October 15, 2019
What your doctor may not know, but you should
Want to stay mentally sharp for as long as possible?
I certainly do, and I’m guessing you do, too: an AARP survey found that 87 percent of respondents reported being very concerned about this issue.
And in April 2015, a highly influential nonprofit released a new report whose recommendations represent the best available medical knowledge on how our brains change as we age and what we can do about this.
The report by the Institute of Medicine (IOM), the health arm of the National Academy of Sciences, is called “Cognitive Aging: Progress in Understanding and Opportunities for Action.” The full report is a pretty lengthy and comprehensive review. But in a series of shorter related materials, the IOM highlights some practical approaches we can all take to maintain better brain health — whether for ourselves or for an older loved one. It also provides tips on compensating for some common problems related to cognitive aging.
Here are the highlights I consider most important:
Cognitive Aging Happens to Everyone
The IOM defines cognitive aging as “a process of gradual, ongoing, yet highly variable changes in cognitive functions that occur as people get older.”
This process is not considered a disease. Rather, it’s a natural process of age-related changes in the brain. Like other aspects of aging in the body, it tends to happen a little differently for every person, in part due to things like genetics, lifestyle and environmental factors.
In Alzheimer’s, there is extensive neuron loss, and the disease is chronic and progressive. The IOM’s related “Cognitive Aging Action Guide for Individuals and Families” provides a distilled summation.
The action guide also lists four common myths about brain health and aging, and provides the corresponding facts you should know. I’ve paraphrased them below.
4 Myths About Brain Health and Facts About Cognitive Aging
Myth: Maintaining cognitive health means preserving your memory.
Fact: Cognitive health is far more than having a good memory. It also involves decision-making, attention and problem-solving.
Myth: Cognitive function always declines with age.
Fact: Aging can have positive and negative effects on cognition.
Myth: Brain neurons die as you age, so there is no way to prevent cognitive decline.
Fact: In the absence of disease, neuron death is minimal.
Myth: There is nothing you can do to improve your cognitive health.
Fact: There are actions individuals and families can take to help support their cognitive health and adapt to age-related cognitive changes.
6 Ways to Protect Your Brain as You Age
In its full report, the IOM devotes 120 pages to reviewing the factors that affect cognitive aging, along with interventions that might improve brain health. It summarizes the most important suggestions for the public in its handy action guide, and I’ve paraphrased them below (the first three are the most important):
- Be physically active.
2. Reduce your cardiovascular risk factors (including hypertension, diabetes and smoking).
3. Manage your medications by reviewing them with a clinician and learning about their effects on cognitive health.
4. Be socially and intellectually active.
5. Get adequate sleep.
6. Learn to prevent delirium, a decrease in cognitive function that can be triggered by hospitalization, medications or certain illnesses.
Risky Medications and Delirium Prevention
All six of these recommendations are important and useful. But two particularly caught my eye, because they are actions that we especially focus on in geriatrics: medication management and delirium prevention.
Now I hate to say this, but I think you should know the truth: We geriatricians focus on them in part because they are often overlooked by our doctor colleagues. Most clinicians are very busy and usually have not had special training in modifying healthcare to be a better fit for older adults.
The IOM’s “Action Guide for Health Care Providers” spells out what doctors should be doing in those areas. For instance, it mentions that the use of over-the-counter anticholinergics should be assessed. (This is a topic I covered recently in a Next Avenue blog post.)
We hope that many health providers read this IOM action guide and modify their work accordingly.
But here’s an insider tip from me to you: When you find out that expert organizations feel the need to remind doctors to do something, that’s a sign that doctors aren’t doing it reliably. Which means it is smart to be proactive and remind your doctors to help you.
For more information about avoiding risky medications, see this list of online resources.
Why Seniors Get Delirium
Delirium is an incredibly common and important health complication that affects seniors.
It’s basically a state of worse-than-usual mental function that can be brought on by some illness or stress on the body or mind. It is the reason older adults are often confused after surgery, but can also be the only outward sign of a potentially serious infection in someone living at home.
Delirium is associated with all kinds of bad health outcomes, including longer hospital stays, health complications and even acceleration of cognitive decline. But you can help prevent it, or at least make sure it gets noticed and managed promptly. Here’s where to learn more:
- HospitalElderLifeProgram.org: A great program and website founded by Dr. Sharon Inouye, a geriatrician who is the leading researcher on delirium in older adults. (She was also part of the committee that worked on this cognitive aging IOM report.) Information tailored for families is here.
- HealthinAging.org: This is the health information site affiliated with the American Geriatrics Society, and it includes a comprehensive section on delirium.
Driving and Finances in Seniors
The IOM reports that cognitive aging can affect an older adult’s ability to manage complex tasks such as driving and finances. It notes that victims of financial elder abuse lose billions every year. (My guess is that many of those victims are suffering from more than cognitive aging, but yes, this is a serious problem.)
Hence, the IOM has created related resource lists to help people be proactive about preventing, detecting, and addressing problems with finances and driving. See “Online Resources Related to Elder Financial Abuse” and “Online Resources Related to Older Adult Driving.”
Nutrition and Other Approaches for Brain Health
In preparing this report, the IOM conducted a comprehensive review of different approaches that have been studied in relation to cognitive health. So if you are wondering about a particular approach that’s not mentioned above, chances are it is covered in the full report.
Basically, for now the IOM has concluded that some of the dietary approaches have promise but we need more research to confirm their effectiveness. The report also concludes that the medical literature doesn’t convincingly support vitamin supplementation to prevent cognitive decline.
If You or a Relative Has Alzheimer’s
Part of the purpose of the IOM report is to draw attention to cognitive aging as a health issue that is distinct from dementia and deserves its own attention from the public, practicing clinicians and researchers.
This is a reasonable position. That said, if you’re concerned about brain health for someone with a dementia diagnosis, you should know this: The cognitive aging recommendations listed above do improve the brain health of people with Alzheimer’s or another form of dementia.
Why? Because the recommendations are basically about how you can optimize brain health and brain function; they apply whether a person has experienced brain aging or extra damage from a disease.
If we can all do better in helping people optimize their brain health and in compensating for any cognitive aging, our society will be a better place for aging Americans.