Category / Exercise

Is 75 the New 65? How the Definition of Aging Is Changing

May 24, 2019

Chronological age doesn't mean what it used to, and why that matters
By Andrew Scott

Aging and mortality are intrinsic to the human condition. Accepting our mortality as humans underpins our search for meaning in life and our quest for wisdom and maturity. But when the average age of The Rolling Stones exceeds that of the U.S. Supreme Court, it is clear that an adjustment to our concept of aging is warranted.

At least measured chronologically, everyone is aging and at the same rate — one year every year. But aging is so closely connected with our sense of impending mortality that it usually refers to end of life. This is evident in the widespread concern about an “aging society” defined in terms of a rising proportion of older people.

What Defines Being Old?

If aging is about being old what defines being old?

Two aspects tend to feature predominantly in our social discussions of age.

The first is biological and connected to declines in the physical and mental capabilities that circumscribe our daily lives.

The second is psychological and revealed in Cicero’s remark that “old age is the final scene…in life’s drama.” Stanford Center on Longevity’s Laura Carstensen’s Socioemotional Selectivity Theory posits, for example, that as we approach the end of life, our time horizons narrow. We focus on our most emotionally meaningful relations and activities.

These biological and psychological aspects of ageing are deeply embedded. In practice, however, governments rely on more simplistic chronological measures such as the “Old Age Dependency Ratio.” This is a ratio of the number of old people relative to those of working age, where “old” begins at 65. That’s often mentioned in discussions of the solvency of Social Security.

When We Started Relying on Chronological Age

This reliance on chronological age is actually quite recent, though. Starting around 200 years ago, governments began to accurately record birth dates and then started to use chronological age to segregate society. Schooling became defined by age cohorts.

The apotheosis of this approach was the creation of a “retirement age,” broadly defined as 70 in 1908 and then as 65 in 1925. In response, individuals began to base their sense of age on their birth dates. Today, we think about age in terms of the number of candles needed for a birthday cake. (Did you know the Happy Birthday song didn’t start becoming popular until 1935?)

A focus on chronological age would be fine if its relationship with biological age were constant. But sustained improvements in life expectancy mean this isn’t the case.

What’s Wrong With Focusing on Chronological Age?

Over the course of the 20th century, life expectancy increased around 10 years for each generation. What this means in practice is that a 75-year-old today has the same mortality rate as a 65-year-old in 1950. So perhaps 75 really is the new 65.

Over the same period, the average age of the U.S. population has increased from around 32 to 38, while the average mortality rate has fallen by 13 percent. As a result, the average U.S. citizen has never been older, but also has never had so long left to live.

This decline in mortality rates has implications for the understanding of old age. If we are, on average, healthier at each chronological age, then biological aging is occurring more slowly. We are, in effect, younger for longer.

This increase in life expectancy has already changed the way we experience the earlier phases of the lifecycle. Adolescence now extends well into one’s 20s. Young adulthood these days is characterized by a period of exploration and discovery, free from traditional grown-up responsibilities such as marriage and parenthood.

New Thinking on Lifestages

Following on this logic, should our 40s and 50s also become a time of reinvention and rediscovery in anticipation of a longer second half of life?

If we are healthy in our 70s and 80s, should this be a time of more work, deepening engagement in civil society and/or greater leisure and play?

In this era of a “new old age,” we will have a longer time to recreate our own identities, avail ourselves of a wider set of opportunities and come to terms with past mistakes and misfortunes.

There is a further reason why we need to move away from the dominant chronological concept of age.

The real truth about aging is diversity. You may be like the Frenchman Robert Marchand, still breaking cycling speed records at 105. Or you may end up in a wheelchair by 50. This diversity of experience in what it means to be old will become all the more apparent as more people live into old age.

How Shifting to Biological Age Helps

A shift from chronological to a biological sense of age undermines lazy, age-based stereotypes and helps us to understand better how our own efforts may influence the aging process. This shift also forces governments and corporations to rethink education, retirement and pension policies, as well as employment practices.

Our relationship with time changes when we have more of it. Lacking role models for how to live such long lives, we are —  all of us — currently engaged in a huge, new and long-lasting social experiment. This moment provides an opportunity to free ourselves from the numerical determinism of chronological age and revisit a more humane concept based on an individual’s physical and mental characteristics.

To return to Cicero, only then we will approach that final stage with a sharper sense of who we are.

By Andrew Scott

Andrew Scott is professor of economics, London Business School and co-author of The 100-Year Life: Living and Working in an Age of Longevity.

The Transformative Joy of Dance at Any Age

May 21, 2019

The Quicksilver dance company takes an intergenerational spin
By Rebecca Theim

Lifelong dancer and choreographer Nancy Havlik wants the world to know that regardless of age, physical condition or experience, “people transform through the joy that dance offers them. You can see them light up and become more alive.”

Havlik, 78, has 25 years of experience teaching interactive creative movement and dance workshops for older adults through Arts for the Aging (AFTA), aa nationally recognized, Rockville, Md.-based organization that brings free artistic programs to older adults in the Washington, D.C. area.

Credit: Denaise Seals

Invited artist Shanna Lim (center) leads participants in an interpretative dance performance during the Washington, D.C., production of Quicksilver’s “Imaginary Gardens”

Earlier this month, Havlik’s AFTA-sponsored Quicksilver, an improvisational dance company for older adults, staged “Imaginary Gardens,” in partnership with the Dance Performance Group, a small company of professional dancers and musicians of which Havlik is artistic director and choreographer. The interactive, interpretative dance production featured dancer Shanna Lim, who got most of the audience involved in the performance.

“We had all ranges of people,” said Lim, 41. “I didn’t know who the audience would be. I opened before it started, and basically warmed up the audience. I coaxed as many as I could down to the stage, and then more came as we started the show.”

Lim, whose work spans hip-hop, and installation and body art, is one of the more unconventional dancers Quicksilver participants have encountered.

“I came out in full body paint, that real-interesting-piece-of-art-weirdo, and everyone was completely cool,” she recalled. “I got huge satisfaction —not a huge surprise, but more like ‘cool!’ — seeing that generation, and having them all behind me, and seeing them learning. I turned around and I felt accepted.”

Quicksilver and other AFTA programs (which include drawing, painting, poetry and music) engage 1,000 older residents in more than 800 programs annually held at 33 community and residential care centers in the Washington, D.C.-area, in partnership with area museums and cultural institutions. The goal is to engage older adults and their caregivers through regular participation in arts activities that improve physical fitness and cognition, and combat isolation.

“Quicksilver is unique among the programs we offer because dance is accessible to everyone,” said AFTA program director Brandi Rose. “It’s something everyone can tap into, no matter what their cognitive level or physical ability. It’s such a great combination that we’ve thought about how we can bring it into other art disciplines.”

Science Backs the Benefits of Dancing

In addition to the joy Havlik and Lim say dancing brings to participants young and old, there’s science supporting the benefits it offers older adults. Numerous U.S. and Europeans studies have shown that regular dance improves balance and enhances cardiovascular health, stems or slows the advancement of dementia and boosts emotional health.

Nancy Havlik, co-director of Quicksilver, a dance program for participants 65 and older sponsored by Bethesda, Md.-based Arts for the Aging

Patients with Parkinson’s Disease who took part in regular tango lessons experienced improved motor skills and balance, reduced non-motor symptom severity and were able to better perform daily activities, researchers found.

A two decade study by the Albert Einstein College of Medicine found that dancing was the only physical activity that resulted in lower reported rates of dementia among older people who danced frequently. A more recent study of older women in Japan found that those who danced often had a 73 percent lower chance of becoming disabled during the study period, contrasted with women who didn’t dance. Again, no other physical activity — including walking or yoga — produced such significant results, researchers found.

Why is dancing so powerful? Researchers theorize it’s because it demands both mental and physical effort. “Dancing requires not only balance, strength, and endurance ability, but also cognitive ability: adaptability and concentration to move according to the music and partner, artistry for graceful and fluid motion, and memory for choreography,” a study by Chinese researchers concluded.

Quicksilver Participants Dance Around

Quicksilver dancers, who range in age from 65 to 88, are involved in weekly programs within the group, Rose said. Twice a month, they take their performances to the community and senior centers and residential facilities AFTA serves.

“We go out in the community and work with people, some who have never danced before,” Havlik said. “People always say they can’t dance. People get that in their heads, that ‘I’m no good at that.’ I’m really good at getting people dancing; that’s one of my strengths.”

Because of Washington, D.C.’s global draw, participants are often multicultural. Havlik and her Quicksilver co-director Anthony Hyatt, who provides music for the programs, have a trick to engage international participants.

“They may not have the same language, but you don’t need a common spoken language to dance,” Havlik said. “They respond to different music. Anthony knows almost all national anthems of the world, so when we have someone new, he’ll play their national anthem.”

Professional dancers in Havlik’s Dance Performance Group relish working with Quicksilver participants. “These younger dancers are in very competitive fields,” Havlik said. “It’s very tough to be a dancer these days; there’s no money in it. But there’s a warmth and generosity that comes with age, and my young dancers love dancing with the older dancers.”

Lim said her “Imaginary Gardens” experience, her first time working with Havlik, confirmed that observation. “I just liked being part of the energy and the presence of elders who have been there, done that, and getting the chance to work with people who have a full level of knowledge in areas I don’t,” she said.

Quicksilver members also benefit as they begin to grapple with the possibility of their own physical and cognitive limitations. Working with other older adults “allows them to confront some of the fears they may have about aging, and recognize that when those physical or cognitive declines come, there’s still life and there’s still joy,” Rose said.

By Rebecca Theim

Rebecca Theim is a former daily news reporter and periodic freelance writer.@rebeccatheim

Making a Safe Transition From Hospital to Rehab

April 25, 2019

How to ensure your loved one will receive good care after the move
By Cari Shane

If you have a parent or other loved one who will soon be released from the hospital after an injury or surgery, he or she might not yet be well enough to return home, even with the assistance of in-home care. That likely will mean a transition to a short-term rehabilitation facility or nursing home.

If you’ve never had this experience, you may not know what to expect. The following are some important tips, and a few cautionary tales, from caregivers and a patient who have been through the hospital-to-rehab transition.

Before You Leave the Hospital

Don’t let your loved one leave the hospital without being “admitted.” Without the word “admitted” stamped on hospital papers, the stay at the rehab facility is not covered by Medicare. It’s this semantics loophole that left Cat Stone’s mother in severe debt after a 2012 hip fracture.

“Medicare didn’t just abandon my mother — she went to her grave ashamed and afraid knowing they’d stolen her life savings, her security and her dignity with an undisclosed loophole,” says Stone, of New Jersey, whose mother was living in a Florida nursing home. Stone wrote about what happened to her mother and family for The CoveyClub.

Medicare covers nursing home care if a person over 65 has been admitted and remained in a hospital for three days, counting admission day but not the day of discharge. Since Medicare only picks up the rehab tab for the first 20 days, a secondary insurance may cover the $170.50/day co-pay for days 21 through 100.

Know you can request a private room. The hospital’s social worker will place your loved one in the facility of your choosing as long as there’s a bed available. Since a private room doesn’t cost extra, you might want to request one to ensure a restful stay. While many temporary roommates can get along just fine, sometimes it doesn’t work out.

“My grandmother[’s] roommate was not a good match,” says Amie Clark, whose grandmother was in a nursing home near Portland, Ore. “Had we not spoken up, she would have had to continue to tolerate a situation that was not healthy for an 88-year-old.” If your loved one ends up in a double room and it’s not a good situation, you can add his or her name to the private-room waiting list.

Plan for a Sunday, Monday or Tuesday discharge time. Since patients do not receive physical therapy from either the hospital or the nursing home on discharge or arrival days, the prime day to transition is a Sunday. At most facilities, Sunday is a typical off day for therapy, so your loved one won’t miss what he or she won’t get anyway.

By that same calculation, being discharged on a Saturday can ratchet up three missed therapy days: no therapy on Saturday (transition day), no therapy on Sunday (off day) and no therapy on Monday because this is the day department heads assess your loved one’s therapy needs. If the rehab facility doesn’t do assessments on Saturdays, a Friday departure would mean four days of therapy missed.

When You Arrive at the Care Facility

Disinfect the room. Studies show that the rails on the bed, over-bed table, bed control wand, nurse’s button and the room’s door handles can be ripe with germs. Get wipes and disinfect.

Get direct phone numbers. It may prove difficult to get a human to answer any of the phone numbers provided in the welcome pamphlet. Since most department heads carry company cell phones, ask for these numbers. Key ones to get: the nursing supervisor, social worker and the doctor assigned to your loved one’s care.

Schedule advocates. Schedule at least one person — a family member, friend or perhaps a paid aide — per day to advocate for your loved one, at least until you feel like everything is going well. An advocate helps draw attention to the person’s needs, especially in an environment where nurses and other care staff often are over worked and in charge of a large number of patients. If you hire someone to be an aide for this, just know the service is not covered by Medicare.

Make sure the staff understands your loved one’s mental condition. When transitioning from a hospital to a care facility, many older adults suffer from some level of hospital delirium. The rehab staff may assume that this is who your loved one is and create a misinformed treatment plan. Some of this is inherent ageism, says Catherine Callahan, 68, who says she tackled head-on the assumptions about her abilities when she arrived at a nursing home in Santa Barbara, Calif., after major surgery. They “may think you are hard of hearing, confused and limited in your determination … I stated up front that I have a keen sense of hearing … and was very committed to doing my program,” she says.

Check with your loved one’s doctor. The facility may require an immediate influenza and/or tuberculosis shot. Since your loved one may already be up to date on these, insist that the facility wait for you to get medical records. And, while you’re on the phone with the doctor, discuss medication changes and contraindications.

Look and ask before your loved one takes medicine. Each time your loved one is given medication, make sure you, your advocate or the patient asks the nurse to state the names of the pills. Lana Wolfe’s 81-year old mother was prescribed oxycodone despite an allergy, which was noted on her chart. “She was given this for two days before I found out,” says Wolfe, of Fort Colins, Colo., whose mother was in a rehab facility near Denver. Also, a few times “the medication was just left with my mom [even though] the nurse is supposed to wait until the patient actually takes the medication,” she says.

Don’t ever accept “we can’t do that” or “you have to do that” as gospel. Patients have the right to turn down treatment. “Many people assume that they have to follow the doctor’s orders and don’t have a choice, but they do,” says Clark, who is also a former long-term care social worker. Also, a family member or other individual who is legally designated can refuse treatment and make other decisions for a person in the hospital or rehab.

While Medicare’s Bill of Resident’s Rights states that patients have the right to be treated with dignity and respect, sometimes it can be a battle. “Nurses aides insisted that my mother wear a diaper even though she could go to the bathroom on her own,” says Dr. Carole Lieberman, whose 101-year old mother spent time in two Los Angeles-area rehab facilities. “Diapers are easier for the staff … but they infantilize the patients.”

Patients also have the right to ask for treatment. “My speech was unclear … [but] my program did not include speech therapy,” says Callahan. “I never gave up asking for it.” She gave doctors specific reasons for why she needed it, “such as therapists not being able to understand me.” By the second week, Callahan was assigned a speech therapist.

You have the right to read all paperwork before signing. Remind your loved ones that they do not need to sign something they don’t understand, haven’t read or for which they do not agree.

If you don’t like how your loved one is being treated, go straight to the top. It may be difficult to get the facility administrator on the phone, but keep trying. If the person remains elusive, demand an internal investigation about your loved one’s treatment from the director of nursing or social work.

By Cari Shane

Cari Shane is a freelance journalist and corporate writer specializing in public relations and social media strategy. She is based in Washington, D.C.@cariinthecity

Benefits of Pilates: Strength and Stability

March 19, 2019

Learn what it is, and how to find the right class and instructor for you
By Camille LeFevre

Tiza Riley’s client has spinal stenosis, severe osteoporosis and a rotator cuff injury that was never repaired. Still, at 82, her client has never felt better. She does Pilates (pronounced pih-LA-tays), the increasingly popular exercise system for women and men.

“I’ve been working with her for 10 years,” says Riley, a master trainer at CORE Conditioning in Studio City, Calif. “She’s limited in what she can do. There are activities she has to avoid completely. But today, she can do so much without pain.”

Like driving to Palm Springs twice a year to see her son — without back pain. And gardening four days a week. During their sessions, Riley works on her client’s core stability on a floor mat, then moves to a piece of Pilates equipment called the Reformer to strengthen her client’s feet and legs.

Pilates Works the Whole Body

Core strength and stability are at the center of Pilates, which works the whole body to improve posture, balance, flexibility and strength. The core, Riley explains, is comprised of the pelvic floor, transverse abdominis, diaphragm and multifidi along the spine, which, when properly engaged, work together to create the effect of a nice snug corset.

“The core holds up your spine,” Riley explains. “On top is the weight of your head, shoulder girdle and upper body. Then, you need to have mobility in your legs. In Pilates, we bring the top and bottom together through the core. If your core is weak, your upper body is not supported, your spine starts to shrink and hunch, and that affects your gait. As we get older, keeping the right posture through proper core engagement makes all the difference in quality of life.”

As Joseph Pilates, creator of the exercise system, famously said, “If your spine is stiff at 30, you are old. If it is flexible at 60, you are young.”

Pilates’ Beginnings

Originally from Mönchengladbach, Germany, Pilates developed the exercise system during World War I, while he was being held at the Knockaloe internment camp on the Isle of Man. He developed a series of floor exercises on a mat that engage and strengthen the core, stabilize the pelvis, strengthen the arms and legs and lengthen and mobilize the spine.

Working with his fellow internees, including some who were bedridden, he innovated a series of straps and pulleys that would support the body while doing the exercises. After the war, Pilates moved to New York City with his wife and formalized the exercise system he had created, which he called “Contrology.”

He also developed the strap-and-pulley system into equipment designed to help accelerate the process of stretching, strengthening, body alignment and increased core strength started by the mat work. The Reformer is the best-known and most popular of this equipment; it “includes a moving platform that inherently challenges stability and balance,” Riley says.

The Reformer also supports the body during Pilates.

“For people over 50, mat Pilates can be stressful on the neck and shoulders,” Riley notes. “Joe did the mat work first, then created the equipment to help people who needed more support while doing the work. The Reformer gives you something to push against, whereas on the mat you’re pulling against gravity.”

Mental and Physical Benefits of Pilates

The benefits of Pilates are not only physical, but mental. “The Reformer gives the body more input and feedback that the nervous and neurological systems need to wake up and become active,” says Cari Riis Stemmler, owner and master teacher at Paragon Pilates & Physical Therapy in Edina, Minn.

“Pilates, whether on the mat or on a piece of equipment, requires precision and focus,” she says. “Pilates requires you to move in intricate ways, which helps with brain activity and mental acuity. We joke all the time that you’re getting smarter when you do Pilates, because you’re learning new things. It refreshes you mentally.”

Other benefits from a regular Pilates practice include arm and leg strength, balanced muscle development, injury prevention and “increased energy and joy for your activities,” Riis Stemmler says. Runners, golfers, swimmers, runners, dancers and horseback riders all benefit from Pilates — so do people who aren’t as fit, or who come to Pilates with injuries or a chronic disease.

“The over-50 demographic is such a diverse group in the twenty first century, from the very fit to the post-surgical, from the sedentary to those with a condition like Parkinson’s,” Riis Stemmler says. “They also come to us with ankle sprains, meniscus tears and joint-related injuries.”

An acute injury should always be treated by a physician, then followed up with physical therapy. After that, Pilates can help with further rehabilitation and strength building.

“A well-trained, certified and experienced teacher will work with a client on the whole body,” Riis Stemmler adds. “With any injury or condition, the body adapts and creates compensatory patterns. As you’re healing, a good teacher will address the whole body and those compensatory patterns so the body is balanced as part of your recovery.”

Finding the Right Pilates Instructor

Today, Pilates is taught and practiced in a variety of styles, from the classical method Joseph Pilates devised to more contemporary iterations, including Stott Pilates, Balanced Body, Peak Pilates and even a new franchise on the scene: Club Pilates.

To find the right teacher, start by visiting the website of the Pilates Method Alliance (PMA), the nonprofit professional association dedicated to the field, and search the directory for an instructor in your area. Check out instructors’ certifications: In which style or program are they comprehensively certified, meaning, they can teach on all of the Pilates equipment? How many years of experience do they have?

Talk to friends and colleagues about instructors they like or who have helped them. When calling or emailing Pilates studios for information, advocate for yourself: Which instructors have experience with your concern, whether it’s a disk or joint injury, back issue or just wanting to improve your core strength and spine flexibility in a safe way? “If they say, ‘Oh, yes, we do that,’ and it feels more like a sales pitch than a conversation, you might want to look elsewhere,” advises Riis Stemmler.

If You Have Osteoporosis

If you have osteoporosis, many of the Pilates exercises are “contra-indicated,” meaning they could cause more harm than good. An instructor certified in a program like Rebekah Rotstein’s Buff Bones might be the ticket, as it combines bone-strengthening techniques with alignment and balance exercises. Ask if the studio also offers physical therapy, or receives referrals from physical therapists, which is an indication that the trainers can provide you with additional resources or instruction in addressing your physical concerns.

Finally, finding an instructor who feels right, someone who you can trust and connect with, is essential. Moreover, after taking a class, “Trust how your body feels. When you’re done with your workout, you should feel good. Worked, but supported and stronger,” Riley says.

When practiced safely and correctly, with an expert instructor, Pilates “is perfect form of exercise for people even into their 90s,” adds Riis Stemmler.

By Camille LeFevre

Camille LeFevre is a professional freelance writer and Balanced Body® certified Pilates mat instructor.

Our Brains Need Exercise, Too

March 12, 2019

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

Understanding the Types of Rehab for Stroke Therapy

February 15, 2019

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.

5 Hidden Causes of Heart Disease

January 25, 2019

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.

  1. 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.

  1. 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.

  1. 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.

  1. 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

8 Reasons You’re Losing Sleep

January 8, 2019

Avoid these culprits to get a better night's rest
By Sheryl Kraft


As if there weren’t enough things keeping you tossing and turning each night, here’s a new one: Using short-wave, blue light-emitting e-readers, like the iPad, iPhone, Nook Color, Kindle and Kindle Fire before bedtime can make it harder to fall asleep, according to a December 2014 study at Brigham and Women’s Hospital in Boston.

“When blue light hits the optic nerve, it tells the brain to stop producing melatonin,” which is “the key that starts the engine for sleep,” says Michael Breus, diplomate of the American Board of Sleep Medicine and fellow of the American Academy of Sleep Medicine. “This is especially problematic, since as you get older, the ability to produce melatonin becomes even more compromised.”

Fixes: Open up a real book instead. (Remember those?) If giving up your e-reader is impossible, look for screens and glasses that can block the sleep-stealing blue light on websites like 6 Habits That Ruin a Great Night’s Sleep)


Carry extra pounds, especially in the neck and trunk section, and it’s more likely you’ll suffer from sleep apnea, which causes your airway to become blocked or obstructed during sleep, robbing you of quality deep sleep. The condition affects 90 percent of obese men, though it’s not purely a man’s disease. The Cleveland Clinic reports that after menopause, it’s just as likely to affect women. Even more disturbing, it goes undiagnosed in as many as 80 percent of those who get a lousy night’s sleep.

“Sleep apnea can mask itself as fatigue, trouble with concentration, dry mouth or even depression,” Breus states.

Unfortunately, the relationship between sleep apnea and obesity is a bit of a chicken-egg scenario. Do sufferers have problems because they’re obese, or is their obesity stoked by their compromised sleep? No one knows for sure, but what is known is this: Poor sleep makes people less motivated to increase physical activity, which can lead to more weight gain. Additionally, reduced sleep is associated with elevated levels of the hormone leptin, which helps regulate appetite.

Fixes: Among the various treatments for sleep apnea is a continuous positive airway pressure (CPAP) machine, which delivers air pressure via a mask that sits over your nose or mouth while you sleep. Other treatment options include losing weight, oral appliances (that resemble mouthguards), and Inspire Upper Airway Stimulation (USA) therapy, a new FDA-approved implantable device.(MORE: A Good Night’s Sleep Could Ward Off Alzheimer’s)


Many popular over-the-counter pain medications, like Excedrin and Bayer Back and Body, may contain caffeine, which helps the medication get absorbed more quickly, but can cut into your sleep, according to Breus (who suggests always checking the label first). If you’re feeling under the weather, beware of nasal decongestants and daytime cold or flu medicines, as well, which can contain pseudoephedrine; you’ll feel jittery instead of tired.

Diuretics, water pills for heart disease and high blood pressure, and ADD medications like Adderall and Ritalin can also disrupt sleep, says Dr. Hrayr Attarian, a neurologist at Northwestern Memorial Hospital in Chicago, Ill. Other culprits include steroids and some medications for depression or asthma. “As with any new medication, always check with your doctor first,” Attarian says.

Fixes: If your meds are causing sleep problems, “First, I’d suggest talking to your physician to see if your medication can be changed or the dose adjusted,” Attarian says. “If that doesn’t work, you can go to a sleep clinic to discuss treatment options that may or may not include sleep aids. Taking a sleeping pill is not always the right thing right away, especially if you are taking other medications to manage health conditions.”

(MORE: 6 Foods and Medications That Don’t Mix)


Body temperature naturally begins to drop before bedtime, preparing us for sleep. Although a warm bath can relax and calm you, taking one too close to bedtime will not give your body enough of a chance to cool sufficiently to bring on slumber.

Fixes: To reap the full benefits of your bath, the National Sleep Foundation recommends finishing up your soak at least an hour before climbing into bed. While you’re at it, keep your room cool. “We sleep better in cool rooms,” says Dr. Patrick D. Lyden, chairman of the Department of Neurology at Cedars-Sinai Medical Center in Los Angeles, Calif..(MORE: Can’t Sleep at Night? Look at Your Day)


If you like to snack before bed, watch what you eat. Loading up on foods that contain excessive salt or fat can stimulate brain waves, bringing on nightmares instead of sweet dreams, says the National Sleep Foundation. Choose foods that contain tryptophan (an amino acid linked to sleep quality), whole-grain carbs (which help boost serotonin production) and certain minerals (like calcium and magnesium, which can have a calming effect). Examples include half a banana and a handful of almonds, whole-grain crackers and peanut butter, a mug of warm milk, or half a turkey sandwich on whole-wheat bread.

Fix: In general, stick to a routine of eating early in the evening and try to avoid sugar at night. “Late meals are more likely to make it harder to sleep; snacking in the middle of the night can worsen insomnia,” says Dr. Andrew J. Westwood, a member of the American Academy of Neurology and American Academy of Sleep Medicine. Additionally, eating too much can make you feel physically uncomfortable when you lie down, and may cause heartburn, contributing to wakefulness.(MORE: 6 Healthy Foods to Put in Your Grocery Cart)


The ideal bedroom should be simply furnished and decorated, so there’s not much to distract you from the primary reason you’re in there — to sleep. Excess clutter and mess can often cause anxiety, and remind you of all your unfinished business, making it harder to fall — and remain — asleep.

(MORE: Take the 30-Day Declutter Challenge)


Sure, being physically active can make you tired, promote sleep and improve the quality of your rest, but exercising vigorously too close to bedtime can rev you up instead. “Aerobic exercise can raise your core body temperature long after you’ve finished,” says sleep specialist Rubin Naiman.

Fixes: Naiman suggests completing exercise at least three hours prior to bedtime. However, gentle exercise like yoga, he says, can be helpful to promote relaxation and sleepiness.(MORE: The Best Exercise to Protect Your Bones)


When you’re stressed, your body secretes cortisol, a hormone produced by the adrenal gland. This can disrupt the body’s natural rhythm, says Naiman. “Cortisol is naturally produced in the morning. It peaks at around 8 a.m., when it can be helpful to naturally energize us,” he explains. “But at the wrong time—like nighttime—it can make us hyper-aroused and disrupt our sleep.”

Fixes: In addition to yoga for relaxation, a new study in adults over 55 finds that practicing a popular form of meditation known as mindfulness meditation can reap improvements in sleep quality and reduce insomnia and fatigue. Mindfulness meditation can also help reduce stress, according to a 2009 Massachusetts General Hospital study. Visit to learn some basics.(MORE: 6 Health Risks of Poor Sleep)

If meditation is not your thing, there’s always a good old-fashioned belly laugh; laughter actually induces physical changes in your body, says the Mayo Clinic. It cools your stress response and can increase positive thoughts, which, in turn, causes your body to release neuropeptides to help fight stress.

By Sheryl Kraft

Sheryl Kraft is a freelance journalist, essayist and writer of non-fiction based in Fairfield County, Conn. Her writing covers all areas, with a concentration in health, wellness and fitness.@sherylkraft

Stand Up to ‘Sitting Disease’

December 18, 2018

Adding movement to your day can boost your health and prevent disease
By Lisa Fields

Not long ago, when I interviewed one of the leading experts on “sitting disease” — the buzzy catch phrase that’s been attached to physical inactivity for the past few years — he walked in place on his treadmill desk while we chatted by phone. The irony wasn’t lost on me: I was sitting idly at my desk while writing an article about the health problems associated with sitting idly at desks. Meanwhile, the expert in the know was staying active, even though he had a desk job.

I recently added a treadmill desk to my office, which I fashioned myself out of a regular treadmill and some supplies from the hardware store. It’s empowering to work while walking at 1.6 miles per hour, knowing that I’m taking care of my health.

Why Sitting Has Become More Routine

Unless you make an effort to get moving, it can be easy to fall into a physically inactive lifestyle. You can accomplish some of the same tasks from a seated position today that required walking just a few years ago: Think online shopping and drive-through everything. And with the widespread popularity of screen time, you’re likely allured into a seated position by your smartphone, laptop or TV for several hours daily. Between your desk job, commute, meals and nightly leisure time on the couch, you probably sit for the bulk of your day.

Unfortunately, an inactive lifestyle can be detrimental to your health. Prolonged sitting is linked to a host of health problems, including heart disease, diabetes, obesity, high blood pressure and cancer.

Luckily, research shows that there are simple ways to combat chronic physical inactivity, but it requires consistent effort; your morning walk won’t help to counteract the effects of a full day of sitting. Finding ways to add more movement all day long is key.

“Moving more frequently throughout the day, even at lower intensities and for shorter duration, has a positive impact on health markers and is just as important as regular exercise,” says Lauren Shroyer, director of product development for the American Council on Exercise.

Sneak Movement Into Your Lifestyle

Think about your daily schedule, then figure out ways to be more active.

“The default in America is to end up on your bottom,” says Dr. James Levine, author of Get Up! Why Your Chair is Killing You and What You Can Do About It and president of Fondation IPSEN, a Paris-based nonprofit medical research foundation. “I want the default to be up and doing something.”

The last time that I spoke with Levine — who is also the former director of obesity solutions for the Mayo Clinic — he was walking on his treadmill desk. Now he says that people can inspire themselves to be more active by mapping out a weekly plan, scheduling one appealing activity each day: Window-shopping downtown, volunteering at the library, wandering the aisles at Walmart or spending the afternoon with grandkids.

“The trick is absolutely to find the stuff that you want to do,” Levine says. “There’s no point in going to weight training if you hate going.”

Get Up Often

The problem with sitting is that once you park yourself at your desk or on the couch, you’re likely to stay seated for hours. But regularly shifting from sitting to standing helps to improve your health and preserve your long-term mobility.

“Losing mobility is probably the Number One cause of all the deteriorating we see with aging,” says Joan Vernikos, author of Sitting Kills, Moving Heals: How Everyday Movement Will Prevent Pain, Illness, and Early Death – and Exercise Alone Won’t, and former director of NASA’s life sciences division. “The most basic motion that you can do is structure your life so you have to change your posture often.”

For this reason, Vernikos advocates standing often, whether you place your water bottle just out of reach to encourage movement or train yourself to get up when commercials come on TV. Her research found that standing for one to two minutes every 20 to 30 minutes helps prevent deterioration caused by physical inactivity.

“Your body needs this on-off stimulation of changing posture,” Vernikos says.

Standing from a seated position seems like the simplest of skills, but as people get older, the inability to do this prevents some from being able to use the bathroom independently, which makes them more likely to end up in a nursing home or assisted-living facility, Vernikos says.

Be More Active at Work and Home

There are ways to counteract the inclination to stay seated all day.

“Most modern companies are offering some variant of active work: Walk-and-talk meetings, active lunchtime programs, walking clubs, running clubs, treadmill desks and standing desks,” Levine says. “There’s a whole range of active work opportunities, many of which cost nothing.”

If you’re retired, you don’t have to sit at home all day, even when you have no plans.

“Pacing the room while on the phone, using your standing work station or putting your laptop on the kitchen counter for 15 minutes are additional ways to work in more muscle activity throughout the day,” Shroyer says.

Do Things the Old-Fashioned Way

Just because there are modern conveniences doesn’t mean you have to use them constantly. Try doing activities the way you would have done them decades ago: Walk into your co-worker’s office to share an idea instead of emailing him. Visit the teller at the bank instead of frequenting the drive-through. Order something online, then pick it up at the store instead of having it shipped to you.

“If you want to improve or restore your mobility, be aware of what you’re not doing that you used to do,” Vernikos says. “Every time you go through the drive-through, you are aging yourself. Even getting out of your car and walking two steps to pick up your drugs at the pharmacy is something.”

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.

The Best Way to Improve Brain Health

November 8, 2018

The first in a series of interviews with Longevity Innovators
By The Milken Institute Center for the Future of Aging

(Advances in science and public health are increasing longevity and enhancing the quality of life for people around the world. In a series of interviews with the Milken Institute Center for the Future of Aging, 14 visionaries will be revealing exciting trends and insights regarding healthy longevity, sharing their vision for a better future. The Longevity Innovators interviews highlight new discoveries in biomedical and psychosocial science, as well as strategies to promote prevention and wellness for older adults. This is the first in the series.)

Renowned neurosurgeon Dr. Keith Black (chair of the department of neurosurgery and director of the Maxine Dunitz Neurosurgical Institute at Cedars-Sinai Medical Center in Los Angeles) has pioneered advances in our understanding and treatment of brain cancers and complex neurological conditions. Black is also a research scientist studying targeted drug delivery, cancer stem cells and Alzheimer’s detection through retinal imaging, among many other areas. In an interview with the Milken Institute Center for the Future of Aging, Black talks about the importance of developing a test for early onset Alzheimer’s and his goal to inspire the next generation.

Dr. Keith Black

What is the most important thing that people should know about improving brain health?

People need to know how important lifestyle is to sustain health. Lifestyle, diet, exercise, moderating stress, making sure you get a good eight hours of sleep when you can, making sure you keep your brain engaged particularly in novel activities — all of these matter. You have to remember the brain is a living organism very much like a muscle — the more you use it, the stronger it becomes.

We need to treat our brains better. For example, try to avoid excessive alcohol and make sure that you screen yourself for diseases like diabetes and hypertension that can be devastating to the brain.

What will be the benefits of having a reliable test for early onset Alzheimer’s?

I think there’s a huge misconception that if you get Alzheimer’s or if you’re going to get Alzheimer’s, there’s nothing that you can do about it. And I think the science shows that that perception is incorrect.

We know two things now that address your question. The first is that Alzheimer’s starts about two decades before a person develops symptoms. During that period of 20 years, you’re losing brain cells, and you’re losing brain connectivity. If you can detect the disease at the very start, particularly before you lose enough brain cells to become symptomatic, we may have the ability to stop the process or at least slow it down and prevent an individual from becoming symptomatic.

If people are developing Alzheimer’s in their 50s and 60s, they are going to become symptomatic in their 70s and 80s. If you can slow the overall process and have people become symptomatic in their late 90s or 100s, you have the ability to essentially prevent the disease from being symptomatic in most of our lifetimes. That’s really the major reason to move towards early detection, because preventing brain loss is a lot easier than restoring brain cells once they’ve died.

The other reason people should be interested is that even though we don’t have a pill that can stop the progression, we know that Alzheimer’s also has a lifestyle component. The scientific evidence shows that lifestyle habits such as a Mediterranean diet, exercise, sleep, meditation and other types of mindfulness modify stress levels. We’re seeing that potentially even micronutrients like the omega-3 fish oils may be very important in slowing the progression of Alzheimer’s disease.

What’s your take on Pfizer ending research to find new drugs aimed at treating Alzheimer’s and Parkinson’s diseases? How do you think it will impact ongoing research?

I think a lot of the trials that have failed for Alzheimer’s disease, including the Pfizer trial, could’ve been better designed and better developed. I think we have a lot to learn from the failure of those trials.

For example, how do we get the drugs into the brain more effectively? How can we better select the right population of patients to treat? I think addressing those potential reasons for the failures of those drugs will lead to successful therapies and hopefully successful approvals.

By The Milken Institute Center for the Future of Aging

The Milken Institute Center for the Future of Aging aims to improve lives and strengthen societies by promoting healthy, productive and purposeful aging.


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