AGING WELL

1. AGING WELL Nancy Dombrowski-Losinno, LCSW, CASAC

2. The Demographics of Aging • More than 35.6 million Americans are age 65+ • By 2030, expected to double to 71.5 million • In 2002, 4.6 million Americans were 85+ • By 2030, projected to increase to 9.6 million • Individuals who are age 85+ are the fastest growing segment of our US population

3. “Aging is not something that happens to you. It is something you choose to do well!” • What are the stereotypes of aging? • Common events: forgetting an item at the grocery story, forgetting a name, forgetting why you entered a room, etc. • “Senior moments?” or possible other explanations • Memory can be affected by anxiety, depression, medications, sleep difficulties or just doing too much

4. What is memory? • The ability to store and retrieve information!!!

5. What influences memory? • Stress • Anxiety • Fatigue • Grief • Lack of social interaction • Distraction, too many details at once • Previous memories, biases, perceptions • Alcohol and prescription drugs • Illness (diabetes, depression, HBP, dementia)

6. Types of memory • Two types: short & long-term • Short term memory stores information that you need to remember in the following minutes or hours; • Long term memory stores information that your brain has retained b/c it is impt to you-basic info (family, friends, addresses, how to do something)

7. How Anxiety affects Memory • When you become anxious, your mind & body launch into fight/flight mode • Higher level neurological functions of the brain shut down to a degree • Anxiety cannot exist in a relaxed body • Anxiety prohibits good memory • If you can manage to relax, you will decrease your anxiety & improve your memory!

8. How depression affects memory • Depression affects the ability to focus and concentrate; • Depressed people lose interest in participating in things that used to give them pleasure; • Depression usually interferes with sleep and fragmented sleep impairs memory and cognitive functioning • Many medications for depression and anxiety can alleviate the depression but can have an impact on short-term memory

9. Pay attention to this! (Garbage in/garbage out) • Paying attention is a sophisticated cognitive process that serves as a foundation for memory; • The more attention you pay to a set of data, the more likely you are to remember that data. Better attention equals better memory. • Attention can be active or passive. The more actively you pay attention, the better you will be able to “encode” information into your memory. • Many “memory problems” in middle-aged people are due to the pressures of multi-tasking.

10. Types of attention • Concentration: the ability to sustain directed mental energy for a particular task for an extended. (Reading a book beyond your normal comprehension) • Vigilance: the ability to detect rarely occurring symbols over an extended period of time (watching for falling stars) • Search: the ability to pick out a particular type of data among other similar data (puzzles, looking thru a phone book for a particular listing) • Selective attention: the ability to direct mental energy toward one activity while blocking out other information that may be competing for your attention (reading a book in a noisy room) • Alternating attention: switching back & forth between 2 stimuli (reading while watching the news) • Divided attention: performing two different tasks at the same time (listening to music while washing the dishes)

11. Cognitive Energy & Fatigue • Attention takes effort & effort will improve your memory, but each of us has only a finite amount of energy! • You cannot remember everything—your brain would go into “default” mode • When you are mentally fatigued, your cognitive energy resources are depleted • Use the WETT techniques!

12. WETT • WRITE IT DOWN • ELIMINATE DISTRACTIONS • TAKE BREAKS • TIMING

13. How Memory Works • Acquisition—before you can remember something, you first must learn the information. This acquired information is then put into temporary nerve-cell pathways in the brain. This is where short-term memory is stored.

14. How Memory Works • Consolidation—In order to store something in long term memory, the nerve pathways have to be strengthened and reinforced. This is called consolidation, which can take weeks or even months. Retaining information in long term memory is more likely if it relates to pre-existing memories or somehow stimulates you emotionally. Getting a good night’s sleep also helps you to retain information.

15. How Memory Works • Retrieval—when people retrieve information, they are literally “recalling” it from the nerve pathways. The brain reactivates a particular pathway and information is remembered. This can be fast or slow, depending on how familiar you are with the information and how well you learned it in the first place.

16. Changes in Memory with Age • Trouble paying attention to more than one thing at a time; • Greater effort to learn new things; • More difficulty with word-finding, recalling names and information; • Things most likely to be forgotten: names, where you put something, telephone numbers, words, having told someone something.

17. How to Challenge Yourself • Mental aerobics • Learn to play a musical instrument • Do puzzles, word games, hobbies, play cards, sudoku • Volunteer/keep busy • Interact with others/stay social • Attend lectures, plays, concerts • Read new books & discuss with friends • Travel, garden, keep developing new interests

18. Remembering Tricks • Follow a routine, keep lists, use a calendar; • Put important items in the same place every time; • Repeat names when you meet new people; • Trouble remembering a name or word: run thru the ABC’s in your mind; • Picture mentally where you met this person and make associations.

19. Healthy Habits • Exercise increases blood flow to all parts of the body including the brain; • Brain healthy diets (low-fat/cholesterol) high cholesterol & BP increase risk for dementia. Consume antioxidants, colorful fruits & vegetables, cold water fish or take omega-3 fatty acid supplements. Consider Vit B6, B12 • Drink alcohol in moderation • Protect your head from trauma which increases risk of developing AD, use handrails, helmets for sports, seat belt • Sleep becomes more fragmented as we age—and sleep is necessary for brain to process and memories to form. If you have trouble sleeping, do something about it. • STOP SMOKING!!! • If you are suffering from depression, get treatment. Don’t become socially isolated.

20. Dementia • Dementia is the loss of intellectual ability, a/k/a cognitive functioning. Persons with dementia may be confused, lose skills they once had, may not recognize family members or friends & may be agitated. • Dementia is more common in older adults, but is not a normal consequence of aging. • JAMA article 9/04: regular walking is associated with a reduced risk of developing dementia. • Alzheimer Disease is the most common cause of dementia.

21. Other Causes of Dementia • Parkinson’s disease: a brain disease that causes tremors and muscle stiffness. • Huntington’s disease: an inherited disease that causes abnormal movements and eventual dementia. • HIV, tuberculosis, syphilis, meningitis and encephalitis

22. Warning Signs of Dementia • Misplacement of objects in odd places • Difficulty performing complex tasks that require a series of actions • Disorientation in formerly familiar surroundings and trouble with language • Pronounced changes in behavior (agitation, argumentativeness, delusions etc.) • Confabulation • Impaired abstract thinking and judgment • Difficulty with familiar tasks (using phone, toaster, etc.) • Loss of interest in daily or usual activities

23. Statistics on Alzheimers Disease • In the US, someone develops AD every 72 seconds • Approx 5.1 million Americans suffer from AD, 4.9% are 65+ • One in eight persons 65+ has AD

24. Risk Factors for AD • Gender—men are more at risk than women; • Advanced age • Genetics • Serious head injury • Cardiovascular disease—strong correlation between cardio health and vascular dementia. Heart disease, stroke, diabetes and high cholesterol increase possibility of AD

25. Causes • Scientists do not completely understand the causes of AD. A German physician, Dr. Alois Alzheimer, discovered abnormal structures in the brain of some women. Structures called plaques and tangles which block communication among different parts of the brain b/c they prevent blood flow. Result is the deterioration of part of the brain.

26. Diagnostics • PCP refers and oversees the diagnostic process. No single test exists. Diagnosis is made by a specialist, usually a neurologist who is a specialist in pathology of brain & nervous system. • Physical exam-blood & urine, reflexes, coordination, muscle tone, speech, etc. • MD may ask for tests such as MRI, CT scan, PET scan • Input from family members is especially valuable

27. AD: The Most Common Dementia • Handout • Manage symptoms with input from medical team, medications cannot cure AD but can contribute to better quality of life, 20 meds currently in clinical trials or are waiting for FDS approval • Non-drugs: exercise, good sleep, low-stress • Some psychiatric symptoms can be alleviated by use of psych meds for agitation, hostility, inability to focus. Psych meds need to be monitored very carefully.

28. Stage 1: Mild AD • Can last 2-4 yrs, diagnosis can be difficult; • Often requires only minimal assistance (2-3 hrs./day), can live independently; • Memory problem is most prominent; • Repeating the same things, questions, difficulty in word finding & object naming, losing objects (keys), getting lost when driving, easily confused, arithmetic difficulties (checkbook errors), losing interest in activities previously enjoyed, personality changes.

29. Stage 2: Moderate AD • Can last 2-10 years (longest stage) • More difficult for family & individual b/c of need for supervision (4-8 hrs./day) • Increasing inability to safely live independently, symptoms worsen • Significant difficulties remembering recent events, sig. periods of confusion, some diffic in ADL (dressing, cooking,) • May pace around a great deal • May become fearful/anxious for unknown reasons, suspicious, apathetic, agitated, depressed • May develop delusional beliefs and/or hallucinations

30. Stage 3: Severe AD • Can last 1-3 years, end stage results in loss of sense of self and self-awareness; • Requires 24 hr nursing care/supervision • Death is usually from secondary causes such as pneumonia • Symptoms: extreme confusion, disorientation, inability to communicate, very severe memory deficit, inability to perform basic ADL’s (eating, toileting, bathing, dressing)

31. Caring for a person with AD or dementia • Be aware of your own stress level; • Recognize that it is a degenerative disease with no known cure; • Enlist the help of a professional “care manager” • Find a support system • Develop a “big picture” view esp. as it relates to financial/estate planning • Finances and legal matters will eventually need to be assumed by another person. It is important to be proactive early after the diagnosis is made. This is the best time—since the person will still have their wishes able to be known & will be able to locate documents that will be needed.

32. Geriatric Care Management Services • Provides in-home assessment and guidance for elder care needs www.caremanager.org or call EAP for referral • Care manager will recommend solutions and help you develop a plan • You gain objective and professional guidance from a professional • Areas of risk are identified • Written assessment and care planning report is given, including referrals to appropriate services and support resources. Follow-up services are provided.

33. Community Resources • Long Island Alzheimers Foundation, Port Washington 516-767-6856 • Alzheimers Assn of LI, Ronkonkoma 631-580-5100 • Stony Brook Health Sciences Center, Alzheimers Disease Assistance Center of LI 631-444-1365 • Memory Disorders Center at Geriatric Medical Group (Dr. Gisele Wolf Klein) offers evaluations, treatment and psychosocial services. Experts at dementia 516-708-2520 • Neuwirth Memory Disorders Center, part of Zucker Hillside Hospital offers geriatric psychiatrists, gero-psychologists and SW expert in diagnosis and treatment of AD and dementia. Has a caregivers support group. • NYU School of Medicine’s Center for Brain Health is doing research on Alzheimer’s. 212-263-5805 Dr. Mony deLeon Professor & Director or Susan DeSanti 212-263-5699

34. Your Employee Assistance Program • Multiple points of access • Onsite EAP Manager X4567 Nancy Losinno • Website: www.magellanassist.com • 24/7 phone: 1-800-327-2182 • Network of community-based clinicians for up to 5 free visits • Assistance with financial, legal and eldercare services available thru Magellan