flourishing in later life – cognitive and emotional health

Flourishing in Later Life – Cognitive and Emotional

Health

Cognitive and Emotional Health –

An Idea Whose Time Has Come?

Hugh Hendrie MB ChB DSc

Professor, Department of Psychiatry, Indiana University School of Medicine

IU Center for Aging Research

Cognitive and Emotional Health In the Elderly Project

Goals

• to assess the state of longitudinal and epidemiological research on demographic, social and biological determinants of cognitive and emotional health

• to determine how these pathways reciprocally influence each other


Critical Evaluation Study Committee[NIA, NIMH, NINDS]

Hugh C. Hendrie, Committee Chair

Indiana University

Marilyn Albert

John Hopkins

Sujuan Gao

Indiana University

David Knopman

Mayo Clinic

KristineYaffe

Univ. of California at San Francisco

Meryl Butters

University of Pittsburgh

Lenore Launer

NIA Intramural

Bruce Cuthbert

NIMH

Emmeline Edwards

NINDS

Molly Wagster

NIA


Conclusions from CEHP Review

• Widespread public interest• A different set or combination of risk factors (or

different emphases) may be identified than those from illness-focused research

• Research in brain health maintenance should be pursued with vigor

• Health promotion and disease prevention are complimentary

• Cognitive and emotional health must be studied simultaneously


• Cognition•Upper Classes•Men•“Hard” Science•Neurology•Health System•White•“Stiff Upper Lip”•“White Man’s Burden”

• Emotion•Lower Classes•Women•“Soft” Science•Psychiatry•Mental Health System•Minorities•“Cry Baby”•“Savages”


An Idea Whose Time Has Come?

http://www.free-nature-animal-butterfly-wallpaper.com/animate/245.gif


Positive PsychologyMartin Seligman

• Studies the strengths and virtues that enable individuals and communities to thrive

• Pleasant life

• Good life

• Meaningful life


International Interest in Well Being

• Felicia Huppert

• Co-Director of the Well Being Institute

• University of Cambridge


A well-being module for the European Social Survey (ESS)

• ESS is a cross-national time-series survey conducted every 2 years on community residents aged 16+

• Round 1 2002/2003 – 23 participating countries Round 2 2004/2005 – 26 participating countries

• Round 3 underway – includes a 54-item personal and social well-being module

Winner of the 2005 Descartes Prize Europe’s top award for science


Conceptual framework for the ESS Well-Being Module

Personal Interpersonal

Feeling

(having, being)

Satisfaction

Positive affect

Negative affect

Optimism

Self esteem

Belonging

Social support

Social approval

Social progress

Functioning

(doing)

Autonomy

Competence

Interest in learning

Goal orientation

Sense of purpose

Resilience

Caring

Social engagement Altruism


Psychological approaches to improving well-being

• Behavior– Regular exercise– Other lifestyle habits– Being kind to others

• Cognition– Interpreting events in a positive light– Savoring the moment– Belief in change (‘growth mind set’)

• Motivation– Striving for valued goals– Intristic motivation


Relationship between mental health in the individual and the

population• The mental health of individuals is

influenced by the characteristics of the population in which they live

• Populations thus carry a collective responsibility for their own mental health and well-being

• Interventions are unlikely to succeed if they do not involve population-wide changes


The Healthy Brain Initiative: A National Public Health Road Map to

Maintaining Cognitive Health• A call to action

and a guide for implementing a coordinated approach to moving cognitive health into public health practice

Available at www.cdc.gov/aging and www.alz.org


The Model: Moving Science into Public Health Practice - Developing

the Road MapCreate/expand the

science and knowledge base

Create/sustainsocial/environmental

demands

Build and strengthen capacity

Intermediate outcomes

Long-range outcome

Adapted from Orleans CT. Helping pregnant smokers quit: meeting the challenge in the next decade. Tobacco Control 2000; 9(supple 3): III6-III11


Developing the Road Map• Convened a Steering Committee• Public health research meeting• 4 Workgroups – Expert panels

– Developed 42 recommended actions• External feedback (n=40)• Concept mapping

– Engage a large group of stakeholders to organize the recommendations in a way that make sense to all groups

• Rating (importance and action potential)– 49% participation rate (N=140)

• Sorting– 73% participation rate (N=20)


Priority Actions• Determine how diverse audiences think about cognitive

health and its associations with lifestyle factors• Disseminate the latest science to increase public

understanding of cognitive health and to dispel common misconceptions

• Help people understand the connection between risk and protective factors and cognitive health

• Initiative policy changes at the federal, state, and local levels to promote cognitive health by engaging public officials

• Include cognitive health in Healthy People 2020, a set of health objectives for the nation that will serve as the foundation for state and community public health plans


Priority Actions

• Conduct systematic literature reviews on proposed risk factors (vascular risk and physical inactivity) and related interventions for relationships with cognitive health

• Conduct controlled clinical trials to determine the effect of reducing vascular risk factors on lowering the risk of cognitive decline and improving cognitive function

• Conduct controlled clinical trials to determine the effects of physical activity on reducing the risk of cognitive decline and improving cognitive function

• Conduct research on other areas potentially affecting cognitive health, such as nutrition, mental activity, and social engagement

• Develop a population-based surveillance system with longitudinal follow-up that is dedicated to measuring the public health burden of cognitive impairment in the United States


SocioDemographic/Political Trends

• Baby Boomers come of age

• Concerns about the cost of health care/aging population

• Dissatisfaction with the sole use economic indices to determine policies

• Concerns about global ecology


Brain Health Current State of the Art

Two models for preserving brain health

Cautionary Notes


Healthy Brain

To see ourselves as others see us.

To be, or not to

be.E = mc2


Maintaining Brain HealthModel 1 (Spartan)


Maintaining Brain HealthModel 2 (Dionysian)

Enjoy yourself!!


The Current State of the ArtCautionary Notes

• A paucity of large scale prevention trials, both efficacy and effectiveness

• Problems of complex models, publication bias, and confounders in observational studies

• “ Blame the victim" implications for health care• Public acceptance -The “worried” well or

increasing skepticism• Need for comprehensive approach


Confounders

“They’re a bit posh, they get plenty of exercise, they work, they have strong

social supports, and more”

Ben Goldacre

The Guardian, December 22, 2007



• A paucity of large scale prevention trials• Problems of complex models, publication

bias and confounders in observational studies

• “ Blame the victim”• Public acceptance -The “worried” well or



Health Disparities

• Poorer and disadvantaged people have poorer access to– Safe spaces for exercise– Good sources of nutrition– Preventive health care– Overall health care services– Quality health care services

Cherry and Reid





• “ Blame the victim”• Public acceptance -The “worried” well

or increasing skepticism• Need for comprehensive approach


Hypochondriasis Health Variation (Hendrie Syndrome)

• Diagnostic Criteria (Two or more criteria)• Ruminations about health status > 2 hrs. per day (Confirmatory

evidence spouse, relatives, friends, refuse to engage in conversations about health)

• Consulting with health professionals >1 per week (Confirmatory evidence > two personal physicians take early retirement)

• Monitoring “numbers” > every 30 minutes per day (or alternatively phobic avoidance of sphygmomanometers or other instruments)

• Engaging in “health games” > 2 per day (e.g. balancing, deep breathing, “ brain” games)

• Exercising with > three braces (alternatively guilt about not exercising) • Modifications of diet >2 per week to correspond with the latest news

headlines • Ingestion of > 1 vitamin (or other dietary) supplement per day


Hypochondriasis Health Variation (Hendrie Syndrome) (continued)

• Severe Form• Hiring personal “ health advisor”





• “ Blame the victim”• Public acceptance -The “worried” well or


Society-wide strategies to alter behavior

• Smoking

• Alcohol

• Sexual Behavior

• Illicit Drugs


Components of a Strategy for Brain Health

(each intervention component tested for efficacy and effectiveness) • National commitment

• Development of a supportive infrastructure• Inclusive, persuasive, non coercive approach• Realistic goals, congruent with those of other

disciplines• Integration with health services• Community as well as individual targeting• Development of a national surveillance system• (NB All approaches will be influenced by advances

in treatment)


“ Mens Sana in Corpore Sano”Juvenal Satire X


Review References

• Hendrie et al. Alzheimer’s and Dementia 2006 2; 12-32

• Fratiglione et al. Lancet Neurol 2004; 3:343-353• Launer. Ageing Res. Rev 2002;1(1):61-77 • Jedrziewski et al. Alzheimer’s and Dementia

2005;1(2):61-77• CDC/AA. Alzheimer’s and Dementia Special

supplement 1 2007 3(2) • Brayne Carol. Perspectives. Nature 8: 2007,

233-237


Review References

• Gilbert, Daniel Todd. Stumbling on Happiness. Knopf Canada. 2007.

• Huppert, F, Baylis, N, Keverne, B. The Science of Well Being. Oxford University Press. 2005

flourishing in later life – cognitive and emotional health

Documents

scienceiu center

nindsiu center

simultaneouslyiu center

aging researchconclusions

otheriu center

aging researchrelationship

aging researchinternational

aging researchcognitive