Category Memory Loss

By Meredith Kimple

Our elderly parents start to wear the same outfit for three days in a row.

We may notice that their hair is unusually messy, that there is always food stuck in their teeth, or that they have started to smell. Our senior loved ones’ hygiene, or lack thereof, is of great concern to us, especially if they were typically well groomed in the past. We may feel embarrassed for them, or worry that their dignity will be compromised if they live in a state of uncleanliness, and these fears are certainly valid.

However, if our senior loved ones suddenly stop taking care of themselves, we need to examine the underlying causes for this change. While shifts in self-care practices are often par-for-the-course as a person ages, this does not mean we should take them lightly.

Why do many older people have poor hygiene?

There are a number of reasons, but we’ll look at three of the primary problems:

1. Physical Challenges

Tasks that were once easy have become difficult and dangerous due to age-related physical limitations. Your senior loved one may not be as steady on their feet, so getting out of a bathtub or shower, while wet, could lead to slipping and falling. They may have trouble brushing their teeth, flossing, and doing the laundry; their solution might be to simply ignore these activities until they are absolutely necessary. Whether self-care tasks are physically difficult or daunting for our older relatives, their hygiene suffers for it.

2. Cognitive Impairment

Seniors who have Alzheimer’s disease or dementia often forget to bathe or perform other basic self-care tasks. They may not remember how to take a shower, and certain parts of the process can be confusing or terrifying. They may believe that they have already performed that part of their routine, even if they haven’t.

3. Psychological Changes

Depression can destroy a person’s motivation to practice self-care and other hygiene-related tasks. Elderly depression is often overlooked and underestimated, but it is not at all uncommon, as seniors are forced to adjust to many difficult changes and events. Grooming activities may also be an area in which our older loved ones attempt to exercise control; they might feel powerless or frustrated by a recent lack of independence, and as a result, neglect cleaning as a form of rebellion.

We must first identify which of these factors are impacting our senior loved ones’ ability to perform essential hygiene tasks; each of the aforementioned issues requires a different approach.

If an older person finds bathing physically difficult, there are tools to help make the process easier and less strenuous. A shower chair is an excellent option for seniors who have trouble standing for long periods of time or who have a poor sense of balance; installing railings in the bathroom can also lessen their risk of falling. A hand-held showerhead and a loofah on a stick can help them clean areas that would otherwise be too hard to reach due to their mobility constraints. Modifications like these will allow them to retain independence for as long as possible, but eventually they may need assistance with bathing and other hygiene-related tasks.

Cognitive impairments often prevent older people from properly taking care of themselves; those who have dementia or Alzheimer’s disease may require the involvement of others to ensure that they are practicing good hygiene. Establishing a routine is very important, but that alone is not always enough. Those suffering from cognitive impairments may not know how to bathe, or the process may terrify them to the point that they neglect it entirely; if you are their primary caregiver, you may need to assist them with these tasks. Though it can be difficult, creating a comfortable environment and responding to their needs will help to reduce their anxieties and give them a sense of security.

If you are concerned that your senior loved one has stopped practicing self-care because of depression, express your concerns to their regular physician, who will know how best to proceed. Depression is by no means uncommon among the elderly; many feel isolated and overwhelmed by the difficult and painful changes that age brings. Helping them get involved in activities or taking them on regular outings may improve their mood and give them a reason to practice good hygiene; however, depression is not something people can simply “get over.” Therapy and medication can go a long way towards helping older individuals manage their depression, but it often remains a work in progress. Similarly, feelings of powerlessness can lead our older loved ones to resent our well-meant concerns over their hygiene. Choosing whether or not to bathe or change clothes may be their way of grappling for control over some small aspect of their lives.

Patience, understanding, and a willingness to listen are key when it comes to addressing these problems. Though cleanliness is important in its own right, not practicing good hygiene can cause more serious health issues, like rashes, sores, and even infections. Beyond that, engaging in self-care is tied to our self-esteem. An older individual who does not bathe or maintain cleanliness might think that it no longer matters if they appear or smell their best. They may not feel the need to practice good hygiene because they have been removed from the social sphere they once occupied; they may not think such activities are “worth the trouble.”

For the sake of their dignity, safety, and self-respect, we as their loved ones must support and encourage them. This does not mean that we unflinchingly hold them to our standards of cleanliness; while not always ideal, a sponge bath is better than not bathing at all, and wearing the same shirt two days in a row won’t kill them.

Rather, our commitment to helping them maintain good hygiene should be a commitment to reinforcing their worth. Starting a conversation about cleanliness is very difficult, and the reality is, our senior loved ones might be offended if we raise our concerns. Present your worries and then offer to help them make adjustments so that the process of self-care becomes easier and enjoyable once more.

By Meredith Kimple

As technology evolves at a break-neck speed, we often hear cautionary reminders that we are becoming too reliant on our cellphones, tablets, and computers. While there is nothing wrong with encouraging us to detach from these objects, such warnings ultimately sell the truly helpful aspects of new technology short.

Older people may be the most resistant to these developments, and understandably. But there’s a new incentive to invest in your interactive screen of choice; recent research shows that activities like regularly using email may help protect against dementia.

The Mayo Clinic conducted a study that followed nearly 2,000 cognitively normal individuals over the age of 70 for a span of four years. Participants received neurocognitive evaluations every 15 months for the duration of the study, and were ultimately labeled either cognitively normal or mildly impaired. Researchers found that individuals who engaged in certain activities at least once or twice a week experienced less cognitive decline than those who only performed them a few times a month, if that.

What were these activities?

You might guess something like puzzles or knitting, or perhaps regular social interaction, but the activity that had the greatest bearing on participants’ cognitive health was computer use.

Those who used a computer a few times per week lowered their risk of new-onset mild cognitive impairment by roughly 30 percent; other activities, including arts and crafts, social interaction, and games, brought a 20 percent decrease. Even participants who were genetically predisposed to developing cognitive impairment or Alzheimer’s disease saw some benefit from engaging in weekly computer use.

The results of the study corroborate earlier findings that certain mentally stimulating activities can offer a degree of protection against mild cognitive impairment. You might think that in order to take full advantage of these benefits, these activities must have been performed for many years. However, research suggests that beginning these practices at a more advanced age can still decrease one’s risk.

Another study showed a possible connection between mentally stimulating activities and a reduced risk for suffering delirium, a state of sudden confusion that the elderly sometimes experience after a major procedure. Researchers found that the 32 percent of participants who developed post-operative delirium engaged in fewer leisure activities than their counterparts who were not delirious. The activities that most reduced their risk for delirium were reading books, playing computer games, and using email. Researchers concluded that the more time older individuals invested in these leisure activities, the less likely they were to develop delirium after surgery. Because delirium can increase an older person’s risk for decline and dementia, regular engagement in mentally stimulating activities may be vital for preserving their cognitive health.

In both studies, computer use played a surprising role in lowering seniors’ risk for developing a cognitive impairment. But why might this surprise us? Reading, even when done on the computer, helps to keep our minds sharp. Using a computer requires practice and to a certain extent, keen concentration.

Yet, since the advent of in-home television, society has denounced the convenient practice of gleaning information from screens.

Though we rush to buy the newest smart phone upgrade and gladly spend hours on social media, deep down, we harbor a fragment of guilt. As a culture, we simultaneously glorify and decry the ever-changing face of technological advancement. Feelings towards the latest innovations are highly charged, and perhaps most so among the elderly population.

Our senior loved ones grew up without computers and cellphones, and depending on their age, without television. While many older people have embraced the most recent developments in technology, others are frustrated and afraid of it. Part of this may be an ornery loyalty to the traditional ways of doing things, or a belief that computers and smartphones offer nothing to their demographic. However, these dismissals may attempt to mask an inability to use the technology.

Because computer-related activities seem to have a positive effect on seniors’ “cognitive reserve”, encouraging our loved ones to jump on the bandwagon may help to preserve their mental faculties. We should do everything we can to help them feel comfortable using a computer; search for local classes geared towards senior learning, and offer to demonstrate basic applications, like email.

While computer usage is certainly not the only mentally stimulating activity, being able to access email and search the Internet provides a link to public life. It’s a great way to keep in touch with long-distance friends and family, stay up-to-date on the news, or watch TV shows and viral videos. Computers can help seniors with limited mobility maintain a strong connection with the world, and this inclusivity may help boost their self-esteem.

By Meredith Kimple

When a senior loved one is diagnosed with Alzheimer’s disease, we are suddenly barraged with a variety of new questions and concerns. How will they carry out their daily tasks as the disease progresses? How rapidly and to what extent will their comprehension be compromised? What medical care will they need, and should they enter an assisted living facility or move in with family?

What if they wander outside the home and become lost, or worse, hurt themselves?

An estimated three out of five people diagnosed with Alzheimer’s exhibit wandering behavior, and across all stages of the disease. We might have certain preconceived notions about what wandering entails. But people who suffer from Alzheimer’s are not necessarily on autopilot when they wander, and they do not always attempt to leave the house. As with other aspects of the disease, there has been no general consensus about what causes those with dementia to wander; it often begins as a result of boredom, perceived necessity, frustration, or stress.

What are the warning signs that your senior loved one might have a tendency to wander? The reality is that anyone with dementia has the potential, but the following are a few of the signs that usually precede wandering:

1. Restlessness.

They might find it difficult to stay in one place; they might walk around the house without purpose, pace in the same vicinity for an extended period of time, or engage in repetitive movements.

2. Confusion.

Your senior loved one might become disoriented when entering an environment that is either new or altered in some way. They may get lost in areas that offer too much stimulation, like the grocery store or the mall. But they also may have difficulty in identifying familiar places, like the rooms in their own home.

3. Repetition of Tasks.

They may continuously perform the same task without actually completing it; for example, they may think they are organizing their room, but are only moving the same few items around over and over again.

4. Following an old routine.

A person with Alzheimer’s may try to return to a past residence or the site of a former job, or attempt to run unnecessary and irrelevant errands.

5.  Delayed Return.

If they regularly go for walks, they may take longer than usual to arrive home; this might be a sign that they are starting to lose their way while walking, or forgetting the route that leads back to their house.

Wandering is not dangerous in and of itself; if it occurs within the safety of the home, under supervision, it poses few threats. However, when a person with Alzheimer’s wanders outside alone, they are rendered completely vulnerable to a number of risks. They might become confused and lose track of the way home, or they may not recognize their surroundings at all. Others may try to rob or take advantage of them while they are lost, and, worst of all, they may be seriously injured.

In order to keep our loved ones safe, there are several concrete steps we can take to limit their wandering:

1. Establish a regular routine.

Structure can be very beneficial to people with Alzheimer’s. A daily routine may help combat boredom and stress, both of which can trigger wandering in those with dementia. If you notice that the wandering occurs at a certain time of day, plan activities to occupy their attention during that period.

2. Provide security.

Anything we can do to assuage their fears and reassure them that they are not lost is very important. Make sure that they are never left unsupervised in the home or out in public, and try to avoid crowded, noisy places that might disorient them. Be patient if your loved one insists on going to an old residence or office, and instead of invalidating their desire, tell them that they should stay with you at home for the time being. Hide all car keys so that they can’t drive off.

3. Adapt the environment.

Install alarms and locks that are either out of reach or out of sight. Obscure doorknobs by covering them in fabric or painting them to match the door. Hide the door behind a curtain. Reduce in-home dangers by blocking the stairs with a baby-gate and removing clutter from the floors.

4. Help them meet basic needs.

Wandering may at times be motivated by the need to eat, drink, or use the bathroom. Ensuring that they meet these needs regularly may help prevent some of their wandering.

It’s best to have a plan in place in the event that your senior loved one does wander and become lost. Know your surroundings; make sure that you can contact your neighbors, and familiarize yourself with any physical dangers in the vicinity, like stairs, hills, busy roads, or bodies of water. Keep in mind any places that your loved one may try to reach, such as the site of an old job, a former residence, or their place of worship. Search for no more than 15 minutes before calling the police. Consider buying identification jewelry that includes your loved one’s name, address and your phone number; people with Alzheimer’s may not remember these details while lost.

A recent study published in the journal Neuron has helped to shed light on the biological origin of wandering behavior. Researchers found that course-plotting capabilities are compromised by the build up of tau protein in the entorhinal cortex (EC), a part of the brain largely responsible for memory and navigation. Within the EC, there are nerve cells called excitatory grid cells that fire as we move through a space; these grid cells form a map of the environment around us that enables us to find our way in any area.

They observed the impact a build-up of tau had on the excitatory grid cells of mice; the protein only damaged the excitatory cells, creating a severe imbalance in the mice’s internal grids. The findings support the theory that tau in the EC does contribute to wandering in those with Alzheimer’s disease.

Though further research is needed, the results of the study offer the possibility for treatment in the future; researchers believe that they may one day be able to correct the imbalance with the right therapy. Dr. Karen E. Duff, who co-led the study, even thinks that the results of the study may make it possible for navigation-based cognitive tests to be administered as a screening for early stage Alzheimer’s.

Wandering is a behavior that can make us, as caregivers and relatives, feel utterly powerless. Alzheimer’s can transform aspects of our loved ones in what seems like the blink of an eye; we make adjustments, and we do everything possible to create the semblance of order in the midst of constant, inexplicable change.

The truth is that we may not be able to keep our loved ones from wandering. Despite our best efforts, they may still slip away from us. But understanding where this behavior comes from can only help to prepare us for those terrifying moments. There are steps we can take to better ensure their safety, and in preparing for the worst, hopefully we can acquire some peace of mind.

Obesity is on the rise in the United States with an estimated 36.5 percent of adults affected; this means that approximately one-third of the adult population has the condition. Rates are highest among those between the ages of 40 and 59, as well as those over the age of 60. It is widely known that a substantial excess of fat in the body can lead to a host of health troubles, including type 2 diabetes, heart disease, and even some forms of cancer.

For older adults, an inability to maintain a healthy body weight can have an additional consequence; new research has shown a potential link between obesity and cognitive impairment later in life.

A recent study conducted by scientists from the Indiana University Center for Aging Research has revealed a possible connection between a high BMI (body mass index) and a weakened reception to memory training. Researchers observed roughly 2,800 cognitively normal participants over a span of ten years, the majority of whom were white and female with an average age of 74 years. For the duration of the study, scientists compared the degree of progress made by those with a normal BMI, those who were overweight, and those who were obese.

Results indicated that while a high BMI seemed to have little to no impact on reasoning or processing speed training, it significantly affected the benefits a participant gained from memory training; those who were considered obese received approximately one-third the benefit attained by their lower BMI counterparts. Though scientists are not sure exactly how obesity brings such an outcome, Dr. Daniel O. Clark, primary author of the study, referenced imaging studies that showed an association between obesity and a faster loss of hippocampal volume. The hippocampus is the part of the brain that is responsible for memory, and the implication is that older individuals who are obese may not have the same capacity to benefit from memory training as those who have a lower BMI. Dr. Clark also references prior research indicating that safe, intentional weight loss can actually lead to improvements in memory.

While not directly related to obesity, another recent study has found evidence that sedentary adults with no genetic risk factors for dementia have the same likelihood of developing the condition as those who do. Individuals who carry a variant of the genotype “apolipoprotein E” have a greater risk of developing dementia than those who do not, but researchers found that people who are primarily sedentary, but not carriers, exponentially increase their risk by their inactivity.

People who have a sedentary lifestyle, whether by choice or because of a medical condition, may have trouble maintaining a healthy body weight, and prolonged inactivity often leads to obesity. For a variety of reasons, seniors may have greater difficulty fitting exercise into their lives than the young or middle aged; they may have a disability or other impairments that make any physical activity impossible, they may tire more easily, or they may not be able to exercise the way they used to and become discouraged. If they aren’t active or eating well, they will put on weight very quickly, which in turn may put them at an increased risk for dementia.

How can we help our older loved ones build safe, effective exercise into their daily routine?

The good news is that health professionals estimate an intentional weight loss of as little as 5 to 10 pounds can yield significant benefits for a senior. There is no need for strenuous exercise to see at least some improvement. With this in mind, there are plenty of exercise options for those with mobile impairments and those who need a gentler form of physical activity.

There is a post on this blog about the benefits of Tai Chi for the elderly; this thoughtful exercise is perfect for older adults who are still mobile but who may not feel confident in their ability to balance. Tai Chi can also be adapted for seniors who are not secure enough to stand while performing the motions.

Water activities are another great way to get our older loved ones moving again. Walking around in a pool and swimming are forms of exercise that do not strain the joints and free the senior body from the limitations imposed by gravity.

If none of these are feasible, encourage your senior loved one to talk with their doctor about seeing a physical therapist. A physical therapist will help them develop a safe and effective exercise regimen tailored to their level of ability.

All exercise should be approved by your older loved one’s doctor before they add it to their routine.

Having a lower body weight provides a number of benefits to seniors; with fewer pounds to carry, walking is less strenuous. They may feel more alert and more in control of their bodies. Their risk of diabetes and heart disease may decrease. Certainly, the fact that obesity may negatively impact cognitive function is only the newest incentive to maintain a lower weight. Because obesity can lead to and exacerbate multiple severe health issues, it is crucial that we help our parents, grandparents, and older loved ones access the resources they need to keep as active as possible.

By Meredith Kimple

How many times do we get teased for a little snoring at night?

While all snoring has the potential to annoy those around us, some snoring might be indicative of sleep apnea. This chronic, but treatable, condition impairs an individual’s ability to breathe regularly while asleep, either via an obstruction in the upper airway (obstructive sleep apnea) or as a result of the brain failing to trigger a breath (central sleep apnea).

Despite sleep apnea’s presence across all age groups, it is especially prevalent among seniors. As we age, our throat muscles and tissue are more relaxed, so that when we sleep our airway can become obstructed; being overweight can also increase our risk of developing the condition. At best, sleep apnea’s effects on the senior body are limited to daytime sleepiness and an increased difficulty concentrating. At worst, the body’s inability to breathe while sleeping can be fatal.

But there may be another risk for seniors who have sleep apnea.

Two studies have linked sleep apnea with early onset cognitive impairment in the elderly. The Journal of the American Medical Association published a study that observed the relationship between sleep apnea and cognitive impairment in approximately 300 healthy, elderly women over a span of five years. None of these women had any memory problems prior to the start of the study, but a third suffered from sleep apnea, averaging 15 instances of breathlessness per hour. At the end of the study, more than a third of the women had developed dementia or were experiencing memory troubles. The participants who had sleep apnea made up 44 percent of the women who developed cognitive impairments, while those who did not made up only 31 percent.

The researchers concluded that, even considering other factors like weight and age, sleep apnea had the greatest impact on the results of the study. The connection between the two conditions has to do with the blood oxygen levels of each participant; the episodes of breathlessness caused by sleep apnea cut off the oxygen supply to the brain, which, when occurring multiple times an hour over many years, can impair a senior’s cognitive function. Those participants who had low blood oxygen levels because of sleep apnea were more likely to develop dementia.

Another study published in Neurology shows evidence that the breathing disruptions of sleep apnea can have a massive impact on seniors’ cognitive health. Dr. Ricardo Osorio, of NYU’s Center for Brain Health, and his colleagues observed a group of 2,000 individuals aged 55 to 75, ranging from those who were cognitively normal to those who had Alzheimer’s disease. The participants were questioned about their snoring and sleep apnea, and then bi-annually over the next two to three years, they returned to monitor any cognitive changes.

The majority of participants who reported having sleep apnea developed mild cognitive impairments, and more astonishingly, their symptoms emerged 12 years earlier than in those who don’t suffer from respiratory disruptions at night. Dr. Osorio noted that those who were treating their sleep apnea with a CPAP machine seemed to experience cognitive decline at around the same age as those who do not have the condition.

It goes without saying that more research is needed to cement the link between sleep apnea and impaired cognitive function, but given the positive correlation evident in the aforementioned studies, recognizing and treating the condition as soon as possible can’t be a bad idea.

If you or a senior loved one snores at night, how can you determine whether or not it really is sleep apnea?

The following are some of the more common symptoms:

• Loud snoring, particularly when lying on their back
• A long pause in breathing, anywhere from a few seconds to over a minute, followed by choking or gasping
• Daytime grogginess
• Difficulty concentrating and remembering
• Waking up with a headache and / or dry mouth
• Sharp mood swings and heightened irritability

But the only way to know for sure is to have a sleep study done at a hospital or clinic. That said, you could always monitor an older loved one by recording their snoring at night; this way you can listen for any irregular breathing.

There’s also a smartphone app in development that can monitor the breathing of a person with sleep apnea.

Once your loved one has been diagnosed with sleep apnea, there are a variety of treatments by which to manage it. The most common method is to use a CPAP machine, a mask connected to an apparatus that helps maintain regular breathing throughout the night. Wearing a mask may be uncomfortable or difficult to put on at first, but it’s important to help them with these adjustments to ensure that they receive the treatment they need.

If you do notice the above signs in an older loved one, it’s very important that you talk with them. Those who have sleep apnea often are totally unaware that they snore and stop breathing while they’re asleep, so it’s crucial that you inform them and encourage them to talk to their physician. Sleep apnea may have a significant impact on seniors’ cognitive functioning and overall health, but luckily it’s easily treated.

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

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.

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.

It has been some time since I have had the opportunity to check in here at our blog. Since that time, my Dad declined in a heart-breaking spiral which can be typical in the last stages of Alzheimer’s, and we said good-bye to him on August 22, 2015. Over the last months, we wrestled with the pain of watching Dad lose function and mobility day by day, and toggled between spending our time savoring what we knew to be our final days with him and making frantic attempts to prevent him from slipping away. In that short time, Dad’s care needs began to exceed what even our own Aegis caregivers could safely provide in the home, so we hastily arranged for his transition to a skilled nursing facility nearby. The “paper” transition was smooth, but the Dad transition was not.

At every turn, we tried to handle the demands of our own families and the challenges that came with Dad’s confusion and frustration in his new environment. We experienced the gnawing second-guessing of whether we had done the right thing (there was no other choice, was there?), and the guilt (newness and unfamiliarity had to be the worst possible thing for a person with dementia, didn’t it?), but also gained a small measure of peace that Mom (87) was finally getting a full night’s sleep, and not pushing herself to the brink of a major health crash. Dad was also going to have more access to more comprehensive services that a facility could provide to try to preserve as much of his functioning as possible. Yet, it was still wrenching to see my parents physically separated for the very first time after 64 years of marriage. They had always shared that same bed, and the thought of Dad calling my mom’s name when we weren’t there, even for just a few hours, was devastating.

We are so grateful that Dad’s needs were well-served and he received professional and compassionate care until his death. And I am grateful, too, that our out of town family members bore the news of the advancing changes with understanding. No shaming. No resentment. Just a collective wistfulness and profoundly joyful appreciation for the life of a man who by many would be called a quiet hero. I know it’s what he was and continues to be for me and our family–an example of deep faith and integrity.

For each person, for each family, the path takes it own kind of turn, but it is never easy. On a routine basis we expertly transition families or help families enable their loved ones to age in place with abundant support. Yet because we have had to weather these very storms ourselves, we get it.  We never take for granted that although it might look smooth on the outside, families will still need support to cope with deeply intimate challenges.  It is our promise that we are here to provide it.

I’d like to tell you that Aegis Care Advisors was a long time in the making, and was rolled out with strategic military precision, but if I did, I would be lying. We took a somewhat circuitous route to get to this spot, and as often is the case in life, we are guided by the meanderings of personal experience.  So I feel like now is probably a good time to share a little something about my Dad.  He is 88, and has Alzheimer’s disease.

My Twitter feed lights up with purple these days, as the ENDALZ logo pops up minute after minute, recounting the celebrity appearances for a popular event meant to raise funds to fight Alzheimer’s disease. If I were a more healthy-minded person, I would be excited and proud of the people toiling over this effort, but I struggle to cheer this on, since I am still angry. We have been victimized by this thief, and our family has felt the chronic helplessness of being forced to stand by while our Dad is stolen from us — little by little — no matter how tightly we try to hold him in our grasp. Along with his intellect, a lifetime of professional knowledge in the field of textile chemistry, and his fatherly wisdom, the thief has stolen my Dad’s story. And over time, as the stealthy stalker was making away with golden pieces of treasure that is my Dad, I was ignoring my own weak promptings to gather in the nuggets of my parents’ earlier lives, and I failed to do important things like ask how he felt when he asked  Mom for their first date, or how he managed to get himself to South Bend alone at the age of 18 to pursue his Masters’ Degree in Chemistry at Notre Dame. Now, like the lover rushing to intercept the train at the platform, my heart sinks as I feel the crushing weight of regret that I have arrived too late.

We do have the well-worn stories that we yearned to hear told and retold over the years, like the turbulent time when brain cancer took Dad’s youngest brother, our would-be uncle Jimmy, at the age of 11, whose last days were spent in a hospital room with a singular, dismal view of a building bearing an advertisement for a coffin company. Or the time when Dad, in the days when young children were allowed to be adventurers, benevolently spruced up a neighbor’s car with a fresh coat of paint after coming across a can and brush found in their garage–doing so with the bright-eyed, whimsical earnestness of the 4 year old artist eager to present a lovingly crafted gift. But now these stories are like bulky pixels that make us want to rush to focus and readjust the picture into crisper clarity. We are desperate to bring into view the rich, brilliant colors and detail of the rest of the story, but the thief has craftily and irreparably scrambled the settings to do this.

Now we feel cheated. And violated. And afraid.

So we push ahead in our helplessness, and offset our heavy hearts with a larger counterweight of gratitude for this father, son, husband, friend, and disciple. We remember how Dad was–the coach, the advisor, the business man, the prayer giant. The guy who let you know that faith in God, honesty, integrity, and strength of character were paramount. The guy who was always in your corner. But today, I think maybe Dad is telling us his greater story more eloquently now than ever. No day goes by without Dad’s kindness and gentle, loving spirit shining through–a flash revealing the authentic man. The wide and warm smile, the willingness to chuckle and be playful remains while Dad continues his valiant quest to somehow convey to us the drama unfolding, yet locked, inside his brilliant mind. His gestures and words are strung together to form a language that we struggle to make sense of much of the time, but he speaks a language today that outshines and outperforms any form of conventional wording. He beams with recognition and love when we walk in to greet him, with an expression that is unfailingly joyful, hopeful, grateful, and unconditional, but the greatest expression of this must be witnessed first-hand when Mom comes in after short respite times, as the love Dad has for her, the mother of their seven children, and wife of 64 years, defies any form of written description. Underneath all of this, you cannot miss the relentless desire my Dad has to continue to share. He wants to share his moments with others, with us–he wants to just “be with.”

Dad was always one to advise us and encourage us to take on as many challenges as we could withstand and recognize opportunities in front of us. So hopefully that’s what we are doing now–sharing what we have with whomever might find what we say and do to be valuable. In the end, we are all here to need each other.

So Dad, thank you. You have revealed that you are the opportunity in front of us–our opportunity to share back, reassure you with our presence and care; and in this way, your life is perhaps even more eminently valuable now than it ever has been. And — you continue to be brilliant, for in this way, you have managed to foil, outsmart and outmaneuver your thief.