Search

Balance declines with age, but exercise can help stave off some of the risk of falling

<a href="https://theconversation.com/profiles/evan-papa-1433146">Evan Papa</a>, <a href="https://theconversation.com/institutions/tufts-university-1024">Tufts University</a> My wife and I were in the grocery store recently when we noticed an older woman reaching above her head for some produce. As she stretched out her hand, she lost her balance and began falling forward. Fortunately, she leaned into her grocery cart, which prevented her from falling to the ground. Each year, about <a href="https://www.cdc.gov/mmwr/volumes/65/wr/mm6537a2.htm">1 in every 4 older adults experience a fall</a>. In fact, falls are the leading cause of injuries in adults ages 65 and older. Falls are the <a href="https://doi.org/10.1007/bf00298717">most common cause of hip fractures</a> and <a href="https://doi.org/10.1111/j.1553-2712.2000.tb00515.x">traumatic brain injuries</a>. Injuries like those are also <a href="https://doi.org/10.1056/NEJM199710303371806">risk factors for placement in a nursing home</a>, where the fall risk is <a href="https://doi.org/10.7326/0003-4819-121-6-199409150-00009">nearly three times higher than for people living in the community</a>. A number of physical changes with aging often go unseen preceding falls, including muscle weakness, decreased balance and changes in vision. I am a <a href="https://facultyprofiles.tufts.edu/evan-papa">physical therapist</a> and <a href="https://scholar.google.com/citations?user=T9B_dHQAAAAJ&hl=en">clinical scientist focused on fall prevention</a> in older adults, commonly ages 65 and older. I’ve spent most of my career investigating why older adults fall and working with patients and their families to prevent falls. <h2>Why aging leads to increased risk of falls</h2> Aging is a process that affects the systems and tissues of every person. The rate and magnitude of aging may be different for each person, but overall physical decline is an inevitable part of life. Most people think aging starts in their 60s, but in fact we spend most of our life span <a href="https://doi.org/10.1093%2Fgeront%2Fgnv130">undergoing the process of decline</a>, typically beginning in our 30s. Older adults are more prone to falling for various reasons, including age-related changes in their bodies and vision changes that leave them vulnerable to environmental factors such as curbs, stairs and carpet folds. <figure><iframe src="https://www.youtube.com/embed/ztPbKP68P2Q?wmode=transparent&start=24" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Some straightforward measures to improve the safety of the home environment for older adults can significantly lower the risk of falls.</figcaption></figure> Based on my experience, here are some common reasons older adults may experience falls: First, <a href="https://my.clevelandclinic.org/health/diseases/23167-sarcopenia">aging leads to a natural loss of muscle strength</a> and flexibility, making it more challenging to maintain balance and stability. The loss of strength and poor balance are two of the most common causes of falls. Second, older adults often have chronic conditions such as arthritis, Parkinson’s disease or diabetes that can affect their mobility, coordination and overall stability. In addition, certain medications commonly taken by older adults, <a href="https://doi.org/10.4088/jcp.18f12340">such as sedatives</a> or <a href="https://doi.org/10.1001/jamainternmed.2013.14764">blood pressure drugs</a>, can cause dizziness, drowsiness or a drop in blood pressure, leading to an increased risk of falls. Age-related vision changes, such as reduced depth perception and peripheral vision and difficulty in differentiating colors or contrasts, can make it harder to navigate and identify potential hazards. Hazards in the environment, such as uneven surfaces, slippery floors, inadequate lighting, loose rugs or carpets or cluttered pathways, can <a href="https://doi.org/10.1186/s12877-021-02499-x">significantly contribute to falls among older adults</a>. Older adults who lead a sedentary lifestyle or have limited physical activity may also experience reduced strength, flexibility and balance. And finally, such conditions as dementia or Alzheimer’s disease can affect judgment, attention and spatial awareness, leading to increased fall risk. <h2>Theories of aging</h2> There are numerous theories about why we age but there is no one unifying notion that explains all the changes in our bodies. A large portion of aging-related decline is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295054/">caused by our genes</a>, which determine the structure and function of bones, muscle growth and repair and visual depth perception, among other things. But there are also numerous lifestyle-related factors that influence our rate of aging including diet, exercise, stress and exposure to environmental toxins. A recent advance in scientific understanding of aging is that there is a difference between your <a href="https://theconversation.com/are-you-a-rapid-ager-biological-age-is-a-better-health-indicator-than-the-number-of-years-youve-lived-but-its-tricky-to-measure-198849">chronological age and your biological age</a>. Chronological age is simply the number of years you’ve been on the Earth. Biological age, however, refers to how old your cells and tissues are. It is based on physiological evidence from a blood test and is related to your physical and functional ability. Thus, if you’re healthy and fit, your biological age may be lower than your chronological age. However, the reverse can also be true. I encourage patients to focus on their biological age because it empowers them to take control over the aging process. We obviously have no control over when we are born. By focusing on the age of our cells, we can avoid long-held beliefs that our bodies are destined to develop cancer, diabetes or other conditions that <a href="https://doi.org/10.1016/j.cub.2012.07.024">have historically been tied to how long we live</a>. And by taking control of diet, exercise, sleep and other lifestyle factors you can actually <a href="https://doi.org/10.1111%2Facel.13538">decrease your biological age</a> and improve your quality of life. As one example, our team’s research has shown that moderate amounts of aerobic exercise <a href="https://doi.org/10.1371/journal.pone.0188538">can slow down motor decline</a> even when a person begins exercise in the latter half of the life span. <h2>Fall prevention</h2> Adopting lifestyle changes such as regular, long-term exercise can <a href="https://doi.org/10.1001/jamainternmed.2018.5406">reduce the consequences of aging</a>, including falls and injuries. Following a healthy diet, managing chronic conditions, reviewing medications with health care professionals, maintaining a safe home environment and getting regular vision checkups can also help reduce the risk of falls in older adults. There are several exercises that physical therapists use to improve balance for patients. It is important to note however, that before starting any exercise program, everyone should consult with a health care professional or a qualified physical therapist to determine the most appropriate exercises for their specific needs. Here are five forms of exercise I commonly recommend to my patients to improve balance: <ol> <li> Balance training can help improve coordination and <a href="https://www.sciencedirect.com/topics/neuroscience/proprioception">proprioception</a>, which is the body’s ability to sense where it is in space. By practicing movements that challenge the body’s balance, such as standing on one leg or walking heel-to-toe, the nervous system becomes better at coordinating movement and maintaining balance. A large research study analyzing nearly 8,000 older adults found that balance and functional exercises <a href="https://doi.org/10.1002/14651858.cd012424.pub2">reduce the rate of falls by 24%</a>. </li> <li> Strength training exercises involve lifting weights or using resistance bands to increase muscle strength and power. By strengthening the muscles in the legs, hips and core, older adults can improve their ability to maintain balance and stability. Our research has shown that strength training can also lead to <a href="https://doi.org/10.2147/cia.s104674">improvements in walking speed and a reduction in fall risk</a>. </li> <li> Tai chi is a gentle martial art that focuses on slow, controlled movements and shifting body weight. Research shows that it can improve balance, strength and flexibility in older adults. Several combined studies in tai chi have demonstrated a 20% reduction in the <a href="https://doi.org/10.1002/14651858.cd012424.pub2">number of people who experience falls</a>. </li> <li> Certain yoga poses can enhance balance and stability. Tree pose, warrior pose and mountain pose are examples of poses that can help improve balance. It’s best to <a href="https://theconversation.com/yoga-modern-research-shows-a-variety-of-benefits-to-both-body-and-mind-from-the-ancient-practice-197662">practice yoga</a> under the guidance of a qualified instructor who can adapt the poses to individual abilities. </li> <li> Flexibility training involves stretching the muscles and joints, which can improve range of motion and reduce stiffness. By improving range of motion, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3990889/">older adults can improve their ability to move safely</a> and avoid falls caused by limitations in mobility. </li> <li> Use of assistive devices can be helpful when strength or balance impairments are present. Research studies involving the evaluation of canes and walkers used by older adults confirm that <a href="https://doi.org/10.1016/j.apmr.2004.04.023">these devices can improve balance and mobility</a>. Training from a physical or occupational therapist in the proper use of assistive devices is an important part of improving safety. </li> </ol> When I think back about the woman who nearly fell in the grocery store, I wish I could share everything we have learned about healthy aging with her. There’s no way to know if she was already putting these tips into practice, but I’m comforted by the thought that she may have avoided the fall by being in the right place at the right time. After all, she was standing in the produce aisle.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/204174/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/evan-papa-1433146">Evan Papa</a>, Associate Professor of Physical Therapy and Rehabilitation Science, <a href="https://theconversation.com/institutions/tufts-university-1024">Tufts University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/balance-declines-with-age-but-exercise-can-help-stave-off-some-of-the-risk-of-falling-204174">original article</a>.

Body

Young woman dies after horror cruise fall

A woman in her 20s has died after plunging from the MSC Virtuosa cruise ship in the middle of the night. The cruise ship was travelling from Lisbon to Southampton when disaster struck at around 2am on October 12. While air ambulance successfully winched her out of the English Channel, she was pronounced dead at the hospital despite the best efforts of medics. British and French police are now probing the unidentified woman's death, The Sun reported. The ship originally sounded a Man Overboard alert and spotlights were then used to light up the sea, as aircraft from France and the Channel Islands attended the sea. Infra-red cameras were used to locate the woman, who would've struggled to survive in the cold water. At around 3am French time, an emergency alert was issued saying that a person was missing, a coast guard told The Sun. A helicopter was sent to a search area just north Les Casquets rocks, near the Channel Island of Alderney, while a plane from Channel Islands Air Search was sent to the scene from Guernsey, along with lifeboat crews. The £650 million ($A1.2 billion) vessel, which has a crew of more than 1500 and can carry up to 6300 passengers, remained in the area before making its way to Southampton. “A guest on board MSC Virtuosa went overboard on 12 October, while the ship was sailing to Southampton,” a Virtuosa spokesperson said. “The body was later recovered with the involvement of the authorities. “We are deeply saddened by this tragic event, and our thoughts are with the family during this difficult time. “Out of respect for their privacy, we will not be providing further details.” A Hampshire Police spokesperson added: “The investigation is not being managed by UK authorities.” Images: P.Cartwright / Shutterstock.com/ Channel Islands Air Search

Travel Trouble

Twelve-year-old boy falls to his death on cruise

A 12-year-old boy has fallen to his death onboard the Royal Caribbean Harmony of the Seas, as guests watched on in horror. The cruise was nearing the end of its itinerary on Sunday and was heading back to Texas after its seven-day cruise around the Western Caribbean when the incident occurred. Witnesses recalled that the boy was playing with a group of friends he had made on the ship before he tumbled over a 13-storey balcony, falling into the internal Central Park area of the ship, a plaza filled with bars, pubs and restaurants. Royal Caribbean staff attempted to resuscitate the youngster, but he died before the ship docked in Texas. The cruise company shared a statement that a death had occurred onboard but refused to share any more information as investigations into the incident began. Witnesses took to a Facebook page for passengers to share their condolences to the boy's grieving family, and share their version of event. "My daughter was friends with him and said he was upset today," posted passenger Sara Tullas. "She is so upset. I wish I would have known he was struggling today." The boy had taken part in the cruise's teen-club, and many passengers said their children had got to know the boy before his death. "The conversations I have had to have with my son really tripped me up," wrote Shannon Elizabeth on the Facebook page. "My son and him actually got really close on the cruise, and he saw too much of what happened." "My family and I saw the incident unfold right before us as we were looking down into Central Park from the pool deck," wrote Christa Schoolfield. "We did not see whether he jumped or was playing around." Another passenger wrote, "I looked over the railing after the emergency alert and wish I didn’t." "All I ask is to please hug your children tight and tell your family members you love them. Life can change in an instant. Today I was hiding ducks in Central Park and one second later a child's life was gone in front of me." Friends said the boy was on board with his family, including two sisters, for a birthday celebration. Image credits: Shutterstock

Travel Trouble

Sir Ian McKellen shares health update after fall

Sir Ian McKellen has admitted his health is deteriorating, after he <a href="https://www.oversixty.com.au/health/caring/sir-ian-mckellen-rushed-to-hospital" target="_blank" rel="noopener">fell off stage</a> during a performance in a London theatre a few months ago. The Lord of the Rings actor was starring in a production of Player Kings at the Noel Coward Theatre when he fell off stage and snapped his wrist. He also chipped a vertebrae, but has now revealed that he has other issues too. “I forget names … When you’re older you’ve got more to remember than people who are young," he said. “Nevertheless, it’s a nuisance when you can’t remember your best friend’s name or forget your telephone number.” Despite being 85, the actor is determined to keep working, but said that he will take time off until 2025. “What else would I be doing if I wasn’t working? I shall take the rest of the year off and then get back to work in January," he shared. “Just keep at it as long as the legs and the lungs and the mind keep working.” He is also eager to reprise his role as Gandalf in the 2026 film The Lord of the Rings: The Hunt for Gollum, which would be his first appearance as the wizard in 12 years. In an interview for the BBC, he said: “Well, I’ve had some indication from the powers that be, Gandalf will make an appearance, and I’m not letting anybody else put on the pointy hat and beard if I can help it.” Images: Jeff Moore/ Shutterstock Editorial

Caring

Long COVID puzzle pieces are falling into place – the picture is unsettling

<div class="theconversation-article-body"><a href="https://theconversation.com/profiles/ziyad-al-aly-513663">Ziyad Al-Aly</a>, <a href="https://theconversation.com/institutions/washington-university-in-st-louis-732">Washington University in St. Louis</a> Since 2020, the condition known as long COVID-19 has become a <a href="https://www.hhs.gov/civil-rights/for-providers/civil-rights-covid19/guidance-long-covid-disability/index.html">widespread disability</a> affecting the health and quality of life of millions of people across the globe and costing economies billions of dollars in <a href="https://www.oecd.org/en/publications/the-impacts-of-long-covid-across-oecd-countries_8bd08383-en.html">reduced productivity of employees and an overall drop in the work force</a>. The intense scientific effort that long COVID sparked has resulted in <a href="https://pubmed.ncbi.nlm.nih.gov/?term=%22long+covid%22+or+%22pasc%22+or+%22post-acute+sequelae+of+covid-19%22+or+%22postacute+sequelae+of+covid-19%22+or+%22post-acute+sequelae+of+SARS-CoV-2%22+or+%22postacute+sequelae+of+SARS-CoV-2%22+or+%22post+covid+condition%22+or+%22post+covid+conditions%22+or+%E2%80%9Cchronic+covid-19%E2%80%9D+or+%E2%80%9Cpost+covid-19+condition%E2%80%9D+or+%E2%80%9Cpost+covid-19+conditions%E2%80%9D+or+%E2%80%9Cpost-covid+condition%E2%80%9D+or+%E2%80%9Cpost-covid+conditions%E2%80%9D+or+%E2%80%9Clong+covid-19%E2%80%9D+or+%28%22long-term%22+and+%22COVID-19%22%29+or+%28%22longterm%22+and+%22COVID-19%22%29+or+%28%22long-term%22+and+%22SARS-CoV-2%22%29+or+%28%22longterm%22+and+%22SARS-CoV-2%22%29+or+%E2%80%9Cpostcovid+condition%E2%80%9D+or+%E2%80%9Cpostcovid+conditions%E2%80%9D+&sort=date">more than 24,000 scientific publications</a>, making it the most researched health condition in any four years of recorded human history. <a href="https://www.cdc.gov/coronavirus/2019-ncov/long-term-effects/index.html">Long COVID</a> is a term that describes the <a href="https://www.yalemedicine.org/conditions/long-covid-post-covid-conditions-pcc">constellation of long-term health effects</a> caused by infection with the SARS-CoV-2 virus. These range from persistent respiratory symptoms, such as shortness of breath, to debilitating fatigue or brain fog that limits people’s ability to work, and conditions such as heart failure and diabetes, which are known to last a lifetime. I am a physician scientist, and I have been deeply immersed in studying long COVID since the early days of the pandemic. I have testified before the U.S. Senate as an <a href="https://www.help.senate.gov/imo/media/doc/baf4e4e7-b423-6bef-7cb4-1b272df66eb8/Al-Aly%20Testimony.pdf">expert witness on long COVID</a>, have <a href="https://scholar.google.com/citations?hl=en&user=DtuRVcUAAAAJ">published extensively on it</a> and was named as one of <a href="https://time.com/6966812/ziyad-al-aly/">Time’s 100 most influential people in health in 2024</a> for my research in this area. Over the first half of 2024, a <a href="https://www.nationalacademies.org/our-work/long-term-health-effects-stemming-from-covid-19-and-implications-for-the-social-security-administration#sl-three-columns-afa91458-20e0-42ab-9bd6-55e3c8262ecc">flurry of reports</a> and <a href="https://doi.org/10.1056/NEJMoa2403211">scientific papers</a> on long COVID added clarity to this complex condition. These include, in particular, insights into how COVID-19 can still wreak havoc in many organs years after the initial viral infection, as well as emerging evidence on viral persistence and immune dysfunction that last for months or years after initial infection. <h2>How long COVID affects the body</h2> A new study that my colleagues and I published in the New England Journal of Medicine on July 17, 2024, shows that the <a href="https://doi.org/10.1056/NEJMoa2403211">risk of long COVID declined</a> over the course of the pandemic. In 2020, when the ancestral strain of SARS-CoV-2 was dominant and vaccines were not available, about 10.4% of adults who got COVID-19 developed long COVID. By early 2022, when the omicron family of variants predominated, that rate declined to 7.7% among unvaccinated adults and 3.5% of vaccinated adults. In other words, unvaccinated people were more than twice as likely to develop long COVID. While researchers like me do not yet have concrete numbers for the current rate in mid-2024 due to the time it takes for long COVID cases to be reflected in the data, the flow of new patients into long COVID clinics has been on par with 2022. We found that the decline was the result of two key drivers: availability of vaccines and changes in the characteristics of the virus – which made the virus less prone to cause severe acute infections and may have reduced its ability to persist in the human body long enough to cause chronic disease. Despite the decline in risk of developing long COVID, even a 3.5% risk is substantial. New and repeat COVID-19 infections translate into millions of new long COVID cases that add to an already staggering number of people suffering from this condition. Estimates for the first year of the pandemic suggests that at <a href="https://doi.org/10.1038/s41579-023-00896-0">least 65 million people</a> globally have had long COVID. Along with a group of other leading scientists, my team will soon publish updated estimates of the global burden of long COVID and its impact on the global economy through 2023. In addition, a major new report by the National Academies of Sciences Engineering and Medicine details all the <a href="https://nap.nationalacademies.org/catalog/27756/long-term-health-effects-of-covid-19-disability-and-function">health effects that constitute long COVID</a>. The report was commissioned by the Social Security Administration to understand the implications of long COVID on its disability benefits. It concludes that long COVID is a complex chronic condition that can result in more than 200 health effects across multiple body systems. These include new onset or worsening: <ul> <li><a href="https://doi.org/10.1038/s41591-022-01689-3">heart disease</a></li> <li><a href="https://doi.org/10.1038/s41591-022-02001-z">neurologic problems</a> such as <a href="https://theconversation.com/mounting-research-shows-that-covid-19-leaves-its-mark-on-the-brain-including-with-significant-drops-in-iq-scores-224216">cognitive impairment</a>, strokes and <a href="https://my.clevelandclinic.org/health/diseases/6004-dysautonomia">dysautonomia</a>. This is a category of disorders that affect the body’s <a href="https://my.clevelandclinic.org/health/body/23273-autonomic-nervous-system">autonomic nervous system</a> – nerves that regulate most of the body’s vital mechanisms such as blood pressure, heart rate and temperature.</li> <li><a href="https://www.cdc.gov/me-cfs/hcp/clinical-care/treating-the-most-disruptive-symptoms-first-and-preventing-worsening-of-symptoms.html">post-exertional malaise</a>, a state of severe exhaustion that may happen after even minor activity — often leaving the patient unable to function for hours, days or weeks</li> <li><a href="https://doi.org/10.1038/s41467-023-36223-7">gastrointestinal disorders</a></li> <li><a href="https://doi.org/10.1681/ASN.2021060734">kidney disease</a></li> <li>metabolic disorders such as <a href="https://doi.org/10.1016/S2213-8587(22)00044-4">diabetes</a> and <a href="https://doi.org/10.1016/S2213-8587(22)00355-2">hyperlipidemia</a>, or a rise in bad cholesterol</li> <li><a href="https://doi.org/10.1038/s41590-023-01724-6">immune dysfunction</a></li> </ul> Long COVID can affect people across the lifespan from children to older adults and across race and ethnicity and baseline health status. Importantly, <a href="https://doi.org/10.1126/science.adl0867">more than 90% of people with long COVID</a> had mild COVID-19 infections. The National Academies report also concluded that long COVID can result in the inability to return to work or school; poor quality of life; diminished ability to perform activities of daily living; and decreased physical and cognitive function for months or years after the initial infection. The report points out that many health effects of long COVID, such as post-exertional malaise and chronic fatigue, cognitive impairment and autonomic dysfunction, are not currently captured in the <a href="https://www.ssa.gov/disability/professionals/bluebook/AdultListings.htm">Social Security Administration’s Listing of Impairments</a>, yet may significantly affect an individual’s ability to participate in work or school. <figure><iframe src="https://www.youtube.com/embed/9kJ5GWb2wzw?wmode=transparent&start=0" width="440" height="260" frameborder="0" allowfullscreen="allowfullscreen"></iframe><figcaption>Many people experience long COVID symptoms for years following initial infection.</figcaption></figure> <h2>A long road ahead</h2> What’s more, health problems resulting from COVID-19 can last years after the initial infection. A large study published in early 2024 showed that even people who had a <a href="https://doi.org/10.1038/s41591-024-02987-8">mild SARS-CoV-2 infection still experienced new health problems</a> related to COVID-19 in the third year after the initial infection. Such findings parallel other research showing that the <a href="https://doi.org/10.1016/S1473-3099(24)00171-3">virus persists</a> in various organ systems for months or years after COVID-19 infection. And research is showing that immune responses to the infection are <a href="https://doi.org/10.1126/scitranslmed.adk3295">still evident two to three years</a> after a mild infection. Together, these studies may explain why a SARS-CoV-2 infection years ago could still cause new health problems long after the initial infection. Important progress is also being made in understanding the pathways by which long COVID wreaks havoc on the body. Two preliminary studies <a href="https://doi.org/10.1101/2024.06.18.24309100">from the U.S.</a> and <a href="https://doi.org/10.1101/2024.05.30.596590">the Netherlands</a> show that when researchers transfer auto-antibodies – antibodies generated by a person’s immune system that are directed at their own tissues and organs – from people with long COVID into healthy mice, the animals start to experience long COVID-like symptoms such as muscle weakness and poor balance. These studies suggest that an abnormal immune response thought to be responsible for the generation of these auto-antibodies may underlie long COVID and that <a href="https://doi.org/10.1126/science.zbzipqn">removing these auto-antibodies</a> may hold promise as potential treatments. <h2>An ongoing threat</h2> Despite overwhelming evidence of the wide-ranging risks of COVID-19, a great deal of messaging suggests that it is no longer a threat to the public. Although there is no empirical evidence to back this up, this misinformation has permeated the public narrative. The data, however, tells a different story. <a href="https://covid.cdc.gov/covid-data-tracker/#datatracker-home">COVID-19 infections</a> continue to <a href="https://www.cdc.gov/flu/weekly/index.htm">outnumber flu cases</a> and lead to <a href="https://www.cdc.gov/resp-net/dashboard/index.html">more hospitalization</a> and <a href="https://doi.org/10.1001/jama.2024.7395">death</a> than the flu. COVID-19 also leads to <a href="https://doi.org/10.1016/S1473-3099(23)00684-9">more serious long-term health problems</a>. Trivializing COVID-19 as an inconsequential cold or <a href="https://www.theatlantic.com/health/archive/2024/02/covid-anniversary-flu-isolation-cdc/677588/">equating it with the flu</a> does not align with reality.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/233759/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ziyad-al-aly-513663">Ziyad Al-Aly</a>, Chief of Research and Development, VA St. Louis Health Care System. Clinical Epidemiologist, <a href="https://theconversation.com/institutions/washington-university-in-st-louis-732">Washington University in St. Louis</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/long-covid-puzzle-pieces-are-falling-into-place-the-picture-is-unsettling-233759">original article</a>. </div>

Body

Horrifying moment wheel falls off plane during take-off

Video footage has captured the horrifying moment a wheel fell off a United Airlines Boeing plane just moments after take off on Monday morning. The video captured by RadarBox shows the tire coming loose from the aircraft's undercarriage and plummeting to the ground seconds after take off. The airline confirmed that a wheel fell off the plane as the flight departed Los Angeles International airport en route to Denver, but it safely touched down around three hours later. None of the 174 passengers or seven crew members on board were injured. <div class="embed" style="box-sizing: inherit; margin: 0px; padding: 0px; border: 0px; font-size: 16px; vertical-align: baseline; outline: none !important;"><iframe class="embedly-embed" style="box-sizing: inherit; margin: 0px; padding: 0px; border-width: 0px; border-style: initial; vertical-align: baseline; width: 573px; max-width: 100%; outline: none !important;" title="tiktok embed" src="https://cdn.embedly.com/widgets/media.html?src=https%3A%2F%2Fwww.tiktok.com%2Fembed%2Fv2%2F7389507936625691920&display_name=tiktok&url=https%3A%2F%2Fwww.tiktok.com%2F%40theprojecttv%2Fvideo%2F7389507936625691920%3Fq%3Dboeing%2520wheel%26t%3D1720568253683&image=https%3A%2F%2Fp16-sign-sg.tiktokcdn.com%2Fobj%2Ftos-alisg-p-0037%2FoEEROKIMm2EpV6DrBgf3FeAUB4EjlBg0BMjmzE%3Flk3s%3Db59d6b55%26nonce%3D85756%26refresh_token%3D9848a1a77a4d011f7ceeb76a41229609%26x-expires%3D1720738800%26x-signature%3DKRkuV5%252BXkjrhdVj9cxtL5oLH5ow%253D%26shp%3Db59d6b55%26shcp%3D-&key=5b465a7e134d4f09b4e6901220de11f0&type=text%2Fhtml&schema=tiktok" width="340" height="700" frameborder="0" scrolling="no" allowfullscreen="allowfullscreen"></iframe></div> A United spokesperson said that the wheel has been found in Los Angeles and they are investigating the cause. “The wheel has been recovered in Los Angeles, and we are investigating what caused this event,” the statement read. It is not known whether it caused any damage on the ground. The incident comes just four months after a Japan-bound Boeing airlines carrying 249 passengers also lost a wheel not long after take off in San Francisco. The flight, that took place in March. was diverted to LAX where it landed safely. The wheel reportedly damaged some vehicles in an airport parking lot. Images: CaliPlanes/ Youtube

Travel Trouble

Sir Ian McKellen rushed to hospital

Sir Ian McKellen has been rushed to hospital after he fell off stage during a performance in a London theatre. The Lord of the Rings star, 85, was starring in a production of Player Kings at the Noel Coward Theatre when he lost his footing during a tense fight scene. The actor then tumbled off the stage and into the audience, who heard his cries for help as theatre staff rushed to his aid, according to reports from the BBC. The audience were informed that the remainder of the evening performance had been cancelled and they were evacuated from the premises. Sandro, Trapani, a member of the audience who spoke to the BBC, described the moment as "very shocking." "I really hope that he is going to be alright," they said. "As far as I saw, he was conscious because he was asking for assistance." McKellen's condition is currently unknown, as the extent of his injuries are unclear. The esteemed actor was playing the role of John Falstaff in the production Henry IV, parts one and two, which was adapted and directed by Robert Icke. Image credits: Ken McKay/ITV/Shutterstock Editorial

Caring

Teen actress' parents share update after five-storey fall

Mamie Laverock's parents have shared a promising update with fans, after she was left fighting for her life following a five-storey <a href="https://www.oversixty.com.au/health/caring/teen-actress-on-life-support-after-devastating-mishap" target="_blank" rel="noopener">fall</a>. Her parents Nicole and Rob updated their GoFundMe page for the 19-year-old and said that she was “out of her big surgeries," and confirmed that doctors say she's “doing well.” "Mamie is out of her extensive surgeries and the doctors say she is doing well," they wrote. “It’s impossible for us to be happier,” her parents continued. “Thank you all for your support.” On May 11, Laverock experienced a “medical emergency” and was hospitalised in Winnipeg, Canada before being transferred to another hospital in Vancouver. At the time her parents said her recovery was “unclear", but she was “showing signs of improvement.” More than two weeks later, they shared a harrowing update on their daughter's condition informing fans that she was now on life support after she fell five stories from a balcony walkway while being escorted out of a secure unit in the hospital. Many of her When Calls the Heart co-stars took to social media to promote the crowd-funding page and express their heartbreak. “I love this family, my heart is broken. A devastating time for all who care for Mamie. Please help if you can. They need all the support they can get to make it through this," Laverock’s on-screen mother Molly Sullivan wrote on X. "I just donated. If you have the means to do so, I hope you will too. Link in bio,” wrote the show's leading actress Erin Krakow. The fundraiser has now exceeded the $30,000 CAD target, raising almost $33,000 CAD. Image: GoFundMe

Caring

Another man dies after fall from world's biggest cruise ship

A passenger has died after he fell from the world's largest cruise ship on the first night of a week-long voyage. The unidentified man allegedly jumped from Royal Caribbean’s new 366 metre-long Icon of the Seas, just hours after it left a port in Miami, Florida on its way to Honduras, according to the US Coast Guard. “The cruise ship deployed one of their rescue boats, located the man and brought him back aboard,” the Coast Guard told the <a href="https://nypost.com/2024/05/28/us-news/passenger-dead-after-jumping-off-worlds-largest-cruise-ship/" target="_blank" rel="noopener">New York Post</a>. “He was pronounced deceased. Beyond assisting in the search, the US Coast Guard did not have much involvement in this incident,” the agency added. Royal Caribbean told the publication, “The ship’s crew immediately notified the US Coast Guard and launched a search and rescue operation”. “Our care team is actively providing support and assistance to the guest’s loved ones during this difficult time.” At the time of the incident, the cruise ship had only travelled 500km from Florida, and stopped for two hours to help the search and rescue Coast Guard team to locate the passenger. The man was brought back on-board in critical condition before he succumbed to his injuries and died on the ship. The Icon of the Seas, the world’s largest cruise ship, took its maiden voyage in January this year. The Royal Caribbean ship has 20 decks and is nearly the size of four city blocks, holding 7,600 passengers and 2,350 crew members. Image credits: Royal Caribbean

Travel Trouble

5 ways to avoid going overboard on a cruise

Falling overboard is the stuff of cruising nightmares (and it happens surprisingly more frequently than you might think. Just this year we’ve brought you two stories about passengers falling overboard, but this fishy fate is by no means unavoidable. Here are five ways to ensure you keep your feet dry. 1. Limit your alcohol intake If the prices weren’t enough of a reason to go easy on the sauce on your cruise, perhaps the risk of tipping over the balcony will persuade you. Think of it this way – the effect of alcohol on a cruise is the same as the effect of alcohol on dry land, but when you’re on a cruise you’re travelling through sometimes heavy seas at about 20 knots. 2. Stay in your room during inclement weather If your ship is sailing into dicey conditions, you’re better off keeping to your quarters. You never know how a cruise liner is going to stand up to the ocean’s wrath, and even if you want a good view of Mother Nature’s nasty side, you’re safer below deck. 3. Keep clear of dark corners It’s not a very pleasant thing to think about, but when there are 4,000 passengers on a cruise they’re not all going to be good eggs. Be aware of your surroundings, just as you would be on land, and be sure to report any suspicious activity to a crew member. 4. Pay attention during the practice drills Even if you’ve been on 20 cruises it’s a good idea to pay attention during the practice drills. This will reinforce what you need to do in an event of an emergency, and might just save your life (or someone else’s by knowing where to find the safety gear). 5. Don’t re-enact the Titanic scene Because going overboard will make you look like anything but, “The king of the world.” Have you ever been on a cruise? Did you ever feel unsafe at any point? Let us know in the comments below, we’d love to hear from you. Image credits: Getty Images

Cruising

How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

It’s 3am and you’re suddenly wide awake. Try these seven science-backed strategies to fall back to sleep fast. Give meditation a try As a mindfulness coach, I’m very aware of the day-to-day anxieties and worries that can interfere with a good night’s sleep. One of the most effective natural sleep aids is a quick meditation session to ease yourself out of those stresses. If you’ve never meditated before, you’ll likely find the meditation interrupted by thoughts flashing through your mind. It’s important for you to know that this isn’t a failure on your part, and that you aren’t doing anything wrong. Thinking is just what the brain does, as naturally as lungs take in air. The point is to be non-judgmental yet aware of your thoughts, bodily experiences and breath, moment by moment. Stop wanting to fall asleep It’s counterintuitive, isn’t it? Sometimes trying too hard to do something is the very thing that prevents us from achieving it – and that’s never more true than when it comes to falling asleep. Desperately wanting to sleep will only stoke anxieties that will further stress your brain, essentially feeding it the message that it’s not safe to sleep. Throw in those worries about your to-do list at work the following day, and the whole thing can snowball into a panic attack. Try letting go of that feeling that you absolutely must sleep now, and observe your own anxieties for what they are without judgment. When you stop looking at sleep as a goal, you’ll find it easier to fall asleep. Start a journal If you find yourself struggling to fall asleep, pick up a pen and paper (not your phone!), and start writing: simply scribble down an account of what’s going on inside your head. Although there’s no “right” way to journal, you might start by listing the events of your day, and from there, how those events and encounters made you feel. Building this structured picture of your thoughts may help you see that the problem that’s keeping you up at night, and is likely less overwhelming than you thought. Why my insistence on a pen and paper? First off, studies show the simple motor action that’s involved in the act of handwriting has a calming effect. Secondly, the light emitted by laptops and phones isn’t conducive to falling asleep. Find yourself a "3am friend" Some of us are lucky to have a ‘3am friend’, that close confidant you can call up in the wee hours knowing that they won’t hold it against you in the morning. Although it’s great to have someone to talk to when you want to fall asleep, it’s important that the conversation doesn’t just rehash the anxieties that are preventing you from catching shut-eye in the first place. Rather than using the call to seek solutions for those issues, talk about things that calm your nerves, or even have them assist you in deep breathing. It may sound silly, but doing a series of deep, relaxing breaths can help you let go of the troubles that are keeping you wide awake. Take a warm shower Taking a warm shower not only relaxes your muscles and soothes minor aches and pains, but it also raises your core body temperature. As soon as you step out of the shower, your body starts working at lowering that temperature, which is something that normally happens when you’re falling asleep naturally. (That’s why we always feel the need for a blanket when we sleep, no matter how warm it is!) By kick-starting that temperature-lowering process, you’re tricking your body into falling asleep fast. Stretch yourself to sleep Anxiety keeping you up? Research suggests mild stretching can help take the edge off and relax muscles that have become stiff and sore after a long day. We’re not talking intricate yoga poses or acrobatics here, either: Simple stretches like an overhead arm stretch and bending over to touch your toes should do the trick. Ramp up the relaxation potential with a soundtrack of ambient noise at a volume that’s just barely audible. There are plenty of white noise apps that are free to download, but soft music can work as well (so long as there are no lyrics). Just remember, if you’re using an electronic device to play these sleep-promoting sounds, make sure it’s placed screen-down so you’re not distracted by the light it emits. Read (or listen!) to something new When you’re struggling with insomnia, it might be tempting to pull an old favourite off the bookshelf. In reality, it’s better to read or listen to an audio book that covers a topic on which you know absolutely nothing. New information, while taking attention away from the stressors that are keeping you up at night, gives your brain enough of a workout to make it tire more quickly than when it’s engaged with familiar subjects and concepts. Again, if it’s an audio book or podcast you’re listening to, make sure the light-emitting side of the device is face down to keep the room as dark as possible. Darkness and warmth play an essential part in the production and maintenance of melatonin, the hormone that plays the central role falling asleep. Image credits: Getty Images This article by Deepak Kashyap originally appeared on <a href="https://www.readersdigest.co.nz/healthsmart/conditions/sleep/how-to-fall-asleep-without-sleeping-pills-7-natural-sleep-aids-that-actually-work" target="_blank" rel="noopener">Reader's Digest</a>.

Body

The rise and fall of antibiotics. What would a post-antibiotic world look like?

<a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> These days, we don’t think much about being able to access a course of antibiotics to head off an infection. But that wasn’t always the case – antibiotics have been available for less than a century. Before that, patients would die of relatively trivial infections that became more serious. Some serious infections, such as those involving the heart valves, were <a href="https://pubmed.ncbi.nlm.nih.gov/20173297/">inevitably</a> fatal. Other serious infections, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070694/">tuberculosis</a>, weren’t always fatal. Up to a <a href="https://www.biorxiv.org/content/10.1101/729426v1.full.pdf">half</a> of people died within a year with the most severe forms, but some people recovered without treatment and the remainder had ongoing chronic infection that slowly ate away at the body over many years. Once we had antibiotics, the outcomes for these infections were much better. <h2>Life (and death) before antibiotics</h2> You’ve probably heard of Alexander Fleming’s accidental <a href="https://www.acs.org/education/whatischemistry/landmarks/flemingpenicillin.html">discovery of penicillin</a>, when fungal spores landed on a plate with bacteria left over a long weekend in 1928. But the <a href="https://www.ox.ac.uk/news/science-blog/penicillin-oxford-story">first patient</a> to receive penicillin was an instructive example of the impact of treatment. In 1941, Constable Albert Alexander had an infected scratch on his face that had become infected. He was hospitalised but despite various treatments, the infection progressed to involve his head. This required removing one of his eyes. Howard Florey, the Australian pharmacologist then working in Oxford, was concerned penicillin could be toxic in humans. Therefore, he felt it was only ethical to give this new drug to a patient in a desperate condition. Constable Alexander was given the available dose of penicillin. Within the first day, his condition had started to improve. But back then, penicillin was difficult to produce. One way of extending the limited supply was to “recycle” penicillin that was excreted in the patient’s urine. Despite this, supplies ran out by the fifth day of Alexander’s treatment. Without further treatment, the infection again took hold. Constable Alexander eventually died a month later. We now face a world where we are potentially running out of antibiotics – not because of difficulties manufacturing them, but because they’re losing their effectiveness. <h2>What do we use antibiotics for?</h2> We currently use antibiotics in humans and animals for a variety of reasons. Antibiotics reduce the duration of illness and the chance of death from infection. They also prevent infections in people who are at high risk, such as patients undergoing surgery and those with weakened immune systems. But antibiotics aren’t always used appropriately. <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30084-0/fulltext">Studies</a> consistently show a dose or two will adequately prevent infections after surgery, but antibiotics are <a href="https://irp.cdn-website.com/d820f98f/files/uploaded/surgical-prophylaxis-prescribing-in-australian-hospitals-results-of-the-2020-surgical-national-antimicrobial-prescribing-survey.pdf">often</a> continued for several days unnecessarily. And sometimes we use the wrong type of antibiotic. <a href="https://irp.cdn-website.com/d820f98f/files/uploaded/antimicrobial-prescribing-practice-in-australian-hospitals-results-of-the-2020-hospital-national-antimicrobial-prescribing-survey.pdf">Surveys</a> have found 22% of antimicrobial use in hospitals is inappropriate. In some situations, this is understandable. Infections in different body sites are usually due to different types of bacteria. When the diagnosis isn’t certain, we often <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/resp.13334">err</a> on the side of caution by giving broad spectrum antibiotics to make sure we have active treatments for all possible infections, until further information becomes available. In other situations, there is a degree of inertia. If the patient is improving, doctors tend to simply continue the same treatment, rather than change to more appropriate choice. In general practice, the issue of diagnostic uncertainty and therapeutic inertia are often magnified. Patients who recover after starting antibiotics don’t usually require tests or come back for review, so there is no easy way of knowing if the antibiotic was actually required. Antibiotic prescribing can be more complex again if <a href="https://www.mja.com.au/journal/2014/201/2/antibiotic-prescribing-practice-residential-aged-care-facilities-health-care">patients</a> are expecting “a pill for every ill”. While doctors are generally good at educating patients when antibiotics are not likely to work (for example, for viral infections), without confirmatory tests there can always be a lingering doubt in the minds of both doctors and patients. Or sometimes the patient goes elsewhere to find a prescription. For other infections, resistance can develop if treatments aren’t given for long enough. This is particularly the <a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">case</a> for tuberculosis, caused by a slow growing bacterium that requires a particularly long course of antibiotics to cure. As in humans, antibiotics are also used to prevent and treat infections in animals. However, a proportion of antibiotics are used for growth promotion. In Australia, an <a href="https://www.mja.com.au/journal/2019/211/4/antibiotic-use-animals-and-humans-australia">estimated</a> 60% of antibiotics were used in animals between 2005-2010, despite growth-promotion being phased out. <h2>Why is overuse a problem?</h2> Bacteria become resistant to the effect of antibiotics through natural selection – those that survive exposure to antibiotics are the strains that have a mechanism to evade their effects. For example, antibiotics are sometimes given to <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30279-2/fulltext">prevent</a> recurrent urinary tract infections, but a consequence, any infection that does <a href="https://academic.oup.com/cid/article/73/3/e782/6141409">develop</a> tends to be with resistant bacteria. When resistance to the commonly used first-line antibiotics occurs, we often need to reach deeper into the bag to find other effective treatments. Some of these last-line antibiotics are those that had been <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4202707/">superseded</a> because they had serious side effects or couldn’t be given conveniently as tablets. New drugs for some bacteria have been developed, but many are much more <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955006/">expensive</a> than older ones. <h2>Treating antibiotics as a valuable resource</h2> The concept of antibiotics as a valuable resource has led to the <a href="https://pubmed.ncbi.nlm.nih.gov/8856755/">concept</a> of “antimicrobial stewardship”, with programs to promote the responsible use of antibiotics. It’s a similar concept to environmental stewardship to prevent climate change and environmental degradation. Antibiotics are a rare class of medication where treatment of one patient can potentially affect the outcome of other patients, through the transmission of antibiotic resistant bacteria. Therefore, like efforts to combat climate change, antibiotic stewardship relies on changing individual actions to benefit the broader community. Like climate change, antibiotic resistance is a complex problem when seen in a broader context. Studies have linked resistance to the values and priorities <a href="https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(18)30186-4/fulltext">of governments</a> such as corruption and infrastructure, including the availability of electricity and public services. This highlights that there are broader “causes of the causes”, such as public spending on sanitation and health care. Other <a href="https://academic.oup.com/jac/article/74/9/2803/5512029?login=true">studies</a> have suggested individuals need to be considered within the broader social and institutional influences on prescribing behaviour. Like all human behaviour, antibiotic prescribing is complicated, and factors like what doctors feel is “normal” prescribing, whether junior staff feel they can challenge senior doctors, and even their <a href="https://www.nytimes.com/2016/10/07/upshot/your-surgeon-is-probably-a-republican-your-psychiatrist-probably-a-democrat.html">political views</a> may be important. There are also issues with the <a href="https://www.cambridge.org/core/journals/international-journal-of-technology-assessment-in-health-care/article/value-assessment-of-antimicrobials-and-the-implications-for-development-access-and-funding-of-effective-treatments-australian-stakeholder-perspective/D45758CFB95520DA4FF06E46135E0628">economic model</a> for developing new antibiotics. When a new antibiotic is first approved for use, the first reaction for prescribers is not to use it, whether to ensure it retains its effectiveness or because it is often very expensive. However, this doesn’t really <a href="https://academic.oup.com/cid/article/50/8/1081/449089?login=true">encourage</a> the development of new antibiotics, particularly when pharma research and development budgets can easily be diverted to developing drugs for conditions patients take for years, rather than a few days. <h2>The slow moving pandemic of resistance</h2> <blockquote> If we fail to act, we are looking at an almost unthinkable scenario where antibiotics no longer work and we are cast back into the dark ages of medicine – <a href="https://amr-review.org/">David Cameron</a>, former UK Prime Minister </blockquote> Antibiotic resistance is already a problem. Almost all infectious diseases physicians have had the dreaded call about patients with infections that were essentially untreatable, or where they had to scramble to find supplies of long-forgotten last-line antibiotics. There are already hospitals in some parts of the world that have had to carefully <a href="https://www.reactgroup.org/news-and-views/news-and-opinions/year-2022/the-impact-of-antibiotic-resistance-on-cancer-treatment-especially-in-low-and-middle-income-countries-and-the-way-forward/">consider</a> whether it’s still viable to treat cancers, because of the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6276316/">high risk</a> of infections with antibiotic-resistant bacteria. A global <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)02724-0/fulltext">study</a> estimated that in 2019, almost 5 million deaths occurred with an infection involving antibiotic-resistant bacteria. Some 1.3 million would not have occurred if the bacteria were not resistant. The UK’s 2014 <a href="https://amr-review.org/sites/default/files/AMR%20Review%20Paper%20-%20Tackling%20a%20crisis%20for%20the%20health%20and%20wealth%20of%20nations_1.pdf">O'Neill report</a> predicted deaths from antimicrobial resistance could rise to 10 million deaths each year, and cost 2-3.5% of global GDP, by 2050 based on trends at that time. <h2>What can we do about it?</h2> There is a lot we can do to prevent antibiotic resistance. We can: <ul> <li> <a href="https://www.marketingmag.com.au/news/film-picking-gonorrhoea-wins-tropfest-prize/">raise</a> <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7258-3">awareness</a> that many infections will get better by themselves, and don’t necessarily need antibiotics </li> <li> use the antibiotics we have more appropriately and for as short a time as possible, supported by co-ordinated clinical and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3437704/">public policy</a>, and <a href="https://www.amr.gov.au/">national</a> <a href="https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(22)00796-4/fulltext">oversight</a> </li> <li> <a href="https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/about-aura-surveillance-system">monitor</a> for infections due to resistant bacterial to inform control policies </li> <li> reduce the inappropriate use of antibiotics in animals, such as <a href="https://nam.edu/antibiotic-resistance-in-humans-and-animals/">growth promotion</a> </li> <li> <a href="https://pubmed.ncbi.nlm.nih.gov/11971765/">reduce</a> cross-transmission of resistant organisms in hospitals and in the community </li> <li> prevent infections by other means, such as clean water, <a href="https://apps.who.int/iris/bitstream/handle/10665/204948/WHO_FWC_WSH_14.7_eng.pdf">sanitation</a>, hygiene and <a href="https://www.who.int/teams/immunization-vaccines-and-biologicals/product-and-delivery-research/anti-microbial-resistance">vaccines</a> </li> <li> continue developing new antibiotics and alternatives to antibiotics and ensure the right <a href="https://www.thelancet.com/journals/lanepe/article/PIIS2666-7762(23)00124-2/fulltext#:%7E:text=We%20consider%20four%20incentive%20options,exclusivity%20extensions%2C%20and%20milestone%20payments.">incentives</a> are in place to encourage a continuous pipeline of new drugs. </li> </ul> <a href="https://theconversation.com/profiles/allen-cheng-94997">Allen Cheng</a>, Professor in Infectious Diseases Epidemiology, <a href="https://theconversation.com/institutions/monash-university-1065">Monash University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/the-rise-and-fall-of-antibiotics-what-would-a-post-antibiotic-world-look-like-213450">original article</a>.

Caring

1 in 6 older adults fall victim to impersonation scams

More older adults are likely to fall victim to scams than are currently recognised according to new US research. The problems are global. <div class="copy"> A research team from Rush University Medical Center in Chicago, US, says older Americans who aren’t cognitively impeded, are also at risk. In their study <a href="https://10.1001/jamanetworkopen.2023.35319" target="_blank" rel="noreferrer noopener">published</a> today in JAMA Network Open, the group reports on a behavioural experiment where they targeted 644 adults aged 64-104 in Rush’s Memory and Aging Project – a local scheme that draws on participants from metropolitan Chicago to participate in research – with a pitch mimicking a real-world impersonation scam. The study’s fictitious ‘US Retirement Protection Task Force’ pitched itself to participants as a government social security initiative. This USRPTF told participants via either post, email or a telephone call there’d been irregular activity on their Medicare or social security file and the inquiry was a routine account security check. As part of this, the fake agency asked participants to call a telephone hotline or login to a provided website to provide their details. Over two-thirds of the study failed to respond to any attempts to obtain information by the phoney scheme. The remainder were evenly split by either responding to requests for contact, but expressing scepticism at the authenticity of the USRPTF, or by responding and engaging with the request for information. Those who were engaged with the request for information, but expressed doubts, were also those with the highest cognitive performance, and lowest proportion of dementia. They were also the most financially literate participants, while those who provided their details had the lowest literacy. Those who provided details were also found to have the lowest scam awareness of all participants. Among this group, 1 in 10 willingly provided personal information and 1 in 5 provided details of their social security number. “If extrapolated to a population level, these numbers are astounding and suggest that a very large number of older adults are at risk of victimisation,” the authors say. They also note that, given the use of a fictitious US government organisation name, the number of people vulnerable to well-organised scams is likely much higher. Last year, the US National Council on Aging reported 92,371 older Americans were defrauded of a total of US$1.7 billion. Most were victims of government department impersonation, sweepstakes and robocall scams. Often such scams will simply demand payment while ‘spoofing’ the phone number of a government agency to add the veil of legitimacy. It’s a similar story around the world. This year, the Australian Competition and Consumer Commission found Australians lost a record $3.1 billion last year, mostly via phone scams. Australians over 65 years of age accounted for a quarter of losses and reports. The UK’s Action Fraud initiative found Britons lost about ₤2.35 billion in the 2020/21 financial year, with those aged 50-69 most susceptible to falling victim. <div> Image credits: Getty Images <a href="https://cosmosmagazine.com/people/society/1-in-6-older-adults-fall-victim-to-impersonation-scams/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="null">Cosmos</a>. </div> </div>

Legal

Home and Away star shares shocking injury

Beloved Home and Away star Lynne McGranger has documented a shocking injury she sustained while she was walking her daughter's dog. The 70-year-old shared that she "face planted the road" after taking a tumble and not looking where she was going. She shared a before and after photo of the accident, sharing how quickly her morning had changed. “One minute walking your daughter and son-in-law’s dog with your MOG (mother of the groom). Nek minit (sic) you’ve face planted the road 😳😱😢🤦‍♀️,” she captioned the post. Addressing her caption she later added, “I must’ve been shaken up. I made punctuation mistakes 🤣😱🤦‍♀️”. The close-up of the injuries showed the actress with a bloodied lip and bruising on her chin, right cheek and nose. Friends and followers shared their best wishes for a speedy recovery after the painful accident. “Oh gosh Lynnie!!!! Sending love - I was hoping that was on-set makeup 😮 xx,” former Home and Away actress Sarah Roberts said. “Aww Lynny ❤️❤️❤️ hope you’re all good!” Johnny Ruffo’s partner Tahnee Sims wrote. “Damn, that looks pretty badass! Hope you’re all good though Lynne ❤️,” Home and Away’s Ethan Browne said. <figure><picture>Diehard fans of the show also shared their messages of support, with one person writing, "<source srcset="https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=100&impolicy=sevennews_v2 100w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=150&impolicy=sevennews_v2 150w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=250&impolicy=sevennews_v2 250w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=320&impolicy=sevennews_v2 320w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=414&impolicy=sevennews_v2 414w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=500&impolicy=sevennews_v2 500w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=640&impolicy=sevennews_v2 640w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=828&impolicy=sevennews_v2 828w,https://images.7news.com.au/publication/C-11885705/0db0b6f348379d14736b4992660d3fa675b2b0fd.jpg?imwidth=1024&impolicy=sevennews_v2 1024w" media="(min-width: 0px)" sizes="(max-width: 767px) 95vw,(min-width: 768px) and (max-width: 1020px) 50vw,650px" data-ratio="1080:1350" />Ouch, now how to write that into the script.”</picture> “Oh Lynne. I hope you are ok. That’s a mess. On the plus side, it could make a great story for Irene. Hope you heal quickly, love you lots xxx,” another agreed. Image credits: Instagram </figure>

Caring

Junk fees and drip pricing: the underhanded tactics we hate yet still fall for

<a href="https://theconversation.com/profiles/ralf-steinhauser-1459112">Ralf Steinhauser</a>, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> You see a fantastic offer, like a hotel room. You decide to book. Then it turns out there is a service fee. Then a cleaning fee. Then a few other extra costs. By the time you pay the final price, it is no longer the fantastic offer you thought. Welcome to the world of drip pricing – the practice of advertising something at an attractive headline price and then, once you’ve committed to the purchase process, hitting you with unavoidable extra fees that are incrementally disclosed, or “dripped”. Drip pricing – a type of “junk fee” – is notorious in event and travel ticketing, and is creeping into other areas, such as movie tickets. My daughter, for example, was surprised to find her ticket to the Barbie movie had a “booking fee”, increasing the cost of her ticket by 13%. It seems like such an annoying trick that you may wonder why sellers do it. The reason is because it works, due to two fundamental cognitive biases: the way we value the present over the future; and the way we hate losses more than we love gains. <h2>Present bias preference: why starting over feels too costly</h2> In the case of booking that hotel room, you could abandon the transaction and look for something cheaper once the extra charges become apparent. But there’s a good chance you won’t, due to the effort and time involved. This is where the trap lies. Resistance to the idea of starting the search all over again is not simply a matter of laziness or indecision. There’s a profound psychological mechanism at play here, called a present-bias preference – that we value things immediately in front of us more than things more distant in the future. In their seminal 1999 paper, <a href="https://doi.org/10.1257/aer.89.1.103">Doing it now or later</a>, economists Mathew Rabin and Ted O'Donoghue define present-biased preference as “the human tendency to grab immediate rewards and to avoid immediate costs”. They give the example of choosing between doing seven hours of unpleasant activity on April 1 or eight hours two weeks later. If asked about this a few months beforehand, most people will choose the earlier option. “But come April 1, given the same choice, most of us are apt to put off work till April 15.” In simple terms, the inconvenience and effort of doing something “right now” often feels disproportionately large. Drip pricing exploits this cognitive bias by getting you to make a decision and commit to the transaction process. When you’re far into a complicated booking process and extra prices get added, starting all over again feels like a burden. Often enough, this means you’ll settle for the higher-priced hotel room. <h2>Loss aversion: buying more expensive tickets</h2> Beyond the challenge of starting over, there’s another subtle force at work when it comes to our spending decisions. Drip pricing doesn’t just capitalise on our desire for immediate rewards; it also plays on our innate fear of losing out. This second psychological phenomenon that drip pricing exploits is known as loss aversion – that we feel more pain from losing something than pleasure from gaining the same thing. The concept of loss aversion was first outlined by economists Daniel Kahneman and Amos Tversky in <a href="https://www.jstor.org/stable/1914185">a 1979 paper</a> that is the third most-cited article in economics. <hr /> <figure class="align-center "><img src="https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=497&fit=crop&dpr=1 600w, https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=497&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=497&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=624&fit=crop&dpr=1 754w, https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=624&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/543635/original/file-20230821-25-mca6ku.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=624&fit=crop&dpr=3 2262w" alt="A graphic representation of loss aversion. The pain from losing a good or service will be greater than the pleasure from gaining the same good or service." /><figcaption>How economists Daniel Kahneman and Amos Tversky graphically represented loss aversion. The pain from losing a good or service is greater than the pleasure from gaining the same good or service. Daniel Kahneman and Amos Tversky, Prospect Theory: An Analysis of Decision under Risk, Econometrica, Vol. 47, No. 2</figcaption></figure> <hr /> Drip pricing exploits this tendency, by dragging us away from more “rational” choices. Imagine you’re booking tickets for a show. Initially attracted by the observed headline price, you are now presented with different seating categories. Seeing the “VIP” are within your budget, you decide to splurge. But then, during the checkout process, the drip of extra costs begins. You realise you could have opted for lower-category seats and stayed within your budget. But by this stage you’ve already changed your expectation and imagined yourself enjoying the show from those nice seats. Going back and booking cheaper seats will feel like a loss. <h2>Do consumers need protection?</h2> Empirical evidence supports the above theoretical predictions about the impact of drop pricing on consumers. <a href="https://doi.org/10.1002/mar.21426">A 2020 study</a> quantified how much consumers dislike the lack of transparency in drip pricing (based on tracking the reactions of 225 undergraduates using fictional airline and hotel-booking websites). The authors liken the practice to the “taximeter effect” – the discomfort consumers feel watching costs accumulate. But drip pricing’s effectiveness from a seller’s perspective is undeniable. A <a href="https://doi.org/10.1016/j.jebo.2020.04.007">experimental study</a> published in 2020 found drip pricing generates higher profits while lowering the “consumer surplus” (the benefit derived from buying a product or service). A <a href="https://doi.org/10.1287/mksc.2020.1261">2021 analysis</a> of data from StubHub, a US website for reselling tickets, calculated drip pricing increased revenue by 20%. Which is why the tactic remains attractive to businesses despite customers disliking it. Buyers would benefit from a ban of drip pricing. Many countries are taking steps to protect consumers from drip pricing. The UK government, for example, announced a <a href="https://www.theguardian.com/business/2023/aug/21/growth-of-airlines-add-on-fees-sparks-calls-for-price-reforms">review of drip pricing</a> in June, with Prime Minister Rishi Sunak flagging the possibility of measures to curb the practice. The US government is also considering <a href="https://www.whitehouse.gov/briefing-room/statements-releases/2023/06/15/president-biden-recognizes-actions-by-private-sector-ticketing-and-travel-companies-to-eliminate-hidden-junk-fees-and-provide-millions-of-customers-with-transparent-pricing/">new regulations</a>, with President Joe Biden denouncing “junk fees” in his <a href="https://www.whitehouse.gov/briefing-room/speeches-remarks/2023/02/07/remarks-of-president-joe-biden-state-of-the-union-address-as-prepared-for-delivery/">2023 State of the Union address</a>. Proposed changes include requiring airlines and online booking services to disclose the full ticket price upfront, inclusive of baggage and other fees. The effectiveness of measures, however, is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4430453">still being debated</a>. In the meantime, your principal protection is making a more informed decision, by understanding why the tactic works. Bargains may attract you, but you can learn to not fall for hidden costs and align your choices with your budget and values.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/211117/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/ralf-steinhauser-1459112">Ralf Steinhauser</a>, Senior Research Fellow, <a href="https://theconversation.com/institutions/australian-national-university-877">Australian National University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/junk-fees-and-drip-pricing-the-underhanded-tactics-we-hate-yet-still-fall-for-211117">original article</a>.

Money & Banking

Elton John hospitalised after fall

Elton John has been hospitalised after suffering a fall at his luxury French villa just outside of Nice on Sunday. The Rocket Man singer, 76, stayed overnight at the Princess Grace Hospital in Monaco after "slipping" in his home, as a precautionary measure. The star has since recovered and is back at home after the incident. "Elton visited the local hospital as a precautionary measure," a representative for the icon told People magazine. "Following check ups, he was immediately discharged this morning and is now back at home and in good health." This comes almost two years after the icon revealed he had a hip replacement surgery in November 2021. "I've had a hip replacement, but I'm full of beans and I'm full of zest. But this is just a prompter to say 'come on you've got more to do now,'" he told the Evening Standard at the time. "I may not look as if I'm 100 per cent fit – but I'm not quite – but I'm still raring to go and I've got a lot more work to do as far as my life goes. So this is just a reminder that there's more to do." He recently ended his <a href="https://www.oversixty.com.au/entertainment/music/elton-john-s-final-message-to-crowd-at-last-concert-ever" target="_blank" rel="noopener">final tour</a> in Stockholm, Sweden with a touching message after 52 years of performing. Image: Getty

Caring

Harrowing footage shows passengers clinging for life in falling cable car

Harrowing new footage has shown the moment 12 people were forced to hold on for dear life inside a falling cable car in Pakistan. The video footage, captured by a <a href="https://www.bbc.com/news/av/world-asia-66597447" target="_blank" rel="noopener">BBC News</a> drone, shows the terrified passengers - six children and six adults - clinging on to parts of the cable car as they dangled stranded for 12 hours. The group were travelling to a school in the cable car when a cable broke halfway through their journey high above the remote Allai valley in Pakistan’s Khyber Pakhtunkhwa province. They were more than 300 metres in the air when they became stranded. A daring rescue operation took more than 12 hours to complete, with the use of a military helicopter and several zip wire experts. <blockquote class="instagram-media" style="background: #FFF; border: 0; border-radius: 3px; box-shadow: 0 0 1px 0 rgba(0,0,0,0.5),0 1px 10px 0 rgba(0,0,0,0.15); margin: 1px; max-width: 540px; min-width: 326px; padding: 0; width: calc(100% - 2px);" data-instgrm-permalink="https://www.instagram.com/reel/CwS_rAiMksY/?utm_source=ig_embed&utm_campaign=loading" data-instgrm-version="14"> <div style="padding: 16px;"> <div style="display: flex; flex-direction: row; align-items: center;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 40px; margin-right: 14px; width: 40px;"> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 100px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 60px;"> </div> </div> </div> <div style="padding: 19% 0;"> </div> <div style="display: block; height: 50px; margin: 0 auto 12px; width: 50px;"> </div> <div style="padding-top: 8px;"> <div style="color: #3897f0; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: 550; line-height: 18px;">View this post on Instagram</div> </div> <div style="padding: 12.5% 0;"> </div> <div style="display: flex; flex-direction: row; margin-bottom: 14px; align-items: center;"> <div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(0px) translateY(7px);"> </div> <div style="background-color: #f4f4f4; height: 12.5px; transform: rotate(-45deg) translateX(3px) translateY(1px); width: 12.5px; flex-grow: 0; margin-right: 14px; margin-left: 2px;"> </div> <div style="background-color: #f4f4f4; border-radius: 50%; height: 12.5px; width: 12.5px; transform: translateX(9px) translateY(-18px);"> </div> </div> <div style="margin-left: 8px;"> <div style="background-color: #f4f4f4; border-radius: 50%; flex-grow: 0; height: 20px; width: 20px;"> </div> <div style="width: 0; height: 0; border-top: 2px solid transparent; border-left: 6px solid #f4f4f4; border-bottom: 2px solid transparent; transform: translateX(16px) translateY(-4px) rotate(30deg);"> </div> </div> <div style="margin-left: auto;"> <div style="width: 0px; border-top: 8px solid #F4F4F4; border-right: 8px solid transparent; transform: translateY(16px);"> </div> <div style="background-color: #f4f4f4; flex-grow: 0; height: 12px; width: 16px; transform: translateY(-4px);"> </div> <div style="width: 0; height: 0; border-top: 8px solid #F4F4F4; border-left: 8px solid transparent; transform: translateY(-4px) translateX(8px);"> </div> </div> </div> <div style="display: flex; flex-direction: column; flex-grow: 1; justify-content: center; margin-bottom: 24px;"> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; margin-bottom: 6px; width: 224px;"> </div> <div style="background-color: #f4f4f4; border-radius: 4px; flex-grow: 0; height: 14px; width: 144px;"> </div> </div> <p style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; line-height: 17px; margin-bottom: 0; margin-top: 8px; overflow: hidden; padding: 8px 0 7px; text-align: center; text-overflow: ellipsis; white-space: nowrap;"><a style="color: #c9c8cd; font-family: Arial,sans-serif; font-size: 14px; font-style: normal; font-weight: normal; line-height: 17px; text-decoration: none;" href="https://www.instagram.com/reel/CwS_rAiMksY/?utm_source=ig_embed&utm_campaign=loading" target="_blank" rel="noopener">A post shared by BBC News (@bbcnews)</a> </div> </blockquote> The children were rescued first, with the adults the last to be plucked free. Some of the passengers told AFP that several times they lost hope in ever being rescued, and had considered leaping from the chairlift. “Some of the children were so frustrated and were considering to jump down, but the elder passengers gave us confidence,” 15-year-old Rizwan Ullah told AFP. “When the cable car was twisting, we were terrified and we started reciting the Koran and gave confidence to each other not to jump down.” Gul Faraz, a 25-year-old shopkeeper who was in the cable car, said they had started to lose hope that they would be rescued. “During the whole process we thought we would die. There were some times when we thought we would not survive,” he said. On Twitter, now known as X, Caretaker Prime Minister Anwaar-ul-Haq Kak said he was “relieved” after the safe rescue. “Great team work by the military, rescue departments, district administration as well as the local people.” The owner of the cable car company in Khyber Pakhtunkhwa province was later arrested by police on multiple charges including negligence and endangering valuable lives. Image credits: BBC News

Travel Trouble

Surprise! Scientists find falls likely when texting and walking

It seems obvious that texting while walking is <a href="https://cosmosmagazine.com/people/behaviour/millennials-most-likely-to-text-and-drive/" target="_blank" rel="noreferrer noopener">risky</a> business. But while there has been plenty of research showing it’s a dangerous distraction, <a href="https://www.sciencedirect.com/science/article/abs/pii/S0966636217309670" target="_blank" rel="noreferrer noopener">some</a> <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179802" target="_blank" rel="noreferrer noopener">studies</a> have suggested that younger people are better at negotiating obstacles while on their phones. <div class="copy"> A study <a href="https://dx.doi.org/10.1016/j.heliyon.2023.e18366" target="_blank" rel="noreferrer noopener">published</a> in Heliyon has refuted this, finding that university students are more likely to fall if they walk while texting. It also found they’re less accurate texters while walking. “On any day it seems as many as 80% of people, both younger and older, may be head down and texting. I wondered: is this safe?” said senior author Dr Matthew Brodie, a neuroscientist and engineer at the University of New South Wales. “This has made me want to investigate the dangers of texting while walking. I wanted to know if these dangers are real or imagined and to measure the risk in a repeatable way.” Brodie and colleagues recruited 50 undergraduate students from UNSW to take part in the study. Participants walked across a specially built tiled surface, fitted with a tile that could slip out halfway through. They were asked to either walk across the surface normally, or walk across it while texting “the quick brown fox jumps over the lazy dog”. The students were strapped to safety harnesses so they couldn’t fall, and told they may or may not slip. <div style="position: relative; display: block; max-width: 100%;"> <div style="padding-top: 56.25%;"><iframe style="position: absolute; top: 0px; right: 0px; bottom: 0px; left: 0px; width: 100%; height: 100%;" src="https://players.brightcove.net/5483960636001/HJH3i8Guf_default/index.html?videoId=6332776122112" allowfullscreen="allowfullscreen"></iframe></div> </div> The methods used in the experiment. Credit: Heliyon Brodie et al. “What surprised me is how differently people responded to the threat of slipping,” says Brodie. “Some slowed down and took a more cautious approach. Others sped up in anticipation of slipping. Such different approaches reinforce how no two people are the same, and to better prevent accidents from texting while walking, multiple strategies may be needed.” The researchers recorded motion data from the students as they moved and slipped, analysing how stable they were. They found that texting while walking made the students significantly less stable. Specifically, the students “trunk angle” – the angle of their torsos – varied more when they were slipping while texting. This means they were less stable. Participants were also less accurate texters when they did it while walking as opposed to sitting down, and least accurate when they did slip over. “Pedestrians should therefore be discouraged through new educational and technology-based initiatives (for example a ‘texting lock’ on detection of walking) from texting while walking on roadside footpaths and other environments where substantial hazards to safety exist,” conclude the researchers in their paper. Image credits: Shutterstock <a href="https://cosmosmagazine.com/health/body-and-mind/texting-walking-falls/">This article</a> was originally published on <a href="https://cosmosmagazine.com">Cosmos Magazine</a> and was written by <a href="https://cosmosmagazine.com/contributor/ellen-phiddian/">Ellen Phiddian</a>. </div>

Body

Why do I fall asleep on the sofa but am wide awake when I get to bed?

<a href="https://theconversation.com/profiles/madeline-sprajcer-1315489">Madeline Sprajcer</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> and <a href="https://theconversation.com/profiles/sally-ferguson-64">Sally Ferguson</a>, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> After a long day, you flop onto the sofa and find yourself dozing off while watching TV. The room is nice and warm, the sofa is comfortable, and the background noise of the TV lulls you to sleep. Then a loved one nudges you awake and reminds you to go sleep – in bed. But when you get there, you find to your frustration that you’re wide awake. Why does sleep come so easily on the sofa but not always in bed? <h2>Why is it so easy to fall asleep on the sofa?</h2> <a href="https://www.sleepfoundation.org/circadian-rhythm/sleep-drive-and-your-body-clock#:%7E:text=Sleep%2Fwake%20homeostasis%20balances%20our,that%20it's%20time%20to%20sleep.">Sleep pressure</a> is one reason why you fall asleep on the sofa. This refers to the strength of the biological drive for sleep. The longer you’ve been awake, the greater the sleep pressure. Your body clock or <a href="https://www.thensf.org/what-is-a-circadian-rhythm/">circadian rhythm</a> is another factor. This tells you to be awake during the day and to sleep at night. Your environment will also impact how likely it is you fall asleep. You might have just <a href="https://theconversation.com/health-check-food-comas-or-why-eating-sometimes-makes-you-sleepy-44355">eaten a meal</a>, your very comfortable sofa is in a warm room, with dim lighting and maybe a TV program in the background. For many people, this environment is perfect for falling asleep. So by the end of the day, sleep pressure is strong, your circadian rhythm is telling you it’s time for sleep and your environment is cosy and comfortable. <h2>What happens after a nap on the sofa?</h2> If you’ve had a nap on the sofa before heading to bed, your sleep pressure is likely much lower than it was before your nap. Instead of having more than 16 hours of wakefulness behind you, you’ve just woken up and therefore have less sleep pressure. This can make it much harder to fall asleep in bed. If you just fell asleep on the sofa for five minutes, you might not have too much trouble getting to sleep in bed. This is because a nap that short is unlikely to reduce your sleep pressure very much. But if you were asleep for an hour, it might be a different story. Your sleep cycles might also be working against you. Most sleep cycles are about <a href="https://www.researchgate.net/profile/Mary-Carskadon/publication/287231408_Normal_Human_Sleep_An_Overview_Principles_and_Practice_of_Sleep_Medicine_MH_Kryger_Ed/links/5db0c338299bf111d4c026c5/Normal-Human-Sleep-An-Overview-Principles-and-Practice-of-Sleep-Medicine-MH-Kryger-Ed.pdf">90 minutes long</a>. They start with light sleep, progress to deep sleep, and then end with light sleep again. If you wake up during deep sleep, you’re probably going to feel groggy – and it might be easy to get back to sleep when you go to bed. But if you wake up during light sleep it could be harder to fall asleep again in bed. The activities you might do when you get up from the sofa – like turning on bright lights or brushing your teeth – can also make you feel more alert and make it harder to sleep when you get to bed. <h2>Why can’t I fall asleep in my own bed?</h2> There are other reasons why falling also in your bed could be challenging. Many people experience anxiety about falling asleep. They <a href="https://pubmed.ncbi.nlm.nih.gov/24005330/">worry</a> about getting enough sleep or falling asleep fast enough. In such cases, getting into bed can be associated with feelings of stress and apprehension, which make it even harder to sleep. It might be easier to fall asleep on the couch, where there is less stress involved. It might also be harder to fall asleep in bed because of poor <a href="https://www.sleepfoundation.org/sleep-hygiene">sleep hygiene</a>. This refers to your pre-sleep behaviours and sleep environment. Good sleep hygiene, or healthy sleep habits, includes having a regular routine before bed, a dark, quiet room to sleep in, and not using your mobile phone in bed. For many people who don’t have good sleep hygiene, their behaviours before bed and their bedroom environment might not be conducive to sleep. <h2>How can I make it easier to fall asleep in bed?</h2> First, make sure your room is dark, quiet and comfortable. In winter this might mean putting a heater on 20 minutes before you go to bed or taking a heat pack to bed with you. In summer, you might consider air conditioning or a fan to make your bedroom comfortable for sleeping. If you find it easy to fall asleep with the TV on, you might like to play “<a href="https://www.youtube.com/watch?v=2iL1Ce1PZFM&t=1s">white noise</a>” in your bedroom as you fall asleep. Some evidence suggests this may make it <a href="https://www.sciencedirect.com/science/article/pii/S1087079220301283#abs0010">easier to fall asleep</a> by masking other disruptive noises. Your behaviour before bed also impacts how easy it is to fall asleep. Making sure you follow the same bedtime routine every night (including going to bed at the same time) can help. Also, even though it’s hard, try not to look at your phone while you’re in bed. Scrolling on your phone before bed can make it <a href="https://ieeexplore.ieee.org/document/8329667">harder to sleep</a> due to both exposure to blue light and the potentially stressful or alerting effect of the content you interact with. <h2>In a nutshell</h2> The best way to make it’s easier to fall asleep in your bed is to avoid falling asleep on the sofa in the first place. This will ensure all the sleep pressure you build up during the day will be directed towards a deep sleep in your bed.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/208371/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/madeline-sprajcer-1315489">Madeline Sprajcer</a>, Lecturer in Psychology, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> and <a href="https://theconversation.com/profiles/sally-ferguson-64">Sally Ferguson</a>, Director, Appleton Institute, <a href="https://theconversation.com/institutions/cquniversity-australia-2140">CQUniversity Australia</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/why-do-i-fall-asleep-on-the-sofa-but-am-wide-awake-when-i-get-to-bed-208371">original article</a>.

Body

Bruce Springsteen falls on stage leaving fans stunned

With a spring in his step the rock ‘n’ roll icon, who was confidently heading up the stairs at the Johan Cruyff Arena in Amsterdam, fell on stage after missing the last step. The crowd was left stunned as they all gasped in concern. The trip had caused the singer to lay on his back for a moment, guitar still attached to him, before his bandmates rushed over to help him up. The star laughed it off and proved that he is tougher than the rest as he jokingly shouted "Goodnight everybody,” to the roaring crowd. The incident occurred at the May 27 show, as he and the E Street Band were prepping to sing a rendition of their hit song, Ghosts. Springsteen isn’t said to be injured from the fall and continued to perform after having his guitar handed back to him. Images: TikTok

Music

Over 60

News

Shop

Catalogues

Travel

Health

Lifestyle

Finance

Entertainment

Property

Information

Keep up to date

Search

Balance declines with age, but exercise can help stave off some of the risk of falling

Young woman dies after horror cruise fall

Twelve-year-old boy falls to his death on cruise

Sir Ian McKellen shares health update after fall

Long COVID puzzle pieces are falling into place – the picture is unsettling

Horrifying moment wheel falls off plane during take-off

Sir Ian McKellen rushed to hospital

Teen actress' parents share update after five-storey fall

Another man dies after fall from world's biggest cruise ship

5 ways to avoid going overboard on a cruise

How to fall asleep without sleeping pills: 7 natural sleep aids that actually work

The rise and fall of antibiotics. What would a post-antibiotic world look like?

1 in 6 older adults fall victim to impersonation scams

Home and Away star shares shocking injury

Junk fees and drip pricing: the underhanded tactics we hate yet still fall for

Elton John hospitalised after fall

Harrowing footage shows passengers clinging for life in falling cable car

Surprise! Scientists find falls likely when texting and walking

Why do I fall asleep on the sofa but am wide awake when I get to bed?

Bruce Springsteen falls on stage leaving fans stunned