caregiver alternatives to running on empty · 2019-03-16 · “super-agers” suggest modifiable...

LISA P. GWYTHER MSW, LCSW

D U K E F A M I L Y S U P P O R T P R O G R A M

D U K E C E N T E R F O R A G I N G

D U K E O L L I

S T . L U K E ’ S E P I S C O P A L C H U R C H

D U R H A M , N C

M A R C H 2 1 2 0 1 8

Cognitive Aging:Evidence for Action

Federal Trade Commission 2016

Duke Family Support Program, March 2018

Lumosity paid $2M to

settle FTC deceptive

advertising charges for

“Brain Training” program

Claimed program would

sharpen performance in

everyday life and protect

against cognitive decline

Institute of Medicine (2015)


Cognitive Aging: Progress in Understanding and Opportunities for Action

Sponsors

McKnight Brain Research Foundation

National Institute on Aging

National Institute of Neurological Disorders and Stroke

Centers for Disease Control and Prevention

Retirement Research Foundation

AARP

What is Cognitive Aging?


Cognition includes attention, thinking, understanding, learning, remembering, solving problems, reasoning and making decisions.

Cognitive aging is a process of gradual, ongoing, yet highly variable changes in cognitive functions as people age.

With aging, cognitive health means maintenance of optimal cognitive function over time.

Myths about Cognitive Aging


It’s too late to benefit from lifestyle changes

All memory loss is Alzheimer’s

All memory loss is normal with age

It’s all in the genes and because I couldn’t pick my parents, I’m going to get Alzheimer’s

Vitamins, supplements and memory boosters prevent cognitive aging

Key Features of Cognitive Aging


• Inherent in humans and animals as they age

• Occurs across the spectrum of individuals as they age regardless of initial cognitive function

• Highly dynamic process with variability within and between individuals

• Includes cognitive domains that may not change, may decline, or may actually improve with aging, and there is the potential for older adults to strengthen some cognitive abilities

• Only now beginning to be understood biologically yet clearly involves structural and functional brain changes

• Not a clinically-defined neurological or psychiatric disease such as Alzheimer’s disease and does not inevitably lead to neuronal death and neurodegenerative dementia.

People Forget


Misplace keys, glasses

Why did I come in here?

Forget names, but may remember later

Notice search for words

Calendars, notes, reminders, smart phones and clocks help

Senior Moments but usually remember you forgot

Expectable Aging Changes


Mild declines in:

Visual and verbal memory

Visuospatial abilities

Immediate memory

Ability to name objects

Ability to maintain attention

Common to have less recall of recent events and be slower to remember names and details

Vocabulary remains unchanged or may improve

Financial Decision-Making Risks with Expectable Aging Changes


Over 2.9 billion lost to elder financial abuse

Includes loss of money and goods to legitimate businesses, financial advisors, scams, family, and friends and fraud

Learn more at consumerfinance.gov

Protect Your Cognitive Health (2015)


The Good News


A third of Alzheimer's disease cases worldwide

might be attributable to potentially modifiable

risk factors. Alzheimer's disease incidence might

be reduced through improved access to

education and use of effective methods targeted

at reducing the prevalence of vascular risk

factors, poor quality sleep and depression.

−K. Yaffe, 2014 & 2016

“Super-Agers” Suggest Modifiable Protective Factors


“Super-agers” 2016 findings: People with extensive brain plaques and tangles which should result in neuron death retain superior memory. What protects neurons against the pathology and loss of function?

Stimulating lifestyles? Complex work environments? Genetics? Dietary patterns? Environmental – protective medications,

early or mid-life environments?

2017 Report


Preventing Cognitive Decline and Dementia: A Way Forward, 2017

“…encouraging although inconclusive” evidence for three specific types of interventions

o cognitive training

o blood pressure control for people with hypertension

o Increased physical activity

Interventions that May Help Prevent Cognitive Decline and Dementia

https://www.youtube.com/watch?v=mpF3mqudorI&utm_source=HMD+Email+List&utm_campaign=75d39546b7-EMAIL_CAMPAIGN_2017_10_09&utm_medium=email&utm_term=0_211686812e-75d39546b7-180224061&mc_cid=75d39546b7&mc_eid=68781cdf55

The ACTIVE Study: Ten Year Follow Up


11-14 hours of speed training (virtually processing information quickly) beat memory and reasoning training after 10 years of follow-up with healthy older adults. (2017)

Posit Science 2016 program: Brain HQ “Double Decision” updated speed training preview

8 Later-Life Modifiable Lifestyle Changes To Reduce Cognitive Decline (Lancet 2017)


Protect hearing – decrease social isolation and depression

Control depression

Stay active and fit with aerobic and progressive strength training for

mood, balance, preserved white matter associated with better problem

solving and decisions (2018)

Lower high blood pressure – stop smoking

Stay socially engaged – loneliness is a risk for high blood pressure,

heart disease and depression

Treat diabetes

Lose excess weight – Mediterraean diet

Restorative sleep

Lifestyle Counseling Prevents Decline (2018)


FINGER trial: 1109 Fins including 1/3 ApoE4 carriers (genetically at risk) aged 60-77 yrs. old followed 2+ years

Nutrition, exercise, cardiovascular disease management and counseling significantly prevented cognitive decline.

Global trials underway with diverse groups

Physical Fitness: 90% Reduced Dementia Risk


March 2018 Neurologyresearch article followed Swedish women 44 yrs –those with high fitness levels had an 88% reduction in dementia risk and later onset in later life.

2014 meta analysis of 21 studies: physically active adults were at 35% lower risk of cognitive decline

Physical Activity & Exercise: Interventional Data


Meta-analyses (2017) found modest effect sizes that were moderated by: Cognitive processes being assessed: larger

benefits for executive control processes

Gender: women more than men,

Exercise type: combined aerobic and progressive strength training better than aerobic alone

Age: > 65 years showed larger benefits

Duration: exercise sessions longer than 30 minutes showed larger benefit

“Sitting is the new smoking”


Stairs

Sweep

Push a grandchild on a swing

Throw a ball for the dog

Dance in your living room

Think Movement, Not Just Exercise


Aerobic exercise like walking, swimming

Progressive resistance or strength training bands and weights 2 times/week (CDC 2017)

Yoga and tai chi – balance, strength and flexibility

Find Meaning in Movement


Exercise improves mood, buffers depression, preserves white matter executive function (2018)

Exercise reduces risk of fall injury

Exercise with others adds benefits of social stimulation

Give Your Brain A Boost


Eat a rainbow – food, not supplements – Mediterranean Diet showed less brain shrinkage over 3 years in 1000 70+ (2017)

Play a game, practice a craft

Surf the web

Socialize with friends

Play an instrument

Rest

The more the merrier (combine the above)

http://www.google.com/url?sa=i&rct=j&q=elderly+eating&source=images&cd=&cad=rja&docid=ySfHxp67tjEnaM&tbnid=mvIq_dg3va7UlM:&ved=0CAUQjRw&url=http://www.peoplescare.com/cooking-elderly-homebound&ei=wQ9bUbChK5Lq8gSV74GgAg&bvm=bv.44697112,d.eWU&psig=AFQjCNFqiFMuq9XFQnPVADIhlZMg9y3V9Q&ust=1365008686981466

http://www.google.com/url?sa=i&rct=j&q=elderly+reading&source=images&cd=&cad=rja&docid=9GtgErKRv5KYeM&tbnid=2zgsSzIf05IX_M:&ved=0CAUQjRw&url=http://namayianacare.com/gallery/&ei=BhBbUdXFGY6u8ASssICoDQ&bvm=bv.44697112,d.eWU&psig=AFQjCNF9bbIggvSEzvny_4IFo6pNNJAqCA&ust=1365008758042792

MIND DIET


Butter and margarine

Cheese

Red meat

Fried food

Pastries and sweets

Green, leafy vegetables

All other vegetables

Berries

Nuts

Olive oil

Whole grains

Fish

Beans

Poultry

Wine

Eat these

10

Limit these

5

Vitamins: Interventional Data


Folate supplementation has NOT produced improved cognitive benefit among people, in general, although some benefit has been shown among those with high homocysteine levels

B12 supplementation does NOT appreciably change cognitive function or decline

Check out Supplements


Natural doesn’t mean safe

Supplements can make your prescription meds weaker or stronger

Supplements may adversely affect certain medical conditions

Avoid ingredients you don’t need and don’t assume more is better

Check the science from a reliable source (NCCIH)

Medications and Cognitive Decline


Older adults are prescribed 14 drugs per year on average

Avoid high risk meds, such as those on the AGS Beers list – pain and anxiety meds, PM meds for sleep

20 – 50% of older adults are on anticholinergic drugs (associated with cognitive impairment)

Avoid potent over-the-counter antihistamines such as Benadryl

Restorative Sleep: A Brain Booster


Warm bath or pre-sleep ritual

Room temperature adjustment, darkness, white noise

No caffeine, chocolate, alcohol after noon

Hospitalization and Cognitive Aging


In process of aging, older adults are exposed to many factors which may accelerate cognitive decline:

Nearly every older adult will experience at least one acute illness, surgery, or hospitalization

Nearly 1/3 will be hospitalized each year

−HHS, Profile of Older Americans, 2013

Prevention of Delirium


Delirium is the most common

complication of hospitalization in

older persons, 2.6 million older

adults/year

Leading contributor to cognitive

decline following hospitalization,

major illness, and surgery

At least 40% of cases are

preventable through targeted risk

factor approaches, like HELP or

Duke’s POSH.

http://www.hospitalelderlifeprogram.org/

Sensory Loss and Cognitive Health


Uncorrected deficits in hearing and vision may impact cognition and dementia risk

What studies have shown:

An association between vision impairment and compromised brain function

Stronger evidence that hearing loss can speed cognitive decline

What Else Contributes to Cognitive Decline?


Negative expectations • Lack of organization Grief • Worry • Fatigue • Pain

“Eat, Pray, Love” and More


Volunteer – meaningful engagement enhances cognition –Experience Corps long term benefits (2017)

Sing in a choir

Shop

Strategy games

Mindfulness-based meditation

Seek novelty, creative outlets, pay attention and challenge yourself

http://www.google.com/url?sa=i&rct=j&q=elderly+playing+board+games&source=images&cd=&cad=rja&docid=9d_2uy5CvXeRUM&tbnid=ozRXjFTCBlanLM:&ved=0CAUQjRw&url=http://aboutboardgames.net/tag/strategy-board-games/page/3/&ei=rRJbUfDpBJGC8QSEyoDQBg&bvm=bv.44697112,d.eWU&psig=AFQjCNEXasZwHNk9gqUHOOJNrOEK5cD0Hg&ust=1365009441411679

OLLI, MOOCs, COURSERA & BEYOND


Risk Factors Awaiting More Research


Stress

Social isolation/ loneliness

Early life factors, especially poverty, education quality, literacy, trauma

Chronic inflammation in mid life associated with brain shrinkage and AD (2017)

Cholesterol levels

What Else Helps?


Typical Forgetting: What Helps?


Write it down

Check reminder cues –smart phones

Give everything a place, especially by door

Limit multi-tasking, clutter

Say it out loud to focus attention

Story methods to connect items

Chunk numbers or categorize

Forgetting: What You Can Do?


Limit processed foods

Helmets and seat belts

Falls prevention

Manage stress

Mindfulness, meditation, yoga

Pace and set priorities

Prevention of Alzheimer’s


Dementia may be a disorder that develops over a lifetime, with individual ways to build a better brain as we age.

−Galvin JE, JAGS, Oct. 2017

Remember This


It’s never too early or too late –brains can change with experience

Mood and mobility matter

Treat CVD-risk illnesses

Walk more, more often and with friends – set and pursue goals and purpose, keep records and reward yourself

Forgetting: When to Get Help


Getting lost in familiar places

Repetitive questioning, checking, worry

Money, medication and moving violation mistakes

Odd or uncharacteristic behavior, mood, personality changes

Falls or change in balance, unexplained injuries

Better Outcomes with Early Diagnosis


Access available treatments

Access support services

Better manage medications

Receive counseling

Address driving and safety issues

Manage co-occurring conditions

Advance planning

−CDC 2017

Take Action: Participate in Research


Are you over 65 years old?

Have you stood by a friend or family member living with Alzheimer’s or a related disorder (ADRD)?

Are you concerned about ADRD in your future?

Do you want to know about options to participate in Alzheimer’s prevention studies?

Are you currently free from a diagnosis of Alzheimer’s?

JOIN DUKE’S AD PREVENTION REGISTRY

DUKE FAMILY SUPPORT PROGRAM

DUKEFAMILYSUPPORT.ORG

919-660-7510

Questions???

caregiver alternatives to running on empty · 2019-03-16 · “super-agers” suggest modifiable...

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