How can we look after our aging brains?

How can we look after our aging brains? If you're interested, the following article from the January 4th issues of the Los Angeles Times is a must read. 

The aging brain is a shrinking brain, and a shrinking brain is, generally speaking, a brain whose performance and reaction time are declining: That is a harsh reality of growing older.

But new research shows that brain shrinkage is less pronounced in older folks whose diets hew closely to the traditional diet of Mediterranean peoples — including lots of fruits, vegetables, legumes, nuts and olive oil, little red meat and poultry, and regular, moderate consumption of fish and red wine.

In a group of 562 Scots in their 70s, those whose consumption patterns more closely followed the Mediterranean diet experienced, on average, half the brain shrinkage that was normal for the group as a whole over a three-year period.

To glean how diet might influence brain aging, researchers tapped into a large group of Scottish people who were all born in 1936 and had many measures of health status and lifestyle tracked from an early age.

Around the time they reached age 70, 843 members of the “Lothian Birth Cohort” filled out a dietary frequency form that gave researchers a broad look at what foods they ate, which they avoided, and how often they consumed them. At about age 73 and again around age 76, their brains were scanned to gauge the volume of the overall organ and a few of its key components.

The researchers used the food-frequency surveys to divide the group into two — those who at least approximated a Mediterranean-style diet and those who came nowhere close. Even though many in the Med-diet group were far from perfect in their adherence, the average brain-volume loss differed significantly between the two groups.

Findings on the impact of Mediterranean diet on healthy aging have been pretty strong — this is generally a good way to eat. Studies large and small have established that following a Mediterranean diet is effective at driving down heart attack, stroke and premature death risks, and improving the health conditions — including hypertension, worrisome cholesterol levels and metabolic problems — that raise those risks.

But researchers are less sure of the particulars of how the diet promotes better health.

In recent years, studies have sought to tease out not only how great the benefits are, but how they work: whether healthier brain-aging is a function of better vascular health or preserved brain volume, and whether the diet’s advantages lie in its dearth of red meat, the positive effects of the fatty acids in fish or olive oil, or the combined benefits of its plant-based foods.

Researchers also must demonstrate that, in their measurements of dietary intake and health, they’re not actually capturing well-understood relationships between intelligence, education and long-term health: People with certain cognitive strengths do better and stay longer in school and earn more; yes, the better educated and paid may consume healthier diets, but they are generally healthier anyway, so maybe the healthier diet is incidental.

The newest study, published Wednesday in the journal Neurology, helps untangle many of those mysteries. But it also leaves many questions unanswered.

Contrary to some research findings on the Mediterranean diet, the findings suggest that reduced brain shrinkage is not specifically linked to low intake of meat and high intake of fish. Maybe, the authors suggest (and many researchers believe this), the magic in the Mediterranean diet is all those plant-based foods, acting collectively to improve subjects’ cognitive health.

The study also finds that subjects across the spectrum of intellect and educational attainment reaped the benefits of the Mediterranean diet in reducing brain shrinkage (or, alternatively, suffered the effects of diets that departed sharply from that diet’s emphasis on plants, fish and polyunsaturated fats). That suggests the researchers are not wrongly crediting subjects’ dietary choices for advantages that may actually stem from higher intelligence and educational attainment.

Finally, the researchers wrote, the study’s design helps establish that the brain-shrinkage rates seen are likely to be the result of dietary patterns, and not just an association. That’s because the subjects’ dietary patterns were measured first, about the time that participants reached 70 years old. Their brain volumes were then measured by imaging scans three and six years later.

Assuming that people did not dramatically change their dietary patterns — a shift that is considered unlikely for folks in their 70s — researchers believe that the dietary habits that Scots reported as they entered older age played some role in the brain changes they detected further down the road.

Left unexplored here is whether a midlife shift toward the Mediterranean diet could have the same effects, or whether the group differences in brain volume are the rewards or penalties for a lifetime of dietary choices.

There’s good evidence that, when it comes to making better dietary choices, earlier is better. In a 2013 study of more than 10,000 women, researchers found that those who followed a Mediterranean-style diet in their 50s and 60s were about 40% more likely to live past the age of 70 without chronic illness and without physical or mental problems than were those with less-healthy diets. 

Check signs for possible health issues

Here is an interesting recent article in the Toronto Star that explores how we need to check signs of physical and emotional change for possible health issues. It's relevant not only to those of us passing through middle age, but also for our aging parents and loved ones.

Take a read:  https://www.thestar.com/life/health_wellness/2016/12/26/most-health-problems-are-not-due-to-aging.html

 

 

Caring for a parent afflicted with Alzheimers

Caring for a parent afflicated with Alzheimers is challenging.

Listen here https://soundcloud.com/680cjob/parenting-our-parents​ as Dr. Michael Gordan discusses key considerations in a CJOB 680 interivew with host Jeff Currier in Winnipeg.

Medications and the elderly: some good advice

Here is an excellent recent article in the Globe & Mail about medications and the elderly. Well worth the read and some reflection. 

THE QUESTION
My mother is in her 70s and suffers from a lot of health problems. I am very worried that she has been given too many different medications that are too strong for her. What should I do?


THE ANSWER
It’s possible that your mother may need all the drugs she is currently taking. But it’s also true that patients sometimes get prescribed drugs and remain on them when they are no longer required.
“Doctors are really good at starting medications, we are not so good at stopping them,” says Dr. Kimberly Wintemute, the primary care co-lead of Choosing Wisely Canada, an organization dedicated to reducing unnecessary medical treatments.
During a hospital stay, for instance, a patient might be given a sleeping pill or a heartburn drug and the prescription keeps getting renewed.
Over time, a patient can end up on a growing list of medications. About twothirds of seniors living in their own homes take five or more drugs, according to data collected by the Canadian Institute for Health Information. One-quarter of seniors are prescribed 10 or more medications.
Each new drug that’s added to the mix increases the risk of adverse side effects and medication interactions.
» The elderly are especially vulnerable to these problems. Not only do they tend to have more chronic conditions than younger people, but the aging process can also change the way the body handles medications.
For instance, the liver and kidneys – which play a key role in processing and excreting drugs – tend to work less efficiently as we age.
In fact, the liver can sometimes become overwhelmed trying to handle several drugs simultaneously. As a result, certain medications don’t get “activated” and essentially won’t work.
“Picture a bus and everyone is trying to get on at the same time – some people are not going to fit and will be left behind,” explains Dr. Cara Tannenbaum, co-director of the Canadian Deprescribing Network, a group that is trying to prevent the inappropriate use of medications.
Furthermore, as we age, we lose muscle mass which is replaced with fat and that can cause problems because some drugs are stored in fat tissue. This means medications can linger longer in the body and thereby exaggerate their effects, Wintemute says.
Another concern is the government approval process for new medications. Drugs are usually tested on relatively young people with just one medical condition – not elderly individuals with multiple ailments. “We don’t always know how a new drug is going to act in very old and very frail people,” says Dr. Debbie Elman, the lead physician for the Academic Family Health Team at Sunnybrook Health Sciences Centre.
Patients may suffer from a host of side effects and drug interactions including confusion, dizziness, fatigue, constipation, diarrhea, incontinence, weight loss, depression, agitation, anxiety as well as sexual dysfunction. It can be difficult to tell if a particular symptom is caused by a medication or if it represents a new medical ailment. A patient might be wrongly diagnosed with dementia or another medical condition even though a drug is really to blame.
So, what can be done to reduce the risks posed by multiple medications?
First and foremost, a patient should get all medications at the same pharmacy, Elman says.
She points out that patients are often treated by several medical specialists – and each one may be prescribing different medications. No single doctor may have a complete picture of what a patient is taking. However, when all prescriptions are picked up at the same drug store, the pharmacist can check for potentially hazardous drug combinations.
The pharmacist can also conduct a review of a patient’s medications and help determine if some may no longer be appropriate.
For a thorough assessment, the pharmacist will need to know if the patient is also taking any non-prescription drugs, herbal remedies or vitamin and mineral supplements. It’s important to keep in mind that so-called “natural” health products may interact with medications and either reduce or intensify their effects.
Tannenbaum says many patients don’t know why they are taking certain medications or what they do.
She suggests that patients, or their family members, should use the website medstopper.com to learn more about their medications. Simply type in the name of a drug and up pops a great deal of useful information, including if a certain medication might be particularly risky for seniors. Another website, deprescribing.org, provides guidance on how to wean off a medication that may be harmful or is no longer needed.
Of course, patients shouldn’t quit taking a drug without consulting their medical specialists or family doctor. But by first talking to a pharmacist and checking out the recommended websites, they can at least have an informed discussion with the physician responsible for their medical care, Tannenbaum says.


Paul Taylor is a patient navigation advisor at Sunnybrook Health Sciences Centre. He is a former health editor of The Globe and Mail. You can find him on Twitter @epaultaylor and online at Sunnybrook’s Your Health Matters.

End of life health care wishes: be precise!


The issue of medically assisted dying should be in your estate
planning in the event you can’t make decisions on your own, or that your aging loved ones can't! Michael Gordon has often wirtten ane spoken on this. Here is another piece to consider.


Some people leave this earth with a sense of humour. I think of
Canadian lawyer and successful businessman Charles Vance Miller, who
died in 1926 and held a contest in his last will and testament where a
portion of his estate would be left to the Toronto woman who, in the
10 years following his death, gave birth to the most children. It
became known as the “Great Stork Derby.” Turns out that four women
shared the bequest (each receiving the equivalent in today’s dollars
of $2.1-million), each giving birth to nine children in 10 years.


While dying with humour is not often talked about, the more serious
and controversial issue of “dying with dignity” has been hot in the
press. The whole issue of medically assisted death is one that many
would like to ignore. The fact is, however, the issue should work its
way into your estate planning, particularly in the event you can’t
make decisions on your own. It brings to mind the story of a family
and a court decision from just four years ago.

The story
Mrs. F was a widow who gradually developed dementia. She was visiting
Florida in 2012 when she apparently inhaled some food that required
emergency help. By the time help arrived, she had experienced brain
anoxia and didn’t recover significant consciousness. A feeding tube
was inserted at the hospital in Florida before she was transferred
back to Toronto to a hospital there.


Soon after she arrived in Toronto, her family produced a power of
attorney for personal care prepared 10 years earlier, that included
the following wording: “I hereby instruct that if there is no
reasonable expectation of my recovery from physical or mental
disability, I be allowed to die and not be kept alive by artificial or
heroic measures. I do, however, instruct that medication be mercifully
administered to me to alleviate suffering even though this may shorten
my remaining life.”

It went on to read: “I authorize and direct my
attorneys for personal care to make on my behalf all decisions with
respect to my personal care if I am mentally incapable of making such
decisions myself.” Her attorneys for personal care were her three
children.


Given the wording of the power of attorney, Mrs. F’s doctor, on behalf
of the hospital, requested that they allow her to die. The matter was
taken to the Consent and Capacity Board (CCB), an independent body in
Ontario created under the Health Care Consent Act. On June 14, 2012,
the CCB supported the doctor’s request to end Mrs. F’s life because
they took her words in the power of attorney for personal care to be
directive, and not just precatory. But her children wanted differently
and took the matter to court. (As an aside, I have a problem with
others even trying to force a decision like this without simply
acquiescing to the wishes of the substitute decision makers – the
children who held power of attorney in this case – but I digress.)

The decision
On April 3, 2013, the Ontario Superior Court sided with the children.


Witnesses came forward, including rabbis, attesting to Mrs. F’s
Orthodox Jewish faith and life practices. Removing the feeding tube
would have been contrary to the tenets of Judaism that they believe
would have been important to her and which she embodied in all aspects
of her life.


After examining all the evidence, the court found that Mrs. F likely
did not understand or appreciate the words “artificial and heroic
measures” in her power of attorney for personal care. She likely did
not understand all the implications of what she signed. Her life-long
faith was accepted as an important factor that was not sufficiently
taken into account by the CCB. There was no evidence that she
requested an end-of-life clause (her lawyer had no notes of specific
discussions and simply discussed general issues related to powers of
attorney).

The learning
The issue of medically assisted dying should be in your estate
planning in the event you can’t make decisions on your own
 


Tim Cestnick, FCPA, FCA,
CPA(IL), CFP, TEP, is an author and founder of WaterStreet Family
Offices.

© Copyright The Globe and Mail Inc. All Rights Reserved

A very helpful guide to medical alert systems for the elderly

Since our very first book together in 2002, we've been big advocates to home safety measures for the elderly. We've both written and talked extensively about 'elder proofing' the home of our aging parents in a timely way. It's like having an insurance policy.

One critical component of home safety is having a reliable monitoring system. 

We have found a very interesting online site that reviews various products. One of its recent reviews was on home monitoring systems. It looks thorough, reliable, and unbiased. We thought you may find it helpful. It's here: http://www.reviews.com/medical-alert-systems/

Aging well: helping our elderly parents get the most out of their lives

This article could help you think about ways to inspire your aging parents to get the most out of their lives moving ahead. 

It focuses on lifestyle, motivation, activities, and social interaction. Read it here: http://ctv.news/cAtd84g

Alzheimer’s in the family? Should you test yourself?

Here is a very thought-provoking recent article from the Globe & Mail about whether those of us caring for aging parents with dementia should consider getting ourselves tested to see if we have the gene that will more than likely ensure we end up with Alzheimers. It will make you think about this pressing dilemma. 

A blood test can reveal if you carry a hereditary gene, but many people decline to find out.


Marty and Matt Reiswig, two brothers in Denver, knew that Alzheimer’s disease ran in their family, but neither of them understood why. Then a cousin, Gary Reiswig, whom they barely knew, wrote a book about their family, The Thousand Mile Stare.

Continue reading “Alzheimer’s in the family? Should you test yourself?”

Childless, unmarried baby boomers warned to prepare for future

Childless, unmarried baby boomers warned to prepare for future.
Dr. Mireille Norris says elder orphans are a growing problem across the country.
    
A new study is raising awareness about the problem of "elder orphans" — seniors who have no children, spouse or any other family member to care for them as they age.
The research comes on the heels of an incident earlier this week in North Carolina in which an 81-year-old cancer patient with no caregiver called 911 to ask someone to buy him some food.
Dr. Maria Torroella Carney, the chief of geriatric and palliative medicine at North Shore-LIJ Health System, recently completed a case study and literature review that she will be presenting to The American Geriatrics Society's Annual Scientific Meeting this weekend.

Continue reading “Childless, unmarried baby boomers warned to prepare for future”

Exercise can help slow disease progression in elderly

Exercise can help slow disease progression in elderly.
Though being active won’t reverse dementia, buying ‘two or three years
of quality time is pretty significant,’ researcher says
Sure, physical activity is good for your body and mind. But why? And
how much of it do you really need?
Researchers examining the benefits of exercise are now getting down to
the nitty-gritty, finding new clues about how it may deter illnesses
such as dementia and cancer.
While there’s plenty of evidence to show that regularly breaking a
sweat may reduce the risk of Alzheimer’s disease and other forms of
dementia, much of that research has previously been conducted on
healthy individuals. But new studies presented this week at the
Alzheimer’s Association International Conference in Washington suggest
physical activity may also improve the lives of those who already have
the disease or are on the path to developing it.
One of those studies, conducted in Vancouver, showed “significant”
improvements after exercise in the cognitive function of participants
with mild vascular cognitive impairment, or “silent strokes,”
characterized by small lesions of damage in the brain.
Silent strokes tend to go unnoticed and don’t come with the typical
signs of stroke, such as facial drooping and slurred speech. But they
do tend to lead to these more severe, obvious strokes and increase the
risk of vascular dementia, where restricted blood flow to the brain
causes cognitive issues, explains researcher Dr. Teresa Liu-Ambrose,
an associate professor and Canada Research Chair at the University of
British Columbia and the Vancouver Coastal Health Research Institute.
Among the 71 participants in the study, ages 56 to 96, those who did
moderate-intensity walking for 60 minutes, three times a week, not
only showed better cognitive function, such as memory and attention,
after six months, compared with those in the control group, who were
not assigned regular exercise; their cognitive function also tended to
be better than at baseline, suggesting exercise may minimize the
progression of silent strokes.
Scans showed the brains of those in the exercise group were also more
efficient. Plus, participants who exercised reduced their body mass
index and blood pressure – which is not exactly surprising, but
supports the idea that cardiovascular health is vital to maintaining
brain health.
“The converging suggestion is that exercise … truly can [affect] the
very mechanistic level at which … people are developing the cognitive
issues,” Liu-Ambrose says.
That’s not to say you can reverse dementia with regular exercise, she
says. But it may halt its development. “To even buy yourself two or
three years of quality time is pretty significant,” Liu-Ambrose says.
Meanwhile, researchers in Alberta have found 300 minutes a week of
moderate to vigorous aerobic exercise is better than 150 minutes a
week for reducing the risk of breast cancer. In a study published in
the journal JAMA Oncology earlier this month, Calgary cancer
epidemiologist Dr. Christine Friedenreich and her team tested how
differing amounts of exercise affected body fat in 400 inactive
postmenopausal women, since body fat has previously been shown to
increase the risk of postmenopausal breast cancer.
One group was assigned to exercise 30 minutes for five days a week,
for a total of 150 minutes, which is the minimum recommended by
Canada’s physical activity guidelines. A second group was asked to
exercise for 60 minutes, three days a week for a total of 300 minutes.
Both groups were asked not to change their diets.
“A lot of the [physical activity] guidelines were actually developed
for cardiovascular disease prevention,” explains Friedenreich of
Alberta Health Services and the University of Calgary. “But for
cancer, we hypothesized that we might actually need a greater amount
of exercise.”
The researchers found both groups benefited from sticking to their
assigned exercise regimen for 12 months, but those who did a higher
volume of exercise had greater reductions in body fat. Previous
research by the team showed a dose-response to exercise, leading to
reductions in a series of biomarkers including body fat, endogenous
estrogen, insulin resistance and inflammation.
Friedenreich considers her latest findings empowering for many, as
physical activity is an inexpensive and non-invasive way of reducing
one’s risk of cancer. “A lot of people are quite concerned about
getting cancer and this is something they can do,” she says.

WENCY LE­UNG  © Copyright The Globe and Mail Inc. All Rights Reserved