Of the many incurable diseases which plague humanity, none may experience so prevalent a rise in a few decades’ time as Alzheimer’s. As those of the “Baby Boomer” generation age, it is estimated that as many as 13 million Americans could develop the disease by 2050; the global escalation of Alzheimer’s and the absence of any concrete treatment is disheartening, to say the least.

But in the last few months Alzheimer’s research has yielded potential methods by which the disease may be reversed.

In June, the exciting findings from a study produced by the Buck Institute for Research on Aging and the UCLA Easton Laboratories for Neurodegenerative Disease Research were published, showing the first objective evidence that Alzheimer’s can be reversed. Ten participants, most in the early stages of the disease, followed a personalized program incorporating dietary changes, sleep improvement, supplement usage, and regular exercise, among other things.

The study was designed to test the hypothesis that Alzheimer’s, like cardiovascular disease and HIV, can benefit from a combination of therapies tailored to the patient and their specific needs. A drug may only treat one aspect of the disease, which would ultimately prove ineffective if, like some researchers believe, Alzheimer’s is the result of a series of molecular interactions and not simply a disease of “toxicity”. Dr. Dale Bredesen, a professor at the Buck Institute and UCLA Easton Laboratories, likens a brain affected by Alzheimer’s to a roof with 36 holes; while medication could patch up one hole, there are 35 other holes that require a combination of various treatments.

Following their personalized programs, nine of the ten participants saw significant improvement, and in some cases, they were able to retain the functions lost in their initial decline. Those who had been forced to quit their jobs because of memory impairment were able to return to work with improved performance.

Though the results of the study are very encouraging, they have not yet been replicated in a larger sample size. While nine out of ten improving is astounding, it is worth noting that the participant who did not improve was in the later stages of the disease. All other participants were either in the very early stages of Alzheimer’s, or in a pre-Alzheimer’s stage; these 36-point therapeutic programs may primarily benefit those who are diagnosed early. Most participants tested positive for the APOE4 allele, which put them at an increased risk of developing the disease; as the majority of Alzheimer’s cases in the United States are caused by APOE4, Dr. Bredesen encourages people to have this same test so that they can begin preventative measures as soon as possible.

And just last month, Tel Aviv University published the results of a study to observe the APOE gene’s role in Alzheimer’s disease. APOE moves lipids in and out of cells, but can appear in one of two forms: the effective APOE3 and the impaired APOE4. Researchers studied the APOE4 gene in mice, and found that its presence led to memory and learning difficulties, as well as damaged synapses in the brain. They then activated ABCA1, an enzyme that can help APOE4 with the transport of lipids through cells; this process reversed the impairment of APOE4 and, amazingly, seemed to reverse the impaired mental faculties of the mice.

While neither of these studies offers us an immediate solution to Alzheimer’s disease, the progress evident in their results are exciting and should give us hope for the future. It goes without saying that Alzheimer’s is extraordinarily complex, and the answer to the disease will be equally so. There is no such thing as an overnight cure, or a wonder drug. There are no foolproof diets or other health programs that can guarantee protection.

But a few decades ago researchers had no idea of the role APOE4 plays in the development of Alzheimer’s. There was no evidence that a multi-therapy approach to the disease could have any impact, let alone lead to a reversal of memory impairments. And these new developments in Alzheimer’s research have only occurred in the last few months; the prognosis of the disease can only improve over time, and by exploring multiple potential methods, the odds that a variety of treatments may be found increase.

In the meantime, all we can do is continue to take care of our bodies to the best of our ability, and ensure that our senior loved ones do the same. There is still so much we don’t understand about Alzheimer’s, and our efforts to eat healthily, keep our minds sharp and bodies fit, may not be enough to prevent development of the disease. But maintaining a healthy lifestyle, making sure we get enough sleep, exercising, and staying positive can only help us as we age.

Contributed by Meredith Kimple

An increase in the amount of prescribed and over-the-counter medications we take seems par for the course as we age; the more candles on our birthday cakes, the more likely we are to develop severe health problems that require consistent treatment. The effects of taking multiple medications simultaneously is known as polypharmacy, and often these can lead to an ADE, or an “adverse drug event.”

So how can the taking of various medications cause such a harmful reaction? Aren’t the medications doctors prescribe tested and considered safe?

Problems arise when a physician is not aware of all the medications their patient is taking, as they may unknowingly prescribe a drug that interacts poorly with something the patient already uses. Commonly used over-the-counter drugs, like acetaminophen and aspirin, can be dangerous when taken in combination with certain medications, and they often go unmentioned when a physician asks about a patient’s daily regimen. Additionally, it is estimated that 50% of seniors take at least one medication or supplement that is unnecessary.

But age itself is often responsible for these adverse reactions.

An older body may have more fat and less water than a younger body, which can change the way a drug is distributed; because there is a greater amount of fat, a drug may stay longer in the body than intended. Additionally, our liver and kidney functions tend to function less efficiently as we age, which can reduce clearance and make metabolizing and benefitting from a drug all the more difficult.

Add high blood pressure, diabetes, cardiovascular disease, high cholesterol, and other diseases which often require medication to manage, to a body which has a harder time processing said medication. While not all negative reactions to polypharmacy are life-threatening, there is the potential for an ADE if caution is not exercised in the prescription of medicine to the elderly.

Here are a few of the effects polypharmacy can have on the body:

1. Non-adherence.

Medication non-adherence is, as the name suggests, when an individual does not take their medication as prescribed, or at all. A person may never take the drug in the first place, or they may take too much or too little of it, meaning they put their lives in danger by not adhering to the guidance of a medical professional. While there is no single, cut-and-dry cause of non-adherence, polypharmacy can contribute to this problem among the elderly. The more medications they have to keep track of, the more difficult it may be for them to take the appropriate dosage, or to add a new, necessary drug to their regimen. Straying from their treatment plan can result in the worsening of their condition or hospitalization. At worst, non-adherence can lead to a fatal ADE.

2. Cognitive and Functional Decline

There is some evidence to suggest that polypharmacy (in this case, taking more than 5 medications) increases the likelihood of both delirium and dementia. Cognitive impairments could lead to medication non-adherence, which could in turn cause a senior’s condition to worsen. Polypharmacy also seems to inhibit bodily functioning as a whole, and seniors taking a great number of medicines may experience difficulties in performing essential daily tasks.

3. Fragility

Research shows that there is a potential connection between polypharmacy and an increased risk of falling. For the elderly, a fall is not merely a painful stumble; it can cause significant health problems, like a broken hip, that can be extremely difficult to recover from. Frequent falling is associated with both increased morbidity and increased mortality, and should never be taken lightly when it occurs in an elderly person. Polypharmacy may escalate falling episodes in those who are already frail and at risk.

The concerns listed above are only a few of the negative effects polypharmacy can have on the elderly body. But it can also take a toll on an elderly person’s wallet. Medications are not cheap, and even with coverage, taking upwards of five different drugs can be a financial strain. If a senior does experience an adverse drug event, hospitalization and drug therapy can compound already steep medical expenses.

How can we ensure that our senior loved ones do not suffer the negative effects of taking multiple medications?

Certain medications are essential. The older we are, and the older our parents and grandparents are, the more likely we are to develop medical conditions that require drugs to manage. This is unavoidable, and there is no cause to be suspicious of the medication prescribed by doctors for these serious health problems.

That said, we need to make sure we give our regular physicians as clear a picture as possible of our medication regimen. We need to encourage our elderly loved ones to do the same, and not only where prescription drugs are concerned. Every supplement, nasal decongestant, cold remedy, and over-the-counter pain relief taken should be made known to the doctor.

Polypharmacy seems to be especially prevalent among seniors who live in nursing homes, largely because they often have multiple comorbidities and are prescribed more medication by physicians. There is some concern in the medical community that with the abundance of medicinal treatments and drugs on the market, doctors may be over-prescribing to older adults with various health conditions. As more of the population ages, better techniques for assessing a person’s medication needs may be developed, and more research will be devoted to reducing the negative effects of polypharmacy.

People are living longer than ever before, and while that is certainly something to celebrate, we are also taking prescribed medication for a longer amount of time. Many of us will take more than one prescribed medication. Seeing a doctor regularly to assess and re-asses the number and necessity of the medications we use is crucial; and this goes for our senior loved ones too. As they age and their bodies change, their medications may need to be changed or reduced; it’s vital that they see a physician at least once a year, and that if they see more than one, that they provide them all with as comprehensive a list of their medications as possible.

Contributed by Meredith Kimple

By Meredith Kimple

An apple a day keeps the doctor away.

We know this adage is far from accurate, but what if we substitute “apple” with “multi-vitamin”?

Daily supplements can fill the gaps in our nutrition and fortify our diets. Convenient and easy to take, they may not keep the doctor away, but they certainly make taking care of our health a little simpler.

But as we get older, should we be taking so many vitamins?

As we age, additional supplements are often suggested to accommodate for the minerals we may get less of or that our bodies do not absorb as easily, such as fiber, vitamin D, and calcium. Approximately half of adults over the age of 65 take multiple daily supplements to maintain a healthy lifestyle. But recently there have been increased questions regarding the necessity of such intensive vitamin regimens for seniors.

First and foremost, older adults should only be taking vitamins with the approval of their regular physician. There are those who believe that the supplements often recommended to seniors are unnecessary, as an improved diet can provide as many health benefits, if not more, than a pill.

Let’s take a look at the pros and cons of senior supplement use.

The Pros:

Supplements may just be easier. This may seem like a given; it is much easier to take a pill or gummy than to eat two pounds of broccoli. However, for some seniors, prepping and cooking fresh vegetables just isn’t possible. A decreased appetite or difficulty chewing can make getting the recommended servings of produce a challenge. Taking supplements can help ensure they get the recommended amount of vitamins and minerals every day, no matter their eating habits. Supplements should accompany and bolster a healthy diet rather than replace healthy eating, but for those who are unable to do so, they may be of some help.

High cost of high-quality fresh produce. Not everyone can afford to buy fresh produce, let alone prepare it, and a bottle of vitamins may be cheaper and easier to manage. Supplements can be better than not receiving any nutrients at all, so they may offer a solution to those who cannot afford the cost of healthy eating.

Dietary habits are hard to adjust. Changing one’s regular diet is far from easy, but for some seniors it can pose an even greater challenge. Seniors with memory difficulties may find the necessary lifestyle changes disruptive and hard to adjust to. Adding vitamins to their daily routine may be easier than changing their eating habits, although good nutrition should remain a priority.

The Cons:

The FDA regulates both prescription drugs and over-the-counter cold medication, but it is not obligated to approve dietary supplements for public consumption. This poses a few problems: on the one hand, because they are not regulated, there is no guarantee that they are safe to use. Additionally, this lack of supervision raises questions about the effectiveness of supplements in maintaining our health. For older adults, taking a multitude of unnecessary supplements that their bodies don’t absorb can mean wasted money or, if they ingest too many, serious health concerns.

Supplements are intended to be just as their name suggests: supplementary. Support for a healthy diet, not a substitute. Dietary changes have a greater impact on our overall health, and fresh fruits and vegetables provide benefits beyond what can be attained from a vitamin. Healthy, balanced nutrition is the best way to get all the vitamins and minerals we need to function properly.

Supplements are not neutral.  We don’t normally think of supplements and vitamins as being potentially dangerous. While there is no concrete evidence to show that they actively damage our bodies, they can interact poorly with medication. Certain prescription drugs are rendered ineffective by supplements, and it is very important to check with your doctor before taking them.

This is not meant to discourage everyone from taking vitamins. In all matters pertaining to health their regular physicians should be consulted, and this is no different; none of us should blindly pop vitamins without the approval of a doctor. If they recommend a certain vitamin or other supplement, then please take it.

There are medical professionals who maintain that as we age we don’t need to increase our supplement use. They claim that there is little evidence that older bodies produce fewer of the necessary minerals, and that they do not “fix” any health problems. Supplements do not always work, and in some cases, our bodies do not absorb the vitamins properly.

Above all, doctors agree that a healthy diet offers the most benefits. Instead of immediately reaching for a calcium supplement, incorporate more low-fat dairy products into your diet. This may not be enough, but starting with nutrition is almost always a good course of action. Taking a handful of supplements daily may not be as helpful for seniors as previously thought, and taking supplements that have not been approved by a physician may even be harmful.

“A multivitamin a day keeps the doctor away.”

Maybe. But based on the advice of health professionals, try the apple.

“Is this normal?”

As a Care Advisor to many seniors, I am asked this question a lot.  After all, most of us are loathe to face what we perceive as the inevitable physical changes that come with aging, and we spend lots of time and money trying to curb the effects of time on our aging bodies.  Yet even as we are urged to keep buying the products and services that promise to stave off wrinkles and increase our energy, we do seem to endorse the idea that perhaps our hearing is going to go, our joints will become arthritic, or our eyes will grow cataracts as the moments tick by.  So we are often caught in a state of confusion about just how much change is normal, and what kinds of changes signal the onset of a serious or life-threatening condition.

There is one insidious and under-recognized change associated with aging, however, that many people consider to be inevitable, which might be the very physical issue that has the potential to set us on a course toward progressive decline, loss of function and loss of independence: reduced muscle tone and strength.  Sure, we tend to just accept that we will just not be able to run as fast as we did in our 20s, or be able to bench press 145 lbs. We get up in the morning with some aches and pains. . . and what we chalk up to stiffness.  And that is just . . . well, part of getting older, isn’t it?

Does everyone lose muscle mass?  

Generally, yes.

Gradual loss of muscle mass is a naturally occurring process associated with aging, and it happens to everyone.  This is known as sarcopenia. There are physiologic changes that cause this, and these changes occur for a variety of different reasons.  But not all sarcopenia is created equal. Some people maintain enough muscle mass and the strength they need to remain active and independent into their senior years, while others lose muscle mass and strength at a faster rate.  We all know physically fit and active people in their 90s, and might also see others who seem much older in their 70s.

Up until about age 30, the body is typically in a state of muscle building.  Thereafter, most people begin to lose a percentage of muscle mass at a rate of 3-8% per year.  After about age 50, the process accelerates, with a possible 30-50% decline in muscle mass occurring between 40 and 80 years of age.   The loss of muscle mass may not be as apparent in middle age, as decline in muscle tissue is often offset by gain in fat tissue (especially in the midsection) due to hormonal shifts.  It is estimated that over 50% of older adults in their 80s suffer from sarcopenia.

Why do we lose muscle mass as we get older? 

We lose muscle mass as we age for a variety of reasons.

Many studies have been done on different aspects of muscle loss, but the one thing experts can agree on is that muscle loss is due to a combination of complex interrelated system changes within the aging body.

The muscle building pathways are affected when we age.  For example, research has demonstrated that a major contributor to sarcopenia in aging is that the body’s muscle building pathway is less sensitive and less responsive to ingestion of essential amino acids, which are the building blocks of proteins which are essential to the maintenance of muscle tissue.  Other research has focused on the reduction in the number of motor units in aging skeletal muscle, and others have directed attention to hormonal changes that affect muscle building processes in the body. Anabolic, or “building”, hormones such as testosterone and growth hormone are known to decline in aging, and such declines in these hormones and others have also been linked to declines in muscle mass and strength.  Hopefully new research will reveal ways to interrupt or prevent the progression of muscle loss and strength that leads to undesirable outcomes for older adults.

Lifestyle.   A person’s pattern of living can also influence the degree to which a person experiences muscle loss and loss of strength.  Of course, as we might predict, inactivity and a sedentary lifestyle would contribute to muscle loss and decline in muscle strength over time.   However, dietary intake and exposure to other environmental factors may also contribute to the overall problem.   Most adults take in less calories as they get older, and those calories may be comprised of even less protein which contributes to muscle loss.

What amount of muscle loss is considered “normal”? 

Surprisingly, there has been a lack of consensus in scientific circles over exactly what amount of muscle loss in aging is “normal” and what amount of muscle loss should be considered something for which we should seek some sort of clinical intervention.   New efforts to quantify muscle loss and find reliable ways to measure it are under way.  Only with a standardized approach and specific diagnostic criteria can researches develop a body of credible data on which treatment recommendations can be based.

The international scientific community has recognized that more and more people will face the adverse outcomes associated with loss of muscle mass with aging, and has recently proposed that new standards be set forth so clinicians can make recommendations and provide treatment to prevent or slow down the progression of sarcopenia.

• Foundation for the National Institutes of Health (FNIH) Sarcopenia Project
• European Working Group on Sarcopenia in Older People (EWGSOP)
• International Working Group on Sarcopenia

Through the FNIH sarcopenia project, these groups have focused their efforts on establishing standards for measurement of muscle mass and function.

Should I be concerned about sarcopenia if it is a natural part of the aging process? 

Yes, and here is why:

Adverse health outcomes are associated with sarcopenia.  Loss of muscle mass and strength has been associated with many adverse health outcomes in older adults.  Specifically, declining muscle mass in older adults has been associated with:

• Decline in independence and mobility
• Reduced ability to handle the stress of an injury or other major health event
• Increased risk of Type II diabetes
• Diminished quality of life
• Increased risk of falls and poor health outcomes
• Increased risk of disability
• Increased risk of hospitalizations
• Increased risk for fractures due to comorbidity of osteoporosis and lower bone mineral density (FN: Creating Diagnostic Criteria)
• Increased health costs
• The prediction of earlier mortality    

Are there things I can do to prevent or slow down the muscle loss associated with aging? 

One review of 17 studies on exercise and dietary supplementation in muscle loss and aging revealed that there is little consensus regarding how much exercise or dietary supplement and it will combinations is necessary to result in the best benefits for older adults.

Thus, although there is a lack of consistent data on which to provide recommendations that are evidence-based, there are some general principles that do emerge. It is generally widely accepted that resistance training and increasing dietary protein are both beneficial approaches to correcting muscle loss in older adults. It’s just the specifics now that need to be hammered out by the research and medical communities.

In the meantime, pursuing good exercise and nutrition habits in general is likely to be helpful in spite of a general lack of consensus on specifics:

• Exercise.  The great panacea. We all know this by now, right?
• Resistance training. This means working with weights (even your own body weight is often sufficient,) and bands to provide resistance to the muscle groups.
• Strength training. This means the goal is to increase the amount of weight your muscle groups can move over time.
• Increase dietary intake of protein: Current recommendations have been shown to be inadequate to maintain or contribute to muscle building. New recommendations suggest that optimal protein intake for older adults should be 1.0 to 1.2 g/kg of body weight per day.

Dr. Deborah Gordon recommends an interval training program and describes her views on sarcopenia here. The bottom line is to keep moving, and be sure that the moving involves some resistance to the muscles moving through space.  Check with your doctor before engaging in any kind of exercise and get recommendations that are uniquely suited to you.

By Meredith Kimple

From our first trips to the dentist as children, we are drilled with reminders to brush our teeth, floss daily, and stay away from candy (to our dismay). Oral health is a component of our wellbeing that we maintain largely out of habit, and is so entrenched in our routine that we often give little thought to it. All of the careful brushing, polishing, flossing, and swishing is done to preserve the beauty and utility of our teeth.

But recent studies suggest there may be a more pressing reason to take care of our smiles.

There is evidence that a positive correlation exists between poor oral health and a greater degree of cognitive decline in the elderly. In one study, the presence of gum disease corresponded to a six-fold increase in the speed of cognitive decline among participants. The theory is that the bacteria generated by gum disease and poor oral hygiene triggers the body’s inflammation system; in defending against foreign bacteria, inflammatory molecules also target the human body. Previous studies have suggested that such attacks on the body, and on the brain, lead to an increased rate of cognitive decline in individuals with dementia and Alzheimer’s.

Generally, tooth loss and gum disease become more prevalent as we age, so even greater care must be taken when performing oral hygiene-related tasks. This can be difficult for our older loved ones for a number of reasons, but for those who have dementia or Alzheimer’s, maintaining oral health may be neglected entirely. If the theories that link gum disease with cognitive decline are, in fact, accurate, then this creates a dangerous cycle. If those with dementia and Alzheimer’s neglect their oral health, gum disease is all the more likely, and if the bacteria leads to inflammation, they may suffer more rapid cognitive decline. This decline may make taking care of their teeth even more difficult for them, leading to further instances of gum disease and tooth loss.

And the cycle repeats.

While medical professionals do see the potential in future studies of this correlation, at the moment there is not enough consistent evidence to suggest the veracity of these theories. However, we know that the bacteria produced by oral infections can enter the bloodstream and cause harm to the body, especially to the cardiovascular system. When a loved one is diagnosed with Alzheimer’s or dementia, preserving their oral health may not be our first concern. But maintaining it can have positive effects on their overall wellbeing.

Whether you are the primary caregiver or you utilize at-home assistance, here are some ways to help keep your loved one’s gums and teeth healthy:

• Brush teeth at least twice a day. This may be difficult depending on what stage of the disease your loved one is in, but anything is better than nothing. Using an electric toothbrush may make things easier and remove plaque and food particles more effectively. If using toothpaste is too challenging, use a wet toothbrush rather than stopping altogether.
• Floss daily if possible. Plaque and food build-up between teeth can be hard to reach with a toothbrush and can lead to gum disease. Try using a flossing tool rather than string; this will make it easier for your loved one to do it on their own or for you to do it for them without being too invasive.
• Use mouthwash regularly. Make sure they do not swallow it, and if there is a danger that they might, even swishing and rinsing their mouths with water can be beneficial for cleaning out food particles.
• Make regular dental appointments. Take your loved one to the dentist often, and discuss any concerns you have about their dental health. Their dentist will be able to spot any early signs of gum disease, and can devise a treatment plan with you.

Pay close attention for these signs of gum disease, and make an appointment immediately if you notice any of the symptoms.

It may be that gum disease and tooth loss have no bearing on cognitive decline, but for our loved ones who have dementia or Alzheimer’s, maintaining oral health is vital. If they begin to lose teeth, chewing can become even more difficult, and dentures may add to their discomfort. The bacteria produced by gum disease can trigger the body’s inflammation system and can have a negative impact on their cardiovascular health.

The earlier we take preventative measures to maintain our oral health, the better for our overall health. For our older loved ones, caring for their teeth may become more difficult for a variety of reasons, and they may neglect their typical oral routine. Suddenly forgetting to brush their teeth may be an early indicator that they are experiencing cognitive decline, and so it is of the utmost importance that we take these changes in our loved ones seriously.

I confess.  Coffee is not just a drink.  It’s an experience.

There’s so much more to coffee than just merely drinking it.  Just ask a coffee drinker.  As for me, it has nothing to do with taste, but has become about ritual (the daily routine of standing in front of the coffee maker watching the brew, shifting from bare foot to bare foot as it drips,  taking in the aroma, wrapping my hands around the warm cup, then padding off to the porch to sip.)  For each of us, there is some unique set of reasons that the “act of coffee” resonates at our core and keeps us going back for more.

Is it good for me, or what?  Over the years,  I have tended to exercise my confirmation bias in a single direction and zone right in on all the studies and research declaring the reasons coffee is good for me, knowing full well that with each affirmation,  stories of research would follow to convince me that I was indeed a bit delusional.  It’s been an emotional roller coaster.

So what’s a coffee drinker to do when it’s #NationalCoffeeDay?  Well, first it’s important to get the facts straight.  My plan is not to bore you with all the citations here.  Know that the bottom line is that the research is conflicting. . .  that coffee increases health risks for some conditions  and improves outlook for others. . .

I know!  Shocking!

Here’s a bit of good coffee news from this year.  Take heart in this small take-away from  June of this year:   the WHO declared that coffee would no longer be listed on it’s database of carcinogens!   Yessss!

Just don’t drink it hot. . . !

Study: Elderly’s Family Caregivers Need Help, Too

By Rachel Bluth

Republished from Kaiser Health News.

Elderly Americans’ well-being is at risk unless the U.S. does much more to help millions of family caregivers who sacrifice their own health, finances and personal lives to look out for loved ones, reported a study released Tuesday.

Nearly 18 million people care for a relative who is 65 or older and needs help, yet “the need to recognize and support caregivers is among the most significant challenges” facing the nation’s swelling elderly population, their families and society, according to the report from the National Academies of Science, Engineering, and Medicine. Describing family caregiving as “a critical issue of public policy,” a committee of experts in health care and aging said the next presidential administration in 2017 should direct a national strategy to develop ways to support caregivers, including economically.

According to the report, people who help elderly family members with three or more personal tasks a day devote 253 hours a month to caregiving — almost the equivalent of two full-time jobs.

Five years is the median duration that family members care for older adults with high needs, the report said.

For some Americans who accept that responsibility, that can mean taking a less demanding job, foregoing promotions or dropping out of the workforce.

Lost wages and benefits average $303,880 over the lifetimes of people 50 and older who stop working to care for a parent, according to a study cited in the report. That’s not all: A lower earnings history also means reduced Social Security payments for caregivers when they become eligible.

A possible fix for that problem, proposed by researchers in 2009, is to provide caregivers with a Social Security credit for a defined level of deemed wages during a specified time period, the report said.

Leave programs do exist for some workers shouldering caregiving duties, but many lack such job protections.

The federal Family and Medical Leave Act doesn’t cover 40 percent of the workforce. It allows eligible employees to take 12 weeks of unpaid time off to care for certain family members, but the law only applies to those who work federal, state and local governments and private companies with more than 50 employees. But ineligible family relationships for leave include sons- and daughters-in-law, stepchildren, grandchildren, siblings, nieces and nephews. Many workers can’t afford to give up their incomes for 12 weeks.

In 2011, 17 percent of caregivers didn’t take leave because they feared losing their jobs, according to a national survey cited in the report.

The report recommends that family caregivers receive status as a protected class under existing job discrimination laws and that employers get guidance and training on ways to support workers caring for family members.

Beyond the economic costs of caregiving, the report notes that the social and physical toll of caregiving should get more attention than it does.

“If their needs are not recognized and addressed, family caregivers risk burnout from the prolonged distress and physical demands of caregiving, and the nation will bear the costs,” the report said.

Instead of delivering “patient-centered” care, health care providers should adopt “family-centered” models that include checking with caregivers to ensure they are healthy and capable of filling the role. The report also recommended wellness visits, counseling sessions and better training for caregivers who must understand increasingly complicated medical instructions.

Dealing with feeding and drainage tubes, catheters and other complicated medical devices causes stress, and the study’s authors noted that caregivers report “learning by trial and error and fearing that they will make a life-threatening mistake.”

The study was funded by 13 private foundations, the Department of Veterans Affairs, and an anonymous donor that requested the National Academies undertake the research in 2014.

KHN’s coverage of late life and geriatric care is supported by The John A. Hartford Foundation. KHN’s coverage of aging and long-term care issues is supported by The SCAN Foundation.

by Meredith Kimple

It’s estimated that Alzheimer’s disease affects about one in ten seniors over the age of 65, and 1 in 3 seniors over the age of 85. With those statistics in mind, the prevalence of Alzheimer’s can make developing the disease seem an inevitability. However, recent research suggests that certain dietary changes may significantly lower a person’s risk of developing the disorder.

The MIND diet*, created by nutritional epidemiologist Martha Clare Morris, combines the DASH and Mediterranean diets for an eating plan that promotes better brain health and may decrease one’s chance of developing Alzheimer’s. From 2004 until 2013, Dr. Morris studied the eating habits of over 900 participants aged 58 to 98 in order to determine the efficacy of the MIND diet in Alzheimer’s prevention.

The results of the study show a positive correlation between adherence to the MIND diet and a decreased risk of developing Alzheimer’s. Participants who followed the diet moderately saw their Alzheimer’s risk decrease by about 35%, while those who followed it strictly had a decrease of 53%!

The MIND diet is composed of 10 food groups that promote brain health:

1. Whole grains (3 servings a day) Substitute whole wheat breads for white, choose brown rice or quinoa in place of white rice, and have oatmeal or a whole-wheat cereal in the morning.

2. Leafy green vegetables (at least 1 serving a day)  Spinach, kale, collards, broccoli and cabbage are fine choices. The MIND diet suggests meals be made up primarily of vegetables.

3. Other vegetables (at least 1 serving a day)  Carrots, peas, peppers, tomatoes, radishes, sweet potatoes, beets and more.

4. Nuts (at least 1 serving a day)  Nuts are recommended for daily snacks and provide essential healthy fats that can improve brain function.

5. Beans (1 serving every other day)  Beans can be added to soups, stews and salads, so they are very versatile and easy to work into your current diet.

6. Berries (at least 2 servings a week)  Add berries to your morning cereal or oatmeal, or eat them as is for a healthy snack or dessert. Eating a variety of berries can help with brain function.

7. Poultry (at least 2 servings a week)  Chicken and turkey are excellent choices when you want to have a meat-based dish for lunch or dinner. While the MIND diet places greater emphasis on vegetables, poultry is a brain-healthy option for getting in your recommended protein.

8. Fish (at least 1 serving a week)  Fish is another good source of protein while following the MIND diet.

9. Olive oil  Instead of using butter, cook your food with olive oil. Food tastes just as good without the additional fat.

10. Wine (1 glass a day)  Wine lovers rejoice! A glass of wine once a day can be great for your brain health.

The MIND diet asks that you keep the following 5 food groups to a minimum when planning your meals:

1. Red meat:   Beef, sausage, steak and burgers are fine on occasion, but try to substitute them with chicken or turkey alternatives whenever you can.

2. Butter and margarine: (less than a tablespoon a day)  Use a vegetable-based butter substitute on breads, and use olive oil for cooking.

3. Cheese: (less than 1 serving a week)  This is perhaps one of the most difficult foods to limit, but do your best to avoid cheese. There are dairy-free cheese substitutes available if you really miss it.

4. Sweets and pastries: (less than 1 serving a week)  Try to limit your sugar intake and treat yourself to a favorite dessert only once a week.

5. Fried or fast food: (less than 1 serving a week)   Eliminate fried or fast foods from your diet. Baked dishes can be more flavorful and are much better for you.

The MIND diet may seem too restrictive at first glance, and if that’s the case, try easing into it slowly. Instead of taking away, add in. Eat more leafy greens, vegetables and whole grains. Snack on nuts and berries instead of chips or pretzels. Once you start making changes you may feel more comfortable substituting and restricting foods in the unhealthy categories. Whatever you can do in the moment is worth it for your health. Though the MIND diet is geared toward brain health and Alzheimer’s prevention, it may also improve cardiovascular function, lower blood pressure, and lead to weight loss.

While the MIND diet has not been named a foolproof tool for Alzheimer’s prevention, the results of Dr. Morris’s study indicate that dedicated adherence to such an eating plan may significantly lower one’s risk. The study took into account other factors that contribute to the development of Alzheimer’s, but found that what we eat seems to have the greatest impact on our mental health. Though the nutritional specifics of the MIND diet need further development as research continues, the current dietary suggestions it offers have proven effective for those participants who followed them the longest.

The prevalence and mystery of Alzheimer’s disease can make us feel powerless to prevent it. While there is still so much that doctors and health professionals have yet to determine about the disease, the MIND diet offers us the opportunity to minimize our risk and take control of our bodies in the present moment. Eating well is a choice that gives us some of that power back, and in making that choice, we are allowed some say in the functioning of our minds.

*Before trying a new diet, it’s always best to discuss any changes in your diet with your health care provider to make sure that it is right for you.

By Meredith Kimple

We all understand the importance of exercise when it comes to maintaining our health, but engaging in beneficial physical activity can become more daunting and difficult as we age. Alternative, gentler forms of exercise, like dancing or swimming, can still be taxing on an older body. Many physical activities hurt more than they help, and instead of building or maintaining a senior’s endurance, they exhaust, strain, and weaken their bodies.

Tai Chi, an ancient Chinese exercise that evolved from martial arts, may offer us a method by which balance and strength can be fortified without fatigue.

Over last few decades the popularity of mind-body exercises like Tai Chi and yoga has increased dramatically, and among a variety of age groups. These physical activities are not about raising heart rate, breaking a sweat, or meeting specific time goals; while you will improve your flexibility and balance by participating in these exercises, the aim is to look inward and get in tune with your own body.

Tai Chi in particular is an excellent option for seniors who, for any number of reasons, find exercising difficult. There are many different types of Tai Chi, but most are performed by moving slowly through a series of poses while engaging in deep breathing. Spatial perception becomes impaired with age, making it more difficult for seniors to keep their balance while moving and increasing their anxiety about falling. Tai Chi as a practice emphasizes the individual in relation to the space around them, which fosters greater awareness of one’s body and movements in day-to-day life. Beyond merely strengthening their physical stability, participating in Tai Chi can help restore confidence in their bodies, thereby assuaging their fear of falling.

Research has shown that Tai Chi, though movement-oriented, is also gentle on the joints. In fact, the motions employed in Tai Chi are similar to physician-prescribed exercises to help manage arthritis. The poses are made through fluid, purposeful movements that are not physically taxing on the body and which are meant to relax the participant. When performing Tai Chi the muscles are not tense, and throughout the exercise deep, even breathing is used to focus the body and mind.

There is evidence that Tai Chi reduces stress levels and blood pressure, improves strength, and can make recovery from falls and cardiovascular events easier. But more importantly, it seems to offer a safe, rewarding way for seniors to become reacquainted with their physicality. Aging is an emotionally difficult and physically draining process that we all undergo, and the change in our abilities can be very disheartening. Suddenly running up a flight of stairs is no longer possible. Stepping off the curb becomes a nasty fall. Our backs refuse to let us engage in our preferred physical activity. We are forced to be more cautious in order to navigate a less accessible world.

Practicing Tai Chi can help seniors feel more at home in bodies that are constantly changing. It can restore confidence and inspire self-love. Yes, we won’t always be able to run five miles or hike a mountain trail or bike across town. But our bodies are still amazing, still valid, and still capable of remarkable feats of strength. We just have to approach them differently, and Tai Chi is a wonderful way to foster a deeper awareness of your own body.

Many senior centers offer Tai Chi classes, and while there are YouTube videos and DVDs available for practicing in your own home, you should learn the basics with a certified instructor. This way you can be sure that you are performing the movements correctly and not straining your body. If you or a senior loved one are unable to stand, Tai Chi has been and can be adapted to a sitting position. If you have a pre-existing medical condition you should consult with your physician to make sure that you are well enough to engage in Tai Chi exercises.

If you’re interested in Tai Chi and want to know what it looks like in practice, this video shows a certified instructor leading classes!

With a bigger spotlight, the stigma surrounding men and mental health has eased, but there is still quite a void of understanding to be filled.  Men often will manifest depression in slightly different ways than women.  Depression in men can be exhibited not just by “down” feelings, but also by irritability and anger.   In this informative 5 minute Youtube video from the Harvard Health Minute Library, hear Dr. William Miller, Assistant Professor of Psychiatry at Harvard Medical School speak about men and depression.