This political season’s biggest debate has centered around presidential candidate’s ages and if they are too old for the job. President Biden withdrew from the nomination but there is much we can still learn from our early summer “freakout,” as some have called it.

President Biden’s general demeanor and lapses during the June debate attracted attention and alarm, followed by calls for him to withdraw. Donald Trump has not been spared criticism about his general health and tendency to ramble, sometimes somewhat nonsensically. If he hadn’t withdrawn from the race, the president would have been 86 by the time he completed a second term, Trump 82.

The great unknown for the future of any U.S. president is to what extent their general health will be affected by the stresses of the job. Serious illness or accidents can strike at any age. But when it comes to the likelihood of age-related declines, we do have some data. Average rates of dementia start to increase sharply from unusual to increasingly common after about age 75. Other age-related declines and risks rise with every passing year. These include walking speed, falls and injuries, heart attacks, strokes, and other common conditions like cancer and Parkinson’s Disease.

As many of us enter and march through our third act I think there is a more general issue facing all of us and our aging society—the tendency to deny aging and its accumulative effects. We pay a lot of attention to so-called active aging, the importance of staying engaged, exercising regularly, and maintaining—and ideally improving—our general health and well-being. We emphasize keeping up healthy habits such as hiking, participating in book clubs, volunteering in ways that help others, promoting things we believe in, “making a difference” and making our lives meaningful. And this is all good and important. We want to avoid or minimize age-related decline and loss of abilities for as long as we can. But we are not immortal. Eventually, we all will experience loss and decline before we die.

In my book Enlightened Aging: Building Resilience for a Long Active Life, we emphasize building reserves to stay healthy and active longer, but also the importance of accepting and adapting to changes we wish we weren’t experiencing. I was on a sabbatical in Cambridge University in my late 60s when I began writing the book to summarize what we’ve learned about aging from our research, caring for patients as they aged, and my family’s experiences. Now, 10 years later at age 77, I’m faced with the reality of the age-related changes I wrote about and the more difficult task of accepting changes I didn’t want to experience and thought I might avoid. Rather than just building reserves to combat aging changes, I try to find ways that I hope will minimize the effects of the accumulating declines I am experiencing. Like others, I hope to preserve high levels of functional well-being and happiness, engaging in the world and especially family, friends, and activities in ways that add meaning to my life for as long as I can.

We talk a lot about aging well, but what about the importance of acceptance and adapting? Time will tell how this plays out for President Biden, Trump, and the future of the country and the world. We know the implications of the U.S. presidential race and its outcome for the global stage are colossal and unknown. We also know that for individuals like me and you, it is both challenging and a wonderful opportunity to accept, adapt, and carry on with meaningful, fulfilling, and happy lives as we get older. Aging well and accepting aging itself is a victory worth celebrating.

Eric B. Larson, MD, MPH, is a Professor of Medicine at the University of Washington. He was co-Principal Investigator of the SMARRT trial and formerly Vice President for Research and Healthcare Innovation at Group Health and Kaiser-Permanente Washington. With colleagues he co-founded the long running Adult Changes in Thought (ACT) study in 1986. He continues research through the UW Alzheimer’s Disease Research Center and other projects. He has participated in The Lancet Commission on Dementia since its inception. With co-author Joan DeClaire he wrote the well-received book, Enlightened Aging: Building Resilience for a Long Active Life.

Resilience: The Simple Truth About Living to 100

Be a Part of It

A Pearl Harbor Secret

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By DR. ERIC B. LARSON

In 1978, as I completed my residency and fellowship training and joined the University of Washington faculty, I had a dizzying array of interests.

Aging, and especially the aging brain and dementia, piqued my curiosity, although dementia research and care were not then in the mainstream. Demographic forces portended we would need a lot more research to understand aging processes. The predicted growth of many persons living to advanced old age is now a fact of life. But in the late 1970s, dementia occupied the backwaters of academic medicine. Back then, those who lived into their late 70s, 80s, and beyond and became impaired were typically seen as just experiencing old age or normal senility. Alzheimer’s disease was considered a cause of pre-senile dementia—described decades earlier in the rare, strange case of a middle-aged woman.

Changing demographics predicted a “silent epidemic of dementia in the elderly.” A growing fear of dementia likely contributed to the explosion of interest in Alzheimer’s disease and related dementias since the late 1970s—fueled partly by increased federal funding for research and awareness when a revered former president, Ronald Reagan, withdrew from public life with Alzheimer’s disease.

One recollection I have is of a poll asking doctors what disease they feared most. Many expected doctors might fear a common killer disease like cancer or possibly a heart attack. The surprising result was that the disease doctors feared most was Alzheimer’s disease, now recognized as the most common cause of dementia. Today, ongoing research has vastly expanded what we know about the aging brain and Alzheimer’s disease and related disorders.

No Magic Bullet Cure

Many wish for a cure. Perhaps a vaccine that might eliminate the risk altogether, or a magic bullet that provides a cure for those who develop Alzheimer’s. Nothing like this exists today.

Vast amounts of federal and industry resources have supported science in search of that “magic bullet”—a pill to prevent or cure Alzheimer’s. One drug has recently been approved and another is expected to be approved soon. These drugs are designed to remove amyloid, a degenerative protein implicated in Alzheimer’s. They are expensive, have serious side effects, and do not actually cure or prevent the disease; rather they modestly slow the rate of decline in carefully selected persons. Some smart alecks say the best way to avoid dementia as we get older is to die young!

Focus on Prevention and Risk Reduction

A smart—not a smart aleck’s—approach to epidemics like dementia is to find ways to prevent and reduce the risk of dementia as we age. Prevention research has focused on finding factors that increase the risk for dementia, especially so-called factors that are potentially reversible or at least modifiable.

The Lancet Commission on Dementia—comprised of international experts—has produced two reports and is about to publish its third. The second report estimates that 35 to 40 percent of the risk for late-onset dementia is accounted for by potentially modifiable risk factors. The keywords here are “potentially modifiable.”

A Glimmer of Hope—The FINGER Study and Trial

Is there a better, smarter way to control this epidemic? Might it be smarter to find ways to reduce risk by discovering ways to make changes based on these “modifiable” factors and see if they actually work? Several mostly international studies designed to reduce dementia risk have been published. One promising study, FINGER, or the Finnish Geriatric Intervention Study to Prevent Cognitive Impairment and Disability, focused on nutritional guidance, exercise, cognitive training, social activity, and management of metabolic and vascular risk.

The dementia research field greeted the modestly beneficial results of the FINGER trial with enthusiasm. So-called mini-FINGER trials were launched in the U.S. and around the world. Earlier research had failed to show the cognitive benefits of efforts from changing potentially modifiable risk factors. FINGER provided a glimmer of convincing evidence supporting this concept.

Targeting Risk Factors for Better Results—SMARRT Study and Trial 

A just published new report sheds more light on the prospect of modifying risk factors to reduce cognitive and dementia risk. The study known as SMARRT, or Systematic Multidomain Alzheimer’s Risk Reduction Trial, was released electronically on Nov. 23, 2023, and published in JAMA Internal Medicine journal in January. As the first personalized intervention, SMARRT focuses on maintaining or improving multiple areas of function. This is done by targeting risk factors based on participants’ risk factor profiles, preferences, and priorities. The research team from Seattle and San Francisco who designed the study believed that a personalized approach was better than the one-size-fits-all approach used in previous research. In a planning survey of 600 older adults in Seattle, we found that most were concerned about Alzheimer’s disease. They wanted to know their personal risk factors and were motivated to make changes to lower dementia risk.

The two-year study of 172 persons, ages 70-89, at elevated risk for dementia found that participants in SMARRT had a modest but statistically significant improvement in cognitive testing of 74 percent compared to the control group. Participants also had improvements in measurements of risk factors (145 percent) and quality of life (8 percent).

The SMARRT program involved participants meeting with a health coach and nurse followed by coaching sessions. Initial visits were in person but due to the pandemic, all sessions were switched to phone. In the sessions, risk factors selected by participants were reviewed. Coaches and participants met once per month. Coaches offered advice and discussed progress toward goal achievement including tracking hypertension with a home blood pressure monitor, walking a certain number of steps each day, signing up for a class, and challenges to achieving goals. In addition to tracking progress participants could add new goals. The most common risk factors that were worked on were physical activity (95.1 percent), hypertension (76.1 percent), sleep (52.4 percent) depressive symptoms (45.1 percent), and social engagement (41.5 percent). The less commonly chosen risk factors (<25 percent) were risky medications, diabetes, and smoking.

Compared to other trials of this type, the beneficial change in cognition, while modest, was greater. I believe the SMARRT results occurred because participants were motivated to try to avoid cognitive decline, were prompted to make personal goal choices, and were able to monitor and share their progress, including, for example, by tracking increased physical activity and monitoring blood pressure.

The SMARRT study results point to the “smart” approach for individuals and those working to reduce the impacts of dementia and cognitive decline in our communities.

As awareness of Alzheimer’s disease and dementia has grown, more people have become motivated to find ways to promote cognitive health. The good news is that improvements in these risk factors also promote general health and well-being. Changes don’t have harmful side effects or the high costs associated with new drugs.

The distinguishing feature—what made the SMARRT study so “smart”—was that participants chose personal targets that resonated with their lives and values. They kept track of their progress, even moving on to other targets. Smart, SMARRT moves!

Eric B. Larson, MD, MPH is a Professor of Medicine at the University of Washington. He was co-Principal Investigator of the SMARRT trial and formerly Vice President for Research and Healthcare Innovation at Group Health and Kaiser-Permanente Washington. With colleagues, he co-founded the long-running Adult Changes in Thought (ACT) study in 1986. He continues research through the UW Alzheimer’s Disease Research Center and other projects. He has participated in The Lancet Commission on Dementia since its inception. With co-author Joan DeClaire he wrote the well-received book, Enlightened Aging: Building Resilience for a Long Active Life.

More 3rd Act Articles on Alzheimer’s and Dementia:

The Latest Science on Beating Alzheimer’s

The Four C’s of Alzheimers

Why We Struggle to Prevent and Treat Dementia

Older Adults with Dementia without Close Family

Older Adults with Dementia

The post The Hard Truth about Dementia appeared first on 3rd Act Magazine.

Throughout my career I have often asked older patients and research subjects if they want to live to be 100. The most common answers are, “Yes,” “Yes if I can stay healthy,” or “I can’t imagine living to 100 with all the disabilities of old age and being a burden to others.”

Gerontologists, other scientists, and popular writers study populations and geographic areas experiencing remarkable longevity (Blue Zones, for example) looking for common genetic traits and lifestyles that characterize long-lived families and individuals.

I am fascinated by what we can learn from the stories from persons who live so long. All of us experience personal changes, triumphs along with adversities. Persons living to 100 must adapt and carry on in the face of life’s adversities—for a long time.

I recently enjoyed reading The Book of Charlie: Wisdom from the Remarkable American Life of a 109-Year-Old Man by David Von Drehle. People often asked Charlie White his “secret” of longevity. His answer: “It was just luck.” He avoided dying in a freak accident through no actions of his own. His genome didn’t predestine him to get early heart disease or a stroke. Even as a smoker he believed “luck” allowed him to avoid lung cancer, while others, with less luck, who never smoked, got lung cancer.

Persons living to 100 years old—less than one half of one percent, according to the Social Security Administration and even fewer who live years beyond 100—can teach us a lot through their stories and experiences about navigating the bittersweet nature of life.

Resilience, the ability to bend, not break in the face of adversity, loss, or sorrow characterizes thriving centenarians. Evangeline (Van) Shuler, an extraordinary research subject featured in the book I co-authored with Joan DeClaire, Enlightened Aging, traveled, at age 100, from Seattle to Argentina to dance in a tango festival. Earlier, she’d experienced the unexpected death of her husband while the pair were working as “retired” Peace Corps volunteers in India. Despite her loss, she returned to India to complete her tour of duty. After age 100, when she lost friends, her secret was to “make new friends.” When she needed to move from independent to group living, she organized a breakfast table and her requirement for membership was to “bring a joke to breakfast everyday.” As an avid reader, when her eyesight failed, she turned to books on tape from the library.

Ben Stevenson, who lived to be 101, was a devoted caregiver for his wife when she suffered a series of strokes and dementia. Later, living by himself, he had a horrific accident when he was dragged by his horse. He was hospitalized in a local ICU and I told his daughters that, given his very old age, he might never recover. Stevenson, however, had built physical, cognitive, and social reserves throughout life. He proved resilient and was able to adapt to extreme adversity. He not only recovered, but much faster than expected and went on to have an active social life in an adult living community. On his 100th birthday, I enjoyed his hilarious doggerel about his life, along with his family and the many friends he gained after his accident.

What about Charlie White? Was he “just lucky?” Yes, and he did have a remarkable life. One bit of White’s general advice when faced with disappointments and losses was “let it go.” Later, when asked how he managed, especially the death of his father when he was young White said, “I just ploughed along and followed my mother’s advice to do the right thing.”

As White approached his life’s end, he distilled his philosophy of life into a list of brief commands. Each phrase reflects wisdom he gained from a remarkably long life:

“Think freely.”

“Practice patience.”

“Make and keep friends.”

“Tell loved ones how you feel.”

 “Forgive and seek forgiveness.”

White’s list contains familiar, simple truths. I like a conclusion author Von Drehle drew from White’s life—confirmed by my experience observing long remarkable lives. A life well-lived may consist of two parts: From youth through adulthood, we discover the complexities of life and are “complexifiers.” Then, if we live long enough, we become simplifiers. Our lives may still be complex, but our response to that complexity can be distilled into simple phrases leading to discrete actions—from White’s mother Laura’s advice to “do the right thing,” to “do unto others as you would have them do unto you,” to sound advice from White, “Make some mistakes. Learn from them.”

The experiences and wisdom centenarians leave us are simple truths even if life itself is complex, even bittersweet.

More from Charlie White:

“Work hard.”

“Spread joy.”

“Take a chance.”

“Enjoy wonder.”

 From this aging author: “Accept, be grateful, and cherish aging.”

Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.

Related stories on living a Long Life:

“Striving for Immortality”

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What was it about this painting that drew me to it? In the more than 50 years that followed, whenever I went to a highly regarded museum, I would look for the Vermeer’s and never be disappointed. One great disappointment occurred when thieves stole two of Vermeer’s paintings that were on “permanent” display in the Isabella Stewart Gardner Museum down the street from Harvard Medical School. The museum had minimal security at the time, offered free chamber concerts, and was a haven for me when I had free time over lunch. Beautiful music and paintings by my favorite painter.

Vermeer is considered one of the greatest Dutch Masters from the Dutch Golden Age along with Rembrandt. His output was rather modest and today only 35 paintings are universally attributed to him. Vermeer lived a relatively short life (1632-75) and was only “modestly successful” during his lifetime—ending up earning more as an art dealer, which allowed him to support his quite large brood and left his wife impoverished when he died. Over the centuries, his paintings have been widely appreciated for their unique beauty. And today, Vermeer is well-known and acclaimed as one of the greatest of his time.

When the Rijksmuseum in Amsterdam announced it had assembled 28 of Vermeer’s paintings for the largest exhibit ever, I took notice. And so did hundreds of thousands of others. Within a couple of days, the tickets available for the 16-week exhibition were completely sold out. The demand was so great that the Rijksmuseum figured out ways to extend the hours. Some colleagues in Amsterdam told us to just log on to the tickets site regularly and hope to “hit it” just as new tickets were released. We did and ‘voila’! we got our tickets overlapping with a project for The Lancet in London that allowed us to consolidate a trip to Europe.

The exhibit was a dream come true—something I never expected to experience in my lifetime. While seeing firsthand Vermeer’s great paintings was an immediate source of pleasure, what I learned about his techniques taught me an important lesson about aging. A lesson that confirmed what I had observed in watching patients, research subjects, and family and friends as they aged—the importance of “light” in how to age well through “Enlightened Aging.”

The exhibition narrative was more than the story of Johannes Vermeer’s life and times. For one thing, it highlighted how his ability to use “light” in his paintings was a breakthrough, perhaps the main reason why his paintings are so beautiful and engaging. Vermeer (and likely some of his contemporaries) used more than just canvas and paint. They found new ways to literally find the light by using recently developed camera obscura and camera lucida techniques along with mirrors to create effects that allowed them to find and use light in painting. After all, this was an age where optics became more advanced, including Antonie van Leeuwenhoek’s development of the microscope, an important advance in medical research.

The same month we visited the Vermeer exhibit we also went back to Boston for my 50-year medical school reunion. As expected of a group of Harvard Medical School graduates all around age 75 or more, this was an accomplished bunch. This is a group of individuals who have contributed to medical science, teaching, care of their patients, and communities in many ways. Being together was inspiring and, of course, we had a lot of fun reminiscing and rekindling friendships.

Having just been exposed to Vermeer and the unique way he found light to create beauty made me reflect on just how important finding light is in life—especially as we transition into older ages. Most people will eventually leave a profession that typically has been a source of light—inspiring us to serve, discover, always learning to keep up with knowledge advances, and to just do a better job. Our professions also provide a wealth of social engagement.

Most of my classmates had found or sustained the “light” that lit up their life. Some continued finding light in their professional work, building from the specialty and research work that had been decades in the making. Others went from Deanships and other prominent leadership positions back to their earlier specialty areas. Most were gradually slowing down and gracefully planning to completely retire in the near term. A few had completely retired.

Another common feature was that almost all engaged in regular physical activity—less active than previously, but still part of their routine. Families, other loved ones, and volunteer activities were a great source of meaning and fulfillment. Fortunately, only a few seemed not to have found light. My casual observation was that the few included those who persisted in trying to convince others, without success, that they were right and others in the medical field were wrong. They were unable to accept scientific reality. And there were also a few who seemed unable to accept certain disabilities and conditions and make the best of their situations—the proverbial making lemons out of lemonade just never happened for them. They seemed to embrace a sort of darkness rather than finding or keeping light in their lives.

I loved the reunion. I also gained from appreciating that the beauty and magic of Vermeer paintings involved light and especially finding light in new ways. I think that part of aging is keeping that light that’s helped us throughout our lives, but also finding light in new ways as aging inevitably changes us. It’s there—like Vermeer we can find it and age well.

Eric B. Larson, MD, MPH, is the author, with Joan DeClaire, of Enlightened Aging. He is the founding principal investigator of the Adult Changes in Thought (ACT) study, ongoing for about 30 years. ACT recently was awarded a $55.6 million expansion grant from the National Institutes of Health.

Read more by Dr. Eric B. Larson

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How to guard against over diagnosis and over treatment

The post The Benefits of Slow Medicine appeared first on 3rd Act Magazine.

Studies show that when centenarians are asked to reminisce on past events—especially, to cite their enjoyable or most meaningful events—the trove of events they recall involving their first 20 years of life vastly exceeds the previous 20 years. It’s as if our minds lay down vast amounts of earlier-in-life events that get embedded deeper and stronger into our brains’ circuitry.

It is clear to anyone who speaks frequently with older persons that many delight in the telling—and retelling—of these experiences and relationships of their past lives. Since the time of Aristotle’s Rhetoric, wise people have realized that reminiscing is not harmful, but helpful, and that as we age, people think a lot less about their future and more about their past. This is not unhealthy but simply a feature of aging. People shouldn’t be denied this pleasure.

This can be challenging for many younger persons, and even spouses of older persons who themselves are old, who may find it tiresome to hear the same stories repeatedly. Think of the challenges faced by busy attendants in long-term care or other facilities where older persons live. But it is important to acknowledge that with time, our memory develops into what one eminent memory specialist, the psychologist Douwe Draaisma, calls a “nostalgia factory,” which may bring great pleasure to our lives, especially the older we become.

I believe in our everyday life as we have conversations with older persons, including persons with mild to moderate dementia, engaging in reminiscing is pleasurable and worthwhile. People reminiscing brighten up with a listener who appreciates their memories and is interested in their stories. And in turn, it’s meaningful for families to learn as much as possible from their parents and aging relatives about their family’s past, especially in a time when we are so mobile throughout the life course.

As a dementia researcher I find this a source of immense pleasure. My wife will often hear me say after a home visit or (nowadays) telephone visit, “I just heard the most amazing story about this (guy, older lady) … who grew up … or moved with his family to escape persecution or find a better life. …” These reminiscences are often the high point of my day.

The bottom line: Many people in the late stages of Alzheimer’s disease who might otherwise be totally confused can have a day, or many hours in a day, when they suddenly and out of nowhere recall with great detail important times and delight in sharing them with a child, close relative, friend, or caregiver. In interviews for my research, I hear family members report that it was as if their father or mother was back to normal and I’m asked why they can’t be like this all the time. Sadly, that’s not possible. But there is something indelible, presumably in memory centers involving the hippocampus, that stays with us throughout most, if not all, of our lives. We should strive to treasure the miraculous ability of the brain to hold onto the past as well as it does.

Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017). A version of this story originally appeared on Beingpatient.com.  You can read more articles by Dr. Eric B. Larson here.

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You probably know that good sleep has many health benefits, including the prevention of depression, high blood pressure, diabetes, and more. But do you know how much sleep is enough? There’s no right answer because the range of “normal” sleep duration varies widely, especially among older people.

I’ve noticed, however, that many seem to have a common problem: Uninterrupted sleep gets harder as we age.

Common obstacles include achy backs and joints, plus the need to urinate at night—especially for men, but also for women. Plus, many people seem to have anxiety about their lack of sleep, a worry that, ironically, makes it that much harder to drift off.

Studies have shown that we go through a series of sleep cycles every night, stirring a bit after each round, which typically lasts three to four hours. It’s good to get at least one uninterrupted cycle each night—and two cycles are probably ideal.

What if you don’t get as much sleep as you’d like? You may feel irritable or find it hard to concentrate—a complaint many try to remedy with sleeping pills. But unless you have a serious sleeping disorder that interferes with your well-being, I recommend against such drugs. Everyday use of sleep medication (or alcohol, for that matter) as a way to “unwind” before bed is bad for your health as it leads to dependence. And sleep medications raise the risk for other problems, especially falls and other accidents. I often told my older patients, “Nobody ever died because they couldn’t sleep for a night, but many have broken a hip because a sleeping pill made them dizzy and fall.”

Drugs taken for sleep can cause other problems, too. Anticholinergic over-the-counter sleeping pills (diphenhydramine, the drug in Benadryl and Tylenol PM is an anticholinergic), are linked to higher rates of dementia. And so-called “Z-medications” such as Ambien are associated with serious injuries due to confusion and sleepwalking. Meanwhile, the benefits of these pills are not that great. In studies of prescription sleeping pills, the added duration of sleep usually averages less than 25 minutes.

Fortunately, there are lots of common sense alternatives. For example, you can try to:

• Get plenty of exercise during the day. This can reduce stress, leaving you more relaxed at night.

• Avoid liquids—especially caffeinated ones—after 6 p.m. You’ll feel calmer and be less likely to have to get up and go.

• Avoid alcohol, which can be sedating at first, but after three hours or so, acts as a stimulant.

• Experiment with short, say 20-minute, afternoon “cat naps,” which can be restorative if you didn’t sleep well the night before.

• Try relaxation techniques such as focusing on your breath as you count down from 1,000. If you have distracting thoughts, simply recognize them, let them go, and return your focus to counting and breathing until you fall asleep.

• Try cognitive behavior therapy, which can help you change your ideas and habits regarding sleep and wakefulness in helpful ways. The book, Overcoming Insomnia: A Cognitive Behavioral Therapy Approach by Jack Edinger and Colleen Carney describes how it works.

Most importantly, try not to “medicalize” lack of sleep as though it were an illness requiring treatment. Treat sleep instead as philosopher Viktor Frankl suggested, like “a dove which has landed near one’s hand and stays there as long as one does not pay any attention to it; if one attempts to grab it, it quickly flies away.”

Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).

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And to keep moving, I might add, you’ve got to keep your balance! Without it, you’re at risk for falls. One in four people age 65 and older fall each year. And one in five of those falls causes serious harm such as broken bones or a head injury.

Research shows that exercise focused on building strength and balance can reduce your risk. But what if all your routines for getting physical activity are suddenly interrupted? That’s what happened to many when the coronavirus pandemic started several months ago. Most indoor exercise classes were canceled. And even casual activities such as shopping became curtailed. Walking outdoors is a great alternative. But with the weather changing, some people may be reluctant to brave the elements.

So, what can you do right now to improve fitness and balance? I asked my colleague Ben Balderson, a research psychologist who’s working on a project to help people ages 70 to 89 to develop healthy behaviors. These include setting goals for increased physical activity.

“We start by helping people set weekly goals based on what they personally find enjoyable and doable,” Balderson says, “Then we help them adjust those plans as they do or don’t meet their goals.” The idea is to keep trying new things to find what works for you.

Some folks are discovering the benefits of remote exercise sessions for older adults. Programs such as “Sit and Be Fit” offer classes on PBS television stations, on DVD, and online. You may also find online instruction for yoga, Pilates, and Tai chi, the ancient Chinese practice of continuous, controlled, and slow movement has proven to improve physical and mental well-being.

Simply reminding yourself to sit less can be a boon. A study conducted among older Kaiser Permanente Washington members with obesity found that wrist-worn alarms worked well to inspire people to take breaks from sitting several times a day. So, you might try setting an hourly timer on your kitchen stove or mobile phone to see if an alert could work for you. When the alarm rings, take a few minutes to walk around inside or outside your home—building strength, balance, and stamina.

To avoid losing your balance, always remember to wear proper shoes or slippers. Studies show the best shoes for avoiding falls are those with laces or Velcro fasteners, adequate heel support, and non-slip soles—in other words, “tennis shoes.” You’re at highest risk when you walk barefoot or in stocking feet—even indoors.

Be careful if you’re taking prescription drugs for high blood pressure or chronic pain. Many cause balance problems. Also implicated in falls are antidepressants, anti-psychotics, anti-anxiety, and sleeping medications, especially benzodiazepine tranquilizers.

Get rid of trip hazards in your home—things like loose electrical cords and throw rugs. Avoid slippery floors and icy surfaces. And make sure rooms and passageways are well lit. Use night lights if necessary.

Many falls happen in the bathroom, so install and use handholds. Get a shower chair if you’re unsteady standing for long periods. Keep a pair of slippers beside your bed to wear when nature calls.

Although life may seem unsettling at times, there’s much we can do to remain balanced, healthy, and resilient.

Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).

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In ordinary times, few people I know think about their own deaths on a daily basis. But facts about the pandemic are hard to ignore: Older people and those with certain chronic conditions are at highest risk of dying from COVID-19.

The news reminds us that life is short, death is real, and we can find meaning in simple blessings. I think of a quote from Ronald Blythe’s The View in Winter: Reflections on Old Age. “What does it feel like to be nearly 100 years old?” the shepherd’s widow asks. “You wake up and say, ‘Still here?’ Then make the tea.”

People also seem more willing to contemplate their wishes and plans for late-life care and end of life. Health care providers report that since COVID-19 emerged, increased numbers of patients have completed advance directives such as living wills and durable powers of attorney for health care. Such documents help patients to be more intentional and communicate their choices around accepting or rejecting care and to appoint others to make care decisions for them if they are no longer able.

This activation is a good thing. It’s as though we’re finding a new metaphor for death. Given there’s no way to win a “battle” against aging, we’re burying the hatchet in a manner that puts health care providers, patients, and the true nature of life and death all on the same side.

I have long urged my patients to complete advance directives and to share such documents with their relatives and health care teams. I began doing so years ago after witnessing too many situations where patients suffered unnecessarily near the end of life because providers and family members simply did not know what a gravely ill person wanted. Uncertainty can lead to prolonged care that has little or no value. Advance directives can prevent this—especially when they include specific guidance about what a person wants and does not want.

So my advice during this pandemic is the same always: Be sure you have an advance directive that truly expresses what you want. Keep in mind that your ideas and preferences may change over time or according to your circumstances. If you completed your advance directive some time ago, you might want to revisit it, just in case your views have changed.

And remember, an advanced care plan is only that—a plan. In addition to documentation, we need real conversations with our physicians, other caregivers, relatives, and friends to inform our decisions.

Help to frame such conversations is available from organizations such as Compassion & Choices (www.compassionandchoices.org), which provides a comprehensive guide to help people explore their values and develop legal documents to describe their wishes. The site also provides tools for talking about end-of-life care with your family, friends, and health care providers.

I have observed that taking such steps can lead to greater peace of mind, which is something all us can appreciate during these extraordinary times.

Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).

Read more about advance planning on 3rd Act:

“A new branch of retirement planning is about building our windmills to harness these fresh breezes to our advantage. It is called longevity planning, and the goal is not about adding years to our lives—it’s about adding life to our years.” Read more in our story, Adding Life to Our Years: Build Your Windmill

So, what exactly is this practice of longevity planning, and how can it help us achieve our retirement goals? Read “Longevity Planning—Forecast: Sunny with a Chance of Rain” to learn more.

What are some of those areas we often overlook that are essential to successful planning and preparing for longevity? In “The Power of Planning: Taking Charge of Your Own Aging Journey” we offer a list to review.

The post Advance Care Planning Leads to Better Peace of Mind appeared first on 3rd Act Magazine.

Experts in aging say one great way to build resilience is to stay connected to younger people. My observations as a physician, a researcher—and now granddad—confirm this premise. Time spent with my grandkids, meeting their seemingly endless need for snacks, games, and even diaper changes, keeps me on my toes!

Of course, it takes more than occasional babysitting to build meaningful relationships. And I see how families and communities intentionally create ways for generations to bond. My cousin’s family and their multigenerational Montana cattle ranch is a great example. Without quality childcare options available in mile-high country, Rick and Gayle take charge of their grandchildren while their daughter and son-in-law work the ranch. The little ones enjoy their grandparents’ doting attention, and Rick and Gayle benefit from experiencing their growing up.

This type of arrangement is not new. Anthropologist Margaret Mead wrote about mutually beneficial relationships among children and grandparents in various cultures over the ages. Children provide the stimulation older people need, while the elders give kids the stability they require. Meanwhile, the “sandwich generation” provides material support for both ends of the family. The result is an efficient “economy” where everyone’s needs are met.

Can spending time with children help stave off mental decline? That’s hard to say. A 2016 study of 120 caregiving grandparents in Australia found that women who babysat one day a week scored higher on cognitive tests. Grandparents need to set their limits though. Those who babysat five days a week or more had more trouble than others with cognition.

Still, experts in aging, education, and other services are intrigued—especially with intergenerational learning. One example is an award-winning charter elementary school in Cleveland called The Intergenerational School. Here, elders of all ages and abilities—including some with dementia—help with lessons, storytelling, artwork, gardening, and more. The kids get extra attention from older “mentors,” while the elders get the stimulation of being involved in meaningful activities with kids.

Another model is cohousing, a type of residential development that emphasizes social interaction. Some communities are created exclusively for seniors, but others—like the Capitol Hill Urban Cohousing Community in Seattle—intentionally mix generations. Sheila Hoffman and her husband Spencer Beard were the only retirement-age people in the nine-family community when it opened in 2016.

“If you live with a bunch of people the same age, you’re not going to have as much diversity in views,” Sheila explained. “Living here is going to challenge Spencer and me, and keep our brains more engaged.”

A retired elementary-school gym teacher, Spencer enjoys teaching kids in the community to ride their bikes. The couple also committed to walking one of the second graders to her after-school ballet class. Such favors are sure to earn them “social capital,” if not “surrogate grandparent” status.

“It’s like extended family,” Sheila said. “As Spencer and I get older and it gets more difficult for us to do things for ourselves, we hope someone will be around to say, ‘Hey, can I get you anything from the store?’ Or, ‘Do you need a ride to the doctor?”

As their experience shows, reaching across generations can be valuable to all involved. So, whether you engage with kids, their parents, their schools, or other aspects of community, intergenerational connection may be great for your well-being.

Dr. Eric B. Larson is a senior scientist at Kaiser Permanente Washington and author of Enlightened Aging: Building Resilience for a Long, Active Life (Rowman & Littlefield, 2017).

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