty advertisements. With an expanding older demographic, the proportion of citizens unable to identify with the current representations of beauty has increased.  In sidelining older consumers, this sector has not only been dismissive of the needs and desires of older people but has lost out on the “grey pound”.  In a recent article published by the International Longevity Centre (ILC) UK, the exclusory behaviors of both the fashion and beauty industry was predicted to cost them close to 11 billion pounds.  Further to this, research conducted by the ILC UK revealed that "by 2040, people aged 50 years and over are expected to be this sector's key consumer base".   While this presents an opportunity for increased profit for the fashion and beauty industries, it paradoxically challenges this sectors’ most profitable strategy, the "anti-ageing" and "youth-preservation" fear tactics.  These ageist marketing schemes not only perpetuate reductionist ideologies of ageing and beauty, they also create an "us" versus "them" generational complex. In a 2018 journal article published by IFA expert Dr. Lucie Vidovićová, the intergenerational conflict created by industries is explored further. Her work exposes the oversimplified storyline of ageing presented in social media and argues that these strategies are used to manipulate the behaviours of older and younger people. IFA works tirelessly alongside experts, NGOs and thought leaders to challenge these limiting perceptions on ageing and confront the discomforting gaps in the rights for older people. IFA’s 15th Global Conference on Ageing, themed "Rights Matter", provides global leaders in the fields of ageing, health governance and public policy the platform to have 'game changing' conversations about ageism and the need for accurate and enabling representations of older people. For more information on the global conference please visit:  https://ifa2020.org/

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Life Course Immunization: More Than Just Flu Season

Immunization is recognized globally as an effective means of preventing and minimizing the impact of infectious diseases such as influenza, pneumonia and shingles. An article in the Press Telegram “Senior Living: Scheduling your immunizations as you age” offers an informed perspective on the importance of vaccination throughout a person’s life course. Dr. David Michalik, a pediatric infectious disease specialist in Long Beach, California said “vaccinations that you received as a child also can wear off over time, requiring revaccination or a booster shot to boost your immune system’s ‘memory.’” In the absence of revaccination or booster shots in later life and as the immune system “memory” declines, older adults are more susceptible to vaccine preventable diseases. This is particularly amplified in the presence of behavioural risk factors like smoking and/or chronic conditions including diabetes, cardiovascular disease, or respiratory ailments.  Although local vaccination schedules vary considerably, Dr. Michalik provided a general statement of recommended vaccinations for adults in the local situe: - 50 years or over: annual influenza vaccination, a Tdap (tetanus, diphtheria and pertussis) booster every 10 years, and two doses of the shingles vaccine; - 60 years or over: pneumonia vaccination; and - 65 years or over: annual high-dose flu vaccine can provide additional protection and is specifically developed for this age group. Global efforts to increase vaccination rates over the past few decades have resulted in a decrease in mortality of communicable diseases from 33% in 1990, to 25% in 2010. While European Union public health policies recommend at least a 75% rate of influenza vaccination among high-risk groups all countries, with the exception of the United Kingdom, are well below the target. In a report from the European Centre for Disease Prevention and Control (ECDC), under 50% of older French adults aged over 65 years reported being vaccinated against influenza in the 2014-15 season. An IFA led multidisciplinary expert meeting “Vaccination in France: Changing the Public Perception” in Lyon in December 2019 aimed to reconcile perspectives from important stakeholder groups in the current vaccination discourse and identify challenges and opportunities for improving participation in vaccination campaigns. Prof. Jean-Pierre Michel of Geneva University’s Medical School reported during the meeting that effective adult vaccination schedules can support maintenance of functional ability and help prevent 2.5 million deaths annually due to communicable diseases. An underestimated benefit of both influenza and pneumonia immunization is the growing evidence of a reduction in cardiovascular complications including stroke and heart failure in adults over 65 years of age.  To learn more about secondary benefits of vaccination and related emerging research areas in cardiovascular and pulmonary diseases, contact IFA Experts Prof. Jean-Pierre Michel, Professor of Geriatric Medicine in Geneva, Switzerland, Prof. Catherine Weil-Olivier, Professor of Pediatrics at Paris Diderot University, or Prof. Antoni Torres, Professor of Medicine and Head of the Respiratory Intensive Care Unit at Barcelona University’s Hospital Clinic. In addition, consider following the @Vaccines4Life Twitter page, and being involved with the World Coalition on Adult Vaccination, where stakeholders collaborate on a common agenda around a life course approach to vaccination, with special attention to later life.

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Bad heart? Don't forget your flu shot.

Amid a turbulent flu season, where discussion seems to have centered around the efficacy of this year’s flu vaccine, heartening news from a study done by Public Health Ontario is showing that the flu vaccine may offer secondary protection against heart attacks.Protection from heart attacks has been shown particularly for groups such as older people, and people with cardiovascular and other chronic conditions, who are at high risk of complications.Not only is the risk of heart attack moderated by the flu vaccine, but the vaccine has been compared to other long-term health measures, for example quitting smoking, in its prevention capacity.This news is especially important considering recent additional research showing that the risk of heart attack increases sixfold in the week following a positive flu diagnosis, particularly among vulnerable groups.While younger, healthier people may not be at as high risk of complications from the flu, they too can transmit the influenza virus to others who may be at greater risk.The International Federation on Ageing (IFA) 14th Global Conference theme Toward Healthy Ageing will feature current research on the connections between influenza, ageing, and chronic conditions.For more information on these connections, contact the following experts from the IFA Expert Centre:Source:

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Vaccines are Our Weapon in the Fight for Quality of Life

Diseases such as influenza, pneumococcal pneumonia and herpes zoster (shingles) are preventable through immunization. Preventing these diseases decreases hospital admissions, preserves functional ability and prevents death.In an interview with the IFA, Expert Dr. Mine Durusu-Tanriover describes vaccines as a weapon for fighting off these potentially debilitating diseases, enabling at-risk groups such as older adults to age in a healthy manner. She also emphasizes the power of vaccines in maintaining functional ability and quality of life among older adults.“No one wants to live a long life bedridden” – Dr. Mine Durusu-Tanriover Unfortunately, vaccination uptake rates among older people are below targets. Dr. Durusu-Tanriover argues doctors should educate patients on how vaccines are a powerful tool in preventing diseases in order to shift the paradigm.As a consultant of acute care in Ankara, Turkey and Professor of Internal Medicine at Hacettepe University with over 40 peer-reviewed articles, Dr. Durusu-Tanriover is an expert in the field of adult vaccination and can be contacted through the IFA Expert Centre.This week during World Immunization Week, the IFA joins national and international partners such as Dr. Durusu-Tanriover in spreading knowledge on the importance of vaccination, providing resources and advocating for the use of vaccines to protect people from all ages against preventable diseases.

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Flu Season Continues to Worsen

If you have been following the news lately, you might have noticed headlines warning that influenza risk is especially high this flu season - having already resulted in a significant number of hospitalizations and deaths. What’s more, experts are saying influenza is likely to result in more hospitalizations and deaths as we have not yet reached “peak season.”According to CBC News, this year’s flu strain, H3N2, tends to cause more severe illness, particularly in children and older people, as well as those with compromised immune systems. CBC reports that in Canada so far in 2017-2018, 68% of hospitalizations from the flu have been in people over the age of 65.For those who are not well-versed in the scientific jargon that can accompany warnings about flu season, it can be difficult to recognize what makes this flu season worse than previous ones. As a result, headlines warning of an impending flu catastrophe can be alarming, leading to concern about what can be done.The good news is, despite which flu strain is most prevalent in any given year, the measures taken to protect against flu remain the same. Taking precautions such as getting the flu vaccine not only protect you, but can also help protect vulnerable people in the community. Other safeguards, such as handwashing and remaining home from work when ill can also be taken.With some months to go until the end of winter, it’s not too late to protect yourself, your family and your community against the flu.Find out more about influenza, its consequences, and the importance of flu vaccination through experts on the International Federation on Ageing's Expert Centre. Just click one of their icons to arrange an interview.Source:

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Influenza vaccination in Europe

The rates of influenza vaccination are low and even decreasing in many European nations, with two million preventable cases of influenza occurring in Europe each year. To reach the target of providing 75% of at-risk people with the influenza vaccine, an additional 60 million people would need to be vaccinated in Europe.The Steering Group on Influenza Vaccination recently outlined key methods to increase influenza vaccination rates in the “EU Manifesto on Influenza Vaccination.” The Steering Group consists of various scientific and medical associations (such as the Pharmaceutical Group of the European Union) and aims to produce effective strategies to reach the target of providing 75% of the population with the influenza vaccine.The EU Manifesto on Influenza Vaccination advises health care providers to promote the influenza vaccine, explains the need to focus on at-risk groups such as older people and emphasizes the need for an improved societal understanding of the value and safety of the vaccine within the EU population. Overall, the Steering Group strives for an improved and collaborative practice between professionals in Europe in order to increase influenza vaccination rates.If you would like to learn more about the importance of vaccines for at-risk groups such as older people, consider attending the IFA 14th Global Conference on Ageing, which includes discussion from experts on a life course approach to vaccination. Visit www.ifa2018.com for details.For more information on vaccinations, connect with one of our IFA experts such as Dr. Mine Durusu Tanriover, who was involved in the Global Influenza Hospital Surveillance Network project.Source:

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Vaccination is Europe's greatest public health asset

Written for Parliament magazine, this article discusses vaccination as a crucial public health prevention strategy and stresses the need to boost vaccination coverage rates across the European Union (EU) to protect individuals and others who are vulnerable such as older people and people with immunocompromising conditions.The International Federation on Ageing (IFA) and the IFA World Coalition on Adult Vaccination work toward increasing vaccination uptake rates on a global scale, particularly among older people and at-risk groups, as well as bringing awareness to the role vaccination plays in healthy ageing and preservation of functional ability.The IFA’s work on adult vaccination has been done jointly with stakeholders in the fields of vaccination, ageing, public health, and non-communicable diseases. Stakeholders include Dr. Mine Durusu Tanriover, an expert in acute diseases and adult vaccination who speaks to the combined effects of chronic diseases and vaccine preventable diseases on long-term health, and Dr. Jean-Pierre Michel, an expert in the biology of aging who can speak to the decline in immune system function associated with age.The IFA has found similar barriers to those noted in the article in conducting national and regional meetings on vaccination as a public health priority. A recent report from the Nordic ‘Adult Vaccination: A Public Health Priority’ meeting identified key vaccination barriers including the need for better vaccine registries and surveillance; the need to prioritize vaccination among healthcare professionals; the need for stronger public health messaging around the benefits of vaccination; the need for more effective vaccines; and the need for more cohesive mechanisms of vaccine delivery. These barriers can be elaborated on by adult vaccination expert Dr. Serhat Unal, an attendee of an early IFA adult vaccination expert meeting in Belgium.The life course approach to vaccination is the focus of the IFA’s World Immunization Week 2018 campaign (24-30 April 2018), and will be showcased at the IFA 14th Global Conference on Ageing, happening 8-10 August 2018 in Toronto, Canada.Source:

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The Need for a Lifelong Vaccination Strategy in An Ageing Population

IFA Expert Dr Mine Durusu-Tanriover is a consultant of acute care in Ankara, Turkey and Professor of Internal Medicine at Hacettepe University. Dr Durusu-Tanriover notes that people with chronic disease are frequently admitted to the hospital due to vaccine preventable diseases such as influenza and pneumonia, despite the availability of vaccines.Last year, none of the EU member states achieved the target of 75% for vaccinating at-risk groups such as older people and those with chronic disease with the influenza vaccine, according to a report released by the European Centre for Disease Prevention and Control (ECDC). Dr Durusu-Tanriover also notes the alarmingly low rates of pneumococcal vaccination uptake amongst at-risk groups, emphasizing the necessity of creating a lifelong vaccination strategy for an ageing population."We have a very big problem in vaccinating patients with chronic diseases. We're not reaching the goals. (…) At a global level, we have to share positive messages [about adult vaccination] (…) But in order to solve the problems, we have to act on the local basis, inside the community." - Dr Durusu-Tanriover As a researcher in adult vaccination for close to ten years with over 40 peer-reviewed articles, the IFA was proud to have Dr Durusu-Tanriover participate in the 14th Global Conference on Ageing, where she presented on a plenary panel, Not Just for Kids: Supporting Healthy Ageing through Vaccination in At-risk Groups, that contextualized the intervention of adult vaccination in healthy ageing. The IFA’s Adult Vaccination Program aims to help build a world where healthy ageing and functional ability of older people are maintained. Intrinsic to this focus is improving the uptake rates of adult vaccination by understanding local barriers and building the capacity of in-country collaborators to influence policy. Contact experts like Dr Durusu-Tanriover to discuss the critical and often neglected topic of adult vaccination.For more information on the importance of vaccination to adults with chronic disease, browse recently released reports from the IFA: Vaccinations and the At-risk Adult Population of Diabetes Vaccinations and the At-risk Population of Adults with Heart and Lung Conditions

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Addressing the public health impact of vaccine hesitancy

In recent news, vaccine-preventable diseases (VPDs), specifically measles, are making a resurgence. According to the World Health Organization (WHO), cases of measles have increased by 30%, and outbreaks of measles in Europe and the United States have prompted expansive dialogue on the threat of reappearing VPDs. There is real danger with outbreaks of VPDs and as such it has prompted the WHO to name vaccine hesitancy as one of the top 10 threats to global health in 2019. Vaccine hesitancy is defined by the World Health Organization (WHO) as a delay in acceptance or refusal of vaccines despite availability of vaccination services.Vaccine hesitancy is complex, and there are many reasons why someone may be resistant to vaccination. According to the WHO:“The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy.” The prevention of VPDs can require coverage rates as high as 90-95% to achieve herd immunity; at this rate, communities are protected from VPDs by the high number of vaccinated individuals. Sources such as UNICEF USA warn that without a concerted effort to combat vaccine hesitancy and improve vaccination rates universally, preventable diseases such as pertussis, diptheria and mumps may dip below rates required for herd immunity, increasing incidence of these, and other, diseases and threatening health at all ages. Contact Prof. Ross Andrews for information on the effect of VPDs in diverse populations. Connected to vaccine hesitancy is the threat of a global influenza pandemic, also identified by the WHO as a forthcoming concern. While many dismiss the serious and pervasive nature of influenza, the CDC asserts that as many as 646,000 people may die from influenza each year, with vaccine hesitancy and other barriers to information and access affecting uptake of influenza vaccination globally. What remains clear is that without major changes to vaccination attitudes and uptake rates, new and emerging VPDs will put the health of global populations in jeopardy. Left as it is now, populations will continue to become reacquainted with diseases that were thought to have been eradicated, calling into question why vaccination, one of the most effective public health tools, is not being utilized effectively to preserve health and well-being. The International Federation on Ageing focuses on vaccination within the context of healthy ageing, including addressing barriers like vaccine hesitancy and working to increase access to vaccination information and services as a necessary tool for maintaining functional ability at all ages. For more information on vaccination and ageing, contact Dr Stefania Maggi, an expert in the impact of lifelong health promotion and disease prevention programs on healthy ageing. 

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The Outbreak of Vaccine Hesitancy

According to the World Health Organization (WHO), measles cases have skyrocketed with a 300 % increase worldwide in the first three months of 2019 alone, when compared to last year. Public health officials are concerned over the impact of growing anti-vaccination campaigns.Vaccine hesitancy, which is defined by the WHO as a “delay in acceptance or refusal of vaccines despite availability of vaccination services”, has been reported in more than 90% of countries in the world. Mr Gary Finnegan, Editor of Vaccines Today and IFA Expert, notes in an article from The Independent that although nothing is 100% safe, vaccines have fewer side effects than most medical interventions.With a degree in physiology, an MSc in science communication and a special interest in vaccination, Mr Finnegan has a unique combination of knowledge and experience in the field of health communications.  He can be contacted to learn about the importance of immunization across the life course and how public health officials, health care workers and governments can tackle the increasing uneasiness over vaccines through various platforms, such as social media.While he doesn’t agree with the concept behind anti-vaccination, Mr Finnegan can empathize with some of the concerns:“I took my own kids to have a meningitis vaccine recently and one of them had a temperature afterwards. This usually doesn't happen but I can see that when it does it's unpleasant. However, now he's very unlikely to get this very serious disease and I take a lot of comfort from that.” – Gary Finnegan The public health and science communities are called to improve accessibility, communication and listening. A Lancet article notes that physicians’ advice has been shown to be the most influential factor in the decision to vaccinate. For Mr Finnegan, communication should be a combination of storytelling and science.“…it is essential that when people go online for information they are left with the clear impression that vaccines are safe and effective." – Gary Finnegan, WIRED Vaccination is a critical disease prevention tool and is needed throughout the life course. Physicians are also raising awareness about under vaccination among adults, a recent CBC article notes.  Immunity can wear off over time for some vaccines taken in childhood, and the need for booster shots is highlighted. Older adults in particular are vulnerable to the effects of infectious diseases and should be educated on the importance of immunization to foster healthy ageing. In addition to addressing vaccine hesitancy, this is one of the many conversations the IFA’s World Coalition on Adult Vaccination has taken the lead on to improve vaccination uptake rates globally.

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Ageism in the Advertising Industry – Older People are being Ignored

In the advertising industry, where campaigns against racism, sexism and discrimination are tremendously common, ageism in its practices remains a huge issue. "It's a Peter Pan industry”, says Bensman, an Italian, Florida-based senior writer who turned 57 this year. Fewer people rise to the top and the others just burn out and get let go. According to AdAge, in 2017, the majority (63%) of professionals in advertising, public relations and related services were under 45 years of age. 79 % employees in the advertising and marketing sector agree that the sector comes across as ageist.[i] Rory Sutherland, Ogilvy’s Vice Chairman, explains this issue as below.“Advertising, by failing to ally itself to any recognisable science or body of knowledge, does not really pay a premium for experience. Every argument, every point of view, has to be defended from scratch. This becomes increasingly frustrating with time.” [ii] It does not stop there. In 2018, AARP analyzed a random sample of more than 1,000 images taken from news pages, social media channels and blogs. Although 46% of the U.S. adult population is aged 50 and older, only 15% of the images contain members of that age group.An additional myth perpetuated throughout society is that older people spend their money quite prudently. This misconception is debunked in a recent report from Nielsen,[iii] which explains that older people make up 49% of sales for consumer goods and services.  In fact, older people are the most valuable generation in the history of marketing, yet are ignored as only 5% of all advertising are targeted to adults aged 35-64. If only 5% is targeted towards this age group those over the age of 65, who arguably have the greatest spending power in our history are being completely overlooked by the industry.The world needs experienced, creative, older people in the advertising industry. Brands need to target not only a younger audience a greater priority in needed for older consumers. Ultimately, we need to achieve balance. Balance in the work place, balance in the audiences and, most of all, balance in our approaches to advertising and marketing. The IFA currently partner with WHO to host a series of webinars that are part of an ongoing dialogue to bring to knowledge, new ideas and innovation around age-friendly environments and to end ageism.The IFA also works alongside intergovernmental agencies and its members and supporters to combat ageism by: viewing all organisational priorities through the lens of equity; representation at the UN Open-Ended Working Group on Ageing; membership in the Global Alliance for the Rights of Older People; alignment of priorities with the WHO and UN; and committed to the central theme of “Rights Matter” at the IFA’s 15th Global Conference on Ageing (1-3 November 2020).[1] https://www.campaignlive.co.uk/article/why-ageism-adlands-next-frontier/1416455 [1] https://www.directnewideas.com/magazine/?id=1352 [1] https://www.nielsen.com/us/en/insights/report/2012/introducing-boomers--marketing-s-most-valuable-generation/

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Needs Based Planning for Long Term Care Verses Political Imperative

Long-term care must be designed to facilitate the dignity, autonomy and personal wishes of older people while keeping them connected to their community and social networks. A recent study featured by CBC News shows that there is an increasing trend in declining wage, staff shortage and job dissatisfaction among Ontario, Canada’s personal support workers (PSW). "We want to make sure we're treating our elderly people with care, as human beings, and not as parts on an assembly line," said Brian Dijkema, co-author of the study. Not all countries currently have fully integrated systems to support long-term care – far from the truth.  The level of economic development or the proportion of care-dependent older people within their populations can be a limiting factor in achieving an integrated system to support long-term care.  Without integration there is less emphasis on the planning and development of services to support older people in their location and residence of choice. Promoting new ways of thinking about long-term care, including shifting to a central objective of optimizing functional ability should be the priority for all long-term care systems.  All countries need a fully integrated system of long-term care.  This may imply the development of a national plan and at a minimum, the plan should outline the services to be provided, who will provide them and how these services will be financed.  Serious consideration must be given to, how universal access will be facilitated, how quality will be ensured, and how the system will be coordinated to ensure the provision of integrated and comprehensive long-term care. Comprehensive planning based on population demographics must be adopted if services are to be situated in communities where they are most needed. No longer can needs be based on electoral aspirations of politicians such as exist in countries like Canada for example. IFA believes that governments must develop integrated systems that support long-term care provision based on need, with defined planning ratio benchmarks that ensure both, the allocation of residential and community care places.  Care provision and quality must be measurable across all service settings. Furthermore, long-term care provision must include the development of programs and services specific to the needs of informal/unpaid caregivers.  Research shows that 83% of long-term care provided to older adults coming from family members or other unpaid helpers, and they need help. To ensure services are developed and implemented where they are needed, governments must adopt needs-based planning ratios across defined electoral regions that identify where older people live.  Such ratios should be developed based on a regions’ population aged 70 years and over.  Long-term care provision must include formal residential care facilities and direct care services into the homes or places of residence for our older citizens. Those with special needs should be defined as people from Indigenous communities; people from non-English speaking backgrounds; people who live in rural and remote areas; those with special needs such dementia; and people who are financially or socially disadvantaged.  When considering planning ratios for indigenous communities, consideration must be given to life expectancy of the population. Recommended planning ratio provision in developed countries is 125 places per 1,000 people over the age of 70 with 55 of these places being allocated to community packages of care delivered to an older person’s place of residence and 70 places for the provision of residential and/or nursing home care. Adopting such a model would greatly enhance service provision when you consider that in Canada the average daily subsidy paid by government is approximately $150.00 per day in a nursing home care setting.  Extending subsidies to the provision of home-based package care at the same level could support 2-3 older people at home.  This would not only improve service provision to a greater number of individuals but minimize the number of inappropriate admissions to nursing homes. “Many older people in nursing homes in Canada could actually live in the community with a specially designed package of services rather than be inappropriately placed in a setting that does not help maintain and improve their functional ability” said Mr. GregShaw, Director International and Corporate Relations at IFA.

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You Heard It Here First: Hearing Is Critical to Healthy Ageing

A recent Washington Post article reports that hearing loss can increase risk of dementia, depression and falls.  Why? One theory is that hearing loss can cause the brain to strain to hear or understand what someone is saying at the expense of other brain functions. A second theory points to the high rates of social isolation associated with hearing loss, which has been linked to a range of health issues including Alzheimer’s disease and depression.  For more information on the link between hearing loss and brain health, contact IFA Expert Prof. Perminder Sachdev, Co-Director the Centre for Healthy Brain Ageing in Australia. In addition, consider attending the IFA 15th Global Conference on Ageing “Rights Matter”, where presentations will be made on the key sub-theme “maximizing senses”. A few months ago, the IFA was proud to join the World Hearing Forum, a global network of stakeholders promoting ear and hearing care worldwide, with the aim of promoting and supporting the implementation of the 2017 World Health Assembly resolution on the prevention of deafness and hearing loss. From 4-5 December 2019, the IFA will participate in the first World Hearing Forum Membership Assembly, at the WHO headquarters in Geneva. The main objectives of the Membership Assembly are to: ·        Align members with the vision and mission of the World Hearing Forum; · Establish Working Groups and Steering Committee for the Forum; · Propose advocacy action plan for the next two years; · Serve as a platform for exchange of views among members; and · Explore possibilities for resource mobilization. Keep watch on IFAs social media for the next steps resulting from the World Hearing Forum, as IFA strives to improve functional ability for older people by raising awareness on the importance of hearing screening, health promotion, and hearing rehabilitation.

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Warning signs of diabetes in your eyes

World Diabetes Day on the 14 November is a time to bring awareness to the condition and its complications while also highlighting latest medical advancements and good practices.  Diabetes is known to be a major cause of disability and illness around the world, with devastating social and economic consequences for the individuals as well as society. Diabetic retinopathy (DR) – a complication of diabetes caused by damage to blood vessels in retina – can lead to vision loss and blindness. The good news is that over 50% of type 2 diabetes is preventable with early detection of the risk and lifestyle improvements.  Presented at the European Association for the Study of Diabetes (EASD) in Spain this year was a study that demonstrated the power of science and humanity. Researchers from the Medical School at the University of Exeter used a newly developed biomicroscope to measure the autofluorescence in eyes which reflects the level of advanced glycation end-products (AGEs). High levels of AGEs, detected among people with type 2 diabetes and prediabetes, can contribute to several diseases, including visual complications of diabetes such as retinopathy.   Being able to predict a person’s risk of developing diabetes also provides an opportunity to intervene and prevent long-term consequences. "Lens autofluorescence could be a robust marker of long-term diabetes control predicting future complication risks,” said Dr Mitra Tavakoli, lead author of the study. Blindness due to diabetic retinopathy has serious and life altering consequences to a person’s role and responsibilities as well as identity in family and society. Although early screening and management has been shown to avoid major damage occurs in eyes, individuals diagnosed with diabetes often do not have regular and routine eye exams.   Education, awareness and self management are several key principles for those with diabetes and the associated vision complications. The IFA together with IDF, IAPB and the Vision Academy are working to shape and influence policy to improve the vision health of people with diabetes through the DR Barometer Community. The Community is a collaborative network that brings together health care professionals, patient advocates, individuals living with diabetes and experts from around the world. Join the DR Barometer Community today and contact IFA expert Prof. Hans-Peter Hammes, who is recognized globally as preeminent in the treatment of diabetes and its complications.  

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International Inspiration for Ageing Populations

Population ageing is accelerating around the world; however, every country is ageing at a different pace. In France, it took 115 years for the number of people aged 65 and older to increase from 7 to 14% of the national population, whereas in Japan, this change in demographic took only 26 years. By mid-century, half of the global population aged 60 and older will be in Asia, with the highest rates in Japan, Hong Kong, Taiwan and South Korea. A recent Forbes article outlines that with this demographic change comes great possibilities for Asia. Increasing longevity can drive growth for companies to target innovations to the ageing population, and inter-generational workforces will drive the business of the future. There is however a cautionary note: a longer life lived in poor health is not a reward to the individual or society.Many countries are turning their sights to certain countries in Asia where policy innovations and technology create an enabling environment for an ageing population. Japan, for example, incentives employers that retain older workers; South Korea has invested in smartphone and communication products to optimize engagement for older people; and some tertiary institutions in China offer older people skills and networking opportunities.  Contact IFA Expert Prof Rintaro Mori, Regional Advisor on Population Ageing and Sustainable Development, UNFPA Asia-Pacific Office, for the latest successful age-focused policies and practices in Asia. The Forbes article notes that government officials in Asia, and leaders in health and business are inspired and connected to the potential of the World Health Organization (WHO) ‘Decade of Healthy Ageing’ (2020 – 2030).  Ms Alana Officer, Senior Health Advisor of the WHO Ageing and Life Course department will open the IFA 15th Global Conference on Ageing “Rights Matter” in Niagara Falls, Canada on the Decade of Healthy Ageing as a focal point for current and future generations of global citizens. Be part of driving the agenda for the world’s ageing population by registering for the IFA 15th Global Conference on Ageing, and join delegates from more than 60 countries to learn from one another’s policies and practice for an ageing population. Key themes include Addressing Inequalities, Age-Friendly Environments, Combating Ageism, and Enabling Functional Ability.

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Vision Loss in Focus

October 10th marked not only World Sight Day 2019, but also the release of the WHO’s first ever World Report on Vision. While the report states that over 2.2 billion people around the world are currently suffering from some form of blindness (either complete or partial) the alarming fact is that without clear action this number is only expected to increase with the projections of population ageing. Given the trends and unequivocal evidence that early screening saves vision, it is difficult to understand why vision health has failed to capture the attention within the field of public health.  While vision impairment is not life threatening, the impact on functional ability is immense.  In a recent article entitled “Making Avoidable Blindness a Thing of the Past", many of the clinical and technological advances developed to address vision impairment are explored. These advances, while encouraging are only part of the solution.  As illustrated by the DR Barometer Study, a comprehensive, two-phase, multi-country study which shone a spotlight on the status of prevention, assessment and treatment of diabetic eye disease (DED), poor awareness continues to be a significant barrier for screening and treatment. This lack of awareness is especially troubling as the increase in type-2 diabetes globally is associated with a rise in the rate of diabetic retinopathy, one of the leading causes of preventable blindness.  Significant effort needs to be employed not only in the development of innovative new technologies, but in supporting patient education and empowerment and increasing the efforts around coordinated care for individuals living with diabetes. “While new technology is part of the solution to eliminating avoidable blindness, it won’t be the single solution,” Dr Andy Cassels-Brown, Medical Director, Fred Hollows Foundation Diabetic Retinopathy, while undoubtedly only one piece of this complex puzzle, has been identified by the WHO as one of the main causes driving the increased rates of vision impairment around the globe. This together with late detection, another key factor identified by the WHO and by the DR Barometer Study, makes diabetic retinopathy one of the most significant threats to vision health today.  To learn more about Diabetic retinopathy Join the DR Barometer Community today and connect with IFA expert Dr. Juan Carlos Silva, a key contributor to the WHO World Report on Vision and a valued member of the DR Community.  

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Putting Your Vision First on #WorldSightDay

World Sight Day on the 10th October is a time to encourage friends, family and colleagues to have an eye exam. It is also a time draw attention to conditions that can lead to blindness and visual impairment. As people get older, many will develop aged-related eye diseases such as cataract, glaucoma and age-related macular degeneration (AMD). Much less known is that older people are at greater risk of complications of shingles, which can develop in the eyes and cause vision loss. A recent study from the Kellogg Eye Center at the University of Michigan revealed that women and adults over age 75 years are most vulnerable to shingles in the eye, which will trigger corneal complications and result in permanent visual impairment, and, in rare cases, blindness. The diagnosis and treatment of shingles in the eye is often delayed, increasing the risk of sight-threating complications.  "Sometimes people complain of a headache, or think it's a skin infection, or allergy.  It's only when the characteristic rash comes out that patients are more definitively diagnosed, and that can lag.” says the lead James Chodosh, an ophthalmologist with expertise in viruses at Massachusetts Eye and Ear in Boston. The good news is that there are effective vaccines for shingles, some being more than 90% effective in preventing the infection and recommended for people aged 50 years or over. “Older patients were at far greater risk for shingles in the eye highlighting just how important it is for older adults to get the shingles vaccination,” says Nakul Shekhawat from the Kellogg Eye Center study. As an important element of public health agendas older people must have the right to access eye exams and safe and effective vaccines so that they can contribute to their family and society.  Over 3 out of 4 of the world’s vision impaired are avoidably so.  Join the IFA and the International Agency for the prevention of Blindness (IAPB) and millions of people around the world by giving your voice to #WorldSightDay. To learn more about vision health and the importance of regular eye exams, please contact IFA expert Dr. Juan Carlos Silva, Regional Adviser on eye care for Latin America and the Caribbean at the Pan American Health Organization. 

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The Devastating Consequences of Climate Change for Older Adults

It is an undeniable fact that the world’s population is ageing. According to a report from the World Health Organization, between 2015 and 2050, the percentage of the global population that is over 60 years will almost double. Another undeniable fact is climate change, which has been recently gaining public awareness at an exponential rate. This awareness increased dramatically since the release of the IPCC report in October 2018, which stressed the need to reduce global carbon dioxide emissions by 45% by 2030. How do the two trends of population ageing and climate change intersect? In a recent Toronto Star opinion piece, Dr. John Muscedere, scientific director of the Canadian Frailty Network, argues that older adults or individuals experiencing vulnerability or frailty, face greater risk from climate change. Examples of this risk include isolation and mobility impediment due to more intense storms and related power outages, ill-health impacts and death from heat waves and floods, and emergent or exacerbated respiratory and cardiac issues due to pollution and weather events. According to Dr. Muscedere, “these are not worst-case scenarios. These events and their consequences are happening now.” In addition to older adults, climate change disproportionately impacts other groups including people in the global south, communities of colour and poorer communities. This is illustrated in articles from the Independent, the Atlantic and through the work by the ENRICH Project in Nova Scotia, Canada. It is critical that in this period of rapid demographic and climatic change, we protect older adults, particularly those in these communities that face the most harm from climate change.  IFA expert Prof. Sarah Harper is an expert in global population ageing, longevity, public policy and global migration. Prof. Harper also leads the Complex Environmental Population Interactions Programme which addresses complex interactions between demographic and environmental change. Contact Dr. Harper for an expert opinion on these interactions and consider attending the IFA 15th Global Conference on Ageing where the theme Addressing Inequalities will showcase examples of the impact of climate change on older adults experiencing migration and displacement.

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Defying Ageism in the Beauty Industry

A recent guardian article highlights the growing trend to feature diversity and combat ageism (discrimination based on age) in the beauty and fashion industry. Examples include the Marc Jacob’s February 2019 New York fashion show, where model Christy Turlington, aged 50, walked the catwalk; advertisements by major beauty industries such as L’Oréal Paris now feature un-airbrushed models such as Helen Mirren, aged 74; and MAC Cosmetic’s “What’s Your Thing Campaign” features older women who wear makeup not to make them look younger, but to accentuate their own style and confidence. “What people enjoy about this campaign is seeing older women who look very different from one another, are very stylish, and are not just there to tick the diversity box. Consumers are constantly offered ‘fixes’ or told how to hide wrinkles. But what if you don’t want to hide them?” says Terry Barber, Director of Makeup Artistry at MAC.Ageism is not only found in the beauty industry but is interwoven into many societal levels including politics, health and social services, employment, education and infrastructure. With 2 billion people expected to be aged 60 years and older by 2050, the time is now to end age discrimination. Dr. John Beard, IFA Expert and former Director of the WHO Ageing and Life Course division speaks openly about the need to combat ageism and its global impact. “‘Old’ is a meaningless social construct that boxes an amazingly diverse array of people. Might as well try to group horses, oranges and orangutans. Problem is it drives social policy and, worse, can internalize the expectations that come with the label.” – Dr. John Beard Contact Dr. John Beard through IFA’s Expert Centre for further information.  In addition, register for the IFA 15th Global Conference on Ageing “Rights Matter” where a key theme “combating ageism” will feature efforts from around the world to empower and facilitate inclusion of people of all ages.  

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Alcohol Abuse, One Step Closer to the ER

Despite the fact that considerable scientific evidence had already been amassed on the danger of alcoholism, increasing numbers of older adults drink to excess. A recent study carried out by researchers from New York University and University of California San Diego found that, from 2015 to 2017, more than one in ten (10.6%) U.S. adults aged 65 and older engaged in binge drinking (consuming five alcoholic beverages or more on the same occasion for men, and four alcoholic beverages or more for women) in the past month, a significant increase compared to the data reported in 2007-2008 (7.7%).   Excessive alcohol consumption is a risky behavior for older adults due to the potential of disease exacerbation, harmful interactions with prescription medications, and the increased risk of falling and emergency visits. The research also determined that binge drinkers are more likely to be cannabis users, and “...using both may lead to higher impairment effects... and older adults may not be aware of the possible dangers of using cannabis with alcohol,” said Dr Joseph Palamar, the associate professor in the Department of Population Health at NYU Langone Health. Lack of awareness of harms associated with alcohol abuse also widely exists in Canada. A recent CBC News article disclosed that although more than one million Canadians experience alcohol use disorder annually, less importance was attributed to patient advice and addiction treatment by family doctors because of the alcoholism-related stigma. "Our results underscore the importance of educating, screening, and intervening to prevent alcohol-related harms in older adults, who may not be aware of their heightened risk for injuries and how alcohol can exacerbate chronic diseases," said Benjamin Han, the lead author of the U.S. binge drinking study among older adults. For more information on the impact of alcohol abuse on older person, contact IFA Expert Dr. Madeline Naegle, Professor and Director of the WHO Collaborating Center for Geriatric Nursing Education at Rory Meyers College of Nursing, New York University, whose research has focused on alcohol use disorders and the nursing intervention in the prevention and treatment of substance use abuse. Barriers to older people’s access to alcohol addiction services have not received the attention they deserve. Attending the IFA 15th Global Conference on Ageing under the sub-theme “Access to Health and Social Services” will help address this issue.  

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Diabetic Complications: A Self-fulfilling Prophecy?

Conversations about diabetic retinopathy (DR) often revolve around screening and treatment; such as the latest innovations in detecting of DR, the use of AI in increasing accessibility of treatments, and the consequences of seeking treatment after symptoms have already occurred. In these conversations, however, the voice of those living with diabetes is often absent. In a recent article by Healthline entitled “Fear and Loathing of Diabetes Retinopathy Treatment,” this much-needed voice is brought to the forefront. For Mike Hoskins, who had been diagnosed with type 2 diabetes at the age of five, fear of diabetes-related complications has had a significant impact on his life. While his knowledge of the risk of DR enabled him to undertake regular screening, his apprehension regarding the associated treatment points to a trend in how diabetes is often discussed.DR is widely known as the leading cause of preventable blindness around the world. This statement, while accurate also understandably evokes fear within the millions of people living with this condition. While this fear can encourage individuals such as Hoskins to obtain regular screening, for individuals diagnosed at a young age (which has become increasingly popular), it can also lead to what Hoskins refers to as a “rebellious” phase.This rebellion, often during teenage years, is a significant concern and should be taken into consideration when thinking about how best to approach complications associated with diabetes. The immense array of potential complications that those living with the condition are bombarded with often leads to, as Hoskins explains, a sense of “hopelessness” or apathy during teenage years. As a result, these individuals often are not as careful in the management of their condition and therefore engage in behaviours that have deleterious effects which are then carried into adulthood, consequently increasing the likelihood of the very complications they feared.Addressing phenomenon such as these is imperative in the global effort to prevent diabetic retinopathy. The DR Barometer Program, a collaborative network which includes; health care professionals, patient advocates, individuals living with diabetes and experts from around the world, such as IFA expert Dr. Jane Barratt work together to ensure that issues such as these are brought to the forefront. Join the DR Barometer Community today and make sure your voice is heard!

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Age and Estrogen: Immunosenescence in Older Women

While the natural phenomenon of declining immunological function with age (aka immunosenescence) has been well documented, researchers have discovered that older women experience this more so than men. A recent study led by Dr Sabra Klein from Johns Hopkins Bloomberg School of Public Health suggests that age in addition to declining estrogen levels in menopausal women can decrease immunological response to the influenza vaccination.  This poses a challenge in the development of critical antibodies needed to protect against the virus. “What we show here is that the decline in estrogen that occurs with menopause impacts women’s immunity… these findings suggest that for vaccines, one size doesn’t fit all,” said Klein. This research highlights the need for efforts that explore the ways in which human biological differences impact vaccine effectiveness.  Older adults deserve the right to vaccines that will promote health, longevity, and the maintenance of functional ability.  As menopause is a natural part of female ageing, understanding the hormonal and cellular changes within the body can lead to the development of more effective vaccines for this demographic, thus promoting health for all. If interested in learning more about the impact of menopause on immunological function, contact IFA expert Dr Marla Shapiro, menopause specialist.  Dr Shapiro is the President Elect of the North American Menopause Society, and a Member of the Order of Canada for her commitment to producing high-quality health information.  She is a highly respected health and medical expert in popular media, being featured on such programs as CANADA AM and CTV News Channel.Additionally, consider attending the IFA’s 15thGlobal Conference on Ageing “Rights Matter”in 2020 which will feature “Addressing Inequalities” as a key theme, where topics pertinent to older women’s health will be explored.   

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The Right to Hear

A recent CBS News article notes that only 20% of adults who experience hearing loss in the United States use a hearing aid, a cause for concern considering the significant impact of untreated hearing loss on cognition, depression and hospitalization.The article outlines key barriers to accessing hearing aids, including high costs, the fact that many insurance companies fail to cover hearing aids, and the hassle of obtaining a hearing aid (which requires consultations with both a physician and audiologist).   Thankfully there is hope for the future.  Over-the-counter hearing aids which do not require consultations with a doctor and audiologist beforehand can make accessing hearing aids not only more accessible but more affordable.  For more information on the impact of hearing loss and the importance of accessible and affordable hearing devices, contact IFA Expert Dr. Juan Carlos Silva, Regional Advisor on Visual and Hearing Care, for the Pan American Health Organization (PAHO).   Sensory impairments such as hearing and vision loss are too often dismissed as a normal part of ageing.  Older people deserve the right to accessible, affordable hearing devices, which will be promoted throughout the IFA 15thGlobal Conference on Ageing under the sub-theme “Maximizing Senses” where experts on the impact of hearing and vision loss on functional ability will be featured.  Register for the IFA 15thGlobal Conference on Ageing “Rights Matter” today!

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Could exercise be the magic pill to preventing cognitive decline?

A recent Irish Examiner article outlines the importance of exercise to reduce risk of cognitive decline, with emphasis on the importance of aerobic exercise, specifically. “The strongest evidence seems to be at the moment for aerobic exercise, which makes us think that it’s due to that good, healthy, blood-vessel supply to your brain” – Dr. Suzanne Timmons, consultant geriatrician and clinical lead for the national dementia office, Ireland In a recent IFA webinar, Prof. Yaakov Stern, Professor of Neuropsychology defines ‘reserve’ as the disjunction between the degree of brain damage and the clinical outcome of that damage, however notes that there are differences between brain reserve (how big the brain is, how many synapses there are) and cognitive reserve which is the adaptability of functional brain processes.In simple terms, cognitive reserve is about how your brain works, and individuals with greater cognitive reserve experience less cognitive decline and later onset of dementia, even when brain scans indicate tissue deterioration. “We talk about brain reserve – how big and healthy your brain is – but cognitive reserve is about how your brain works. If you have a large, well, blood-supplied brain, then your reserve, if you develop dementia, is significant. Their brain can compensate better and so they won’t develop symptoms and won’t have difficulties with their activities of daily living until later.” – Dr. TimmonsScholars further note in the article that it can be of even greater benefit to cognitive reserve if the aerobic exercise is mixed with “cognitive exercise” simultaneously. This can be as simple as watching your foot while going on a hike. From 24-25 October 2019, the International Federation on Ageing is hosting the Copenhagen Summit on Cognitive reserve which will feature key speakers including IFA Experts Prof. Michael Valenzuela, Prof. Kaarin Anstey and Prof. Perminder Sachdev. Reach out to these experts to learn more about cognitive reserve and register for the Copenhagen Summit here.

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Ageing outside the gender binary

Identities outside of the gender binary are often framed as something “new”, as “trends”, or as identities only experienced or expressed by younger generations. However, Kate Bornstein, an author, performer and advocate, is 71 and self-describes in an interview as a nonbinary femme-identified trans person.  In a recent New York Times article, Reflections on Life after Stonewall, Borstein, who uses they/them as well as she/her pronouns, describes their lifelong experiences with gender identity.  “At first, it scared me. But it didn’t take me long to enjoy my outsider status.  As neither/nor — as nothing — my life was starting to make sense.  When it comes to gender and sexuality, I am nothing but possibilities.  What’s more, it turns out that these days I’ve got a nonbinary family: lots of people who are neither men nor women.  All of us are virtually nothing in the eyes of a culture that sees two and only two”. – Kate Bornstein Borstein counters the argument that nonbinary gender identities are trends among younger generations and states “that it’s been going on for a long time, and now there’s a more robust and accessible vocabulary to address it”.In an article, counsellor and researcher, Dr Gávi Ansara, discusses how best to support trans and gender nonbinary older adults. Dr Ansara proposes that best methods include treating their needs as “normal and legitimate”, individualised service provision, challenging notions and actions of cisgenderism (for example “pathologising, misgendering, marginalising, coercive queering and objectifying biological language”) and learning from their wisdom and incorporating that wisdom into practice.IFA expert Dr Pamela B. Teaster is an expert in human rights, public policy, active ageing, elder abuse and frailty as well as a co-editor of the book “Handbook of LGBT Elders”. Contact her for an expert opinion on ageing and gender identity and consider attending the IFA 15th Global Conference on Ageing which will draw attention to the role life experience and identity has on the health and ability of older people.

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The Heavy Price of Elder Abuse

“To forget the elderly is to ignore the wisdom of the years” – Donald Laird With the global population of people aged 60 years and older anticipated to reach 2 billion by 2050, the rate of elder abuse will undoubtedly increase. In 2017, the United Nations (UN) collected the best available evidence from 52 studies in 28 countries (including 12 low- and middle-income countries). Results revealed that 15.7% of people aged 60 years and older were subjected to some form of abuse in the past year, and this is likely an underestimation since majority of cases often go unreported. Elder abuse can take various forms such as physical, psychological or emotional, sexual and financial.  It can also be the result of intentional or unintentional neglect. The study provided prevalence estimates of the number of older people affected by different forms of abuse: Psychological abuse: 11.6% Financial abuse: 6.8% Neglect: 4.2% Physical abuse: 2.6% Sexual abuse: 0.9% According to an article by Comparitech, financial abuse (also called elder fraud or financial exploitation), is estimated to be responsible for $27.4 billion in losses annually in the United States alone.  38% of fraud cases intentionally target older adults.“Our elders, along with all people, have the right to live their lives with dignity and respect, free from abuse of any kind. The best way to protect elders from abusive situations is to focus on prevention, providing information, education, and support.” – Yvette Thomas, KELO FM IFA Expert Dr. Mark S. Lachs notes in a BioEdge article that doctors should be able to recognize the signs of elder abuse, as physicians who care for older adults are very likely to encounter a patient who is a victim. Dr. Lachs' research, teaching, and clinical experience focus on elder abuse and improving the quality of life for older adults.  The focus of his research includes the identification of risk factors for reported elder mistreatment and more recently, the survival of older adults who have experienced mistreatment.  He can be contacted through the IFA’s ExpertFile to learn more about elder abuse.On 15 June, World Elder Abuse Awareness Day, the IFA recognizes the individual and societal harms of elder abuse. Combating Ageism is one of the 4 central themes of the IFA’s 15th Global Conference on Ageing, under which abuse has been identified as a sub-theme. Abstracts for these sessions are called to showcase examples of good practice and especially those which have been evaluated. To learn more, please visit the conference website.

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Japan’s increasing retirement income gap

The highest life expectancy for women in the world falls upon Japan, at 87.1 years.Although the country is a leader in technology and innovation to support older people, there are increasing concerns regarding retirement and pension plans. A recent article explains that as life expectancy increases for older people in Japan, the gap between when a person retires and their death increases, meaning increased years are spent in retirement, at almost 20 years for women. Average savings accumulated over the life course in Japan unfortunately are only enough to cover 4.5 years of retirement.Contact IFA expert Mr. Don M. Blandin for what implications this retirement income gap can have on Japan’s ageing population, and for further information on the topic. In addition, consider attending the IFA 15th Global Conference on Ageing where a key theme “Addressing Inequalities” is featured, with focus on the importance of financial security to the world’s ageing population.

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Ageing with Pride: LGBT+ Inclusive Housing

June is Pride Month, a time of year where you are likely to see more rainbow’s than any other. Pride is the time of year where the LGBTQI2S community can reflect and celebrate their advocacy and civil rights history. It is a time of year where individuals can openly and proudly embrace their sexual orientation and gender identity and it is the time of year that should serve as a reminder, not only of how far the LGBTQI2S movement has come, but how far there still is to go in the fight for equality. Pride, which has now come to symbolize the LGBTQI2S civil rights movement, began not as a parade but as a riot. 50 years ago, police stormed the Stonewall Inn, a popular gay bar in New York City resulting in a sustained clash between New York’s LGBT Community and its police force. While the riot only lasted 2 days, the event left an indelible mark within the community and spurred a movement that would spread around the globe. At its core, pride is about equality, as such it is important to stay vigilant of the inequalities faced by certain individuals within the LGBTQI2S community. In a recent article by Forbes, the inequalities faced by the older LGBTQI2S populations was brought to the forefront.The article discusses the launch of New York City’s first affordable housing property for LGBTQ older adults. Over 1000 individuals submitted applications on the first day they were to be accepted. While encouraging, this also highlights an immense need stemming from the discrimination and prejudice many older LGBTQI2S individuals face when searching for and accessing affordable housing. According to SAGE’s National Elder Housing Initiative, upwards of 50% of same-sex couples have experienced housing discrimination; and with a projected 7 million LGBTQI2S elders in the United States alone by the year 2030, addressing the housing needs of older adults is of vital importance.To learn more about the importance of safe and affordable housing for older LGBTQI2S individuals contact IFA expert Judith Wahl, Executive director at the Advocacy centre for the Elderly. Ensuring housing is inclusive for older LGBTQI2S adults is about more than just shelter, its is about providing older LGBTQI2S individuals the opportunity to Age with Pride.

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"Double Whammy": Older women experience ageism and sexism in the workplace

Ensuring older adults have equitable access to employment is critical for healthy ageing, however older adults are often subjected to ageism in the workplace. According to author and activist, Ashton Applewhite, ageism “occurs when a dominant group uses its power to oppress or exploit or silence or simply ignore people who are much older or significantly younger.” Ageism can intersect with other types of discrimination including sexism. An article from Forbes highlights the “double whammy” older women experience through ageism and sexism in the workforce.  The article argues that ageism impacts the genders differently as research shows that with older age, men in the workplace are regarded with increased value and competency while women lose credibility. The article describes how older women are feeling pushed aside, invisible and excluded in their workplace and also fear losing their jobs.Older women also experience discrimination in the recruitment process. A 2017 study submitted 40,000 fake resumes to online applications. The resumes differed only by age and gender. The researchers found that responses declined with age and more so for women compared to men.Despite the discrimination, an article from City A.M. reports that women are increasingly more likely to work beyond 70. Fortunately, in an opinion piece, researchers explain why older women in the workforce will benefit the economy. The researchers explain that impending labour shortages could be mitigated by retaining and recruiting older workers, particularly women.  This is because many of them have high education levels and already occupy the positions that will experience high shortages such as registered nurses, nurse practitioners and occupational therapists.IFA expert Dr Pat Armstrong is an expert in long-term care, health care, health policy, women and work, and feminist political economy. Contact her for an expert opinion on women in the workplace. For more information on the IFA’s work in ageism in the workplace, visit the 15th Global Conference on Ageing website. A central theme of the conference will be 'Combating Ageism' with a sub-theme of ‘Access to Work and Reshaping Retirement.’ Conference registration and abstract submission are now open.

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Reducing Risk of Dementia through Cognitive Reserve

Cognitive impairment such as dementia is an increasingly important public health issue, and efforts to cure the progression of cognitive impairment are extremely costly and have yet to yield positive results.Dementia is an increasing problem that affects close to 50 million people around the world. Recent guidelines issued by the World Health Organization (WHO) titled “Risk Reduction of Cognitive Decline and Dementia” emphasize that the risk of dementia can be reduced through exercise and maintaining healthy blood sugar levels, cholesterol and blood pressure. It is the WHO’s hope that the guidelines are used by health care providers, government and policy makers to develop policy and programs that encourage healthy lifestyles and reduce risk of dementia.The IFA's Copenhagen Summit on Cognitive Reserve acknowledges that it is critical to identify cost-effective, accessible solutions to reduce cognitive ageing and enhance cognitive function by enabling alternative neuronal interconnections to compensate for change caused by cognitive ageing and severe cognitive pathologies. The Summit, to take place from 24-25 October 2019 will feature three IFA experts:Professor Kaarin Anstey, Director of the UNSW Ageing Futures Institute Professor Michael Valenzuela, leader of the Regenerative Neuroscience Group at the Brain and Mind Research Institute, University of Sydney Scientia Professor Perminder Sachdev, Scientia Professor of Neuropsychiatry and Co-Director of the Centre for Healthy Brain Ageing (CHeBA), UNSW Sydney Register for the Summit here and reach out to IFA experts for further information or comments for media on this important event.

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Showcasing the power of art to combat social isolation

When it comes to age-related policy, it has been shown how imperative it is to include older adults in helping shape and influence existing measures that are put in place by high level governmental bodies. Civil society’s voice can be strong, especially when there is a collective and united front. This bottom-up approach to policy change has been at the core of the Global Network of  Age-friendly Cities and Communities, established by the WHO in 2010, whose goal is to create and foster environments in which healthy ageing can be achieved for all. IFA expert member Dr Ruth Finkelstein has been leading the way for Age-friendly cities and communities.  She was an integral part of the award-winning ‘Age-Friendly New York City Initiative’. Dr Finkelstein brings over 3 decades of experience to policy planning and believes strongly in the power of community engagement.A great example of the power of community engagement can be seen In California, where a group of seniors - whom like many - experienced the impact of social isolation and decided to take action. The idea was to display art made my local members of the community that related to social isolation, to creatively express the pain that accompanies this prevalent phenomenon. The numbers speak for themselves:"Lonely adults over 60 have been shown to have a 45% higher risk of death compared to more socially connected peers, and a 59% higher risk of mental and physical decline." Combatting social isolation can be seen as step towards achieving healthy ageing. What started off as an exhibition about social isolation, helped to combat social isolation itself.  “At one of the early [committee] meetings, these women were sitting together, and it came up that they were all recently widowed,” said Ashley Holmes, the museum’s marketing manager. “They became really close, because it was helpful for them to talk to others going through the same thing. One of them actually even did artwork for the exhibit about her experience.”The planning committee attracted close to 200 members, all seniors in the community. Those interested in the exhibit can visit the display until January 2020.

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Addressing ageism in the workplace

The International Federation on Ageing is holding the 15th Global Conference on Ageing in Niagara Falls, Canada from 1-3 November 2020.  One of the conference’s central themes is ‘Combating Ageism’ which refers to prejudice, stereotyping and discrimination directed towards people based on age and can exist on both systemic levels through policies and programs and interpersonal levels through implicit bias.  As ageism can extend to employment, one conference sub-section of this theme is focuses specifically on ‘Access to Work and Reshaping Retirement’, which will address the concept of ‘decent work for all’, the social and economic contribution of older adults, and policy development. A recently published article from Business Insider contextualizes this theme and argues the primary barrier to securing decent work is not skill limitations, but ageism. That is, discriminatory policies/programs and implicit biases limit employment opportunities for older adults.   Adults aged 55 and over are increasing at the greatest rate in the workforce due in part to increased life expectancy and financial limitations. However, many of these older adults are pushed into retirement before they are ready and need to seek out other employment.  In the US three million older adults are seeking full-time work, and among those successful, many end up in precarious-type jobs that pay significantly less than their previous positions. Organizations are working to dismantle ageism in the workplace. For example, AARP not only helps employers develop age-inclusive internal training programs, but also works to shed light on the value older adults bring to workplaces. In doing so, AARP addresses both the policy/program and implicit bias factors of ageism. An article from the CBC describes efforts made by Passport for Employment, on Prince Edward Island, Canada, to help older adults find work.  The article explains that employers are now starting to recognize the many reasons older adults make great employees including their loyalty, experience, strong work ethic, positive attitudes and flexibility. However, more needs to be done. IFA expert Prof. Yitzhak Brick is an expert in health promotion, volunteer work and employment of older adults, technology, ageing and public policy.  Contact him for an expert opinion on employment of older adults.  Also visit the 15th Global Conference on Ageing website to further explore how the conference will incorporate these themes and to register or submit an abstract.

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From loss to new beginnings: Changing the narrative for those affected by vision loss

With Vision Health Month in Canada nearing conclusion, there is a need to keep the conversation going about false narratives surrounding vision loss and older adults. Although older adults are at an increased risk for many of the leading causes for impaired eyesight, it is not true that complete loss of vision is inevitable. For Dr. Tiziano Melchiorre, IFA Expert Member and Secretary General of the International Agency for the Prevention of Blindness (IAPB), it is imperative that messages target the right at-risk populations so that preventative methods reach their full potential. For older adults who are diagnosed with a degenerative eye condition such as glaucoma, cataracts, or diabetic retinopathy, access to the best available treatments is key. A diagnosis which may lead to blindness can be especially devastating for older adults, as treatment options are often not fully discussed.  In a recent article from the Chicago Tribune, Neva Fairchild, ageing specialist and representative of the American Foundation for the Blind says: “A lot of older adults don’t even understand what’s happening with their vision loss, and they might be thinking they’ll go totally blind, which is often not the case [..] We hear from people who say, ‘my doctor told me nothing more can be done.’’ A need for a better understanding of vision loss is part of what inspired the founder of the Hadley Institute to create an establishment where those suffering from vision health disorders could participate in ‘’educational courses and other support services free of charge to anyone with a visual impairment, as well as their families and professionals.’’Conversations surrounding patient education should be a focal point not only during Vision Health Month, but all year long. The IFA serves to empower patients to have access to the latest and most effective treatments for vision loss, learn more here.

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Translating Age-Friendly Policy into Action

With the summer soon approaching in Ontario, Canada, many citizens look forward to increased time spent outdoors. Unfortunately, this may prove challenging for many older adults who live in a city or community that is still undergoing “age-friendly” initiatives.The opinion piece written by Kim Sawchuk, Meghan Joey and Shannon Hebblethwaite for the Montreal Gazette discusses the important gaps between well-intentioned age-friendly policies and the lived reality for older citizens. Montreal has been recognized for its age-friendly initiatives and is a member of the WHO’s Global Network for Age-Friendly Cities and Communities (GNAFCC) as of 2017. However, gaps between policy and best practice can always remain a concern.The authors argue that ongoing discussions and consultations with older people and resources dedicated to age-friendly policy are needed to ensure they are truly making a positive impact on older people in the community. Contact IFA Expert and Board member Prof. Suzanne Garon to learn how the adoption of age-friendly policies can be translated to reality. Since 2006, Prof. Garon has been involved in the WHO Age Friendly Cities Project and research to implement and evaluate the Age Friendly Cities in seven Quebec communities, including the city of Montreal.Additionally, consider attending the IFA’s 15th Global Conference on Ageing “Rights Matter” in 2020 which will feature age-friendly environments as a key theme, and will host a pre-conference summit dedicated to the topic.

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Fighting Blindness with Science: Innovative approaches to vision loss research

May is #VisionHealthMonth in Canada, and the IFA recognizes the importance of vision health for Canadians of every age, especially older adults.For Dr. Michele Corcio, IFA expert and vice president of International Agency for the Prevention of Blindness (IAPB) Italy, breakthroughs in vision loss research are of uttermost importance. For the IAPB, as the name suggests, prevention is key. The IAPB hopes to dispel the perpetuated myth that ‘vision loss as people age is unavoidable’ by showcasing the importance of screening and detection of the most common causes of vision loss such as age-related macular degeneration (AMD), glaucoma, and cataracts.Although preventative measures are key to avoiding vision loss, hope is not lost for those living with reduced or complete loss of vision, as emerging research has made tremendous progress for those already affected.  Researchers at the University of Surrey and Indiana University have been studying the effects of using plant-based interventions to aid in the treatment of disorders that lead to vision loss, such as diabetic retinopathy.The UK-based research group ‘ReNeuron’, who are exploring the use of stem cell treatment for vision loss have already made significant progress:“In February (2019), the company reported that all three of the first cohort of subjects in the study had reported a rapid and significant improvement in vision, on average equivalent to reading an additional three lines of five letters on the EDTRS eye chart, the standardized eye chart used in clinical trials to measure visual acuity.” - ReNeuron, 4 April 2019 Press Release Vision is reported to be the sensory function most feared to be lost by Canadians. It is hoped that as new research continues to emerge, and the importance of preventative measures are put into action, vision loss becomes less of a reality and fear for Canadians and individuals around the world.

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Smartphones and AI - The Future of DR Screening

Diabetic retinopathy (DR) is prevalent among approximately one third of the adult population living with diabetes and occurs when chronic high blood glucose levels lead to damage of capillaries in the retina. Despite the fact that DR continues to be the leading cause of preventable blindness, recommendations for regular screening are often not adhered too, leaving many aware of the illness only after they have started to experience vision loss.Addressing this issue are researchers from the University of Michigan Kellogg Eye Center which have revealed an innovative approach to increase the accessibility of DR Screening through pairing Smartphone Technology with Artificial Intelligence (AI) software.“The key to preventing DR-related vision loss is early detection through regular screening,” says Yannis Paulus, M.D., a Kellogg vitreoretinal surgeon and the study’s lead author. “We think the key to that is bringing portable, easy-to-administer, reliable retinal screening to primary care doctors’ offices and health clinics.” - Yannis Paulus, M.D. The repurposing of smartphones and the integration of AI helps mitigate a number of barriers often associated with DR screening, including the cost typically associated with traditional retinal cameras, which beyond their expense are also large and immovable. Furthermore, this technology significantly cuts down on the time it would take for an ophthalmologist to interpret retinal images, allowing for virtually instantaneous feedback.  These portable devices, which require no specific training to operate, would allow screening to take place in familiar clinical environments with only those who screen positive having to be refered for further ophthalmological care, ultimately deceasing the overall burden and wait times associated with these appointments."We're focused on overcoming patients' reluctance to seek DR screening by bringing it to them," Paulus says, "making it easy, immediate and available in a familiar clinical environment." The AI Software paired with the Smartphone technology, EyeArt (developed by Eyenuk) has demonstrated exceptional performance in clinical trials and is the most extensively validated AI technology for the autonomous detection of Diabetic Retinopathy. To learn more about DR, join the DR Barometer community and connect with a network of organizations and individuals dedicated to improving the vision health outcomes among people living with diabetes. In addition, use IFA’s expert centre to connect with IFA experts Prof Hans-Peter Hammes, an expert in the treatment of diabetes and its complications and Dr Focke Ziemssen, an expert in pharmacovigilance and diabetic retinopathy.

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Prevention Before Antibiotics

“There is not enough awareness about the risk associated with infections and about the importance of preventing them with the vaccines we have now (...)” says Dr Eva Polverino, IFA Expert and pulmonology expert in respiratory infections affiliated with the European Respiratory Society.During an interview at the IFA 14th Global Conference on Ageing, Dr Polverino highlights the importance of vaccines not just in preventing the diseases, but also reducing the use of antibiotics.“The only way to reduce the risk of antimicrobial resistance is to reduce the inappropriate use of antibiotics.” - Dr Eva Polverino Vaccines can help reduce the spread of antibiotic resistance by “reducing the use of antibiotics and the development of resistance” (WHO, 2016). For example, people often take antibiotics unnecessarily when they have flu-like symptoms, which could have been prevented through the influenza vaccine. For these reasons, experts such as Dr Polverino argues prevention should be the goal before prescribing antibiotics. In honour of World Immunization Week (24-30 April), the IFA will be releasing joint statements, social media, blogs and articles to raise awareness on the importance of vaccination. Check out @Vaccines4Life to help spread the important message. 

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The Cost of Care: Addressing the Discrimination Faced by Older LGBTQI Individuals in Care Homes

2019 marks the 50th anniversary of the Stonewall Riots in Greenwich Village, New York, an infamous two-day clash between New York’s LGBTQI population and the police, that has served as a catalyst for the modern day LGBTQI movement and paved the way for the acquisition of LBGTQI rights and policy changes across the world. Despite the progress that has been made, many LGBTQI individuals who have fought for their rights now face the sad reality of having to retreat back into the closet in their later lives. In a recent Article published in the Scotsman, Scotland’s National Newspaper, the phenomenon of older individuals ‘de-gaying’ in order to avoid harassment and discrimination from staff and other residents in care homes is explored.This phenomenon does not occur exclusively in care homes. Many older LGBTQI individuals have reported feeling the need to adapt their behaviours or environments (such as removing pictures of same sex partners from living spaces) in order to avoid discrimination from in home care staff. The repression of sexual identity that many older LGBTQI individuals feel in these spaces can negatively affect them in a number of ways. Older LGBTQI individuals may be deterred from accessing services in order to avoid possible discrimination or the prospect of ‘de-gaying’, while those that do access these services may suffer emotionally as a result of this process. At a broader level this reality also obscures and leads to unreliable population statistics regarding the older LGBTQI population and therefore obfuscates the attention they deserve. Many care homes in Scotland for example report having no LGBTQI residents, which, given other population statistics is highly improbable.It is important to note that this phenomenon also transcends borders. In a previously published article by CBC News, older LGBTQI Canadians expressed the same fear and apprehension of being ‘out’ in long term care facilities. Many individuals articulated discriminatory interactions with health care professionals and staff. With almost a quarter of the global population projected to be over the age of 65 by the year 2024, the need to address this issue is of the upmost importance to ensure the rights of our ageing LGBTQI population are being protected. To learn more about the older LGBTQI population and ways in which individuals, organizations and governments can support and protect the rights of these individuals, contact IFA expert Professor Marie Beaulieu, a leading expert in elder abuse and the unique needs of the older LGBTQI population.

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Addressing the mental health needs of ageing populations

There is a growing recognition globally around the importance of promoting and maintaining mental health. However, this shift in understanding has resulted largely in initiatives targeted toward youth, rather than taking a life course approach to mental health and addressing the unique needs of older people.  A recent opinion piece published in The Guardian underscored the disparity that exists between younger and older populations regarding their access to information and programming related to mental health. One important distinction presented was that campaigns that combat loneliness and social isolation were more common than mental health specific initiatives for older people. Moving forward, acknowledging that mental illness is not a problem that vanishes as you age is a critical step in combating the stigma experienced by this population.It is also important to recognize that changing the narrative around the mental health of older people alone is not enough. Denis Campbell, Health Policy Editor for The Guardian recently discussed the impact the reliance on the prescription of antidepressants versus referrals for talk therapy by General Practitioners (GPs) has had on older people. He highlighted that while almost 10% of people 75 years of age or older are diagnosed with depression, 87% are prescribed medication rather than other forms of treatment. Similarly, only slightly over 6% of all those referred to NHS Improving Access to Psychological Therapies (IAPT) were over 65 years old. According to Caroline Abrahams, the charity director of Age UK, the likelihood of GPs to prescribe medication rather than talk therapy illustrates that older people are missing out on effective treatment for their mental health conditions.As there are many confounding factors that have contributed to the current narrative surrounding ageing and mental health, simply talking about mental illness is not enough. For more information on how individuals, organizations and governments can support the mental health of older people, contact IFA Expert Professor Nicola Lautenschlager. Whether it be through challenging damaging ageist narratives or improving access to services, promoting the mental health of older people is of critical importance moving forward.

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The Impact of Ageism on the Health of Older People – World Health Day 2019

7 April marks World Health Day, and this year, the International Federation on Ageing wants to highlight the importance of addressing ageism to ensure the health of older people is taken into consideration across the globe.Older people are often neglected in the planning of public health strategies due to ageist and false beliefs from government and policymakers that older people only contribute in small ways to the economy. A recent Guardian article explains that ageism may increase ill-health in older age. "Jackson and colleagues suggest that among the possible ways ageism could take a toll are difficulties in adopting a healthy lifestyle – such as gym-going – for fear of discrimination, worse care and less timely diagnoses by health professionals, and even stress – which might affect the body through inflammatory mechanisms, triggering unhealthy behaviours or psychological distress." - Nicola Davis, The Guardian There are countless ways health can be preserved in later life, from regular vision check-ups, to keeping up to date on adult vaccinations such as influenza, pneumonia and shingles. Vaccination is often considered “just for kids”, however it is pertinent in preserving health and functional ability in older age. Contact IFA expert Gary Finnegan, Editor of Vaccines Today to learn more about the importance of vaccination to healthy ageing, and IFA expert Dr. Michele Corcio, Vice President of the International Agency for the Prevention of Blindness on the important role vision plays in healthy ageing. This year’s World Health Day theme is “Universal Health Coverage.” Read the following expert spotlight which discusses the importance of universal health care to older people, and consider registering for the IFA 15th Global Conference on Ageing which will feature experts from around the world discussing the importance of healthy ageing.

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Taking care of caretakers: Celebrating National Carers Day

Today is #NationalCarersDay, which recognizes the invaluable work that caregivers provide to the people they support everyday. Often, the responsibility of caring for a loved one in need of extra support or assistance falls on a family member.  In a recent article from the University of Toronto, Nathan Stall, PhD candidate, notes that more than one third of the population in the workforce also has the job of caring for a loved one.Caregiving is often described as a job that a person can never fully clock out of. Balancing a full-time job, family responsibilities, and caregiving can often result in caregiver burnout. IFA Expert, Dr. Anne Martin-Mathews, a professor in Ageing and Lifecourse from Vancouver BC, has focused part of her research on understanding the complex relationships between caregivers and the ones they care for.  A particular interest Dr Martin-Mathews focuses on is the concept of the “emotional vs. contractual nature of ‘care’." For family members, the motivation to care for their loved ones might weigh more on the side of an ‘emotional’ nature, whereas the feeling of obligation might at times lead to cognitive dissonance.  The latter may result in feelings of unresolved anger which may in turn lead to anxiety and depression. In addition to taking an emotional toll, caregiving can also take on a physical toll on the carer. Speaking from a very personal experience, Nathan Stall discusses the care his grandmother provided for his ailing grandfather, stating: “We provide little to no training for caregivers yet we expect them to carry out complex tasks like managing medication regimens, dealing with complicated behaviours and being navigators and advocates for fragile individuals”.  At the IFA, this sentiment is mirrored. Ensuring older people have the support they need to ensure their health is taken care of is a right that needs to be protected.

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Generations Sharing Knowledge and Wisdom

Ensuring that as people age, they are able to continue to do what they value is of critical importance with a rapidly ageing global population. However, with more and more older people experiencing loneliness, social isolation and the corresponding health issues, for many this is not the case. To combat this growing issue, IFA Expert Dr Amy D’Aprix is part of the growing movement that encourages intergenerational relationships as a means to improve the health and wellbeing of older people globally.With an extensive background working with older people and their caregiving families, as well as educating other professionals about the needs of caregiving and ageing, Dr D'Aprix has seen firsthand the benefits of intergenerational relations. She can be contacted through ExpertFile for more information on how to facilitate these relationships, as well as on how to help people to take a life course approach to planning for later life, so that they can age with more independence and with better quality of life.“If we can start bringing the generations together, I think what we stop doing is having competition between the generations.” – Dr Amy D’Aprix There are many positive benefits to participating in intergenerational relationships for individuals of all ages. Not only does encouraging social interactions between generations reduce loneliness and social isolation, but it actually can lead to health benefits and an increase a person’s lifespan. In a recent article published by the New York Times, the role that older people could have through youth mentoring was discussed as another important way to share wisdom and new learnings across generations.Fostering intergenerational connections and dialogues is just one of many critical ways to encourage the healthy ageing of older people, while also combating ageism. Interested in learning more? The IFA 15th Global Conference of Ageing registration and abstract submission are now open and provide an exciting opportunity to share examples of good practice and learn from global experts!

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Lonely No More

Social isolation and loneliness are an increasing concern as the world ages. According to the World Report on Ageing and Health, a striking 40% of older people feel lonely, and research by IFA expert Prof Martin Knapp has found that social isolation and loneliness place older people at greater risk of poor mental and physical health.Fortunately, organizations, governments and communities around the world have begun to take action to combat social isolation and loneliness amongst older people. For example, the “Lonely No More” Program based in a rural area of Ontario, Canada aims to reduce loneliness amongst isolated seniors by holding a weekly conference call with fellow seniors and a volunteer facilitator.Another strategy to reduce loneliness amongst older people comes from students in Black Isle, United Kingdom who created a game to promote conversation amongst older people.Initiatives such as these allows others to check up on the health and needs of seniors without it seeming like they are being checked up on. Social isolation and loneliness amongst older people are both growing problems that need to be addressed through innovative initiatives such as these. The International Federation on Ageing 15th Global Conference on Ageing will feature presentations from leading experts and academics on how to reduce loneliness and social isolation in later life.

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The pervasiveness of ageism in employment

The World Health Organization (WHO) defines ageism as “stereotyping, prejudice, and discrimination against people on the basis of their age.” Despite the global prevalence of ageism, its existence and widespread impacts on the health and functioning of older people are not often discussed. Instead, incidents of ageism are normalized by suggestions that older people should move out of the way and let others have a chance.Ageism seems to be an especially accepted form of discrimination in the workplace, where older workers are often passed over in favour of “more relevant” counterparts. Recently, the Globe and Mail stated that “older employees are often passed over for promotion, discarded first in hard times or fobbed off with unfulfilling work.” This is troubling when taking into consideration that in the United Kingdom, “people aged 50 and over have made up nearly 80% of the total employment growth over the past decade.”What is most frustrating about ageist rhetoric in employment is that despite what we are led to believe, older people are neither a threat to others’ jobs nor a burden to employers and employees. Older people are simply experiencing increased longevity, wherein continuing to work is necessary for continued financial stability and/or for personal fulfilment. A recent Guardian article illustrates both instances, quoting two women who have continued to work past so-called “retirement age” out of want or need.As illustrated in the Guardian article, ongoing employment becomes an even more worrying experience in older women who face workplace discrimination based on gender in addition to age. According to Entrepreneur, “résumés of older women get far fewer callbacks than both those of older men and younger applicants of either sex.” Ageism in employment is indicative of a larger societal issue that marginalizes older people in various spaces. As a result of ageism, older people are “overlooked for employment, restricted from social services and stereotyped in the media, and excluded from their communities.” Contact ageism expert Dr Liat Ayalon to discuss the positive impacts of combating ageism. Combating ageism is pertinent to ensuring that older people live happy, healthy lives. The need to recognize ageism as a legitimate form of discrimination is a topic that will be discussed at the IFA 15th Global Conference on Ageing in November 2020. If you are interested in submitting abstracts under this theme visit the new conference website to learn more.

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The new old: Let’s think about ageing differently

‘Silver tsunami’, ‘rising tide’, ‘perfect storm’ – these are the phrases typically associated with population ageing and reflect the commonly held and deeply rooted perceptions that older people are all dependent and have nothing to offer to society. How can we influence the population ageing agenda to be more positive, proactive, and inclusive?The International Federation on Ageing (IFA) is driving the population ageing agenda with new approaches to policies related to ageing and older people. Through programs of work and collaboration the IFA is an international platform that seeks to improve our understanding of age-friendly environments, to debate the solutions to address inequalities, to confront the reality of ageism, and to delve into what it means to enable the functional ability of an older person. The upcoming 15th Global Conference on Ageing in Niagara Falls will be held in 2020 and will feature diverse and exciting presentations across these themes. Registration and abstract submissions are now open here. This Wednesday 21 March, the IFA will be participating in a steering group meeting of the Economist Group Initiative on Healthy Ageing in Washington, D.C. to contribute to new ways of thinking about ageing. IFA Expert, Mr Greg Shaw, will share his extensive knowledge of age-related policies as a panellist for the event. Contact him to learn more about the ‘new old’, the IFA’s 15th Global Conference on Ageing, and more.

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The perils of poverty in ageing populations

People are living longer than ever before; yet, many are not enjoying this longevity in good health. As demographics continue to shift and older people continue to make up a growing proportion of the population, the need to ensure all people have access to health and care services becomes increasingly critical.Drawing on a new Centre for Ageing Better report, a recent Guardian article discussed existing disparities experienced by older people in Britain. Titled “The State of Ageing in 2019“ the report brought together publicly available data to highlight the different ways poverty negatively impacts health and wellbeing of older people, emphasizing that “pensioner poverty” is rising, predominantly impacting women and people of colour. Research illustrates that adverse lived experiences significantly impact a person’s ability to live a healthy life. For example, “the poorest people [both men and women] are three times more likely than the wealthiest to retire early because of ill-health” and within the 50-64 age cohort, almost one in four have at least three chronic health conditions. Additionally, the Centre for Ageing Better report illustrates the role of the built environment in promoting health, showing that at least 1.3 million people who live in substandard housing are ages 55 and over. One of the key points raised throughout the article and the referenced report was the importance of structural changes – changes to policies and practices that currently replicate patterns of inequity – to address disparities in health outcomes. Leading such initiatives is IFA expert Dr Debra Whitman, Chief Public Policy Officer at AARP is an international leader in supporting and advancing policy that improve the lives of older people and their families.Contact experts like Dr Whitman today and discuss tangible ways to address these types of disparities.

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Balance for Better: Include older women in the equation

On International Women’s Day (8 March), gender equality is promoted and celebrated. This year’s theme #BalanceforBetter calls for a more gender-balanced world.Why is there a need for such a day? Women experience gender-based discrimination throughout all areas of life, including school, work, and healthcare. This builds up across the life course to negatively impact their wellbeing, safety and security.Today, older women continue to be left behind in the dialogue about gender equality across all sectors: employment, income, innovation, and health. To learn more about how gender and age intersect to produce inequalities in these policy areas, contact Dr. Pat Armstrong, who is an expert in fields of social policy, of women, work and the health and social services.With the 2030 Agenda for Sustainable Development in mind, UN Women has adopted its own theme for this year’s International Women’s Day: “Think Equal, build smart, innovate for change.”Innovations in sustainable infrastructure are required to enable and encourage people of all ages and genders to participate in society through employment and social and civic activities. Older women often face barriers to accessing infrastructure developments due to high costs, poor accessibility, or lack of tech skills. Get in touch with Dr. Ruth Finkelstein to learn more about how these developments can be more age-friendly while also being gender-balanced. The IFA is committed to the protection of rights of older women around the world. The upcoming 63rd Commission on the Status of Women at the United Nations Headquarters in New York this March will focus on social protection and sustainable infrastructure. Read the IFA’s statement to the Commission here.

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