A new study says Skype and FaceTime provide more than just conversation
By Sarah Lindenfeld Hall

Anne Whitley lives 800 miles from her grandchildren’s home in Florida, but she still sees them daily. On her iPhone’s FaceTime app, Whitley catches up with her five-year old granddaughter, Cairo, who might show off a new toy, and her year-old grandson, Garvey, who enjoys practicing his latest words.

All it takes is just a few minutes each day to bridge those miles between them.

“I don’t want them to forget me in between visits,” said Whitley, 83, a retired teacher in Clayton, N.C., who sees her grandchildren in person a couple times a year. “That keeps us connected.”

Whitley’s main concern is staying in touch with her grandkids, but there’s another reason older adults may want to consider dialing up their loved ones by video chat platforms like FaceTime and Skype. to connect with A recent study from Oregon Health & Science University in Portland found that the use of video chat with friends and family also may be an effective way for older adults to dramatically reduce their risk for depression.

Fending Off Depression With a Video Chat

The study, published in the American Journal of Geriatric Psychiatry, used data from the National Institute on Aging’s Health and Retirement Study, which surveys older Americans every two years. Researchers looked at Americans age 60 and up who used four kinds of communication technologies — video chat, email, social media networks like Facebook and instant messaging. Then, they examined their symptoms of depression two years later.

“It gives my dad and me a more immersive, more interactive experience.”

Researchers found that older adults who connected with their loved ones through email exchanges, Facebook posts or instant messaging sessions had about the same rate of depression compared to those who did not. By contrast, those who communicated through video chat cut their probability of depression by nearly half.

“We need to get beyond a discussion of technology being good or bad,” said lead author Alan Teo, an associate professor of psychiatry at Oregon Health & Science’s School of Medicine and a researcher at the VA Portland Health Care System. “The conversation we need to be having, and I hope that this study helps move forward, is what ways should we be using our technology and what particular types of platforms might be the most beneficial for our health and happiness.”

Not Just About Preventing the Blues

Studies show that depression and social isolation can be problems for older adults. While the majority are not depressed, according to the Centers for Disease Control and Prevention, rates can rise as high as about 12% for those who are hospitalized and 14% for those who need home health care. And as many as 32% of people older than 55 feel lonely, according to the National Institutes of Health. Both depression and loneliness can have consequences beyond feeling blue and include links to poorer physical health and a shortened lifespan.

“People literally die earlier when they are lonely,” Teo said.

Teo’s research didn’t examine why video chat might be the better technology, but he can make an educated guess after years of treating patients as a psychiatrist and researching ways to help them. When we’re able to see the emotions and expressions as we talk to our loved one, we have a more intimate exchange, said Teo, who now makes the effort to video chat more often with his father, 82.

“It gives my dad and me a more immersive, more interactive experience,” he said. “We can be tempted to just shoot off a quick text message … but this study is a reminder that we shouldn’t settle for that all the time.”

The findings ring true with Kim G. Johnson, an assistant professor of psychiatry and behavioral sciences at Duke University, who was not involved in the research. She said she regularly hears from patients about their video chats with their grandchildren.

“It’s almost the next best thing to being there,” she said. The trick now, she said, is to make technologies like video chat more accessible to older adults.

4 Ways to Incorporate More Video Chats Into Your Life

Here are four tips on how to see your loved ones’ faces more often:

Get familiar with the technology. If you’re not sure how to use video chat, Teo said, figure out the barriers and get help. Some, like Whitley, get guidance from tech-smart children or grandchildren. Whitley’s daughter gave her an iPhone and showed her how to use FaceTime. “I won’t ever know how to use it as well as she does, but what I do know is good for me,” she said.

You also could sign up for a technology class at your local senior center or search online for tutorials. TechBoomers offers YouTube videos for how to use both Skype and FaceTime.

Switch it up. Daily or weekly video chats may need to be scheduled, but not every session has to be on the calendar, Teo said. If your granddaughter posts a prom picture on Instagram, instead of just posting a comment, contact her on Skype to ask her about the dance. Take the initiative to add more virtual face-to-face chats to your daily life. “Change up the mode of communication when you can,” Teo said.

Look in their eyes. During a video chat, make the effort to appear to be looking at the other person, Johnson said. That means you’ll need to look directly into the tiny video camera at the top of the screen from time to time instead of the screen where your family member’s face is. It’s an important way to help build rapport during your conversation, she said.

Still get together. Video chat and other forms of online communications should never replace your in-person get-togethers, where you can hug and hold and be present with the ones you love, Teo and Johnson said.

“But when you don’t have the option of being in person,” Teo said, “video chat is probably best.”

By Sarah Lindenfeld Hall

Sarah Lindenfeld Hall is a North Carolina-based journalist and freelance writer specializing in family, health, technology, small business and entrepreneurship topics.

A new study says Skype and FaceTime provide more than just conversation
By Sarah Lindenfeld Hall

Anne Whitley lives 800 miles from her grandchildren’s home in Florida, but she still sees them daily. On her iPhone’s FaceTime app, Whitley catches up with her five-year old granddaughter, Cairo, who might show off a new toy, and her year-old grandson, Garvey, who enjoys practicing his latest words.

All it takes is just a few minutes each day to bridge those miles between them.

“I don’t want them to forget me in between visits,” said Whitley, 83, a retired teacher in Clayton, N.C., who sees her grandchildren in person a couple times a year. “That keeps us connected.”

Whitley’s main concern is staying in touch with her grandkids, but there’s another reason older adults may want to consider dialing up their loved ones by video chat platforms like FaceTime and Skype. to connect with A recent study from Oregon Health & Science University in Portland found that the use of video chat with friends and family also may be an effective way for older adults to dramatically reduce their risk for depression.

Fending Off Depression With a Video Chat

The study, published in the American Journal of Geriatric Psychiatry, used data from the National Institute on Aging’s Health and Retirement Study, which surveys older Americans every two years. Researchers looked at Americans age 60 and up who used four kinds of communication technologies — video chat, email, social media networks like Facebook and instant messaging. Then, they examined their symptoms of depression two years later.

“It gives my dad and me a more immersive, more interactive experience.”

Researchers found that older adults who connected with their loved ones through email exchanges, Facebook posts or instant messaging sessions had about the same rate of depression compared to those who did not. By contrast, those who communicated through video chat cut their probability of depression by nearly half.

“We need to get beyond a discussion of technology being good or bad,” said lead author Alan Teo, an associate professor of psychiatry at Oregon Health & Science’s School of Medicine and a researcher at the VA Portland Health Care System. “The conversation we need to be having, and I hope that this study helps move forward, is what ways should we be using our technology and what particular types of platforms might be the most beneficial for our health and happiness.”

Not Just About Preventing the Blues

Studies show that depression and social isolation can be problems for older adults. While the majority are not depressed, according to the Centers for Disease Control and Prevention, rates can rise as high as about 12% for those who are hospitalized and 14% for those who need home health care. And as many as 32% of people older than 55 feel lonely, according to the National Institutes of Health. Both depression and loneliness can have consequences beyond feeling blue and include links to poorer physical health and a shortened lifespan.

“People literally die earlier when they are lonely,” Teo said.

Teo’s research didn’t examine why video chat might be the better technology, but he can make an educated guess after years of treating patients as a psychiatrist and researching ways to help them. When we’re able to see the emotions and expressions as we talk to our loved one, we have a more intimate exchange, said Teo, who now makes the effort to video chat more often with his father, 82.

“It gives my dad and me a more immersive, more interactive experience,” he said. “We can be tempted to just shoot off a quick text message … but this study is a reminder that we shouldn’t settle for that all the time.”

The findings ring true with Kim G. Johnson, an assistant professor of psychiatry and behavioral sciences at Duke University, who was not involved in the research. She said she regularly hears from patients about their video chats with their grandchildren.

“It’s almost the next best thing to being there,” she said. The trick now, she said, is to make technologies like video chat more accessible to older adults.

4 Ways to Incorporate More Video Chats Into Your Life

Here are four tips on how to see your loved ones’ faces more often:

Get familiar with the technology. If you’re not sure how to use video chat, Teo said, figure out the barriers and get help. Some, like Whitley, get guidance from tech-smart children or grandchildren. Whitley’s daughter gave her an iPhone and showed her how to use FaceTime. “I won’t ever know how to use it as well as she does, but what I do know is good for me,” she said.

You also could sign up for a technology class at your local senior center or search online for tutorials. TechBoomers offers YouTube videos for how to use both Skype and FaceTime.

Switch it up. Daily or weekly video chats may need to be scheduled, but not every session has to be on the calendar, Teo said. If your granddaughter posts a prom picture on Instagram, instead of just posting a comment, contact her on Skype to ask her about the dance. Take the initiative to add more virtual face-to-face chats to your daily life. “Change up the mode of communication when you can,” Teo said.

Look in their eyes. During a video chat, make the effort to appear to be looking at the other person, Johnson said. That means you’ll need to look directly into the tiny video camera at the top of the screen from time to time instead of the screen where your family member’s face is. It’s an important way to help build rapport during your conversation, she said.

Still get together. Video chat and other forms of online communications should never replace your in-person get-togethers, where you can hug and hold and be present with the ones you love, Teo and Johnson said.

“But when you don’t have the option of being in person,” Teo said, “video chat is probably best.”

By Sarah Lindenfeld Hall

Sarah Lindenfeld Hall is a North Carolina-based journalist and freelance writer specializing in family, health, technology, small business and entrepreneurship topics.

Are you a full-time caregiver for someone with Alzheimer’s or dementia? A little breather may be just what you need.

Alzheimer's disease is life-changing for both those who are diagnosed and those close to them. Having a helping hand when you need it is key to keeping yourself, and your loved one living with dementia, healthy and happy.

When you need a break, consider adult day services.Not only is it good for you, but it’s good for your loved one. Adult Day Services offer people living with Alzheimer's and other dementias the opportunity to be social and to participate in activities in a safe environment.

Adult Day Services may be for you if:

• You are a full-time caregiver: Adult Day Services can provide a much needed break. While your loved one is at adult day, you'll have time to rest, run errands or finish other tasks.
• You work during the day: Adult Day Services can help you to balance a job with caregiving duties.
• You want a safe, caring environment for your loved one:  Adult Day Service is a chance for your loved one to share time with their peers. It provides a chance for them to be social and to participate in engaging activities such as music and exercise programs, as well as fun outings. 

Did you know that Woodside Place of Presbyterian SeniorCare Network offers Adult Day Services at its campuses in Oakmont (412-828-5600) and Manchester Commons (814-838-9191)? We are here to help!

Are you a full-time caregiver for someone with Alzheimer’s or dementia? A little breather may be just what you need.

Alzheimer's disease is life-changing for both those who are diagnosed and those close to them. Having a helping hand when you need it is key to keeping yourself, and your loved one living with dementia, healthy and happy.

When you need a break, consider adult day services.Not only is it good for you, but it’s good for your loved one. Adult Day Services offer people living with Alzheimer's and other dementias the opportunity to be social and to participate in activities in a safe environment.

Adult Day Services may be for you if:

• You are a full-time caregiver: Adult Day Services can provide a much needed break. While your loved one is at adult day, you'll have time to rest, run errands or finish other tasks.
• You work during the day: Adult Day Services can help you to balance a job with caregiving duties.
• You want a safe, caring environment for your loved one:  Adult Day Service is a chance for your loved one to share time with their peers. It provides a chance for them to be social and to participate in engaging activities such as music and exercise programs, as well as fun outings. 

Did you know that Woodside Place of Presbyterian SeniorCare Network offers Adult Day Services at its campuses in Oakmont (412-828-5600) and Manchester Commons (814-838-9191)? We are here to help!

How to know when caregiving crosses the line to self-neglect
By Randi Mazzella

Stacey G.’s (she asked that we use her last name initial only due to the personal details in the story) parents had a storybook romance. Married for over 60 years, her father still called her mother “sweetheart.”

Stacey’s mother developed dementia. As it progressed, her father tried for several months to take care of his wife at home with the help of health care aides. But then her behavior become explosive and irrational. Stacey, who lives in Voorhees, N.J., was faced with the painful decision of placing her mother in a nursing home.

“It was an extremely difficult decision and I still struggle with it, even though I am certain it was the right decision for everyone — especially my dad,” she says.

Her father’s devotion did not waver. He visited his wife twice daily, with just brief midday respites. “He would call at the same time every day to give me an update me on how my mother was doing,” Stacey says. “He rarely deviated from his routine.”

It didn’t matter that his wife’s dementia made it impossible for her to know if he was there or not. He continued to visit his sweetheart daily for more than three years, until she passed away.

While Stacey found her father’s devotion to her mother admirable, it was also concerning. Her father was in his mid-80s and had given up doing any of his traditional leisure activities, including playing poker and twice-per-week trips to Atlantic City with friends.

“He worried about my mother constantly,” Stacey says. “I was sad for my mother, but I didn’t worry because I knew she was being well cared for by the staff and by him. But I worried about my father. He wasn’t taking care of himself, he was driving exhausted and he didn’t spend time with anyone but my mother.”

Is it possible to be too devoted as a caregiver? And if so, how can a loved one’s help caregivers understand that they need to think about themselves?

The Physical Demands of Caregiving

“Can a vehicle continue to run without regular fill-ups and service? No!” says Rick Lauber, and author of the book, The Successful Caregiver’s Guide. Lauber, who lives in Alberta, Canada, helped care for his parents until they passed away. “Caregivers are no different. Caregivers helping and supporting aging loved ones routinely give too much of themselves while overlooking their own health and wellness.”

Clinical gerontologist David J. Demko adds, “Caregivers tend to get reduced sleep, including much-needed REM sleep. They have muscular aches from the physical demands of caregiving and neglect their personal nutritional needs.”

Stacey’s father eventually wound up hospitalized for five days with pneumonia. “The thing that really troubled me was that he still went to the care facility disregarding the fact that he was starting to feel pretty sick,” she says. “But his needs were unimportant to him.”

Some care partners actually become ill and die before the person they are caring for, says Rachael Wonderlin, a gerontologist and founder of a consulting business called Dementia By Day in Pittsburgh. “And it’s no wonder — they are highly stressed and consumed in their newfound role,” she says.

Strain On Relationships

Caregivers have decreased time for social outings and become emotionally drained. Even when they do take a break, they experience guilt. “When my father came to my house for holidays, he tried to enjoy himself, but I could tell he felt guilty that my mother was alone,” Stacey says. “He seemed lost and sad. He was much happier when I would bring my kids to him at the nursing home, but this was a hard environment for my young son. It was stressful for me to balance my father’s needs with my son’s.”

What Stacey’s father experienced is common, says Katie Ziskind, a family therapist at Wisdom Within Counseling in Niantic, Conn. “The (caregiver) often can develop codependency and depression as a result of caring so much for their loved one, even with the best intentions,” she says.

Stacey says her father is a very warm and kind man, but when he was away from the nursing home, he was usually distracted and anxious due to worrying so much about her mother.

“When we spoke, he would tell the same stories over and over again and was not really focusing on what was going on with me, my kids,” she says. It wasn’t until after her mother died that her father said, “I just realized, you lost your mother.”

How to Help a Caregiver

“Self-care is absolutely essential to be a good (caregiver) because you can’t give from an empty bucket,” Ziskind says. Explaining this to devoted caregivers can be difficult, but try stressing that if they don’t care for themselves, they won’t be as helpful to their loved one or to the other people in their lives who love and worry about them.

Yoga, meditation, writing in a journal or going for a daily walk can all help to replenish a caregiver’s energy and mental well-being.

Socialization for caregivers is also crucial. Encourage them to spend time with friends, connect with family or attend support groups with other caregivers.

Looking back, Stacey says her one regret is that she didn’t insist her mother be placed in a facility closer to her home, instead of over an hour away. It was difficult for her to visit her mother more than once a week while balancing work and childcare responsibilities.

“My father didn’t have a lot of support in the area. If she were closer to me, I could have visited her more often and I could have tag-teamed with my dad instead of him going twice a day,” Stacey says. “He also could have spent more time with his grandchildren and me without feeling guilty that my mother was alone.”

During her mother’s illness, Stacey feared that her father would die from the pace and intensity of his devotion to her mother. She says her father was a beautiful role model to her and to her kids. She is thankful that he now appears to be doing more things for himself.

“He has no regrets about the time he spent taking care of my mother. Even though he is sad that she is gone, he is also calmer and less anxious knowing she is at peace. He is taking better care of himself and is back to his twice a week Atlantic City trips. We still talk daily about my mother, but about other things too,” she says.

By Randi Mazzella

Randi Mazzella is a freelance writer specializing in a wide range of topics from parenting to pop culture to life after 50. She is a mother of three and lives in New Jersey with her husband and teenage son.  Read more of her work on randimazzella.com. 

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How to know when caregiving crosses the line to self-neglect
By Randi Mazzella

Stacey G.’s (she asked that we use her last name initial only due to the personal details in the story) parents had a storybook romance. Married for over 60 years, her father still called her mother “sweetheart.”

Stacey’s mother developed dementia. As it progressed, her father tried for several months to take care of his wife at home with the help of health care aides. But then her behavior become explosive and irrational. Stacey, who lives in Voorhees, N.J., was faced with the painful decision of placing her mother in a nursing home.

“It was an extremely difficult decision and I still struggle with it, even though I am certain it was the right decision for everyone — especially my dad,” she says.

Her father’s devotion did not waver. He visited his wife twice daily, with just brief midday respites. “He would call at the same time every day to give me an update me on how my mother was doing,” Stacey says. “He rarely deviated from his routine.”

It didn’t matter that his wife’s dementia made it impossible for her to know if he was there or not. He continued to visit his sweetheart daily for more than three years, until she passed away.

While Stacey found her father’s devotion to her mother admirable, it was also concerning. Her father was in his mid-80s and had given up doing any of his traditional leisure activities, including playing poker and twice-per-week trips to Atlantic City with friends.

“He worried about my mother constantly,” Stacey says. “I was sad for my mother, but I didn’t worry because I knew she was being well cared for by the staff and by him. But I worried about my father. He wasn’t taking care of himself, he was driving exhausted and he didn’t spend time with anyone but my mother.”

Is it possible to be too devoted as a caregiver? And if so, how can a loved one’s help caregivers understand that they need to think about themselves?

The Physical Demands of Caregiving

“Can a vehicle continue to run without regular fill-ups and service? No!” says Rick Lauber, and author of the book, The Successful Caregiver’s Guide. Lauber, who lives in Alberta, Canada, helped care for his parents until they passed away. “Caregivers are no different. Caregivers helping and supporting aging loved ones routinely give too much of themselves while overlooking their own health and wellness.”

Clinical gerontologist David J. Demko adds, “Caregivers tend to get reduced sleep, including much-needed REM sleep. They have muscular aches from the physical demands of caregiving and neglect their personal nutritional needs.”

Stacey’s father eventually wound up hospitalized for five days with pneumonia. “The thing that really troubled me was that he still went to the care facility disregarding the fact that he was starting to feel pretty sick,” she says. “But his needs were unimportant to him.”

Some care partners actually become ill and die before the person they are caring for, says Rachael Wonderlin, a gerontologist and founder of a consulting business called Dementia By Day in Pittsburgh. “And it’s no wonder — they are highly stressed and consumed in their newfound role,” she says.

Strain On Relationships

Caregivers have decreased time for social outings and become emotionally drained. Even when they do take a break, they experience guilt. “When my father came to my house for holidays, he tried to enjoy himself, but I could tell he felt guilty that my mother was alone,” Stacey says. “He seemed lost and sad. He was much happier when I would bring my kids to him at the nursing home, but this was a hard environment for my young son. It was stressful for me to balance my father’s needs with my son’s.”

What Stacey’s father experienced is common, says Katie Ziskind, a family therapist at Wisdom Within Counseling in Niantic, Conn. “The (caregiver) often can develop codependency and depression as a result of caring so much for their loved one, even with the best intentions,” she says.

Stacey says her father is a very warm and kind man, but when he was away from the nursing home, he was usually distracted and anxious due to worrying so much about her mother.

“When we spoke, he would tell the same stories over and over again and was not really focusing on what was going on with me, my kids,” she says. It wasn’t until after her mother died that her father said, “I just realized, you lost your mother.”

How to Help a Caregiver

“Self-care is absolutely essential to be a good (caregiver) because you can’t give from an empty bucket,” Ziskind says. Explaining this to devoted caregivers can be difficult, but try stressing that if they don’t care for themselves, they won’t be as helpful to their loved one or to the other people in their lives who love and worry about them.

Yoga, meditation, writing in a journal or going for a daily walk can all help to replenish a caregiver’s energy and mental well-being.

Socialization for caregivers is also crucial. Encourage them to spend time with friends, connect with family or attend support groups with other caregivers.

Looking back, Stacey says her one regret is that she didn’t insist her mother be placed in a facility closer to her home, instead of over an hour away. It was difficult for her to visit her mother more than once a week while balancing work and childcare responsibilities.

“My father didn’t have a lot of support in the area. If she were closer to me, I could have visited her more often and I could have tag-teamed with my dad instead of him going twice a day,” Stacey says. “He also could have spent more time with his grandchildren and me without feeling guilty that my mother was alone.”

During her mother’s illness, Stacey feared that her father would die from the pace and intensity of his devotion to her mother. She says her father was a beautiful role model to her and to her kids. She is thankful that he now appears to be doing more things for himself.

“He has no regrets about the time he spent taking care of my mother. Even though he is sad that she is gone, he is also calmer and less anxious knowing she is at peace. He is taking better care of himself and is back to his twice a week Atlantic City trips. We still talk daily about my mother, but about other things too,” she says.

By Randi Mazzella

Randi Mazzella is a freelance writer specializing in a wide range of topics from parenting to pop culture to life after 50. She is a mother of three and lives in New Jersey with her husband and teenage son.  Read more of her work on randimazzella.com. 

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Learn the ways you can have a positive effect on your cognitive health
By Paula Spencer Scott

The basics of heart health have been drilled into our brains: Eat less saturated fat. Keep moving. Know your “numbers” for cholesterol, blood pressure and BMI.

But what about that brain itself? Although life expectancy has more than doubled since 1900, our “mindspan” — how long we stay cognitively healthy — hasn’t kept pace.

Forgetfulness, slower processing and feeling less sharp plague most of us as we age. One in five people develops mild cognitive impairment, a decline in thinking skills beyond normal aging, which may or may not advance to dementia. After 65, your odds of developing Alzheimer’s disease are one in 10.

It doesn’t have to be that way, mounting research suggests.

“The very term ‘age-related memory loss’ may be a misnomer,” says neurologist Dr. Richard Isaacson, an Alzheimer’s specialist at Weill Cornell Medicine in New York.

Time and genetics alone don’t erode brain functions. How we spend our lives managing the modifiable risk factors that affect our genes is highly significant for our brain health, researchers say.

That’s why you’re likely to hear a lot more in the coming years about brain health and what you can do for your own. Educating the public on this is, in fact, one of the four core purposes of the Centers for Disease Control’s Healthy Brain Initiative, which recently kicked off its 2018-2023 road map for public health agencies, says program leader Lisa McGuire.

Brain Health: Stop Thinking There’s Nothing You Can Do

“Awareness of the steps to improve cognitive brain function is at least a generation behind that of heart health,” says cognitive neuroscientist Sandra Bond Chapman, director of the Center for Brain Health at the University of Texas at Dallas.

When our fathers and grandparents died of a heart attack or stroke, we chalked it up to tragic luck. Clogged arteries, high blood pressure and high cholesterol were considered normal features of aging before 1948, when Congress commissioned researchers to begin tracking the cardiovascular lives of some 5,200 residents of Framingham, Mass.

The Framingham Heart Study (now three generations old and still going) introduced the phrase “risk factors” to the medical lexicon and helped prove which prevention tactics work.

Today, it’s the brain we’re in the dark about. In a review of public awareness studies by PLOS One, a nonprofit, peer-reviewed, online scientific journal, nearly half of the respondents mistakenly believed Alzheimer’s disease is a normal process of aging that you can’t do anything about. In reality, a third or more of dementia cases can be delayed or prevented by lifestyle factors, according to a 2017 report sponsored by the Lancet Commission on Dementia Prevention, Intervention and Care.

Read on to find out what we can do to help our brains stay in shape.

Use Brain Health to Motivate Your Health Habits

Advances in neuroimaging kicked off this new era of brain health by allowing scientists to see inside the brain. Intervention studies on how lifestyle affects brain function are newer still.

One of the largest such investigations to date, the BrainHealth Project, launched in December. Researchers across more than a dozen institutions will study 120,000 subjects to find out how cognitive training, sleep, nutrition, exercise and more can extend mental strength over time.

What’s already clear: All health roads lead to the brain. “The No. 1 cause of cognitive decline is healthy people letting their brains decline,” says Chapman, the BrainHealth Project’s director.

That’s powerful motivation the next time you’re tempted to skip a workout or not opt for a healthy meal, do nothing about stress or loneliness, or avoid treatment for conditions like depression, anxiety, diabetes and sleep apnea. Effects of all of these choices, and many others, travel north.

Resist Too Much Habit and Routine

A particular challenge from midlife and beyond is the brain’s natural inclination to steer toward efficiency. It figures out the easiest, most comfortable ways to get something done and hits repeat.

But while toweling dry in the same mechanical pattern every morning allows you to get on with the day quickly, running your whole life as a creature of habit — doing the same things, seeing the same people — deprives the brain of something else it craves: newness and challenge.

Hallmarks of brain-stimulating activities that improve cognitive abilities, according to a 2017 report by the Global Council on Brain Health (GCBH) are novelty, high engagement, mental challenge and enjoyableness.

If you like crosswords, fine, but push beyond to new games and challenges. Good examples from the GCBH: Tai chi, researching genealogy, picking up an old hobby you dropped, making art and community volunteering. When activities include a social component, so much the better.

Be Aggressive About Blood Pressure

In 2018, a groundbreaking study became the latest persuasive link between heart health and brain health. Researchers at Wake Forest University in Winston-Salem, N.C., showed for the first time that lowering blood pressure can significantly reduce the risk of mild cognitive impairment (MCI).

Standard medical care had long included a systolic blood pressure of above 140 as the target defining hypertension and requiring treatment. (Systolic pressure is the first number in a blood pressure reading, as in “140 over 80.”) In 2017, that definition was revised to 130 by the American Heart Association and American College of Cardiology.

The recent, long-term, large-scale SPRINT-MIND clinical trial, sponsored by the National Institutes of Health, found that the more aggressively high blood pressure was treated toward reaching a systolic pressure below 120, the lower the risk of MCI. Treatment measures included a combination of not smoking, medication management, nutrition counseling, social and cognitive stimulation and exercise.

Work Your Brain Harder, But Not by Multitasking

Your brain grooves on doing — but only one thing at a time. Multitasking stresses it.

Researchers say one better alternative is a cognitive exercise called “strategic attention.” The Strategic Memory Advanced Reasoning Training program at the University of Texas at Dallas, advises this: Every day, pick two substantial tasks requiring fairly deep thinking. They might be tracking and analyzing your household budget, planning a vacation, writing a memo or following a complex new recipe.

Then carve out two 30-minute sessions to focus without interruption. Turn off email alerts. Shut the door. No quick scrolls through your news feed that will take you off your task. It takes up to 20 minutes to refocus after a disruption.

Over time, you’ll find that you’ll achieve much more, and much more quickly, with improved attention. It’s the equivalent to your brain of a good workout at the gym.

Do (the Right Kind of) Nothing

It’s not all about activity. The brain needs two kinds of downtime to function optimally: Rest and sleep.

Rest means taking intentional breaks from active thinking. Try taking five minutes, five times a day, to sit still and do nothing, Chapman says. Other routes to mental R&R include mindfulness, meditation and yoga nidra (also known as iRest and sleep yoga).

Not least, there’s sleep itself. Our awareness of how important it is to the brain grew with the discovery of the body’s glymphatic system — a kind of internal trash-hauling system — less than a decade ago. The system’s pace increases by over 60 percent during sleep, a possible link to why getting more sleep is linked with a reduced dementia risk. Alzheimer’s prevention experts recommend eight to nine hours a night, Isaacson says.

By Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and An Oral History: Preserve Your Family's Story. A longtime journalist, she's also an Alzheimer's and caregiving educator.@PSpencerScott

Learn the ways you can have a positive effect on your cognitive health
By Paula Spencer Scott

The basics of heart health have been drilled into our brains: Eat less saturated fat. Keep moving. Know your “numbers” for cholesterol, blood pressure and BMI.

But what about that brain itself? Although life expectancy has more than doubled since 1900, our “mindspan” — how long we stay cognitively healthy — hasn’t kept pace.

Forgetfulness, slower processing and feeling less sharp plague most of us as we age. One in five people develops mild cognitive impairment, a decline in thinking skills beyond normal aging, which may or may not advance to dementia. After 65, your odds of developing Alzheimer’s disease are one in 10.

It doesn’t have to be that way, mounting research suggests.

“The very term ‘age-related memory loss’ may be a misnomer,” says neurologist Dr. Richard Isaacson, an Alzheimer’s specialist at Weill Cornell Medicine in New York.

Time and genetics alone don’t erode brain functions. How we spend our lives managing the modifiable risk factors that affect our genes is highly significant for our brain health, researchers say.

That’s why you’re likely to hear a lot more in the coming years about brain health and what you can do for your own. Educating the public on this is, in fact, one of the four core purposes of the Centers for Disease Control’s Healthy Brain Initiative, which recently kicked off its 2018-2023 road map for public health agencies, says program leader Lisa McGuire.

Brain Health: Stop Thinking There’s Nothing You Can Do

“Awareness of the steps to improve cognitive brain function is at least a generation behind that of heart health,” says cognitive neuroscientist Sandra Bond Chapman, director of the Center for Brain Health at the University of Texas at Dallas.

When our fathers and grandparents died of a heart attack or stroke, we chalked it up to tragic luck. Clogged arteries, high blood pressure and high cholesterol were considered normal features of aging before 1948, when Congress commissioned researchers to begin tracking the cardiovascular lives of some 5,200 residents of Framingham, Mass.

The Framingham Heart Study (now three generations old and still going) introduced the phrase “risk factors” to the medical lexicon and helped prove which prevention tactics work.

Today, it’s the brain we’re in the dark about. In a review of public awareness studies by PLOS One, a nonprofit, peer-reviewed, online scientific journal, nearly half of the respondents mistakenly believed Alzheimer’s disease is a normal process of aging that you can’t do anything about. In reality, a third or more of dementia cases can be delayed or prevented by lifestyle factors, according to a 2017 report sponsored by the Lancet Commission on Dementia Prevention, Intervention and Care.

Read on to find out what we can do to help our brains stay in shape.

Use Brain Health to Motivate Your Health Habits

Advances in neuroimaging kicked off this new era of brain health by allowing scientists to see inside the brain. Intervention studies on how lifestyle affects brain function are newer still.

One of the largest such investigations to date, the BrainHealth Project, launched in December. Researchers across more than a dozen institutions will study 120,000 subjects to find out how cognitive training, sleep, nutrition, exercise and more can extend mental strength over time.

What’s already clear: All health roads lead to the brain. “The No. 1 cause of cognitive decline is healthy people letting their brains decline,” says Chapman, the BrainHealth Project’s director.

That’s powerful motivation the next time you’re tempted to skip a workout or not opt for a healthy meal, do nothing about stress or loneliness, or avoid treatment for conditions like depression, anxiety, diabetes and sleep apnea. Effects of all of these choices, and many others, travel north.

Resist Too Much Habit and Routine

A particular challenge from midlife and beyond is the brain’s natural inclination to steer toward efficiency. It figures out the easiest, most comfortable ways to get something done and hits repeat.

But while toweling dry in the same mechanical pattern every morning allows you to get on with the day quickly, running your whole life as a creature of habit — doing the same things, seeing the same people — deprives the brain of something else it craves: newness and challenge.

Hallmarks of brain-stimulating activities that improve cognitive abilities, according to a 2017 report by the Global Council on Brain Health (GCBH) are novelty, high engagement, mental challenge and enjoyableness.

If you like crosswords, fine, but push beyond to new games and challenges. Good examples from the GCBH: Tai chi, researching genealogy, picking up an old hobby you dropped, making art and community volunteering. When activities include a social component, so much the better.

Be Aggressive About Blood Pressure

In 2018, a groundbreaking study became the latest persuasive link between heart health and brain health. Researchers at Wake Forest University in Winston-Salem, N.C., showed for the first time that lowering blood pressure can significantly reduce the risk of mild cognitive impairment (MCI).

Standard medical care had long included a systolic blood pressure of above 140 as the target defining hypertension and requiring treatment. (Systolic pressure is the first number in a blood pressure reading, as in “140 over 80.”) In 2017, that definition was revised to 130 by the American Heart Association and American College of Cardiology.

The recent, long-term, large-scale SPRINT-MIND clinical trial, sponsored by the National Institutes of Health, found that the more aggressively high blood pressure was treated toward reaching a systolic pressure below 120, the lower the risk of MCI. Treatment measures included a combination of not smoking, medication management, nutrition counseling, social and cognitive stimulation and exercise.

Work Your Brain Harder, But Not by Multitasking

Your brain grooves on doing — but only one thing at a time. Multitasking stresses it.

Researchers say one better alternative is a cognitive exercise called “strategic attention.” The Strategic Memory Advanced Reasoning Training program at the University of Texas at Dallas, advises this: Every day, pick two substantial tasks requiring fairly deep thinking. They might be tracking and analyzing your household budget, planning a vacation, writing a memo or following a complex new recipe.

Then carve out two 30-minute sessions to focus without interruption. Turn off email alerts. Shut the door. No quick scrolls through your news feed that will take you off your task. It takes up to 20 minutes to refocus after a disruption.

Over time, you’ll find that you’ll achieve much more, and much more quickly, with improved attention. It’s the equivalent to your brain of a good workout at the gym.

Do (the Right Kind of) Nothing

It’s not all about activity. The brain needs two kinds of downtime to function optimally: Rest and sleep.

Rest means taking intentional breaks from active thinking. Try taking five minutes, five times a day, to sit still and do nothing, Chapman says. Other routes to mental R&R include mindfulness, meditation and yoga nidra (also known as iRest and sleep yoga).

Not least, there’s sleep itself. Our awareness of how important it is to the brain grew with the discovery of the body’s glymphatic system — a kind of internal trash-hauling system — less than a decade ago. The system’s pace increases by over 60 percent during sleep, a possible link to why getting more sleep is linked with a reduced dementia risk. Alzheimer’s prevention experts recommend eight to nine hours a night, Isaacson says.

By Paula Spencer Scott

Paula Spencer Scott is the author of Surviving Alzheimer's: Practical Tips and Soul-Saving Wisdom for Caregivers and An Oral History: Preserve Your Family's Story. A longtime journalist, she's also an Alzheimer's and caregiving educator.@PSpencerScott

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

A breakdown of the various offerings and where insurance fits in
By Lisa Fields

After a stroke, only about 10 percent of people recover almost completely without intervention. For everyone else, therapy is a crucial part of the recovery process. Whether you need physical, occupational and/or speech therapy following a stroke depends on your needs, but the goal is the same: to help you regain control of your body and be independent once again. The therapy you receive should be tailor-made to suit your lifestyle.

“Is the goal returning to driving or returning to work, or (is the person) a retiree who needs to take care of their own bodily functions and participate in playing with a grandchild?” says Glen Gillen, professor and director of programs in occupational therapy at Columbia University in New York and a fellow of the American Occupational Therapy Association.

Kinds of Rehabilitation Facilities

Most stroke patients stay in the hospital for five to six days. Their therapy needs are assessed within the first two days, and therapy may begin on the second. Some patients are sent home from the hospital right away. They may receive outpatient therapy sessions three times a week or get therapy at home from visiting nurses or therapists.

“If they’re higher-functioning, they can potentially go to outpatient therapy, if they have the means to get there,” Gillen says. “That is a challenge for many.”

Many stroke patients are discharged from the hospital to inpatient rehabilitation facilities, where they receive therapy at an intensity that’s best for their needs, based on the severity of the disability. Some go to acute inpatient rehab facilities, which offer the most intense therapy for the most responsive patients. Those with a greater degree of impairment may be sent to “subacute rehab” facilities, where the therapy isn’t as intense as acute rehab.

At acute rehab facilities, “people are guaranteed a minimum of three hours of therapy a day, and a physician visits six days a week,” says Dr. Alexander Dromerick, professor of rehabilitation medicine and neurology and chairman of rehabilitation medicine at Georgetown University Medical Center in Washington, D.C. “(At a subacute facility), they may get a few minutes a day, up to two hours a day, of therapy, and a physician visits every few weeks. They’re very different levels of intensity of care.”

Patients who are making great strides in a subacute facility might be moved to an acute facility for more intense therapy. Those who don’t have the endurance to tolerate an acute facility’s therapy, might be transferred to a subacute facility. “A subacute unit can be a way station back to the community,” Dromerick says, “or it can be a way station to go to a nursing home for the long term.”

Types of Therapy for Stroke Patients

Stroke patients often need physical therapy to strengthen their muscles, retrain their sense of balance and coordination and relearn certain movements. They may need occupational therapy to ensure they can do the tasks associated with daily living, like getting dressed, feeding themselves, showering or relearning skills necessary to return to work. Speech therapy also might be required to relearn how to speak or swallow food.

“Sometimes occupational therapists and physical therapists work together, but occupational therapists focus more on mobility activities that have to do with returning to work or returning to their role in their family or community,” says Carolee Winstein, professor of biokinesiology and physical therapy and director of the Motor Behavior and Neurorehabilitation Laboratory at the University of Southern California. “Physical therapists work on fundamental skills that are needed to be functional in their particular life, whatever it is. We work a lot on mobility. We teach people a lot about the importance of remaining physically active.”

Physical therapists help patients overcome physical challenges — this includes when a stroke has weakened or partially paralyzed one side of the body. Medical professionals refer to that side as “paretic.”

“If they’re having trouble reaching and grasping with their paretic side, I have them do it with their less paretic side to remind them what it should feel like,” Winstein says. “A lot of motor skills are implicit — we don’t think; we do it automatically.”

Occupational and speech therapists also address cognitive challenges.

“We consider most tasks physical, like dressing yourself, (but) all tasks that we do across the day have a cognitive component,” Gillen says. “With getting dressed, it’s the sequence of the clothing: which goes on what body part, which goes on first. If cognition is involved after a stroke, it’s a time-consuming process. We know it will take much longer, much more repetition of practice to get them there.”

Insurance Plans Could Limit Therapy

Health insurance may limit how much therapy a person can receive during a single calendar year or during his or her lifetime. If a person can afford to pay out of pocket, he or she may continue therapy without interruption. Otherwise, many therapists offer plans that patients can follow at home or at a fitness center either on their own or with the help of a family member, friend or personal trainer.

“You can keep working on the stroke problems indefinitely,” Dromerick says.

Therapists hope to get stroke patients functioning independently again, even after their sessions are complete.

“They may need a cane and a brace, but (we teach) them how to navigate with their disability so their disability does not become a barrier in their participation of being active,” Winstein says. “If there are certain things they can’t do, we show them what they can do and get them to work on those things.”

To learn more about stroke rehab and recovery, check out the American Stroke Association’s website.

By Lisa Fields
Lisa Fields is a writer who covers psychology and health matters as they relate to the workplace. She publishes frequently in WebMD and Reader’s Digest.

A lifetime of challenges has never slowed the author's spirited mother
By Donna Trump

Part of the Vitality Arts Special Report

My mother, Anne Pols, celebrated her 87^th birthday in November. In that same month, she also made her art show debut, exhibiting a half-dozen freehand colored pencil drawings at the Long Island Museum in Stony Brook, N.Y.

She and six other residents of her assisted living program at Jefferson’s Ferry contributed 25 pieces to a show called “Through Our Eyes.” The accomplishment is particularly sweet for my mother for several reasons. She has lived with a physical disability for most of her life. She took up drawing at 86. And six months prior to the show, she lost, in a single instant, most of the vision in her left eye.

One of my sisters said that days after the eye failed, my mother told her she was working on regaining her appetite. “Well, you’ve been though a lot in the last few days,” my sister said. To which our mother replied, “That’s history.”

She returned to her art classes a few weeks later.

Through Her Eyes

In our youth, my three sisters and I were never far from seeing a somewhat terrifying childhood through our mother’s eyes. At six, she nearly died from a ruptured appendix. In the hospital, she was forced to lay on her belly for a month to allow infected fluids to drain from the open surgical incision. A well-meaning relative doused the wound with perfume to diminish the odor. “That hurt,” our mom told us with a whistle.

At nine, she suffered a stroke — likely a burst aneurysm. There were no CAT scans or MRIs then, so the diagnoses ranged, she told us, from cerebral palsy to polio to some kind of infectious disease. In any case, she lost the use of the right side of her body and her speech as well. Her Irish immigrant family didn’t have much, so she was treated at public hospitals. She recalled for us the times she was paraded, naked or partly clothed, across a stage for a roomful of doctors-in-training. “I’d rather do that than go to the dentist any day,” she’d tell us.

When she was 12, her mother died of her own cerebral hemorrhage. Her father followed her mother to his grave within months, succumbing either “to the drink” or tuberculosis or a broken heart, depending on the telling. It didn’t matter why, we learned. What did matter was that her beloved Aunt Mary (barely a decade older than my mother at the time) and Uncle Bill took my mother and her siblings in after they were orphaned. These fine people supported my mother through years of physical therapy and multiple orthopedic surgeries in her teens, and, in fact, for the rest of their also tragically brief lives.

Mild but persistent right-sided weakness and a tendency of her right arm to tighten in spasticity kept my mother from nothing but learning to drive. An occasional word-finding problem showed up most often in calling her four sons-in-law by the wrong names, errors over which she was frequently the first to laugh out loud.

Learning to Draw

At the exhibit, my mother’s drawings are small in scale but realistic, colorful and expertly shaded. In some, she uses a brush to wash over the pencil for a watercolor effect. The subject is generally still life: a cornucopia, a parrot, a bowl of fruit, daffodils.

The daffodil drawing was one of my mother’s first, and when I saw it, it took my breath away. Not only was it was expertly drawn, it reminded my sisters and me of one of my father’s favorite poems. He was the love of her life but is gone nearly six years now, yet another in a series of losses which our mother appears, most times, to take in stride.

My mother started Saturday morning art classes about a year ago, with an accomplished Long Island artist she knows only as Jill. The class is one of many offered by the fine recreational therapy staff at my mother’s assisted living home. She enrolled in part because there wasn’t a lot of other programming on weekends: “It was something to do on a Saturday morning,” she said, adding, “something I was interested in.”

Although she writes with her weaker right hand (assisting with a steadying grip on the wrist with her left hand) she draws with the left. “It’s easier to control,” she said.

The class started with simple coloring of already-drawn designs, which my mother enjoyed, but soon prompted her to tell Jill, “Let me see if I can copy that.” She did. “Then I colored it and watercolored it, too,” she said with satisfaction.

Jill is a constant source of expertise, support and encouragement. “She taught me all about the shading,” my mother said. “That’s what makes it 3-D.”

I do not recall one incident in my mother’s life up to now where she made art for its own sake. She cooked just about every meal we ate, crocheted hats and blankets and sewed some of our clothes — surely artistic endeavors — but always in service to her family.

Not this time. Not with this pursuit of drawing. One of my favorite things about the exhibit was watching my mother, now unable to stand or walk independently and so using a wheelchair for mobility, crane her neck upwards toward exhibit attendees (mostly strangers) to respond to their comments and questions. Her face is animated. She laughs often. Her hands fly up in enthusiasm. She is an artist discussing her work, her process. Her self.

Self and Others

Contrary to much of today’s advice about being one’s own biggest advocate, my sisters and I were raised (in a fairytale compared to our mother’s childhood) with the understanding that “Self-praise is no praise at all.”

I hope it was not only me, among the four of us sisters, whose ego was periodically trimmed by our mother’s quick-tempered, “Who the hell do you think you are?” Let’s just say there wasn’t much discussion about self-actualization.

And yet, the image of her animation at the exhibit stays with me. What is it in drawing that gives her this joy?

In our daily phone calls what I hear most is how time flies — how, in fact, she loses her self — when she’s drawing. “I look up and two hours have passed,” she says. “It relaxes me. It’s like meditation.”

When pressed, she offers just a touch more: “I think that something special came out of me when I started those classes.” I ask her if she feels in any way that she has found herself through this art. “I know who I am,” she informs me, somewhat curtly. “I don’t need to find myself.”

As to the question of what might have come of it all had she started earlier, she is adamant: “I never think about that. My life went the way it did and it was full of love, consideration and respect.”

And now, Saturday morning art classes with Jill.

Donna Trump’s work has been published in december magazine (forthcoming in November 2018), Ploughshares and Mid-American Review, among others. She has received several Pushcart Prize nominations.  Honors include a Loft Mentorship, mentorship with Benjamin Percy, a MN Emerging Writer grant and the selection of her story “Portage” by judge Anne Tyler for first prize in a 2018 contest sponsored by december.

A lifetime of challenges has never slowed the author's spirited mother
By Donna Trump

Part of the Vitality Arts Special Report

My mother, Anne Pols, celebrated her 87^th birthday in November. In that same month, she also made her art show debut, exhibiting a half-dozen freehand colored pencil drawings at the Long Island Museum in Stony Brook, N.Y.

She and six other residents of her assisted living program at Jefferson’s Ferry contributed 25 pieces to a show called “Through Our Eyes.” The accomplishment is particularly sweet for my mother for several reasons. She has lived with a physical disability for most of her life. She took up drawing at 86. And six months prior to the show, she lost, in a single instant, most of the vision in her left eye.

One of my sisters said that days after the eye failed, my mother told her she was working on regaining her appetite. “Well, you’ve been though a lot in the last few days,” my sister said. To which our mother replied, “That’s history.”

She returned to her art classes a few weeks later.

Through Her Eyes

In our youth, my three sisters and I were never far from seeing a somewhat terrifying childhood through our mother’s eyes. At six, she nearly died from a ruptured appendix. In the hospital, she was forced to lay on her belly for a month to allow infected fluids to drain from the open surgical incision. A well-meaning relative doused the wound with perfume to diminish the odor. “That hurt,” our mom told us with a whistle.

At nine, she suffered a stroke — likely a burst aneurysm. There were no CAT scans or MRIs then, so the diagnoses ranged, she told us, from cerebral palsy to polio to some kind of infectious disease. In any case, she lost the use of the right side of her body and her speech as well. Her Irish immigrant family didn’t have much, so she was treated at public hospitals. She recalled for us the times she was paraded, naked or partly clothed, across a stage for a roomful of doctors-in-training. “I’d rather do that than go to the dentist any day,” she’d tell us.

When she was 12, her mother died of her own cerebral hemorrhage. Her father followed her mother to his grave within months, succumbing either “to the drink” or tuberculosis or a broken heart, depending on the telling. It didn’t matter why, we learned. What did matter was that her beloved Aunt Mary (barely a decade older than my mother at the time) and Uncle Bill took my mother and her siblings in after they were orphaned. These fine people supported my mother through years of physical therapy and multiple orthopedic surgeries in her teens, and, in fact, for the rest of their also tragically brief lives.

Mild but persistent right-sided weakness and a tendency of her right arm to tighten in spasticity kept my mother from nothing but learning to drive. An occasional word-finding problem showed up most often in calling her four sons-in-law by the wrong names, errors over which she was frequently the first to laugh out loud.

Learning to Draw

At the exhibit, my mother’s drawings are small in scale but realistic, colorful and expertly shaded. In some, she uses a brush to wash over the pencil for a watercolor effect. The subject is generally still life: a cornucopia, a parrot, a bowl of fruit, daffodils.

The daffodil drawing was one of my mother’s first, and when I saw it, it took my breath away. Not only was it was expertly drawn, it reminded my sisters and me of one of my father’s favorite poems. He was the love of her life but is gone nearly six years now, yet another in a series of losses which our mother appears, most times, to take in stride.

My mother started Saturday morning art classes about a year ago, with an accomplished Long Island artist she knows only as Jill. The class is one of many offered by the fine recreational therapy staff at my mother’s assisted living home. She enrolled in part because there wasn’t a lot of other programming on weekends: “It was something to do on a Saturday morning,” she said, adding, “something I was interested in.”

Although she writes with her weaker right hand (assisting with a steadying grip on the wrist with her left hand) she draws with the left. “It’s easier to control,” she said.

The class started with simple coloring of already-drawn designs, which my mother enjoyed, but soon prompted her to tell Jill, “Let me see if I can copy that.” She did. “Then I colored it and watercolored it, too,” she said with satisfaction.

Jill is a constant source of expertise, support and encouragement. “She taught me all about the shading,” my mother said. “That’s what makes it 3-D.”

I do not recall one incident in my mother’s life up to now where she made art for its own sake. She cooked just about every meal we ate, crocheted hats and blankets and sewed some of our clothes — surely artistic endeavors — but always in service to her family.

Not this time. Not with this pursuit of drawing. One of my favorite things about the exhibit was watching my mother, now unable to stand or walk independently and so using a wheelchair for mobility, crane her neck upwards toward exhibit attendees (mostly strangers) to respond to their comments and questions. Her face is animated. She laughs often. Her hands fly up in enthusiasm. She is an artist discussing her work, her process. Her self.

Self and Others

Contrary to much of today’s advice about being one’s own biggest advocate, my sisters and I were raised (in a fairytale compared to our mother’s childhood) with the understanding that “Self-praise is no praise at all.”

I hope it was not only me, among the four of us sisters, whose ego was periodically trimmed by our mother’s quick-tempered, “Who the hell do you think you are?” Let’s just say there wasn’t much discussion about self-actualization.

And yet, the image of her animation at the exhibit stays with me. What is it in drawing that gives her this joy?

In our daily phone calls what I hear most is how time flies — how, in fact, she loses her self — when she’s drawing. “I look up and two hours have passed,” she says. “It relaxes me. It’s like meditation.”

When pressed, she offers just a touch more: “I think that something special came out of me when I started those classes.” I ask her if she feels in any way that she has found herself through this art. “I know who I am,” she informs me, somewhat curtly. “I don’t need to find myself.”

As to the question of what might have come of it all had she started earlier, she is adamant: “I never think about that. My life went the way it did and it was full of love, consideration and respect.”

And now, Saturday morning art classes with Jill.

Donna Trump’s work has been published in december magazine (forthcoming in November 2018), Ploughshares and Mid-American Review, among others. She has received several Pushcart Prize nominations.  Honors include a Loft Mentorship, mentorship with Benjamin Percy, a MN Emerging Writer grant and the selection of her story “Portage” by judge Anne Tyler for first prize in a 2018 contest sponsored by december.

A noted life and career coach offers her five-step plan
By Allison Task

Would you like to make 2019 a remarkable year for you?

A new year has begun. It’s is as exciting and fresh as the first day of school and a brand new lunchbox. You’re past those school days, of course, but you aren’t past embracing the new and possibilities to recharge your job or career this year.

As a career and life coach, I help people set — and more importantly — achieve life-changing goals. It’s what I do: identify what isn’t working, clarify what could be better and help people pursue a life they’d rather lead. I’d love to help you make 2019 a remarkable year.

Ready?

What you’ll need:

A 2018 calendar, filled out (or your memories of 2018 fresh in your mind)

A 2019 calendar, fresh and new

Blank paper (or a Word doc if you’re more of a  computer person)

What you’ll get: A remarkable year.

There are five parts to this exercise — reflection, selection, envisioning, planning and sharing. Here’s how it works:

Reflection

For this part, pull out that 2018 calendar if you have it or rely on your memory.

Write down the names of the months on three pieces of paper. Put four months down on a page, in separate quadrants. January, February, March, April on one, May, June July, August on another and September, October, November and December on the last page.

Now, review 2018 month by month. Let’s start with the trips you’ve taken. Where did you go, in which month? Short trips, overnights and longer trips. Write them down on the calendar.

Next: were there any landmark events for you? A new job, a promotion, weddings, graduations, births and deaths? What big events happened in your life, and the life of loved ones?

Sit with this for a while, as you start remembering one thing, which leads to another. As you start filling up the months, you may realize that you need more pages. Enjoy the memory trip.

You’re ready for phase two.

Selection

Once you’ve got a thick set of memories from 2018, take out another piece of paper. On one side, write “coming” and on the other side write “leaving.”

Imagine that you are packing your bag for 2019, and you can choose five things that come with you, and five things you’d like to leave behind. Maybe you hired a terrible contractor last year; leave him or her in the past. More importantly, what incredible things happened? New relationships or experiences that you could pick as the “best of” 2018?

Keep that list of five things you treasured from 2018 and want to bring with you and five things you’d prefer to leave behind.

Envisioning

You’ve just taken stock of 2018 and my guess is that it was more extensive and powerful than you may had remembered. So many things happened. And 2019 will be the same. Right now, you can choose those things.

Look at your top five treasures from 2018. If you were to elevate these, build on the joy they delivered and create even more joy, how could you do that? How could you plan that into the coming year? If you improved your health, how could you celebrate that or take that to the next level? If you became closer to an old friend, is there a new old friend you’d like to connect with this year?

Write it down. Acknowledge and elevate your top achievements from 2018.

Is there something missing that you’d like to be sure to add to this year? Think about what that would be

Maybe you’d like to start meditating more, or get off medications that you think are slowing you down.

Maybe you’d like to travel more, or nest more. This is your life; your choice.

Write it down. Add new goals for 2019.

Next, look at the four seasons and the month at the center of each: February, May, July and October. When you think of these seasons, what do you love most? Is it apple picking in October, and the beach in July? How can you embrace the upcoming season with a new or well-loved experience or person you’d like to have in the center of the season? What is the treasure you’d like to look forward to?

Write it down. Make sure to add your favorite parts of the year to 2019.

Planning

Now take out that 2019 calendar. What is already in place? Have you booked any travel already? When is your birthday? Any upcoming weddings, graduations or other events? Put those on the calendar.

Your 2019 treasure map is starting to take shape.

And now (drumroll please)… add in those extras: those bigger dreams and seasonal joys. Add in the items you identified in the “envisioning” phase. If you can dream it, you can build it. You’ve dreamt it, so put it on the calendar.

Have fun with this. You may find there’s too much to do in one year; some items may need to wait until 2020. Others that seemed important may not seem as urgent now that you’ve raised your game, so they can be replaced.

Sharing

Onto Sharing. This is where the rubber meets the road. It’s time to share your dreams and your calendar with your friends and family members. Make a list of the top five items you want to do this year (that you’ve always done) and top five new objectives (that you’ve never done). Identify something, each month that you are looking forward to doing.

On the first of the month, announce the thing that you’re excited about. You may be telling your loved ones, but what you’re REALLY doing is telling yourself, reminding yourself how sweet your life is, and then sucking every last bit of sweet off your finger tips.

You have now created a treasure map for 2019 of the things you’d most like to do. Pursue that treasure. You’ve created a powerful vision. It can be as remarkable as you let it be.

Allison Task, is a Montclair, N.J. life and career coach whose business is Allison Task Career & Life Coaching. She is a author of Personal (R)evolution: How to Be Happy, Change Your Life and Do That Thing You’ve Always Wanted to Do.

A noted life and career coach offers her five-step plan
By Allison Task

Would you like to make 2019 a remarkable year for you?

A new year has begun. It’s is as exciting and fresh as the first day of school and a brand new lunchbox. You’re past those school days, of course, but you aren’t past embracing the new and possibilities to recharge your job or career this year.

As a career and life coach, I help people set — and more importantly — achieve life-changing goals. It’s what I do: identify what isn’t working, clarify what could be better and help people pursue a life they’d rather lead. I’d love to help you make 2019 a remarkable year.

Ready?

What you’ll need:

A 2018 calendar, filled out (or your memories of 2018 fresh in your mind)

A 2019 calendar, fresh and new

Blank paper (or a Word doc if you’re more of a  computer person)

What you’ll get: A remarkable year.

There are five parts to this exercise — reflection, selection, envisioning, planning and sharing. Here’s how it works:

Reflection

For this part, pull out that 2018 calendar if you have it or rely on your memory.

Write down the names of the months on three pieces of paper. Put four months down on a page, in separate quadrants. January, February, March, April on one, May, June July, August on another and September, October, November and December on the last page.

Now, review 2018 month by month. Let’s start with the trips you’ve taken. Where did you go, in which month? Short trips, overnights and longer trips. Write them down on the calendar.

Next: were there any landmark events for you? A new job, a promotion, weddings, graduations, births and deaths? What big events happened in your life, and the life of loved ones?

Sit with this for a while, as you start remembering one thing, which leads to another. As you start filling up the months, you may realize that you need more pages. Enjoy the memory trip.

You’re ready for phase two.

Selection

Once you’ve got a thick set of memories from 2018, take out another piece of paper. On one side, write “coming” and on the other side write “leaving.”

Imagine that you are packing your bag for 2019, and you can choose five things that come with you, and five things you’d like to leave behind. Maybe you hired a terrible contractor last year; leave him or her in the past. More importantly, what incredible things happened? New relationships or experiences that you could pick as the “best of” 2018?

Keep that list of five things you treasured from 2018 and want to bring with you and five things you’d prefer to leave behind.

Envisioning

You’ve just taken stock of 2018 and my guess is that it was more extensive and powerful than you may had remembered. So many things happened. And 2019 will be the same. Right now, you can choose those things.

Look at your top five treasures from 2018. If you were to elevate these, build on the joy they delivered and create even more joy, how could you do that? How could you plan that into the coming year? If you improved your health, how could you celebrate that or take that to the next level? If you became closer to an old friend, is there a new old friend you’d like to connect with this year?

Write it down. Acknowledge and elevate your top achievements from 2018.

Is there something missing that you’d like to be sure to add to this year? Think about what that would be

Maybe you’d like to start meditating more, or get off medications that you think are slowing you down.

Maybe you’d like to travel more, or nest more. This is your life; your choice.

Write it down. Add new goals for 2019.

Next, look at the four seasons and the month at the center of each: February, May, July and October. When you think of these seasons, what do you love most? Is it apple picking in October, and the beach in July? How can you embrace the upcoming season with a new or well-loved experience or person you’d like to have in the center of the season? What is the treasure you’d like to look forward to?

Write it down. Make sure to add your favorite parts of the year to 2019.

Planning

Now take out that 2019 calendar. What is already in place? Have you booked any travel already? When is your birthday? Any upcoming weddings, graduations or other events? Put those on the calendar.

Your 2019 treasure map is starting to take shape.

And now (drumroll please)… add in those extras: those bigger dreams and seasonal joys. Add in the items you identified in the “envisioning” phase. If you can dream it, you can build it. You’ve dreamt it, so put it on the calendar.

Have fun with this. You may find there’s too much to do in one year; some items may need to wait until 2020. Others that seemed important may not seem as urgent now that you’ve raised your game, so they can be replaced.

Sharing

Onto Sharing. This is where the rubber meets the road. It’s time to share your dreams and your calendar with your friends and family members. Make a list of the top five items you want to do this year (that you’ve always done) and top five new objectives (that you’ve never done). Identify something, each month that you are looking forward to doing.

On the first of the month, announce the thing that you’re excited about. You may be telling your loved ones, but what you’re REALLY doing is telling yourself, reminding yourself how sweet your life is, and then sucking every last bit of sweet off your finger tips.

You have now created a treasure map for 2019 of the things you’d most like to do. Pursue that treasure. You’ve created a powerful vision. It can be as remarkable as you let it be.

Allison Task, is a Montclair, N.J. life and career coach whose business is Allison Task Career & Life Coaching. She is a author of Personal (R)evolution: How to Be Happy, Change Your Life and Do That Thing You’ve Always Wanted to Do.

What can increase your risk and how to prevent it
By Frieda Wiley, PharmD

Heart disease kills about 610,000 people in the United States each year — 1 in every 4 deaths — more than any other disease, according the Centers for Disease Control and Prevention. It’s commonly known that exercise and eating a healthful diet are keys to keeping your heart in tip top shape. But there are seemingly unrelated conditions and lifestyle habits that can lead to heart disease.

Here are five lesser-known causes of heart disease that you can do something about: Sleep apnea; stress, anxiety and loneliness; sitting all day, influenza and dental disease.

1. Sleep Apnea

“Sleep apnea is very common, especially as we get older, and it puts enormous stress on the heart,” says Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

People who have sleep apnea tend to also have other conditions that are associated with the disease, such as high blood pressure, atrial fibrillation (a kind of irregular heartbeat) or pulmonary hypertension, which Freeman defines as high blood pressure on the right side of the heart.

Symptoms of sleep apnea include daytime sleepiness, memory problems and irritability. Being overweight or obese and even structural features, such as having a big chin or tongue, may also make you more likely to develop sleep apnea, according to the American Lung Association.

Premenopausal women are less likely to have sleep apnea than men, but postmenopausal women and men of any age share similar risks. After reaching adulthood, sleep apnea becomes more common with age until you reach 60, when the chances of developing it begin to taper off.

One way to treat sleep apnea is to use a continuous positive airway pressure (CPAP) machine at night. However, Dr. Mark Peterman, a cardiologist at Texas Health in Plano, says that many people find the machine uncomfortable to use. Other treatment options, depending on the severity of the problem, include weight loss, oral appliances (similar to a mouth guard), nasal decongestants and surgery.

2. Stress, Anxiety and Loneliness

Stress can have powerful effects on the body that wreak havoc on your health. Some stresses, such as learning a new language or skill, can be positive. But Freeman says the majority of stress people experience, like worrying about children or finances, tend to have negative effects on the body.

While it might be difficult to see the connection, the lack of social interaction and fulfilling relationships also impacts heart health.

“It might sound strange to hear a heart doctor talk about love, but people need what we call social support and connection,” Freeman says. “People don’t talk about it much, but people who lack social support or are lonely are at higher risk for heart disease and depression.”

The American Heart Association says that, while stress can harm the heart, researchers still haven’t quite figured out the role stress plays in causing heart disease. Even for those who manage stress well, keeping up with life in our increasingly fast-paced world can still take its toll.

“Treating stress with medication can be difficult, so it usually requires counseling and lifestyle changes,” Peterman says.

3. Sitting All Day

We hear a lot about how important exercise is to keep your body and mind in shape. Studies also show that sitting the majority of the day increases your chance of developing heart disease.

In a 2014 study of how a sedentary lifestyle affects blood pressure, researchers found a strong association between a sedentary lifestyle and an increase in blood pressure. This finding was independent of time spent in moderate to vigorous exercise. A 2015 study came up with similar findings: Sitting down the majority of the day can increase your risk for heart disease, stroke and even diabetes — even if you exercise an hour a day.

Luckily, this heart risk factor is easily remedied with increasing physical activity. If you’re having trouble getting started, Peterman suggests technological devices like Fitbits to help you become more aware of your daily movement and motivate you to exercise.

4. Influenza

If you think the only consequences of getting the flu are having body aches, a runny nose and fever for a week or two, think again. The flu can increase the risk for heart problems stemming from the inflammation it causes.

Peterman says the flu has been linked to increased risk of heart trouble between the months of October and February. One study published in the 2016 found that people who had the flu were six times more likely to have a heart attack within the first seven days of their condition being confirmed with laboratory testing.

Sounds like your doctor may have more than one reason for recommending you get a flu shot.

5. Dental Disease

Dental health is important for more reasons than a great smile; it can also work wonders for your heart.

Mouth issues like cavities and gum disease can trigger chronic inflammation, which Peterman warns can speed up hardening of the arteries, or atherosclerosis, causing the risk of heart problems to soar.

But not to worry. This problem is easily remedied by maintaining good brushing and flossing habits along with regular trips to the dentist.

How to Reduce Body Inflammation

Freeman says these five hidden causes of heart disease lead to inflammation in the body, which is the root of other common diseases, including cancer, diabetes and arthritis. Luckily, there are four key practices you can adopt to put your body in anti-inflammatory mode and strengthen your heart in the process:

• Eat a predominantly plant-based diet; limit your consumption of animal-based products.
• Get at least 30 minutes of brisk activity each day.
• Make time for a little stress relief each day. Prayer, yoga, meditation or anything else that helps you become more mindful and live in the moment helps.
• Build a strong social network so you feel connected, supported and loved.

“Switching the body into an anti-inflammatory healing environment is what we’re trying to do to get people to heal,” Freeman says.

Hopefully these extra tips will help you take a load off your heart — and your life.

By Frieda Wiley, PharmD

Frieda Wiley, PharmD, CGP, RPh, is a board-certified geriatric pharmacist and freelance medical writer based in the Piney Woods of East Texas. She enjoys using her background in patient care to empower people with more knowledge about living well.@frieda_wiley

What can increase your risk and how to prevent it
By Frieda Wiley, PharmD

Heart disease kills about 610,000 people in the United States each year — 1 in every 4 deaths — more than any other disease, according the Centers for Disease Control and Prevention. It’s commonly known that exercise and eating a healthful diet are keys to keeping your heart in tip top shape. But there are seemingly unrelated conditions and lifestyle habits that can lead to heart disease.

Here are five lesser-known causes of heart disease that you can do something about: Sleep apnea; stress, anxiety and loneliness; sitting all day, influenza and dental disease.

1. Sleep Apnea

“Sleep apnea is very common, especially as we get older, and it puts enormous stress on the heart,” says Dr. Andrew Freeman, director of cardiovascular prevention and wellness at National Jewish Health in Denver.

People who have sleep apnea tend to also have other conditions that are associated with the disease, such as high blood pressure, atrial fibrillation (a kind of irregular heartbeat) or pulmonary hypertension, which Freeman defines as high blood pressure on the right side of the heart.

Symptoms of sleep apnea include daytime sleepiness, memory problems and irritability. Being overweight or obese and even structural features, such as having a big chin or tongue, may also make you more likely to develop sleep apnea, according to the American Lung Association.

Premenopausal women are less likely to have sleep apnea than men, but postmenopausal women and men of any age share similar risks. After reaching adulthood, sleep apnea becomes more common with age until you reach 60, when the chances of developing it begin to taper off.

One way to treat sleep apnea is to use a continuous positive airway pressure (CPAP) machine at night. However, Dr. Mark Peterman, a cardiologist at Texas Health in Plano, says that many people find the machine uncomfortable to use. Other treatment options, depending on the severity of the problem, include weight loss, oral appliances (similar to a mouth guard), nasal decongestants and surgery.

2. Stress, Anxiety and Loneliness

Stress can have powerful effects on the body that wreak havoc on your health. Some stresses, such as learning a new language or skill, can be positive. But Freeman says the majority of stress people experience, like worrying about children or finances, tend to have negative effects on the body.

While it might be difficult to see the connection, the lack of social interaction and fulfilling relationships also impacts heart health.

“It might sound strange to hear a heart doctor talk about love, but people need what we call social support and connection,” Freeman says. “People don’t talk about it much, but people who lack social support or are lonely are at higher risk for heart disease and depression.”

The American Heart Association says that, while stress can harm the heart, researchers still haven’t quite figured out the role stress plays in causing heart disease. Even for those who manage stress well, keeping up with life in our increasingly fast-paced world can still take its toll.

“Treating stress with medication can be difficult, so it usually requires counseling and lifestyle changes,” Peterman says.

3. Sitting All Day

We hear a lot about how important exercise is to keep your body and mind in shape. Studies also show that sitting the majority of the day increases your chance of developing heart disease.

In a 2014 study of how a sedentary lifestyle affects blood pressure, researchers found a strong association between a sedentary lifestyle and an increase in blood pressure. This finding was independent of time spent in moderate to vigorous exercise. A 2015 study came up with similar findings: Sitting down the majority of the day can increase your risk for heart disease, stroke and even diabetes — even if you exercise an hour a day.

Luckily, this heart risk factor is easily remedied with increasing physical activity. If you’re having trouble getting started, Peterman suggests technological devices like Fitbits to help you become more aware of your daily movement and motivate you to exercise.

4. Influenza

If you think the only consequences of getting the flu are having body aches, a runny nose and fever for a week or two, think again. The flu can increase the risk for heart problems stemming from the inflammation it causes.

Peterman says the flu has been linked to increased risk of heart trouble between the months of October and February. One study published in the 2016 found that people who had the flu were six times more likely to have a heart attack within the first seven days of their condition being confirmed with laboratory testing.

Sounds like your doctor may have more than one reason for recommending you get a flu shot.

5. Dental Disease

Dental health is important for more reasons than a great smile; it can also work wonders for your heart.

Mouth issues like cavities and gum disease can trigger chronic inflammation, which Peterman warns can speed up hardening of the arteries, or atherosclerosis, causing the risk of heart problems to soar.

But not to worry. This problem is easily remedied by maintaining good brushing and flossing habits along with regular trips to the dentist.

How to Reduce Body Inflammation

Freeman says these five hidden causes of heart disease lead to inflammation in the body, which is the root of other common diseases, including cancer, diabetes and arthritis. Luckily, there are four key practices you can adopt to put your body in anti-inflammatory mode and strengthen your heart in the process:

• Eat a predominantly plant-based diet; limit your consumption of animal-based products.
• Get at least 30 minutes of brisk activity each day.
• Make time for a little stress relief each day. Prayer, yoga, meditation or anything else that helps you become more mindful and live in the moment helps.
• Build a strong social network so you feel connected, supported and loved.

“Switching the body into an anti-inflammatory healing environment is what we’re trying to do to get people to heal,” Freeman says.

Hopefully these extra tips will help you take a load off your heart — and your life.

By Frieda Wiley, PharmD

Frieda Wiley, PharmD, CGP, RPh, is a board-certified geriatric pharmacist and freelance medical writer based in the Piney Woods of East Texas. She enjoys using her background in patient care to empower people with more knowledge about living well.@frieda_wiley

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

The contagious bacterial infection can be more serious for older adults
By Mark Ray

When you were a child, did you worry about monsters hiding under your bed or lurking behind your closet door? It turns out one monster — clostridium difficile, or C. diff — may actually be closer at hand, at least in hospitals and nursing homes.

Transmitted via fecal matter, the C. diff bacterial infection can cause severe diarrhea, nausea, fever, dehydration, abdominal pain, kidney failure and even death. Older adults are more vulnerable to it because of naturally weaker immune systems, more likelihood of underlying health issues and more time spent in health care settings.

1. diff is resistant to some antibiotics, but there are some shown to work against it. In serious and recurrent C. diff cases, patients may undergo a fecal transplant or surgery to remove a portion of the colon.
2. diff spores adhere to every imaginable surface, including toilet seats, faucet handles, doorknobs, linens, bedrails, nurse call buttons, chair arms, ceiling vents and even floors. A 2017 study in the United Kingdom detected it in floor corners in 86 percent of hospital rooms that had undergone routine cleaning.

Since its spores resist standard cleaning methods and alcohol-based hand wipes, C. diff is tough to eradicate. “We know those spores can last nine months or more in a room,” says Dr. Kate Mullane, an infectious disease specialist at The University of Chicago Medicine. “It takes a high concentration of bleach to kill the spores: a cup of bleach in a gallon of water.”

And killing the spores is critically important because C. diff itself is a killer. The most common microbial cause of health care-associated infections in the United States today, it causes nearly half a million infections and 15,000 deaths annually — almost as many deaths as drunk driving and HIV/AIDS combined,  according to the U.S. Centers for Disease Control and Prevention (CDC). Eighty percent of C. diff deaths occur among people 65 and older, and one in 11 patients in that age group dies within 30 days of diagnosis.

A two-pronged approach can keep this microscopic, but deadly killer, at bay. Prong one is antibiotic stewardship; prong two is infection control.

Antibiotic Stewardship

You’ve doubtless heard the world uses far too many antibiotics, wasting money and contributing to the growing problem of antimicrobial resistance. The Pew Charitable Trusts reported that 30 percent of outpatient antibiotic prescriptions in the U.S. are unnecessary (antibiotics prescribed for a viral infection, for example).

Doctors are getting more judicious in their use of antibiotics, but Mullane says patients should still talk with their doctors about the drugs they’re prescribing. If you can avoid antibiotics, or at least broad-spectrum antibiotics, you will be less vulnerable to C. diff. This is because, along with the bad bacteria the drugs are after, antibiotics also kill much of the good bacteria in our intestines. This leaves C. diff an opportunity to overwhelm the gut and cause illness.

1. Diff Infection Control

Given C. diff’s persistence in health care environments, it’s also important to prevent transmission between patients, health care workers and visitors — including people who aren’t symptomatic.

“We know at any one time, about 5 percent of the population is colonized with C. diff,” Mullane says. “They may not be sick with it, but they’re at least carrying it.”

The easiest way to stop transmission is with proper handwashing, according to Anna Barker., a researcher in the medical scientist training program at the University of Wisconsin-Madison. “Even with hospital-grade hand sanitizer, which in many cases is pretty similar to what you would buy out in the community, you do still need to use soap and water,” she says.

“It’s not only the soap and water (that gets rid of the germs), it’s the friction and having your hands under the tap water, which you just don’t get when you use (hand sanitizer) gel,” Barker says. A good rule of thumb to make sure you get rid of the germs: Wash your hands for as long as it takes to sing Happy Birthday to You.

But hand hygiene is just the beginning. In the April 2018 issue of the journal Clinical Infectious Diseases, Barker and two colleagues reported their research on the effectiveness of nine discrete C. diff hospital interventions, including everything from patient hand hygiene to terminal cleaning (deep cleaning of a room after a patient is discharged).

Using computer models, Barker and her colleagues found that daily room cleaning with a sporicidal cleaner plus screening for C. diff at the time of admission reduces hospital-associated infections by roughly 82 percent and asymptomatic colonization by about 91 percent.

“When hospitals try to combat their C. diff rates, they’ll end up doing lots of things at once,” Barker says. “This paper showed you can get a considerable reduction in C. diff with only those two interventions.”

What Patients Can Do

While patients don’t have much control over infection-control practices in a hospital or clinic, they can take two concrete actions.

The first is to ask health care providers if they’ve remembered to wash their hands.

“That’s easier said than done given everything we know about power dynamics and the patient-doctor relationship, but I think that really has a potential to make a big impact,” Barker says.

The other action, perhaps surprisingly, is to reduce the clutter in hospital patient rooms.

“One of the things we hear from the cleaning staff is that it’s very difficult to clean a patient’s room effectively if there are newspapers everywhere or books or food or other items throughout the room,” Barker says. “They can’t, at least at our institution, move the patient’s things for them.”

While decluttering your hospital room may not be quite as simple as switching on the lights to banish an under-bed monster, it can go a long way toward keeping you safe from C. diff.

Mark Ray is a freelance writer who has written for Scouting, Eagles’ Call, Presbyterians Today, Kentucky Homes & Gardens and other publications. He has also written, edited and/or contributed to a dozen books for the Boy Scouts and the Presbyterian and United Methodist churches.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.

How to find a place that wants to be a real home
By Denise Logeland

Part of the Transforming Life as We Age Special Report

What makes a nursing home a good place for you or your parents? While “good” can mean a lot of things, it should include qualities like dignity and self-determination for the people who live there. The Pioneer Network offers tips on how to check for those qualities.

Formed 20 years ago, the nonprofit Pioneer Network is made up of professionals who work in long-term care, people who live in long-term care and families who advocate for them. The network, active nationally and through coalitions in 36 states, belongs to a broad-based movement in long-term care that is sometimes called simply “culture change.” That is a movement away from generic, system-based care and toward more individual, person-directed care. With culture change, residents have a large voice in the care they get and have as many of the freedoms they had in their earlier homes as possible.

You can find out if a nursing home is guided by the principles of culture change by asking specific questions when you visit to take a tour. A few examples:

• Can residents wake up when they want to in the morning?
• How do you get to know the people who live here?
• How do you build a sense of community and give those who live here a voice in how things are done?
• What is the turnover rate for the direct care workers on your staff?

There are 18 questions in all to ask at nursing homes, and a similar set of 16 to ask when looking at assisted living facilities. You can see the questions and the answers to listen for on the Pioneer Network website, where they are also available as downloads.

Denise Logeland is a writer and editor in Minneapolis who has covered business, health and health care. She is the author of Next Avenue's ebook, 10 Things Every Family Should Know: Aging With Dignity and Independence.