Living longer has meant living long enough to lose cognitive function.  Two of every three Alzheimer’s patients are women and the fact that women generally live longer does not account for all of the increased risk.  While dying from heart disease is a greater risk for women than dementia, we fear losing control of our lives more.

Not all dementia is due to Alzheimer’s disease.  Parkinson’s Disease, Fronto-temporal, Trauma and Vascular disease are a few other causes.   Often dementia is due to a mix of both Alzheimer’s and another issue such as vascular disease.

So what can you do to reduce your chances of  losing cognitive function and developing dementia.

Get 6-8 hours of natural restful sleep.  Avoid sleeping pills and nighttime cold and other over the counter “sleep” remedies.  Sleep is an important part of staying cognitively functional.  Not only does your brain get “washed” of the chemical breakdown products of brain chemicals, sleep is when memories are stored.

Eat well.  The Mediterranean diet has been shown to provide cardiac and other health benefits.

Exercise.  Regular exercise such as walking has been shown to help prevent depression and promotes cardiovascular and brain health.

Control your blood pressure and maintain a healthy weight to avoid Type 2 (non-insulin requiring) diabetes.

Minimize stress and maximize social and other activities.

Learn new things and challenge your brain.

While a new drug was just approved to treat dementia, the best approach is to minimize your chances of developing dementia.

As people live longer and often need help, society is grappling with what to do for us and with us.  While some situations may require appointment of a guardian, most people just need assistance or oversight.

Too often it seems that guardianship actions are being commenced by family members either thinking they are helping their older relative or in an effort to gain control over the person’s finances.  Guardianship should be the action of last resort. Most of the time there are good or adequate less restrictive measures that can be put in-place rather than risking losing control over a loved ones life.

Nearly every client and patient I have ever met who is in the midst of a guardianship proceeding or who has been through one feels angry. devalued, and humiliated.  Their loss of dignity and sense of person-hood is immense and rarely appreciated.  No longer a person, the newly deemed incapacitated are now “Wards”.  Even this term hearkens back to an unsophisticated time when there was no effective treatment for mental illness.  Every “ward” is or was a loved one to someone.  Getting old should not mean growing in fear of losing one’s privacy and constitutional rights to live the way one wants to live.

Where possible, individuals should be supported in remaining in their homes with whatever assistance is needed.  People with significant financial means should have their monies managed by trust officers with a fiduciary duty to preserve and allocate funds appropriately.  Support for the person’s medical and life needs can and should be provided by skilled and caring people who are licensed health care professionals with appropriate oversight.

Where guardianship is necessary, different people or entities should manage the personal issues and the financial ones.  No one person should have total control over another – ever.  Lastly, and most importantly, everyone needs to think through who they would want to make their personal life decisions if they become unable to do so themselves.  This decision needs to be memorialized in writing and notarized.  Ideally, it is part of comprehensive estate planning.

Let’s try to be a little kinder to each other.  We will all be old someday and remember we are teaching our kids and other young people how to treat us.

Significant differences in the approaches evidenced by the elder law, trust and estate, and other attorneys serve to demonstrate that Living wills, Health Care Surrogate/Proxy designation, and the current legal approach to end of life planning is not only inadequate, it is sometimes inappropriate.

Physicians cannot and should not give legal advice.  Attorneys cannot and should not give medical advice or purport to help patients understand and decide these complex personal matters. Medical care has become so complex and nuanced that it is no longer appropriate for legal professionals to put templates in-place or attempt to fashion effective medical treatment plans for their clients.

Personal Medical Care Planning by an appropriately trained professional is critical so that individuals understand their medical issues, the medical and legal decisions they may face, and the risks and benefits of the various treatment modalities and interventions.  This personalized medical knowledge coupled with discussions around the beliefs, preferences, and deeply held values is required for there to be true informed consent and an increased likelihood that clients’ wishes will in-fact be honored.

While the “what” someone wants is important, the “why” they want it and feel this way is often more important.

Personal Medical Care Planning requires a skill set that draws from both the medical and legal professions.  In addition to a personalized focus on end of life decisions, this planning encompasses how the person wants to live before they die.   A “medical road map” becomes part of the estate planning documents and provides guidance to the Health Care Surrogate/Proxy and family in making medical decisions for their loved one helping avoid conflicts and disagreements.

Recently, the media has been reporting on a new phenomenon spreading across the U. S. – Death Cafes.  Flyers inform us about the opportunity to enjoy great coffee or tea while engaging in conversations about our mortality.  Trying to get people to think about their mortality or at least the need to think about thinking about their mortality is difficult.

The reality is that someday – regardless of how rich, famous, attractive or talented we are (or think we are)  – each of us will die.  It is puzzling that the certainty that each of our lives will end has not translated into embracing our mortality and thinking about how we want our lives to unfold.  Death is life’s completion.  Acceptance of the fleeting and fragility of our lives frequently leads to an appreciation for the time we have left, thereby freeing  us to be present for each moment.

Death Cafes provide a place to discuss thoughts about the great equalizer among all people – our death and the death of those we love.  Perhaps these gatherings create an opportunity for the kinds of conversations that take place between strangers on airplanes.  These conversations are sometimes surprisingly personal, and often ones we’ve never had with our loved ones.

So grab your coffee mug. Go to the nearest “Death Café”  Join  the conversation.  Then go home and communicate your thoughts and wishes about the kind of medical care you want when the time comes -to those who love you.

Americans are reluctant to spend much time contemplating their death.  Strange, because death is the ultimate destination on life’s journey.  Most of us spend a lot of time planning our vacations, but few of us put a personalized plan in-place for what we want when we become unable to make medical decisions for ourselves. Given that it is less and less likely that our personal physician will be at the hospital at the time we face life-threatening conditions, medical professionals who are strangers to us will be in-charge of our care.

These decisions don’t just come as we are dying – they frequently come as the result of cognitive impairments and other debilitating conditions.  We need to make our wishes known about what we want if our condition prevents a return to a meaningful life – and this means different things to each of us. We also need to document our wishes if we become unable to care for ourselves – do we wish to age in-place or move to an assisted living community?

Documentation of who we want to be our guardian in the event we become incapacitated helps prevent the appointment of a professional guardian to decide our care and living conditions. Personalized wills and trust documents are important guides to the disposition of our money and property after our death.  They safeguard those we love.  A personalized medical plan provides a road map for our care during incapacity and at the time of our impending death.  This road map provides guidance and comfort to those who love you when they must make critical medical decisions on your behalf.  These decisions should not be left to strangers or family members in crisis.

The recent arrest of an elderly man for having sex in a nursing home with his wife highlights the importance of advanced medical planning.  In this case, the wife had been diagnosed with dementia, but even people who have lost the ability to handle their finances and make medical decisions, may still be able to consent to intimacy. It is not clear from the media reports whether or not this 78 year old man is cognitively intact.

With more and more of the boomers getting to retirement age, living with cognitive impairment and needing care will occur with increasing frequency. If you want to age at home and have the money to pay the cost, then you should draft documents spelling this out.  If you want your spouse to be able to be intimate with you as long as it does not cause you distress, you should draft documents clearly stating your wishes.

While in the Iowa case, the jury did not convict this man, the pain, humiliation and costs of defending himself against charges of felony sexual assault serve as a wake-up call for us to plan so that our wishes are known and so that family members are protected.  Not to be missed when thinking about this case is the fact that it was the woman’s daughters from her prior marriage that raised the issue resulting in the arrest of their mother’s husband.  Blended families beware.

Research about the effects of diet on our bodies continues to show that as Euell Gibbons famously said; “you are what you eat”.  Like many of you reading this post, I am concerned about living well until the very end of my life. I have become convinced that diet and exercise are the “holy grail” of living well and continuing to think well as I age.

So what does the medical research say about what to eat and what to avoid? With the caveat that recommendations continue to change and that big dietary changes should be discussed with your doctor before embarking on a significant lifestyle change. Consider the following: Research continues to support the findings that high fat and high glucose diets appear to be associated with increased risk of dementia.

Further, studies point to simple and refined sugars as contributors to high cholesterol and triglycerides and negative effects on our body’s insulin and blood sugar. Eat lots of fresh fruit and vegetables. In order to avoid chemicals, excess salt, excess sugars, and trans fats – consider limiting or eliminating processed foods. Limit intake of red meats and avoid cold cuts and other processed meats. Limit/Avoid foods with high gluten content, fried foods, and margarine. Choose wild fish when possible. Getting your omega3 fatty acids from fish rather than supplements is preferable.  Avoid charring foods when cooking. Nuts and seeds- particularly walnuts and almonds appear to be important to good health.

Make sure your Vitamin D levels are well within the normal range – check with your doctor about supplementing your diet if your levels are low.  Many adults are Vitamin D deficient and may be at increased risks of certain cancers and issues with brain functioning.  While milk is generally fortified with Vit. D, many foods made from milk, like cheese and ice cream are not.  Outdoor (not indoor) sunshine is important, too.

Drink enough water and avoid sodas and artificial sweeteners. Ensure adequate protein, but don’t overdo it.   Moderate egg consumption is good for most people. Moderate caffeine intake may have good effects on the brain. Try to avoid eating withing 3 hours of going to bed and try – if medically able – to allow 12 hours to elapse since your last food intake before bed and your first morning meal. Eat better, feel better, think better!

As the population ages, concerns about dementia and Alzheimer’s disease continue to rise.  While there is no cure for Dementia and  Alzheimer’s Disease, there is evidence that lifestyle choices play a role.  After age and genetics (Family history), the seven key risk factors appear to be diabetes, high blood pressure, obesity, lack of physical exercise, smoking, depression, and low education. The good news is that these issues are something that we can do something about!

Let’s start at the beginning.  Normal aging is associated with changes in cognitive functioning, including some slowing of brain processing speeds and some loss of memory.  Not all memory problems are signs of dementia or Alzheimer’s disease, but they do need to be evaluated.   Evaluations typically include a careful history from the patient and their family/friends, a neurological exam, blood studies to rule-out low thyroid, Vit B12, folate, thiamine, anemia, kidney, diabetes and other diseases. Heart disease and infection are also considered.

Careful assessment for depression, visual or hearing loss, and review of medications is also important as many medications – alone and in combination – can effect alertness and cognitive functioning. Often an MRI is obtained. History of recent hospitalizations is also an important consideration. Not all memory problems are Alzheimer’s disease or dementia, but may be early signs of cognitive problems. Less common forms of dementia may present with problems other than with memory. Memory loss that is significant and especially when accompanied by difficulties in recalling new information, reasoning, language, and changes in personality must be evaluated.  Activities requiring calculation and planning, such as filling a pill box or balancing a check book may be one of the earliest signs of impairment.

Now you know more about brain changes and that there are things you can do now to decrease your risk of having problems as you age. Take a look at the posting about dietary changes you can make starting today to “Fuel” your brain with premium instead of contaminated fuel (junk foods and those contributing to inflammation)!

Once again patients are being notified of another data breach at a hospital and medical center where personal information, including social security numbers were accessed. Physicians Regional/Collier HMA Physician Management, LLC now affiliated with Community Health Systems Professional Services Corporations are among those entities where patient data was taken.

Kroll ID monitoring service is touted as being available to assist those whose information was unlawfully accessed, but calls to their number are either disconnected or placed excessive holds without answer. When one goes on the website to register, social security numbers are required to be entered into the website. As one of the affected patients, I do not want to enter my social security number into an online website so am unable to get any help and suspect others are having difficulty too.

Why are patients with insurance cards and drivers licenses providing identification required to disclose their social security numbers in the first place? There is still too little concern given to protecting individual’s personal information. Electronic medical records have not yet lived up to the promise of easy access and connectedness of patient data, yet they have led to the vulnerability of thousands of patient records. HIPAA, the national health information privacy legislation while providing for federal protection for disclosure of PHI – protected health information – has not resulted in enough vigilance by data systems and aggregators.

Legislation is needed instituting stiff fines and penalties for the failure to ensure protection of personal information. In the meantime be very careful with your personal information and question why the disclosure is needed before handing it over.

Is there such a thing as too much exercise? Almost everyone knows that exercise brings many health benefits; longevity, positive impact on brain functioning, decreased of heart attacks and strokes, as well as weight management and increased sense of wellbeing.

While moderate exercise has been demonstrated to reduce pain and improve joint functioning, a new study reveals that vigorous exercise can result in a progression of osteoarthritis – the most common type of arthritis – in the knees. So keep moving, but avoid vigorous or strenuous exercise and activities.