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a legitimate customer service number. Be wary of romantic relationships in which the person of interest requests money and/or is unavailable to meet in person. Fake lottery scam Victims are told they are the recipients of contest winnings or a celebrity give‐away. Victims are asked to pay a fee and/or disclose private information (such as account numbers) in order to receive their winnings. Victims may be asked to forward a portion of their winnings to another account (similar to the fake‐check scam). In the US, it is illegal to require additional fees to collect winnings after a lottery ticket is purchased. Follow the same guidance as for the fake check scam.

       Consider freezing credit and/or obtaining a credit monitoring service.

       Consider granting banking account access to a spouse, adult child, or other trusted family member, to monitor accounts for suspicious activity.

       Never provide private information (including insurance numbers) to strangers.

       Never send money to strangers. Wire transfers and gift cards are preferred currency for scammers because the money is difficult to get back.

       Carefully review bills, explanations of benefits, and other financial documents to confirm that all charges and prices match expectations.

       Review website URLs and email domains carefully. Scammers use ‘spoofing techniques’, such as URLs that closely match a well‐known company but differ by a single letter.

       Be wary of high‐pressure sales techniques or solicitations from charities.

       Be wary of threats of immediate legal action, extortion, or dire consequences.

       Offers that seem too good to be true usually are. Work‐from‐home jobs that offer a high salary in exchange for minimal skills/labour, unsolicited contest winnings, overpayments, etc., are almost always scams.

Anti‐ageing medications are another type of fraud that deserves special consideration. Pseudoscientific claims of agents that will ‘reverse the ageing process’ or ‘prevent dementia’ are advertised online, on television, and in printed media. Many of these claims are based on questionable studies demonstrating minimal benefit. Other claims are based on hypotheses with some biologic basis but no proven results, which are then misrepresented in the mainstream media. Still other claims seem to have no scientific basis at all. Although emerging technologies such as stem cells, agents targeting telomerase, and other new innovations may one day impact the ageing process, claims of ‘anti‐ageing’ agents should be treated with the utmost scepticism by providers and patients alike.

      Natural disasters

      Disasters can be environmental (hurricanes, monsoons, tornados, etc.) or anthropogenic (gun violence, terrorism, etc.). Rising global temperatures and climate change are predicted to increase both the frequency and severity of natural disasters. In times of disaster, older adults are considered a vulnerable population. Limitations to mobility and cognition may limit older adults’ abilities to evacuate quickly. Impaired hearing and cognition place older adults at risk to miss warning sirens or issued directives. Chronic illnesses make many older adults vulnerable to physiologic stressors such as extreme temperatures or reduced food supply. Medical equipment may depend on power supplies, and medications may require refrigeration, making power outages life‐threatening. Global studies have demonstrated that older adults are disproportionately affected in times of natural disasters, and as many as one‐third of older adults experience worsening of their medical conditions during disasters.

      In addition to large‐scale disasters, deaths from fires are common in older people. People living in mobile homes or old homes with faulty electrical systems are at particular risk. Smoking and excessive alcohol use are also associated with fires. Deaths from carbon monoxide is another significant public health concern. An estimated 400 people in the US die from carbon monoxide poisoning annually, with thousands more seeking medical care from unintentional exposure.⁴⁸ Carbon monoxide poisoning is most common during winter months or following large‐scale power outages, due to inappropriate fuel‐burning in unventilated spaces. All older adults should be counselled to keep smoke and carbon monoxide detectors in their home and replace batteries per the manufacturer’s recommendations.

Data from the Health and Retirement Study demonstrated that only one‐third of older adults had read materials or participated in an educational programme on disaster preparedness. Fewer than 10% reported receiving any counselling on disaster preparedness from a healthcare provider. Increasing age, lower level of education, and decreased income were all associated with lower levels of disaster preparedness.⁴⁹ All older adults should be counselled on disaster preparedness. They should have a disaster care plan and emergency kit readily available. An example disaster care plan is provided in Table 4.4. Components of an emergency kit can be found on the Federal Emergency Management Agency (FEMA) website (www.FEMA.gov).

Table 4.4 Care plan for emergencies: record the answers and keep them in a secure location.

      Source: Based on FEMA (2018), ‘Prepare for emergencies now: information for older Americans’.

Who will you call in the event of an emergency? Name, relationship, and phone number.

In the event of power loss:Do you have any medical equipment that requires an electric supply? If so, what is the plan for a power outage? Batteries, access to a generator, etc.? Consult the manufacturer if additional information is needed.Do you have medications that require refrigeration? If so, what is the plan for a power outage? Generator, cooler and ice packs, etc.?What will you do during a heatwave? Locations you can go with air conditioning? Do you have access to battery‐powered fans?

Where will you go if ordered to evacuate? Where is the location of the nearest shelter? Does it accept pets (if applicable)? Do you know the hurricane/monsoon evacuation route (if applicable)?

If needed, can you physically evacuate the premises where you live? If yes, do you have reliable transportation? If no, who will assist you during evacuation if needed? Note – many local governments allow you to register as a person with a disability, so you will receive priority emergency care.

If applicable, where will you shelter in the event of a tornado?

If you are deaf, have a speech impairment, or speak limited English, how will you communicate with emergency providers? Consider keeping pen and paper and/or a laminated card with medical information with your emergency kit.

If you use specialized medical equipment, have you shown other caregivers how to operate in the event you become incapacitated or need extra assistance? Do you have directions readily available?

If you utilize a meal‐delivery service, what will you eat in the event services are interrupted?

Do you have an emergency kit? Where is it stored? Can you easily access and lift it in the event of a sudden emergency?

      Key points

       The population is ageing, both absolutely and relatively.

       The traditional gender gap of females outnumbering males in older age will lessen but not disappear in the coming decades.

       There are trends towards more assertiveness, a higher likelihood of living independently, and greater technology use in older adults.

       Providers

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