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These Preventive Measures Might Help Delay Dementia Or Cognitive Decline

In a landmark report, scientists have endorsed three strategies for preventing dementia and cognitive decline associated with normal aging — being physically active, engaging in cognitive training and controlling high blood pressure.

This is the first time experts convened by the National Academies of Sciences, Engineering and Medicine have deemed scientific evidence strong enough to suggest that preventing dementia and age-related cognitive decline might be possible.

Seven years ago, in a separate report issued by the Agency for Healthcare Research and Quality, scientists said they couldn’t recommend any interventions to forestall or slow cognitive deterioration because state-of-the-art science at that time didn’t offer enough support.

Now there’s a considerably larger body of research to draw upon. And while findings are still far from definitive, “we found encouraging evidence that supports the value of several interventions,” said Story Landis, vice chair of the 17-member panel that prepared the report and director emeritus of the National Institute of Neurological Disorders and Stroke.

That doesn’t mean the strategies are guaranteed to protect brain health. “You can do everything right and still get dementia in later life,” said Dr. Kenneth Langa, a panel member and professor of internal medicine, gerontology and health management and policy at the University of Michigan School of Public Health.

Nor does it mean these are the only interventions that offer promise. Managing depression, controlling diabetes and high cholesterol, engaging in social activities, getting adequate sleep, eating a healthful diet, taking disease-modifying treatments for dementia (if and when they become available) and getting enough vitamin B12 and folic acid also appear worthwhile, though more research is needed before those tactics can be formally recommended, the NAS report said.

Addressing lifestyle factors that raise the risk of cognitive impairment could help prevent more than one-third of dementia cases across the globe, according to a separate comprehensive analysis published in The Lancet on Thursday.

The NAS panel proposed that its findings be shared with the public and physicians, but stopped short of proposing a major public health campaign, citing the need for further research.

Here are insights from the report, based on interviews with panel members and outside experts:

Strategies Work In Some Cases, Not Others

As people age, mental processing becomes slower and memory becomes less reliable — a normal condition known as age-related cognitive decline.

Two of the interventions recommended in the NAS report — cognitive training and physical activity — appear to have the potential to delay age-related cognitive decline. But there’s no evidence that they can prevent dementia or mild cognitive impairment, an intermediate condition that sometimes progresses to dementia.

Managing high blood pressure is the only strategy thought to have the potential to prevent or delay the onset of Alzheimer’s disease. But it wasn’t shown to have an impact on age-related cognitive decline.

Once the hallmarks of Alzheimer’s are detected — notably amyloid beta plaques and tau tangles in the brain — some interventions might not be effective, said Dr. Ronald Petersen, a member of the NAS panel and director of the Mayo Clinic’s Alzheimer’s Disease Research Center.

Start Early

It’s now known that biological changes associated with Alzheimer’s and related dementias begin a decade or more before any symptoms become evident. So it’s best to make recommended lifestyle changes early and sustain them over time.

“Prevention really needs to start in people who don’t show any sign of the disease — probably when people reach their 40s,” said Jeffrey Keller, director of the Institute for Dementia Research and Prevention at Louisiana State University, who was not involved in the NAS study.

Controlling high blood pressure, a strategy that helps preserve the health of blood vessels in the brain, is most effective if begun in middle age, the NAS report explained. But if you’ve reached age 65 and your blood pressure isn’t well managed, you’re still well advised to bring it under control, Landis said.

The same applies to physical activity: It’s best if you start in middle age, but becoming more active in later life is still good for your health. While it’s not yet known which type of activity is most effective, for what duration and how often it should be pursued for maximum brain benefit, walking briskly for 150 minutes a week or about 20 minutes a day is a good idea, Petersen said.

On Cognitive Training

Probably the best cognitive training you can get is a good education and ongoing mental stimulation. “There’s growing evidence that the ways in which your brain is challenged all through your life matter,” noted Langa, whose research has documented a decline in dementia rates in high-income countries over the past 25 years.

But the impact of education on brain health is very difficult to quantify. So the NAS panel endorsed cognitive training based largely on a randomized controlled trial known as Advanced Cognitive Training for Independent and Vital Elderly, which studied several thousand older adults over the course of 10 years.

ACTIVE had certified trainers work with seniors in small group sessions on various cognitive exercises for 10 sessions lasting an hour or more over five to six weeks. Feedback was an essential part of the intervention and booster sessions were offered. At 10 years, there was evidence of a positive effect on seniors’ independence and ability to perform daily tasks.

What was responsible for this effect? The training? Social interactions? Feedback? Booster sessions? All or some of the above? It’s not yet clear.

It’s important to note that the panel insisted that commercially sold computer-based brain games can’t be assumed to have the same effect. So far, research about brain games has failed to prove that this type of training improves broad-based cognitive functioning and people’s ability to function independently.

“The data supporting their efficacy just isn’t there,” said Petersen of the Mayo Clinic.

Try Several Things, Not Just One

When scientists examine the brains of people with Alzheimer’s disease, they find amyloid beta plaques and tangles, but also changes in blood vessels, evidence of microbleeds, and lesions in the brain’s white matter. “It’s mixed dementia, due to multiple factors — not just one thing,” Landis said.

The corollary: Mix it up and try several ways to reduce age-related cognitive decline or dementia, not just one.

“If we think of Alzheimer’s as a multifactorial disease, it makes sense to reduce multiple risk factors simultaneously,” said Rong Zhang, associate professor of neurology and neurotherapeutics at University of Texas Southwestern Medical Center. Zhang is also the principal investigator for a five-year study investigating whether aerobic exercise combined with intensive control of hypertension and cholesterol can help prevent Alzheimer’s. That study, the Risk Reduction for Alzheimer’s Disease trial, is currently enrolling participants at six medical centers.

“The brain is complicated and its response to interventions is complex,” Langa said. “Therefore, the more strategies that you use to try to improve the brain’s health long term, the more likely they’re going to work.”

Don’t Bother

The NAS report found no evidence supporting the use of ginkgo biloba and vitamin E, which are widely marketed to people concerned about brain health. And it questioned the value of other supplements, noting that overall dietary patterns appear more important than any single substance.

KHN’s coverage related to aging & improving care of older adults is supported by The John A. Hartford Foundation.

The Elderly and Falls

The older you get the harder you fall might be a misquote from the old adage, but has some truth to it. For those aged 65 and older, falls are among the leading cause of death due to injury and it is estimated that in the United States, one out of every three adults 66 years or older falls each year.

Unfortunately, research published in the American Journal of Preventative Medicine found that 60 percent of fatal falls for older adults 65 and older occur at home, 30 percent happen in public places and 10 percent occur in health care institutions. Unfortunately, many falls cannot be foreseen or prevented but there are some risk factors that can be controlled.

Risk Factors
Environmental factors, including slippery surfaces, poor lighting, steps and loose rugs
Use of equipment, such as a cane or walker
Non-adherence to safety practices
Gait and balance impairments
Visual impairment
Physical conditions, such as stroke, arthritis, muscle weakness, glaucoma, cataracts, hearing loss or foot problems
Age
Fall history and fall related injury
Neurological disabilities, including Parkinson’s disease or stroke
Cognitive impairment and/or behaviors
Medication use, side effects, multiple medications or psychotropic utilization

While caretakers cannot necessarily prevent an elderly adult’s fall, they can work to minimize the risk as well as increase the response time of medical assistance should a fall occur. The most common fractures from a fall include pelvis, hip, femur, vertebrae, hand, forearm and ankle.

In addition to the stress and pain, the elderly who have taken a fall are also at a greater risk of complications such as pressure sores resulting from immobility as well as decreased appetite, infections, respiratory issues, pneumonia and incontinence.

So what can you do if your aging loved one does experience a bad fall? Develop a care plan that takes into account your loved one’s age, medical history, risk factors for falling again, mental health, functional abilities, expectations and willingness to follow the plan. Determine whether recovery and rehabilitation should occur in home or in a care facility and work with doctors, physical therapists, occupational therapists and other care givers on developing and following exercise, restorative and/or physical activity programs.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.

How To Help Alzheimer’s Patients Enjoy Life, Not Just ‘Fade Away’

Alzheimer’s disease has an unusual distinction: It’s the illness that Americans fear most — more than cancer, stroke or heart disease.

The rhetoric surrounding Alzheimer’s reflects this. People “fade away” and are tragically “robbed of their identities” as this incurable condition progresses, we’re told time and again.

Yet, a sizable body of research suggests this Alzheimer’s narrative is mistaken. It finds that people with Alzheimer’s and other types of dementia retain a sense of self and have a positive quality of life, overall, until the illness’s final stages.

They appreciate relationships. They’re energized by meaningful activities and value opportunities to express themselves. And they enjoy feeling at home in their surroundings.

“Do our abilities change? Yes. But inside we’re the same people,” said John Sandblom, 57, of Ankeny, Iowa, who was diagnosed with Alzheimer’s seven years ago.

Dr. Peter Rabins, a psychiatrist and co-author of “The 36-Hour Day,” a guide for Alzheimer patients’ families, summarized research findings this way: “Overall, about one-quarter of people with dementia report a negative quality of life, although that number is higher in people with severe disease.”

“I’ve learned something from this,” admitted Rabins, a professor at the University of Maryland. “I’m among the people who would have thought, ‘If anything happens to my memory, my ability to think, I can’t imagine anything worse.’

“But I’ve seen that you can be a wonderful grandparent and not remember the name of the grandchild you adore. You can be with people you love and enjoy them, even if you’re not following the whole conversation.”

The implication: Promoting well-being is both possible and desirable in people with dementia, even as people struggle with memory loss, slower cognitive processing, distractibility and other symptoms.

“There are many things that caregivers, families and friends can do — right now — to improve people’s lives,” said Dr. Allen Power, author of “Dementia Beyond Disease: Enhancing Well-Being” and chair for aging and dementia innovation at the Schlegel-University of Waterloo Research Institute for Aging in Canada.

Of course, the final stages of Alzheimer’s disease and other types of dementia are enormously difficult, and resources to help caregivers are scarce — problems that shouldn’t be underestimated.

Still, up to 80 percent of people with dementia are in the mild and moderate stages. Here are some elements of their quality of life that should be attended to:

Focus On Health

One notable study analyzed lengthy discussions between people with dementia, caregivers and professionals at six meetings of Alzheimer’s Disease International, an association of Alzheimer’s societies across the world.

Those discussions emphasized the importance of physical health: being free from pain, well-fed, physically active and well-groomed, having continence needs met, being equipped with glasses and hearing aids and not being overmedicated. Cognitive health was also a priority. People wanted “cognitive rehabilitation” to help them learn practical techniques for promoting memory or compensating for memory loss.

Up to 40 percent of people with Alzheimer’s disease suffer from significant depression, and research by Rabins and colleagues underscores the importance of evaluating and offering treatment to someone who appears sad, apathetic and altogether disinterested in life.

Foster Social Connections

Being connected with and involved with other people is a high priority for people with dementia. Based on research conducted over several decades, Rabins listed social interaction as one of the five essential elements of a positive quality of life.

But fear, discomfort and misunderstanding routinely disrupt relationships once a diagnosis is revealed.

“The saddest thing that I hear, almost without exception, from people all over the world is that family, friends and acquaintances desert them,” said Sandblom, who runs a weekly online support group for Dementia Alliance International, an organization for people with dementia that he co-founded in January 2014.

Adapt Communication

Not knowing how to communicate with someone with dementia is a common problem.

Laura Gitlin, a dementia researcher and director of The Center for Innovative Care in Aging at Johns Hopkins School of Nursing, offered these suggestions in an article in the International Encyclopedia of Rehabilitation: Speak slowly, simply and calmly, make one or two points at a time, allow someone sufficient time to respond, avoid the use of negative words, don’t argue, eliminate noise and distraction, make eye contact but don’t stare, and express affection by smiling, holding hands or giving a hug.

Also, understand that people with dementia perceive things differently.

“You have to understand that when you have dementia you lose a lot of your natural perceptions of what others are doing,” Sandblom said. “So, a lot of us get a little nervous or suspicious. I think that’s a natural human reaction to knowing that you’re not picking up on things very well.”

Address Unmet Needs

Needs that aren’t recognized or addressed can cause significant distress and a lower quality of life. Rather than treat the distress, Power suggested, try to understand the underlying cause and do something about it.

Which needs are commonly unmet? In a study published in 2013, Rabins and colleagues identified several: managing patients’ risk of falling (unmet almost 75 percent of the time); addressing health and medical concerns (unmet, 63 percent); engaging people in meaningful activities (53 percent); and evaluating homes so that they’re safe and made easier to navigate (45 percent).

Respect Autonomy And Individuality

Rabins called this “awareness of self” and listed it among the essential components of a positive quality of life. Sandblom called this “being seen as a whole person, not as my disease.”

At the Alzheimer’s Disease International meetings, people spoke of being listened to, valued and given choices that allowed them to express themselves. They said they wanted to be respected and have their spirituality recognized, not patronized, demeaned or infantilized.

In a review of 11 studies that asked people with dementia what was important to them, they said they wanted to experience autonomy and independence, feel accepted and understood, and not be overly identified with their illness.

None of this is easy. But strategies for understanding what people with dementia experience and addressing their needs can be taught. This should become a priority, Rabins said, adding that “improved quality of life should be a primary outcome of all dementia treatments.”

By Judith Graham | California Healthline. This story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.

Make New Friends But Keep the Old

One is silver and the other gold

The old Girl Scout song may be more true than you knew as recent research has shown that a variety of social isolation elements may “pose health risks, including living alone, having a small social network, infrequent participation in social activities, and feelings of loneliness” for adults, particularly older adults.

Luckily, there are some simple solutions that may have immediate health benefits, such as spending time with family and friends as well as making new friends. A New York Times headline event went so far as to claim, “Study Shows The More You Hang Out With Your Mom, The Longer She’ll Live – Make sure you call grandma over for dinner tonight.”

According to the NYT article, University of California, San Francisco researchers discovered that loneliness is a factor in the decline that often associated with old age. Controlling for socioeconomic status and health, the study followed 1,600 adults (with an average age of 71) and found the lonely consistently had higher mortality rates. In fact, “nearly 23 percent of lonely participants died within six years of the study, as opposed to only 14 percent of those that reported adequate companionship.”

The need to have people who know and value us never goes away and as we age, we tend to be more tolerant of our friends’ imperfections and idiosyncrasies. The rashness of a hotheaded youth often mellows as the years go by, bringing awareness of what’s worth fighting (or not) over. That patience and experience may carry over when spending quality time with their grandchildren, though the symbiotic relationship benefits everyone. The parents can take a bit of a break from the daily demands from their kids, the grandparents receive companionship, conversation and a sense of value, while the children can to learn about their family history, hear stories and share secrets while everyone feels the love. If you live close enough to visit your aging parents or relatives regularly, so much the better for everyone.

But, if you don’t live near your parents or if they are no longer able to live independently, there are still options. Encourage your elderly loved ones to reach out to older friends or make new ones. Help them form new relationships within an independent or assisted living facility if that is where they are currently residing. Despite popular beliefs, these types of living arrangements can provide more than physical assistance; they offer new ways to mingle and to connect, combating loneliness and possibly prolonging life.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink. We will help you find elder care services or an assisted living facility within California that is personalized for your family.

Holiday Scams Target Elderly

You answer the phone and an unfamiliar voice with a scary message urges you to take urgent action to prevent something terrible from happening – your grandchild is in trouble, you owe back taxes or your computer has been hacked. But, you can make it all go away if you just purchase an iTunes gift card (or Amazon gift card) via online or in a store and then once the card has been activated, provide the 16-digit code on the back of iTunes cards via phone, email or text message to the caller/con artist. Often multiple gift cards may be “required” by the caller, equaling hundreds, or even thousands, of dollars.

For a holiday twist on the “grandparent scam,” the caller pretends to be their grandchild who is in trouble and needs help (money) to come home for the holidays. The caller will plead for secrecy, claiming to be embarrassed or not wanting to get in further trouble with his/her parents. This seasonal adaptation is in place of request for money so the caller (“grandchild”) can avoid jail, come home from a foreign trip or to get their car repaired.

These types of scams can also occur via email, text or even regular mail and as a loving grandparent and concerned citizen, you want to do the right thing. But in these cases, the right thing is to recognize these types of calls are scams and you should report them to the Federal Trade Commission (FTC).

Phone scams are nothing new, nor are playing on the sympathies of older adults. Creating a sense of urgency and panic are tools of the trade for scammers. What is new is taking advantage of senior citizens’ lack of knowledge about how digital gift cards actually work. For example, it is likely that a grandparent has purchased gift cards, including iTunes and Amazon cards for their grandchildren, but are unlikely to be aware that such gift cards can only be used to purchase items from the issuing merchandiser (such as iTunes or Amazon). Like prepaid debit cards, iTunes and Amazon gift cards are a simple and practically untraceable method for con artists to get money, or for their victims to get those funds back.

According to the FTC, as soon as money has been put on a card and code has been shared, the money’s gone for good. Almost immediately, the card’s value will be drained, traded or sold on the black market. Unfortunately, the victim will not only have lost those funds, they are likely to be become a target for even more frauds.

Being able to convert these types of gift cards to the equivalent of cash as resulted in a recent uptick in popularity in scams and should be a tip-off of fraud. Apple, the parent company of iTunes, issued a warning on their website, “iTunes Gift Cards are solely for the purchase of goods and services on the iTunes Store and App Store. Should you receive a request for payment using iTunes Gift Cards outside of iTunes and the App Store please report it at ftc.gov/complaint.”

Other scammer-preferred payment demands also include reloadable cards, such as MoneyPak, Reloadit or Vanilla; PayPal and wire transfers like Western Union and MoneyGram but according to AARP, the FTC states that, “no government agency nor any but a handful of businesses require any of these payment methods.”

To find out about other scams, particularly those targeting the elderly, as well as discover tips and resources to help spot and avoid identity theft and fraud, consider signing up for AARP Fraud Watch Network. You can also track scams and law enforcement alerts in your area on the AARP Scam-Tracking Map.

Key Takeaways

  • Do not trust any caller who asks for money but insists on secrecy, including a government agency or a non-profit organization. If you do not recognize the voice or are unsure who the caller is, ask for more information so you can verify what you have been told. No one should ever discourage you from seeking support and counsel from family members, friends or trusted advisers, especially before making any financial transaction.
  • No government agency, including the IRS, will require you to use a specific payment method, such as a prepaid debit card, nor will they threaten you with arrest for not paying.

If the time has come when your aging loved one is no longer able to live independently, please contact the knowledgeable staff at ElderLink to help you find elder care services or an assisted living facility within California that is customized for your family.