In the 21st century, digital technology has changed many aspects of our lives. Generative artificial intelligence (AI) is the latest newcomer, with chatbots and other AI tools changing how we learn and creating considerable philosophical and legal challenges regarding what it means to “outsource thinking”.

But the emergence of technology that changes the way we live is not a new issue. The change from analogue to digital technology began around the 1960s and this “digital revolution” is what brought us the internet. An entire generation of people who lived and worked through this evolution are now entering their early 80s.

So what can we learn from them about the impact of technology on the ageing brain? A comprehensive new study from researchers at the University of Texas and Baylor University in the United States provides important answers.

Published today in Nature Human Behaviour, it found no supporting evidence for the “digital dementia” hypothesis. In fact, it found the use of computers, smartphones and the internet among people over 50 might actually be associated with lower rates of cognitive decline.

What is ‘digital dementia’?

Much has been written about the potential negative impact from technology on the human brain.

According to the “digital dementia” hypothesis introduced by German neuroscientist and psychiatrist Manfred Spitzer in 2012, increased use of digital devices has resulted in an over-reliance on technology. In turn, this has weakened our overall cognitive ability.

Three areas of concern regarding the use of technology have previously been noted:

1. An increase in passive screen time. This refers to technology use which does not require significant thought or participation, such as watching TV or scrolling social media.

2. Offloading cognitive abilities to technology, such as no longer memorising phone numbers because they are kept in our contact list.

3. Increased susceptibility to distraction.

Why is this new study important?

We know technology can impact how our brain develops. But the effect of technology on how our brain ages is less understood.

This new study by neuropsychologists Jared Benge and Michael Scullin is important because it examines the impact of technology on older people who have experienced significant changes in the way they use technology across their life.

The new study performed what is known as a meta-analysis where the results of many previous studies are combined. The authors searched for studies examining technology use in people aged over 50 and examined the association with cognitive decline or dementia. They found 57 studies which included data from more than 411,000 adults. The included studies measured cognitive decline based on lower performance on cognitive tests or a diagnosis of dementia.

A reduced risk of cognitive decline

Overall, the study found greater use of technology was associated with a reduced risk of cognitive decline. Statistical tests were used to determine the “odds” of having cognitive decline based on exposure to technology. An odds ratio under 1 indicates a reduced risk from exposure and the combined odds ratio in this study was 0.42. This means higher use of technology was associated with a 58% risk reduction for cognitive decline.

This benefit was found even when the effect of other things known to contribute to cognitive decline, such as socioeconomic status and other health factors, were accounted for.

Interestingly, the magnitude of the effect of technology use on brain function found in this study was similar or stronger than other known protective factors, such as physical activity (approximately a 35% risk reduction), or maintaining a healthy blood pressure (approximately a 13% risk reduction).

However, it is important to understand that there are far more studies conducted over many years examining the benefits of managing blood pressure and increasing physical activty, and the mechanisms through which they help protect our brains are far more understood.

It is also a lot easier to measure blood pressure than it is use of technology. A strength of this study is that it considered these difficulties by focusing on certain aspects of technology use but excluded others such as brain training games.

These findings are encouraging. But we still can’t say technology use causes better cognitive function. More research is needed to see if these findings are replicated in different groups of people (especially those from low and middle income countries) who were underrepresented in this study, and to understand why this relationship might occur.

A question of ‘how’ we use technology

In reality, it’s simply not feasible to live in the world today without using some form of technology. Everything from paying bills to booking our next holiday is now almost completely done online. Maybe we should instead be thinking about how we use technology.

Cognitively stimulating activities such as reading, learning a new language and playing music – particularly in early adulthood – can help protect our brains as we age.

Greater engagement with technology across our lifespan may be a form of stimulating our memory and thinking, as we adapt to new software updates or learn how to use a new smartphone. It has been suggested this “technological reserve” may be good for our brains.

Technology may also help us to stay socially connected, and help us stay independent for longer.

A rapidly changing digital world

While findings from this study show it’s unlikely all digital technology is bad for us, the way we interact and rely on it is rapidly changing

The impact of AI on the ageing brain will only become evident in future decades. However, our ability to adapt to historical technological innovations, and the potential for this to support cognitive function, suggests the future may not be all bad.

For example, advances in brain-computer interfaces offer new hope for those experiencing the impact of neurological disease or disability.

However, the potential downsides of technology are real, particularly for younger people, including poor mental health. Future research will help determine how we can capture the benefits of technology while limiting the potential for harm.

Nikki-Anne Wilson, Postdoctoral Research Fellow, Neuroscience Research Australia (NeuRA), UNSW Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Seeing a medical specialist can leave you with significant out-of-pocket costs. Yet political parties have not adequately addressed this in their pre-election bids.

Labor has promised A$7 million to expand the government’s Medical Costs Finder website, which potentially allows you to compare specialists’ fees. But it hasn’t outlined a policy to lower these fees. The Coalition and the Greens have not addressed specialists’ fees directly.

During a cost-of-living crisis, this is a major omission.

Specialists’ fees are high, vary across specialties and across geographical regions.

That’s what we found when we used actual Medicare data to map costs across Australia to see a specialist doctor.

What we did and what we found

We used data from the national 2023 Medicare Benefits Schedule (or MBS) accessed from the Australian Bureau of Statistics. We calculated mean (average) fees charged by doctors in 17 specialties for initial face-to-face appointments after a GP referral.

Under MBS billing rules, different specialties use different item numbers (104 or 110) for an initial consultation. These attracted a different Medicare schedule fee ($91.80 and $161.90, respectively, as of January 2023). These schedule fees are what Medicare considers a fair price for doctors to charge.

Most patients pay the gap between 85% of the Medicare schedule fee and the specialist’s fee. This is their out-of-pocket cost. But that percentage can differ, depending on the circumstances. So not all patients have the same out-of-pocket costs for the same consultation.

We only looked at fees charged by private specialists at private clinics. We didn’t include free specialist care in public clinics. Nor did we look at GP fees.

We then looked at how specialists’ fees varied by patients’ geographical location to create some maps.

Use the map below to search for mean specialists’ fees and mean out-of-pocket costs for cardiology, rheumatology, neurology, and oral and maxillofacial surgery.

Fees for the other 13 specialties we looked at are available via maps on the HALE Hub’s Australian Healthcare Atlas website.

Which specialists charged the most?

Specialist fees varied substantially. On average, rheumatology had the highest fees, followed by neurology and immunology. Oral and maxillofacial surgery had the lowest fees, followed by general surgery.

Some specialties used the item number that attracted the $91.80 Medicare schedule fee. But almost all these specialists (except for general surgery) charged more than twice this amount (an average $183.60) in at least 80% of geographical areas.

Other specialties used the item number that attracted the $161.90 Medicare schedule fee. This included rheumatologists, which charged an average of over $323.80 (twice the schedule fee) in 17.6% of geographical areas. Neurologists charged the same amount in 19.2% of geographical areas.

Which parts of the country had the highest fees?

Certain states and territories consistently had higher fees for some specialties. For example:

• cardiology was most expensive in Western Australia, Australian Capital Territory and Queensland

• orthopaedics was most expensive in ACT, New South Wales and Queensland

• obstetrics was most expensive in ACT, WA and NSW.

High fees matter

Higher specialists’ fees directly translate to patients’ higher out-of-pocket costs. That’s because Medicare rebates are fixed, and private health insurance does not cover out-of-hospital consultations.

If patients avoid their initial consultation due to cost, their health can worsen over time, potentially leading to more expensive treatments later.

Higher specialists’ fees and the barrier to care could also entrench inequalities. That’s because people in lower socioeconomic groups already tend to have worse health.

What can I do?

You can use our maps to look at what specialists charge near you. Although the maps use 2023 data and look at average fees and out-of-pocket costs, you can get a general idea. Then you can call specialists’ offices and the receptionist will tell you how much the doctor charges for an initial appointment.

If there are several referral options, comparing fees will help you make an informed decision about your health care, alongside wait times, geographical location, quality of care and other factors. You can discuss these issues with your GP so they can refer you to the best available specialist for your circumstances.

What else can we do?

1. Make fees transparent

Patients often do not know how much a specialist consultation costs until they arrive at the doctor’s office. GPs typically do not refer to specialists based on their fees and often don’t know them anyway.

The government’s Medical Costs Finder website relies on doctors voluntarily reporting their fees. But only a few report them.

If re-elected, the Labor government says it will upgrade the website to display the average fee charged by every eligible specialist (other than GPs) using Medicare data, without asking doctors to spend time inputting their fees.

This is a welcome move. But the government should also mandate disclosure of fees on the website, which would be more up-to-date than looking back through past Medicare data.

2. Doctors need more advice, and can help

Specialists in Australia can charge what they like, and as we’ve found, sometimes way above the Medicare schedule fee.

But professional medical colleges can provide guides on how to set “reasonable” fees. They can also develop codes of conduct about fee practices, and counsel members who consistently charge high fees.

Once specialists’ fees are more transparent, GPs can inform patients about fee variations and options for more affordable care.

3. We need more public clinics

Government could also open more public clinics that offer free specialist care for those who cannot afford large gap fees in private clinics. This type of investment may be warranted in some low-socioeconomic areas if we’re aiming for all Australians to receive the specialist care they need.

Yuting Zhang, Professor of Health Economics, The University of Melbourne and Chenhao Liang, Foundation Fellow and Data Analyst, Melbourne Institute of Applied Economic and Social Research, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.