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Flourishing in Later Life – Cognitive and Emotional Health

Flourishing in Later Life – Cognitive and Emotional Health. Cognitive and Emotional Health – An Idea Whose Time Has Come?. Hugh Hendrie MB ChB DSc Professor, Department of Psychiatry, Indiana University School of Medicine. Cognitive and Emotional Health In the Elderly Project. Goals

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Flourishing in Later Life – Cognitive and Emotional Health

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  1. Flourishing in Later Life – Cognitive and Emotional Health

  2. Cognitive and Emotional Health – An Idea Whose Time Has Come? Hugh Hendrie MB ChB DSc Professor, Department of Psychiatry, Indiana University School of Medicine

  3. Cognitive and Emotional Health In the Elderly Project Goals to assess the state of longitudinal and epidemiological research on demographic, social and biological determinants of cognitive and emotional health to determine how these pathways reciprocally influence each other IU Center for Aging Research

  4. Critical Evaluation Study Committee[NIA, NIMH, NINDS] IU Center for Aging Research

  5. Conclusions from CEHP Review Widespread public interest A different set or combination of risk factors (or different emphases) may be identified than those from illness-focused research Research in brain health maintenance should be pursued with vigor Health promotion and disease prevention are complimentary Cognitive and emotional health must be studied simultaneously IU Center for Aging Research

  6. Cognition Upper Classes Men “Hard” Science Neurology Health System White “Stiff Upper Lip” “White Man’s Burden” Emotion Lower Classes Women “Soft” Science Psychiatry Mental Health System Minorities “Cry Baby” “Savages” IU Center for Aging Research

  7. An Idea Whose Time Has Come? IU Center for Aging Research

  8. Positive PsychologyMartin Seligman Studies the strengths and virtues that enable individuals and communities to thrive Pleasant life Good life Meaningful life IU Center for Aging Research

  9. International Interest in Well Being Felicia Huppert Co-Director of the Well Being Institute University of Cambridge IU Center for Aging Research

  10. A well-being module for the European Social Survey (ESS) ESS is a cross-national time-series survey conducted every 2 years on community residents aged 16+ Round 1 2002/2003 – 23 participating countries Round 2 2004/2005 – 26 participating countries Round 3 underway – includes a 54-item personal and social well-being module Winner of the 2005 Descartes Prize Europe’s top award for science IU Center for Aging Research

  11. Conceptual framework for the ESS Well-Being Module IU Center for Aging Research

  12. Psychological approaches to improving well-being Behavior Regular exercise Other lifestyle habits Being kind to others Cognition Interpreting events in a positive light Savoring the moment Belief in change (‘growth mind set’) Motivation Striving for valued goals Intristic motivation IU Center for Aging Research

  13. Relationship between mental health in the individual and the population The mental health of individuals is influenced by the characteristics of the population in which they live Populations thus carry a collective responsibility for their own mental health and well-being Interventions are unlikely to succeed if they do not involve population-wide changes IU Center for Aging Research

  14. The Healthy Brain Initiative: A National Public Health Road Map to Maintaining Cognitive Health A call to action and a guide for implementing a coordinated approach to moving cognitive health into public health practice Available at www.cdc.gov/aging and www.alz.org IU Center for Aging Research

  15. The Model: Moving Science into Public Health Practice - Developing the Road Map Create/expand the science and knowledge base Create/sustain social/environmental demands Build and strengthen capacity Intermediate outcomes Long-range outcome Adapted from Orleans CT. Helping pregnant smokers quit: meeting the challenge in the next decade. Tobacco Control 2000; 9(supple 3): III6-III11 IU Center for Aging Research

  16. Developing the Road Map Convened a Steering Committee Public health research meeting 4 Workgroups – Expert panels Developed 42 recommended actions External feedback (n=40) Concept mapping Engage a large group of stakeholders to organize the recommendations in a way that make sense to all groups Rating (importance and action potential) 49% participation rate (N=140) Sorting 73% participation rate (N=20) IU Center for Aging Research

  17. Priority Actions Determine how diverse audiences think about cognitive health and its associations with lifestyle factors Disseminate the latest science to increase public understanding of cognitive health and to dispel common misconceptions Help people understand the connection between risk and protective factors and cognitive health Initiative policy changes at the federal, state, and local levels to promote cognitive health by engaging public officials Include cognitive health in Healthy People 2020, a set of health objectives for the nation that will serve as the foundation for state and community public health plans IU Center for Aging Research

  18. Priority Actions Conduct systematic literature reviews on proposed risk factors (vascular risk and physical inactivity) and related interventions for relationships with cognitive health Conduct controlled clinical trials to determine the effect of reducing vascular risk factors on lowering the risk of cognitive decline and improving cognitive function Conduct controlled clinical trials to determine the effects of physical activity on reducing the risk of cognitive decline and improving cognitive function Conduct research on other areas potentially affecting cognitive health, such as nutrition, mental activity, and social engagement Develop a population-based surveillance system with longitudinal follow-up that is dedicated to measuring the public health burden of cognitive impairment in the United States IU Center for Aging Research

  19. SocioDemographic/Political Trends Baby Boomers come of age Concerns about the cost of health care/aging population Dissatisfaction with the sole use economic indices to determine policies Concerns about global ecology IU Center for Aging Research

  20. Brain Health Current State of the Art Two models for preserving brain health Cautionary Notes IU Center for Aging Research

  21. Healthy Brain To be, or not to be. To see ourselves as others see us. E = mc2 IU Center for Aging Research

  22. Maintaining Brain HealthModel 1 (Spartan) IU Center for Aging Research

  23. Maintaining Brain HealthModel 2 (Dionysian) Enjoy yourself!! IU Center for Aging Research

  24. The Current State of the ArtCautionary Notes A paucity of large scale prevention trials, both efficacy and effectiveness Problems of complex models, publication bias, and confounders in observational studies “ Blame the victim" implications for health care Public acceptance -The “worried” well or increasing skepticism Need for comprehensive approach IU Center for Aging Research

  25. The Current State of the ArtCautionary Notes A paucity of large scale prevention trials, both efficacy and effectiveness Problems of complex models, publication bias, and confounders in observational studies “ Blame the victim" implications for health care Public acceptance -The “worried” well or increasing skepticism Need for comprehensive approach IU Center for Aging Research

  26. Confounders “They’re a bit posh, they get plenty of exercise, they work, they have strong social supports, and more” Ben Goldacre The Guardian, December 22, 2007 IU Center for Aging Research

  27. The Current State of the ArtCautionary Notes A paucity of large scale prevention trials Problems of complex models, publication bias and confounders in observational studies “ Blame the victim” Public acceptance -The “worried” well or increasing skepticism Need for comprehensive approach IU Center for Aging Research

  28. Health Disparities Poorer and disadvantaged people have poorer access to Safe spaces for exercise Good sources of nutrition Preventive health care Overall health care services Quality health care services Cherry and Reid IU Center for Aging Research

  29. The Current State of the ArtCautionary Notes A paucity of large scale prevention trials Problems of complex models, publication bias and confounders in observational studies “ Blame the victim” Public acceptance -The “worried” well or increasing skepticism Need for comprehensive approach IU Center for Aging Research

  30. Hypochondriasis Health Variation (Hendrie Syndrome) Diagnostic Criteria (Two or more criteria) Ruminations about health status > 2 hrs. per day (Confirmatory evidence spouse, relatives, friends, refuse to engage in conversations about health) Consulting with health professionals >1 per week (Confirmatory evidence > two personal physicians take early retirement) Monitoring “numbers” > every 30 minutes per day (or alternatively phobic avoidance of sphygmomanometers or other instruments) Engaging in “health games” > 2 per day (e.g. balancing, deep breathing, “ brain” games) Exercising with > three braces (alternatively guilt about not exercising) Modifications of diet >2 per week to correspond with the latest news headlines Ingestion of > 1 vitamin (or other dietary) supplement per day IU Center for Aging Research

  31. Hypochondriasis Health Variation (Hendrie Syndrome) (continued) Severe Form Hiring personal “ health advisor” IU Center for Aging Research

  32. The Current State of the ArtCautionary Notes A paucity of large scale prevention trials Problems of complex models, publication bias and confounders in observational studies “ Blame the victim” Public acceptance -The “worried” well or increasing skepticism Need for comprehensive approach IU Center for Aging Research

  33. Society-wide strategies to alter behavior • Smoking • Alcohol • Sexual Behavior • Illicit Drugs

  34. Components of a Strategy for Brain Health(each intervention component tested for efficacy and effectiveness) National commitment Development of a supportive infrastructure Inclusive, persuasive, non coercive approach Realistic goals, congruent with those of other disciplines Integration with health services Community as well as individual targeting Development of a national surveillance system (NB All approaches will be influenced by advances in treatment) IU Center for Aging Research

  35. “ Mens Sana in Corpore Sano”Juvenal Satire X IU Center for Aging Research

  36. Review References Hendrie et al. Alzheimer’s and Dementia 2006 2; 12-32 Fratiglione et al. Lancet Neurol 2004; 3:343-353 Launer. Ageing Res. Rev 2002;1(1):61-77 Jedrziewski et al. Alzheimer’s and Dementia 2005;1(2):61-77 CDC/AA. Alzheimer’s and Dementia Special supplement 1 2007 3(2) Brayne Carol. Perspectives. Nature 8: 2007, 233-237 IU Center for Aging Research

  37. Review References Gilbert, Daniel Todd. Stumbling on Happiness. Knopf Canada. 2007. Huppert, F, Baylis, N, Keverne, B. The Science of Well Being. Oxford University Press. 2005 IU Center for Aging Research

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