Issue 4: Brain Power

BRAIN POWER What is Normal Aging of the Mind?

MAY/JUNE 2014 ISSUE 4

The Science of Older & Wiser

FRANKLIN DELANO ROOSEVELT III

Having Fun with Neurobics i

CALL FOR ENTRIES

INNOVATION IN CAREGIVING AWARD The Benjamin Rose Institute on Aging invites creative caregivers to apply for the fourth annual Innovation in Caregiving Award. Up to three award winners will each receive a commemorative plaque and $1,000. Awards will be presented at Benjamin Rose’s annual conference on November 13, 2014 in Cleveland, Ohio.

The Innovation in Caregiving Award recognizes adults (age 18 and over) who, in the course of caring for an adult aged 60 or over in a private home or a residential setting, invent a device or find a new application for an existing device or technique that supports caregiving and eases the burden on caregivers.

Applicants for the 2014 awards may be family caregivers, paid care providers, or support staff whose ingenuity and inventiveness in giving care is worthy of recognition and replication. The award criteria includes:  Innovativeness  Usefulness  Potential for adoption or duplication by others  Possibility for improving quality of care or quality of life

Applications for the award are available online at www.benrose.org/award or by calling 216.791.8000.

Deadline for applications is June 30, 2014.

The Innovation in Caregiving Award is made possible through a gift to the Benjamin Rose Institute on Aging by former board member, the late Elizabeth H. (Betty) Rose. Betty created several devices that made it easier for caregivers to assist older adults. Her efforts resulted in improvements in care and increased comfort for those receiving care. Betty realized that caregivers are often creative problem-solvers as well. She intended this award to recognize and celebrate the accomplishments of these individuals who serve on the frontlines of caregiving.

The award is not meant for organizations or individuals who developed their device or technique with financial help through a business, grant, or other outside support. It honors direct caregivers: family members, friends, and those working in the human services field, such as nurses, therapists, and home care aides, who have on their own developed a procedure or device with special benefit.

The Benjamin Rose Institute on Aging (www.benrose.org) is a nationally recognized nonprofit pursuing innovation in practice and policy to address the important issues of aging. As a champion for older adults, Benjamin Rose works to advance their health, independence, and dignity. The organization has established itself as a trusted resource for people who counsel, care for and advocate on behalf of older adults. The state-of-the-art Conference Center at Benjamin Rose hosts educational programming that is responsive to the evolving demands of an aging population.

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30 Franklin Delano Roosevelt III: The Legacy of a Name

by Walter Backerman

35 No Gym Required: Using Neurobics for Brain Fitness

38 Man’s Best Therapist: The Growing Field of Pet Therapy

by Seamus Mullarkey

40 The Science of Older & Wiser

by Phyllis Korkki

Communicating to Someone with Dementia

by Janice Lynch Schuster 2

MIKE AGLIOLO/CORBIS

49

BRAIN POWER What is Normal Aging of the Mind?

ISSUE 4  MAY/JUNE 2014

DEPARTMENTS

IN EVERY ISSUE

6 Remember When

4

10 Did You Know?

53 Books: Michio Kaku’s

The Future of the Mind

12 Health & Wellness:

Identifying a Stroke

Letter from the Publisher

54 Fun & Games for Kids

16 Life with The Eden Alternative: The Evolving Brain by Al Power

56 Fun & Games

20 The Benjamin Rose Institute

on Aging: Reducing

Disability Through Exercise

62 Puzzle Solutions

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59 Horoscopes

64 The Last Laugh

House Call with Dr. Kramps: Healthy Brain Aging and 10 Early Warning Signs and Symptoms of Alzheimer’s

3

LET TER FROM THE PU BLISHER Since the dawn of consciousness many millennia ago, people the world over have celebrated and embraced the indisputable correlation between life experience and acquired wisdom. Elders have rightfully governed this societal domain, and the generational reverence we have for their learned insights and life guidance is now an inherent part of our cultural DNA. A favorite homage of mine to this time-honored truth is the playful quote penned by Mark Twain: “When I was a boy of 14, my father was so ignorant I could hardly stand to have the old man around. But when I got to be 21, I was astonished at how much the old man had learned in seven years.”

As each of us passes through life, our perspectives evolve and our bodies age. What was once unknown to us becomes realized and, inevitably and eventually, time and the good fortune of health dictate that we join the ranks of Elderhood.

Until the last few decades, most research on longevity and healthy aging was “body-focused,” centered mainly on nutrition, exercise, and good lifestyle choices. Recently, technological advancements and an increased social awareness of brain-related diseases like Parkinson’s and Alzheimer’s have heightened our attention to the study and care of our brains— and, more specifically, our minds.

More than any other part of our physical being, our minds are the vessels within which we carry our humanity and connect ourselves to each other.

Helping others maintain a healthy mind benefits them as individuals as well as everyone who loves and cares for them.

PS Lifestyle Magazine has endeavored to play our part in the conversation by populating this issue with thoughtful and stimulating insights that explore how our minds age. Please exercise your mind and enjoy!

Sincerely,

John Polatz Publisher and CEO 4

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5

POP CULTURE, NEWS, AND EVENTS FROM PAST DECADES

Remember When...

1944 Cartoonist Dik Browne (who would later be known for the H채gar the Horrible comic strip) created Ms. Chiquita, the trademark logo for Chiquita Banana.

HULTON ARCHIVE/STRINGER COLLECTION/GETTY IMAGES

Infamous bank robber and outlaw John Dillinger was killed in front of a Chicago movie theater during a prolonged FBI hunt.

Singing sensation Pat Boone was born on June 1 in Jacksonville, Florida.

GILLES PETARD/REDFERNS/GETTY IMAGES

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The G.I. Bill of Rights was signed into law by President Franklin D. Roosevelt, which in part gave returning war veterans housing subsidiaries and financial assistance for higher education.

LIBRARY OF CONGRESS, PRINTS AND PHOTOGRAPHS DIVISION

FORT WORTH STAR-TELEGRAM/MCT VIA GETTY IMAGES

1934

1954

1964

1974

The Supremes released their No. 1 hit song, “Where Did Our Love Go.”

ALADDIN COLOR, INC./ALADDIN COLOR, INC./CORBIS

The first Howard Johnson’s motor lodge opened in Savannah, Georgia.

DAVID FARRELL/REDFERNS/GETTY IMAGES

“Dial-A-Joke” had comedians including Henny Youngman, Joey Adams, and Phyllis Diller telling jokes to customers who paid per call.

Walt Disney’s amusement ride, It’s a Small World, premiered at the 1964 New York World’s Fair as a tribute to UNICEF.

NBCUNIVERSAL/NBC VIA GETTY IMAGES

On Flag Day (June 14), President Dwight D. Eisenhower signed a bill into law that placed the words “under God” into the Pledge of Allegiance.

JOHN G. ZIMMERMAN ARCHIVE/COURTESY EVERETT COLLECTION/ SUPERSTOCK

Dr. Henry Heimlich introduced the Heimlich maneuver in an article entitled, “Pop Goes the Cafe Coronary,” that was published in the journal Emergency Medicine.

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1984 The Chicago White Sox and Milwaukee Brewers played the longest timed Major League baseball game, which lasted 8 hours, 6 minutes over the course of two days.

The comedy film Ghostbusters was a critical and commercial success along with its theme song by Ray Parker Jr., creating the catchphrase: “Who You Gonna Call? Ghostbusters!”

1994

2004 The romantic drama film, The Notebook, based on the novel with the same name by Nicholas Sparks, was released.

JOSEPH R. VILLARI/AP/CORBIS

O.J. Simpson was widely broadcast fleeing from police in his white Bronco truck after failing to turn himself in on double-murder charges in the deaths of his ex-wife Nicole Brown Simpson and Ronald Goldman.

© WC ‘94 TM

© 1984 COLUMBIA PICTURES INDUSTRIES, INC.

8

ALL RIGHTS RESERVED. COURTESY OF COLUMBIA PICTURES

The US hosted the 1994 FIFA World Cup, which was the best attended in history.

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40th President of the United States Ronald Reagan died at 93 years old, ten years after having been diagnosed with Alzheimer’s disease.

Remember When...

D-DAY WAS THE BEGINNING OF THE END OF WORLD WAR II

Above: General Dwight D. Eisenhower gives the order of the day: “Full victory—nothing else.” June 5, 1944 LIBRARY OF CONGRESS, PRINTS AND PHOTOGRAPHS DIVISION

Above: Times Square, New York, June 6, 1944

The Battle of Normandy commenced under a full moon with the landing of Allied troops on the beaches of Normandy, France. Back home, the country stood still in collective prayer and contemplative thought, intensely awaiting news of the outcome.

Between 130,000–156,000 American, Canadian, and British soldiers successfully broke through Nazi Germany’s Atlantic Wall and pushed inland in the largest military operation in history.

LIBRARY OF CONGRESS, PRINTS AND PHOTOGRAPHS DIVISION

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?

DID YOU KNOW

FASCINATING FACTS TO KNOW AND TELL

Immediately following his death in 1955, Albert Einstein’s brain was removed for scientific research.

It vanished until 1978, although it wasn’t too difficult to track it down—it was in the possession of the same doctor who performed the brainectomy.

FRED STEIN ARCHIVE/ARCHIVE PHOTOS/GETTY IMAGES

About 12% of people dream in black and white and those are generally people over the age of 60. A 2008 study revealed that people who had access to black-and-white television before color television experienced more grayscale dreams than people with no such exposure. In the 1940s, studies showed that three-quarters of Americans reported “rarely” or “never” seeing any color in their dreams.

Research has shown that “the knowledge” acquired by blackcab drivers in London enlarges their brain’s capacity. Brain scans have shown that they have a larger hippocampus—the part of the brain associated with navigation and visual spatial awareness—than in other people. London cabbies can spend 3–4 years learning a detailed mental map of the city before they are given a license.

Grape-Nuts were initially marketed as “brain food” with testimonials that the cereal made from wheat, barley, yeast, and water could enhance health and vitality. C.W. Post had the idea after spending time as a patient at the sanitarium of Dr. John Harvey Kellogg (later associated with Kellogg breakfast cereals), who practiced holistic methods, with a particular focus on nutrition, enemas, and exercise.

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ARCHIVE PHOTOS/GETTY IMAGES

HEALTH & WELLNESS

Identifying a Stroke

by KATHERINE ADAMS

O

n the morning that Dr. Jill Bolte Taylor had her stroke, she awoke to a sharp, intense pain directly behind her left eye. She closed the blinds to her bedroom because the light was hurting her eyes. Thinking she needed to get the blood flowing, she started her morning exercise, only to have a strange sensation wash over her, one of a disassociation with reality; she could think clearly, but her body felt detached, almost autonomous from her thoughts. Still able to function, she stopped exercising and headed for the bathroom, her 12

body jerkily moving along, unbalanced. Unaware of her danger, she stepped into the shower, only to find that her sense of hearing had become warped, the sound of the gushing water amplified and disturbing. At this point, Jill realized she was having a severe neurological problem. As she grappled with what the problem might be, a sense of peace came over her, the result of her blood pressure dropping from blood loss in her brain.

Esoteric thoughts came to her as her hemorrhaging brain detached from the internal chatter that usually occupies us. Then, the tingling

began and her arm became paralyzed. That was the moment she realized she was having a stroke.

Of the two kinds of stroke, Jill was experiencing the more rare: a hemorrhagic stroke, which occurs when blood is lost from the brain, escaping the arteries and coming into direct contact with neurons causing damage. This type of stroke includes aneurysms, in which the weakened wall of a blood vessel bulges out then ruptures, releasing the blood into the skull.

Much more common is the ischemic stroke, accounting for about 83–88% of strokes. A blood clot is carried to an artery, then transferred to smaller and smaller branches of vessels until the clot can no longer pass through. The clot blocks the needed oxygen carried by red blood cells. The cells may die, which can result in permanent damage. Traditionally, the way to overcome a stroke is for other neurons to compensate or adapt for the loss. Sadly, the brain does not always recover, depending on the area affected and the extent of the damage.

Each year nearly one million Americans have a stroke. Stroke is

the fourth leading cause of death.

The southeast has a highest rate and African Americans are 80% more likely to have a stroke than caucasian Americans. Women are at greater risk than men. Indeed, women succumb to strokes at double the rate of breast cancer.

Not surprisingly, the indicators for overall bodily health and wellbeing come into play when it comes to stroke. High blood pressure, high cholesterol, circulation pro-blems, atherosclerosis, atrial fibrillation, and diabetes are disorders that put you at risk of stroke, while lifestyle choices such as tobacco use, alcohol consumption, and a lack of physical exercise increase your risk, as well.

Thus, eating well and exercise are keys to prevention. In March 2013, the New England Journal of Medicine published a study showing that people aged 55–80 who followed the Mediterranean diet (a low carb, high fat [the good fats, like nuts, olive oil] diet, rich with fish, vegetables, beans, and fruit) were at less risk for strokes by as much as 30%.

Jill’s recovery was long and arduous. Though able to think, she 13

was unable to speak or coordinate movements in the immediate aftermath. But she did recover, even though she was unable to retrieve certain aspects of her thinking and mental processing that she recognizes were once present, but no longer are part of her brain’s “make-up.”

New scientific discoveries are helping to shed light on the complex system of the brain. We are now able to manipulate neurons with gene therapy and electromagnetic stimulation, among other ways.

And our understanding of the brain and how it functions has increased exponentially just in the last two decades. Because scientists are devising more and more detailed maps of the brain and our technology is better able to scan and analyze the brain, it is possible to identify what areas have been affected or damaged by stroke, and focus attention on repairing it. If the brain cannot be repaired, there will soon be technologies to assist stroke victims. Moreover, science anticipates that it will be able to promote the growth of new neurons using stem cells.

Meanwhile, other research is honing in on aspects of brain health 14

through examining the causes of inflammation and disease. In the fight against all kinds of health problems, including stroke, sugar and simple carbohydrates consistently prove our worst enemies.

For example, glycated hemoglobin, or too much sugar in the blood (indicated by elevated levels of A1C, the protein found in red blood cells that carry oxygen and bonds to sugar), has been linked to stroke.

Additionally, evidence suggests A1C is linked to brain size, and that people with elevated levels of A1C demonstrate loss of brain tissue. This may mean that too much sugar could actually atrophy the brain. Again, proper nutrition and exercise help keep blood sugars low and insulin balanced.

Researchers recently found that too much homocysteine in the blood may increase a person’s risk for stroke. Homocysteine is an amino acid or building block of protein that is produced naturally in the body. Elevated homocysteine may be offset by vitamins B6 and B12, as well as folic acid, either as supplements or in foods. Folic acid can be found in fruit, lentils, chickpeas, and asparagus, while

You can read about Jill’s experience with her debilitating stroke and her long and intense recovery in her book, My Stroke of Insight: A Brain Scientist’s Personal Journey.

ROZ CHAST, THE NEW YORKER COLLECTION/THE CARTOON BANK

B6 and B12 are found in fish, low-fat meat, bananas, watermelon, baked potatoes, and milk products.

The best thing you can do to prevent a stroke is to maintain a healthy body.

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LIFE WITH THE E DE N ALTERNATIVE

THE EVOLVING BRAIN

by AL POWER, MD

H

aving recently entered another decade of life, I find that my contemporaries are increasingly fixated on the state of their brains. A slip of the memory or the inability to call up a name leads to nervous jokes about having “senior moments.” We have become obsessed with trying to “slow our inevitable decline” through all manner of brain stimulating activities, resulting in a multimillion dollar industry of games and puzzles “guaranteed to increase your brain health.”

There are a few problems with this philosophy. First, it appears that doing certain brain puzzles can improve your ability to do those puzzles, but there is little or no carryover to other brain skills.

And there seems to be no evidence that doing any of them prevents Alzheimer’s.

But the larger problem here is the basic notion that brain aging 16

is all about decline. In fact, it is astounding that we would view the most complex entity known to man in such simplistic terms. Instead, let’s look at the brain from a “postmodernist” lens: one that sees shades of gray and recognizes both decline and growth occurring simultaneously.

Like many parts of the body, the aging brain certainly seems to slow a bit or become less efficient.

Processing speed slows, and there is a loss of white matter and a general shrinkage of brain tissue over time. It is more common to have difficulty retrieving memories, and new skills, such as learning a foreign language, require more effort and repetition than they do in childhood.

It is said that we are less likely to engage novel patterns of thinking as we age, and that many people do their best and most creative work in young adulthood. But is this

ILLUSTRATION BY JONATHAN BURTON

really true? I was certainly more prolific in several areas as a younger adult, but I do not think I was more creative. I will now use that creativity to reframe some of the aspects of “deterioration” described above.

Let’s start with the socioeconomic aspect of aging. Many outside factors come into play during a person’s life that may affect both creativity and productivity—raising a family, spending a stretch of time in a stifling job, experiencing divorce, or the death of a loved one.

The longer we live, the more likely it is that “life” will get in the way of our productivity.

Regarding the speed of our thinking, perhaps there is an evolutionary reason for thinking more slowly as we age. Is it merely due to deterioration of white matter, or does slower thinking also reduce our tendency to be impulsive and enable us to consider more possibilities before making decisions?

For an older adult, being less impulsive increases our resilience.

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Recent research from Germany suggests that our more frequent memory lapses in middle and older age may be a function of having larger memory banks to search. If a grandparent and child are walking down the street and someone approaches, the child will have to remember the person’s name from the dozens he knows, while the grandparent may have to search a database of thousands.

Aging artists, musicians, and writers often create works that look less complex on the surface, but in fact they have peeled away the excess to discover a purer essence in their art.

Recent research from Germany suggests that our more frequent memory lapses in middle and older age may be a function of having larger memory banks to search.

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There are even several ways in which the older brain is superior to the younger version. There is a larger fund of knowledge. There is a better appreciation of nuance—in language, in emotional processing, and in problem-solving. There are more experiences from which to draw, and the older person has a better sense of perspective, having seen many trends come and go.

Such perspective makes the older person less likely to dwell on trivial concerns and focus on larger issues instead. All of this adds up to a level of wisdom that the younger person cannot achieve.

This is why leadership in our society defies the biology that states that our brains work best in our 20s. Most of our leaders and advisors are much older than that, because their wisdom provides valuable guidance for organizations and nations alike. Traditional societies have long recognized this, with revered tribal elders who dispense advice and arbitrate conflict.

Principle Nine of The Eden Alternative reminds us that you cannot separate human life from human growth. Such opportunities exist even in the face of progressive

illness or changing abilities. The brain evolves throughout life. Some skills diminish, while others become more enriched. This may reflect our evolving societal role as we move from a life of doing to one more concerned with being. It is more akin to ripening than rotting.

And what about all of those brain fitness exercises? Stimulating the mind is good for brain health, but much more so when infused with meaning and purpose. So put away the flash cards and find ways

to enrich your world and that of your neighbors. Your brain, and everyone else’s, will benefit.

Al Power, MD is the author of Dementia Beyond Drugs: Changing the Culture of Care, and the upcoming Dementia Beyond Disease: Enhancing Well-Being.

He serves as an Eden Educator and as a Board Member for The Eden Alternative. For more information, go to www.alpower.net.

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Reducing Disability Through EXERCISE MIMI HADDON/THE IMAGE BANK/GETTY IMAGES

THE BE NJAMIN ROSE INSTITUTE ON AGING

20

T

he key to a better quality of life and an overall improvement of memory and mood is regular exercise. Physical activity is important, and possible, even for people who have physical health, memory, or mental health problems. Although health problems can make it challenging to be physically active, exercise can still be beneficial.

Researchers at the Benjamin Rose Institute on Aging studied an exercise program for older adults with dementia which can cause behavior problems such as wandering or being agitated or confused. The exercise program, called Reducing Disability in Alzheimer’s Disease (RDAD), was designed to help people with dementia and the relatives or friends who assist them with daily activities.

The RDAD program includes 15 simple exercises that are done for about 30 minutes each day. Exercises include strengthening, balance, flexibility, and endurance.

These exercises improved moods and the ability to do daily activities, such as dressing, bathing, and walking.

Caregivers who also took part in the exercise routine reported less strain in their relationship with their loved one with dementia, and experienced

KEYS TO GETTING THE MOST FROM EXERCISE • Consistently do exercises over the long-term. It usually takes around six weeks to notice the physical benefits, but the mood-enhancing benefits may show up right away.

• Do the right exercises for you; doing the wrong exercises can be risky and may not lead to the benefits you want.

• Encouragement from family members or friends can help, especially if your health limits what you can do alone.

• Some people find it helpful to have a set time or schedule for exercising each day, or every other day.

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The Benjamin Rose Institute on Aging (www.benrose.org) is a nationally recognized nonprofit addressing the important issues of aging through service, research, and advocacy. As a champion for older adults, Benjamin Rose works to advance their health, independence, and dignity.

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STRENGTH

KNEE EXTENSION While sitting in a chair, raise your foot until your knee is straight. Return to the start position, then repeat with your other leg.

PLANTARFLEXION

While standing, slowly raise your heels off the ground, then back down.

ILLUSTRATIONS Š JASON LEE

improvements in their own physical health. Furthermore, the exercises were a positive activity individuals with dementia and their caregivers could do together.

Even though participants involved in the study had health problems that affected memory, the exercises were not too difficult and most people continued for six months or longer.

Many older adults, especially those with health problems, have a hard time starting or consistently doing exercises. However, there are easy exercises for those who do not have much energy or do not feel well. Getting started is the hardest part. Begin with a gentle routine and after a few weeks the intensity can be increased. Consider asking an exercise professional or consult your health care provider to help you decide what’s right for you.

SIMPLE EXERCISES for Reducing Disability BALANCE

FLEXIBILITY

CHAIR STAND

NECK STRETCH

With or without the help of your arms, sit in a chair, then stand, then sit. If stable, use dumbbells in each hand.

While sitting in a chair, slowly turn your head side-to-side.

TANDEM WALK

SHOULDER STRETCH

Walk in a straight line heel-to-toe.

While sitting in a chair, reach up with one arm, then repeat on the other side.

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HOUSE CALL S WITH DR. KR AMPS

Distinguishing NORMAL MENTAL AGING from MEMORY DISORDERS

ILLUSTRATION © SPARKSTUDIO

by MELISSA KRAMPS, DNP

“Is this normal for my age?” is one question I’m often asked in my practice as a memory disorders specialist. This is such a common inquiry that the Alzheimer’s Association published a brochure entitled, “Is it Alzheimer’s or Just Signs of Aging?” which offers counseling points to discuss the warning signs of Alzheimer’s disease or other dementia.

(See page 27 for the 10 signs and symptoms of Alzheimer’s disease) 24

It is expected that older adults will develop some degree of age-related cognitive decline, characterized by slowed mental processing. This may be experienced as delayed retrieval of a name or word, or forgetting why you walked into a room. Older adults take longer to learn new material and may need information to be taught more slowly as there is an age-related decline in the ability to divide attention, especially for new or complicated tasks. However, memory for factual information or general knowledge is relatively preserved.

Dementia is an umbrella term used to describe a set of symptoms such as problems with memory, language, or reasoning that combine to hinder a person’s day-to-day functioning. Alzheimer’s disease is the most common cause of dementia as people get older. Memory loss can also been seen in the dementias associated with Parkinson’s disease, Lewy body disease, or Frontotemporal dementia (FTD).

Temporarily forgetting a word or a person’s name is not abnormal.

However, it is not considered normal aging if you frequently

need to describe the word you want to use, or if you are using words that sound similar to the word you want to use, or lose your way mid-conversation either while speaking or listening. For example, if you say, “that thing you cut with” when referring to a knife or use the word “artichoke” instead of “architect” then you should speak with your health care provider.

Repetition is the most common symptom reported when I interview patients and their families about memory disorders. Asking the same question over and over is not a normal part of aging. On occasion you might repeat a story or joke but it is not common to do this in the course of a single conversation. If you are being told, “You just asked me that,” or “We just talked about this,” you may be exhibiting signs of early Alzheimer’s disease.

When memory loss interferes with day-to-day function it is cause for concern. This may be as alarming as having difficulties in your occupation or it could be a minor occurrence such as getting lost in a familiar area. It is not uncommon to have a challenging time finding your way to a new 25

place, but you should not have difficulty navigating your way to places you know well such as the grocery store or a child’s home.

There are some retired people who do not feel the need to know the date. However, if it becomes difficult to keep track of time, whether it is the day of the week or the time of day, it should raise a red flag.

Difficulties with planning or problem-solving are concerning.

This can manifest as having trouble following a recipe or putting together the proper steps to complete a task. Perhaps you are in the routine of traveling once or twice a year and you come to the realization that making flight or hotel arrangements is more challenging for you. I have had families report that it has taken a loved one hours to pay a single utility bill. If something as minor as calculating change or a tip poses a problem for you, it might be a symptom of a larger problem.

Everyone misplaces keys or glasses from time to time, but are you spending increasing amounts of time looking for your belongings?

Are you finding things in odd places or have you lost any important 26

documents? If it is arduous for you to retrace your steps or if you are not seeing things that are right in front of you, then it might be more than normal aging.

If you are getting into fender benders or find yourself drifting into other lanes when driving, you may be experiencing trouble with spatial relationships. Are you finding it difficult to hold your place on the page while you are reading or are people telling you that you are not making eye contact? These types of visual problems are not typical of older age.

Certain behaviors may raise concern of family and friends but may not be evident to you. Changes in mood or personality can be observed. This can manifest as withdrawing from social activities, becoming more quiet, or acting more aggressively. Depression is very common in older adults so it is important to discern whether the mood changes are from dementia or depression.

Poor judgment can come to light when a person falls victim to a scam or ends up in an unsafe situation such as stepping into traffic. As an observer, you may notice a friend

or family member dressing inappropriately for the weather or neglecting personal hygiene.

If you or someone you care about experience symptoms you fear are not simply age-related cognitive decline, I encourage you to consult a health care provider.

There are many medications and conditions that can impair thinking abilities. If the answer is not revealed with basic laboratory tests and close examination of the medication list (including over-thecounter medications and vitamins),

you may request an MRI of the brain to evaluate whether there have been silent strokes. Neuropsychological testing can be performed to assess for the presence of depression and evaluate cognitive functions such as memory, reasoning, planning, language, and attention. If you find yourself asking, “Is this standard for my age?” take charge of your health and seek the help of a professional.

Early diagnosis can reverse some causes of memory problems and improve the quality of life in others.

THE 10 EARLY WARNING SIGNS AND SYMPTOMS OF

ALZHEIMER’S DISEASE Have you noticed any of these warning signs? Make a checklist with any concerns you have and discuss them with your health care provider. Early diagnosis provides the best opportunities for treatment, support, and future planning.

Note: This list is for information only and not a substitute for a consultation with a qualified professional.

1. One of the most common signs of Alzheimer’s, especially in the early stages, is forgetting recently learned information.

Others include forgetting important dates or events; asking for the same information over and over; relying on memory aides (e.g., reminder notes or electronic devices) or family members for things one used to handle 27

on their own.

What’s typical?

Sometimes forgetting names or appointments, but remembering them later.

2. Some people may experience changes in their ability to develop and follow a plan or work with numbers. They may have trouble following a familiar recipe or keeping track of monthly bills. They may have difficulty concentrating and take much longer to do things than they did before. What’s typical?

Making occasional errors when balancing a checkbook.

3. People with Alzheimer’s often find it hard to complete daily tasks. Sometimes, people may have trouble driving to a familiar location, managing a budget at work, or remembering the rules of a favorite game.

What’s typical? Occasionally needing help to use the settings on a microwave or to record a television show.

4. People with Alzheimer’s 28

can lose track of dates, seasons, and the passage of time. They may have trouble understanding something if it is not happening immediately. Sometimes they may forget where they are or how they got there. What’s typical?

Getting confused about the day of the week but figuring it out later.

5. For some people, having vision problems is a sign of Alzheimer’s. They may have difficulty reading, judging distance, and determining color or contrast. In terms of perception, they may pass a mirror and think someone else is in the room. They may not recognize their own reflection. What’s typical? Vision changes related to cataracts.

6. People with Alzheimer’s may have trouble following or joining a conversation. They may stop in the middle of a conversation and have no idea how to continue or they may repeat themselves. They may struggle with

vocabulary, have problems finding the right word, or call things by the wrong name (e.g., calling a watch a “hand clock”). What’s typical? Sometimes having trouble finding the right word.

7. A person with Alzheimer’s disease may put things in unusual places. They may lose things and be unable to go back over their steps to find them again.

Sometimes, they may accuse others of stealing. This may occur more frequently over time. What’s typical? Misplacing things from time to time, such as a pair of glasses or the remote control.

8. People with Alzheimer’s may experience changes in judgment or decision-making.

For example, they may use poor judgment when dealing with money, giving large amounts to telemarketers. They may pay less attention to grooming or keeping themselves clean. What’s typical? Making a bad decision once in a while.

9. A person with Alzheimer’s may start to remove themselves from hobbies, social activities,

work projects, or sports. They may have trouble keeping up with a favorite sports team or remembering how to complete a favorite hobby. They may also avoid being social because of the changes they have experienced.

What’s typical?

Sometimes feeling weary of work, family, and social obligations.

10. The mood and personalities of people with Alzheimer’s can change. They can become confused, suspicious, depressed, fearful, or anxious. They may be easily upset at home, at work, with friends, or in places where they are out of their comfort zone.

What’s typical? Developing very specific ways of doing things and becoming irritable when a routine is disrupted.

Published with permission from the Alzheimer’s Association. © 2009 Alzheimer’s Association.

All rights reserved.

29

The Legacy of a Name

by WALTER BACKERMAN

30

HANSEL MIETH/THE LIFE PICTURE COLLECTION/TIME & LIFE PICTURES/GETTY IMAGES

FRANKLIN DELANO ROOSEVELT III

F

ew things are as comforting as the cherished snapshots

of those lost loved ones indelibly etched in our memories.

Captured in a photo is a portrait of a family consisting of four generations gathered together for a festive occasion— lost in time, if it were not memorialized in a photograph.

It was the 21st of September in 1940 when the grand

matriarch of this family, Sara Delano Roosevelt (seated to the left), celebrated her 86th birthday. Standing behind was her 26-year-old grandson, Franklin Delano Roosevelt, Jr. Seated to the left was her only child Franklin Delano Roosevelt, who was then, arguably, the most important man in the world, carrying the weight of the world on his shoulders.

Above: An inscription by President Roosevelt to his grandson and namesake on an official White House copy of his inauguration address.

31

But in this relaxing moment, away congressman and Ethel Dupont (heir from the scrutiny of a troubled world, to the Dupont fortune), it would be he enjoyed his grandson Franklin quite easy to move within the upper Delano Roosevelt III’s comforting class with total disregard for those presence sitting next to him. of more humble origins. Frank It was an idyllic moment of family firmly acknowledges that he is very life, fleeting and never to be revisited fortunate “by an accident of birth” again. Less than a year later, two not to struggle as much as others do. weeks short of her 87th birthday, And so, he has committed his life to the grand matriarch would be helping those aspiring for something gone. Franklin would join his better with the chance to realize mother on April 12, 1945, a day their dreams. of profound sadness for much of After serving in the Navy, which the world. And Franklin Jr. would was certainly a family tradition, later join his ancestors on the day Frank went on to a storied career of his 74th birthday in 1988. Young as an educator. A graduate of both Franklin the third, the heir to the Yale and Columbia, with a Ph.D in Roosevelt name and legacy, is the economics from the New School, sole survivor from that photograph, and several published works the living embodiment of history. including a textbook he coI’ve known some people born authored, Frank taught at Sarah into wealth who have squandered Lawrence College from 1977 until their fortune, and contributed he retired two years ago. He still nothing to the betterment of gives lectures there from time to mankind. Frank’s grandfather, time and earned the title of President Roosevelt, was also professor emeritus. born wealthy and privileged yet He was on the board of directors dedicated his life to improving the at the Manhattan Country School, lives of the common people. The an educational facility dedicated to very same thing could be said about the proposition that every child has his grandson, Frank. Being the a right to have the very same grandson of the former President, quality of education regardless and the son of the former of their station in life. Children 32

ELLE CHYUN

Above: Frank at home in front of a painting by students at the Manhattan Country School.

go from pre-K through 8th grade at this prestigious private school.

Half of the school’s students are from very affluent families and half are from underprivileged households; those families who can well afford the tuition also pay for the other students who cannot.

After working his entire life, Frank could not accept retirement easily, and now works at Metropolitan College of New York, where his wife also teaches, pro bono.

This unique college provides

affordable education to those returning to the work force—people in the 30s, 40s, and 50s who are looking for a second chance in life.

Frank welcomes the opportunity to inspire these students, who refer to him affectionately as “Professor.”

Of the accomplishments in Frank’s life, one thing that he is most proud happened quite serendipitously. In the late 1980s, one of Frank’s friends, who lived on the top floor of 5 Riverside Drive in Manhattan, lamented over dinner 33

EMILIO GUERRA

one evening how Riverside Park had fallen into disrepair. They talked about Frank’s grandmother, Eleanor, and how much she meant to him.

And like a light bulb going on above his head, Frank had an epiphany: “It would be nice to see a statue of my grandmother there.” From that moment of inspiration there ensued a procession of proposals, meetings, and fundraisers (even then President Bill Clinton and his wife Hillary were part of the process).

At 72nd Street and Riverside Drive, in a formerly forlorn park, there now stands a stately

Above: The statue of Eleanor Roosevelt at Riverside Park in Manhattan.

34

statue of Eleanor Roosevelt—a fitting memorial to Frank’s beloved grandmother.

We all have pictures, buried in photo albums and hanging on walls, that capture a moment in time and fond memories. I cherish those who have been part of those times and who continue to inspire me.

Memories in faded photos—these are the monuments that endure and remind us of them.

Writer’s Note: When my mother went into an assisted living facility at age 90, we moved pictures of my ancestors with her to decorate the walls in her new home. I labeled the backs of each photo with the names and relationship of those pictured. I give this as good advice to others to preserve their family mementos for younger generations.

Walter Backerman is best known as Walter the Seltzer Man, a third generation seltzer delivery man in New York City who works the route that was originally created on horse and cart by his grandfather in 1919. Walter has a great fondness for American history, particularly of the 20th century, and is an avid collector of popular culture memorabilia.

NO GYMED

R I U Q RE

USING NEUROBICS FOR BRAIN FITNESS

“Neurobics” is a form of

MIKE AGLIOLO/CORBIS

mental stimulation that is simple and quite fun. Popularized by the late neurobiologist Dr. Lawrence Katz, the idea behind these activities is to consciously use your six senses—the five physical senses and your emotional sense—to engage different parts of the brain to do your daily tasks.

35

DONALD REILLY, THE NEW YORKER COLLECTION/THE CARTOON BANK

So how do neurobic exercises work? Neurobics involves using your senses in everyday activities in a slightly different way. Dr. Katz professed that as you do the exercises, you encourage new brain cell growth as different, underused nerve path-ways and connections get activated, resulting in lower levels of age-related mental decline.

Neurobic exercises can range from the practice of using your nondominant hand to brush your teeth to learning to read Braille in order to increase your sensitivity to touch.

It can be a form of mental stimulation to create your own neurobic exercises. When doing so, it is important to remember to break your routine in a significant way, be conscious of what you are doing, and to use one or more of your senses in a new context.

36

NEUROBIC EXERCISES To stimulate your senses and improve your brain’s function • Upon waking, smell something like a container of peppermint

• Walk through a familiar room with your eyes closed

• Take a shower with your eyes closed

• Practice handwriting instead of typing on a keyboard

• Use your non-dominant hand to complete tasks such as brushing your teeth or eating a meal

• Use an unfamiliar scented candle

• Dress yourself using only one hand

• Learn Braille or sign language

• Visit a new place such as a park that you are unfamiliar with • Walk backwards in a familiar room • Change your favorite reading spot • Step out of your front door with your non-dominant foot

• Rearrange the contents of your drawers or cabinets

• Set time limits to activities, such as finishing a puzzle • Eat outside if the weather permits • Try a new class or activity, such as yoga or gardening • Read a new magazine that you are not yet familiar with

37

LEON DANIEL/THE LIFE PICTURE COLLECTION/TIME & LIFE PICTURES/GETTY IMAGES

MAN’S BEST THERAPIST The Growing Field of Pet Therapy

S

by SEAMUS MULLARKEY

igmund Freud, the father of psychoanalysis, often had his pet dog, Jofi, present during his sessions, something that he felt helped his patients to relax and confide in him. Today, specialists in elder care are now recognizing just how beneficial interactions with animals can be as we age.

The modern field of AAT (animalassisted therapy) is a steadily growing field of practice and research.

38

Animals have been deployed for at least the past 200 years in such therapeutic fields as trauma recovery and aiding in the performance of everyday duties among those physically incapacitated. However, their use as a specific targeted means to maintain cognitive function in an aging population is a relatively new area of academic interest.

Research in the field is ongoing with new studies being conducted

on a regular basis. For example, pet therapy for those afflicted with later-stage Alzheimer’s seems to offer benefits in a number of different ways. Firstly, quiet and structured interactions between with dogs have been shown to produce a calming effect on patients as witnessed by lowered blood pressure and decreased agitation.

Second, pet therapy can be effective in boosting social interactions, decreasing loneliness, and offering an overall improvement to mood.

Additionally, playing with and grooming therapy animals can offer a chance to practice coordination and motor skills.

Pet therapy is a widely growing field at such leading medical institutions as the Mayo Clinic and Mount Sinai Hospital, and shows every sign of increasing in importance as holistic approaches become more widely accepted and practiced.

Do you have an anecdote about pet therapy and its benefits to share with other readers?

If so, please send an e-mail to christinaburns@salonps.com

MORE ABOUT PET THERAPY • While 95% of therapy animals are dogs, other animals including cats, rabbits, and even chickens have been successfully used.

• Effectively trained therapy animals are taught to behave calmly and not be distracted in the presence of unfamiliar people.

• Not all patients are comfortable around animals or will benefit from it. In cases of doubt, pet therapy experts advocate holding back and making sure the exposure is a little at a time.

• Therapy animals need regular breaks and lots of alone time to relax and recuperate, especially if they are residents on-site.

39

THE SCIENCE OF

RF PICTURES/CORBIS

WISER

40

IMAGEMORE CO., LTD./CORBIS

OLDER

by PHYLLIS KORKKI

41

WISER

S

ince ancient times, the elusive concept of wisdom has figured prominently in philosophical and religious texts.

The question remains compelling: What is wisdom, and how does it play out in individual lives? Most psychologists agree that if you define wisdom as maintaining positive well-being and kindness in the face of challenges, it is one of the most important qualities one can possess to age successfully—and to face physical decline and death.

Vivian Clayton, a geriatric neuropsychologist in Orinda, California, developed a definition of wisdom in the 1970s, when she was a graduate student, that has served as a foundation for research on the subject ever since. After scouring ancient texts for evocations of wisdom, she found that most people described as wise were decision-makers. So she asked a group of law students, law professors, and retired judges to name the characteristics of a 42

OLDER wise person. Based on an analysis of their answers, she determined that wisdom consists of three key components: cognition, reflection, and compassion.

Unfortunately, research shows that cognitive functioning slows as people age. But speed isn’t everything. A recent study in Topics in Cognitive Science pointed out that older people have much more information in their brains than younger ones, so retrieving it naturally takes longer. And the quality of the information in the older brain is more nuanced. While younger people were faster in tests of cognitive performance, older people showed “greater sensitivity to fine-grained differences,” the study found.

It stands to reason that the more information people have in their brains, the more they can detect familiar patterns. Elkhonon Goldberg, a neuroscientist in New York and author of The Wisdom Paradox, says that “cognitive

ALL IMAGES (UNLESS NOTED): 123RF.COM

templates” develop in the older brain based on pattern recognition, and that these can form the basis for wise behavior and decisions.

According to Dr. Clayton, one must take time to gain insights and perspectives from one’s cognitive knowledge to be wise (the reflective dimension).

Then one can use those insights to understand and help others (the compassionate dimension).

Working from Dr. Clayton’s framework, Monika Ardelt, an associate sociology professor at the University of Florida in Gainesville, felt a need to expand on studies of old age because of research showing that satisfaction late in life consists of things like maintaining physical and mental health, volunteering, and having positive relationships with others. But this isn’t always possible if the body breaks down, if social

HOW OUR

BRAINS AGE Through our lifespan, physical changes in the brain’s structure occurs, affecting our reasoning, perception, and knowledge as well as our personality and relationships.

INFANCY yy Communication begins through crying, then cooing and babbling yy Motor skills progress from simple reflexes to coordinated motor abilities such as grasping and walking; sensory and perceptual abilities develop rapidly yy Emotional responses change from basic reactions to more complex, selfconscious responses yy Early personality traits start to develop CHILDHOOD yy Frontal lobes become active leading to the development of emotions, attachments, planning, working memory, and attention yy Emotional well-being is shaped with experiences, helping to fine-tune the brain’s responses to stimulation yy A sense of self develops as the parietal and frontal lobe circuits become more integrated (CONT’D ON PAGE 45) 43

An acceptance of aging is necessary for growth, but “it’s not a resigned acceptance; it’s an embracing acceptance.” roles are diminished and if people suffer major losses. “So these people cannot age successfully?

They have to give up?” she recalled asking herself.

Wisdom, she has found, is the ace in the hole that can help even severely impaired people find meaning, contentment, and acceptance in later life. She developed a scale consisting of 39 questions aimed at measuring three dimensions of wisdom. People responding to statements on Professor Ardelt’s wisdom scale—things like “a problem has little attraction for me if I don’t think it has a solution,” or “I can be comfortable with all kinds of people,” and “I’m easily irritated by people who argue with me”—were not told they were being measured for wisdom.

Respondents later answered questions about hypothetical challenges 44

and crises, and those who showed evidence of high wisdom were also more likely to have better coping skills, Professor Ardelt found. In general, for example, they said they would be more active than passive about dealing with hardship.

An impediment to wisdom is thinking, “I can’t stand who I am now because I’m not who I used to be,” said Isabella S. Bick, a psychotherapist who, at 81, still practices part-time out of her home in Sharon, Connecticut. She has aging clients who are upset by a perceived worsening of their looks, their sexual performance, their physical abilities, their memory. For them, as for herself, an acceptance of aging is necessary for growth, but “it’s not a resigned acceptance; it’s an embracing acceptance,” she said.

“Wise people are able to accept reality as it is, with equanimity,” Professor Ardelt said. Her research shows that when people in nursing homes or with a terminal illness score high on her wisdom scale, they also report a greater sense of well-being. “If things are really bad, it’s good to be wise,” she said.

The Berlin Wisdom Project, a research effort begun in the 1980s

BOTTOM IMAGE: MARIA SCHRIBER/CULTURA/CORBIS

that sought to define wisdom by studying ancient and modern texts, called it “an expert knowledge system concerning the fundamental pragmatics of life.”

A co-founder of the project, Ursula M. Staudinger, went on to distinguish between general wisdom, the kind that involves understanding life from an observer’s point of view (for example, as an advice giver), and personal wisdom, which involves deep insight into one’s own life. True personal wisdom involves five elements, said Professor Staudinger, now a life span psychologist and professor at Columbia University. They are selfinsight; the ability to demonstrate personal growth; self-awareness in terms of your historical era and your family history; understanding that priorities and values, including your own, are not absolute; and an awareness of life’s ambiguities.

ADOLESCENCE yy The prefrontal cortex is the last to mature, which involves the control of impulses and decision-making, personality expression, and moderating social behavior yy Logical thought progresses to abstract thinking; long-term knowledge base grows yy Ability to grasp irony and sarcasm develops ADULTHOOD yy The brain reaches peak power at around age 22 and lasts for about 5 years yy Cognitive abilities related to experience and intelligence flourish, leading to further formation of expertise yy By age 45–49, the capacity for memory, reasoning, and comprehension begins to wane ELDERHOOD yy Short-term memory, inductive reasoning, spatial orientation, and verbal memory may decline yy The brain becomes physically smaller (most of the weight loss is water) and functions more slowly yy Wisdom, experience-based problemsolving, and semantic knowledge increase; abilities to cope with stress and manage personal relationships improve 45

Wisdom in this sense is extremely rare, Professor Staudinger said, and research has shown that it actually declines in the final decades. As a coping strategy, it is better to be positive about life when you are older, she said, and the older people skew that way. They are more likely to look back on their lives and say that the events that occurred were for the best; a wise person would fully acknowledge mistakes and losses, and still try to improve.

True wisdom involves recognizing the negative both within and outside ourselves and trying to learn from it, she said. Modern definitions of wisdom tend to stress kindness—even if it’s not on the order of Buddha, Gandhi, or the Dalai Lama. Wisdom is characterized by a“reduction in self-centeredness,” Professor Ardelt said. Wise people try to understand situations from multiple perspectives, not just their own, and they show tolerance as a result. “There’s evidence that people who rank high in neuroticism are unlikely to be wise,” said Laura L. Carstensen, a psychology professor and founding director of the Stanford Center on Longevity 46

in California. “They see things in a self-centered and negative way and so they fail to benefit emotionally from experience, even though they may be very intelligent.”

Professor Carstensen does not consider herself a wisdom researcher because “there’s a piece of me that thinks it’s not useful to use a term that’s been around for 1,000 years.”

Some researchers are skeptical about testing for such an amorphous trait as wisdom.

But Professor Carstensen does study emotional regulation, and says that is a key component of wisdom. If you are wise, she said, “You’re not only regulating your emotional state, you’re also attending to another person’s emotional state.” She added: “You’re not focusing so much on what you need and deserve, but on what you can contribute.”

Daniel Goleman, author of Focus and Emotional Intelligence, said, “One aspect of wisdom is having a very wide horizon which doesn’t center on ourselves,” or even on our group or organization.

He said an important sign of wisdom was “generativity,” a term used by the psychologist Erik

Erikson, who developed an influential theory on stages of the human life span. Generativity means giving back without needing anything in return, Dr. Goleman said. The form of giving back could be creative, social, personal, or financial, and “the wisest people do that in a way thatdoesn’t see their lifetime as limiting when this might happen,” he said.

Dr. Goleman interviewed Erikson, along with his wife, Joan, in the late 1980s, when both were

6

in their 80s. Erikson’s theory of human development had initially included eight stages, from infancy to old age. When the Eriksons themselves reached old age, though, they found a need to add a ninth stage of development, one in which wisdom plays a crucial role. “They depict an old age in which one has enough conviction in one’s own completeness to ward off the despair that gradual physical disintegration can too easily bring,” Dr. Goleman wrote in The Times.

FACTORS IN PROMOTING

BR AIN HE ALTH

AVOIDING HYPERTENSION High blood pressure speeds up normal brain shrinkage and loss of mental abilities.

PHYSICAL EXERCISE ACTIVELY An increased heart rate LEARNING pumps more oxygen to Constantly learn the brain, and and keep your improves brain brain active. function.

GENERAL HEALTH Eat a balanced diet, don’t smoke, and maintain healthy blood pressure and cholesterol levels.

REST About 7–8 hours of sleep a night may help prevent memory loss.

REDUCING STRESS Stress leads to the release of a hormone that in large amounts wears away the neurons in the hippocampus.

47

In the final years of life, “Even the simple activities of daily living may present difficulty and conflict,” Joan Erikson wrote in an expanded version of her husband’s book,The Life Cycle Completed. “No wonder elders become tired and often depressed.” The book adds: “To facedown despair with faith and appropriate humility is perhaps the wisest course.” “One must join in the process of adaptation. With whatever tact and wisdom we can muster, disabilities must be accepted with lightness and humor.”

Whatever the nature of one’s limitations, simplifying one’s life is also a sign of wisdom, Dr. Clayton said, for example, by giving your things away while you are still alive. Some people have trouble with the idea of settling for less— “they’ve gotten so used to the game of acquiring more,” she said.

Settling for less and simplifying is not the same as giving up. In fact, when older people lack challenges, self-absorption and stagnation may take over, the Eriksons said.

The key is to set goals that match one’s current capacities.

Continuing education can be an important way to cultivate wisdom 48

in the later years, researchers say, for one thing because it combats isolation. But training in practical skills may be less useful for older people than courses in the humanities that help people make sense of their lives, Professor Ardelt says.

She and other researchers recommend classes in guided autobiography, or life review, as a way of strengthening wisdom. In guided autobiography, students write and share their life stories with the help of a trained instructor.

Dr. Clayton says there’s a point in life when a fundamental shift occurs, and people start thinking about how much time they have left rather than how long they have lived. Reflecting on the meaning and structure of their lives, she said, can help people thrive after the balance shifts and there is much less time left than has gone before.

From The New York Times, March 13, 2014 © 2014. All rights reserved. Used by permission and protected by the Copyright Laws of the United States.

The printing, copying, redistribution, or retransmission of this Content without express written permission is prohibited.

COMMUNICATING

to Someone with

DEMENTIA

by JANICE LYNCH SCHUSTER

ILLUSTRATION Š MYRA MUSGROVE

L

ast year, my 93-year-old grandmother reported that she’d seen three giraffes in her backyard. She is otherwise sharp (and also kind and funny), but the giraffe episode was evidence of the mild cognitive

impairment that has been slowly creeping into her life. Not knowing how to respond, and not wanting to argue

with her, I turned

to the experts.

Communicating with someone who

has a cognitive impairment can be frustrating and disheartening, even downright depressing for patient and caregiver alike.

49

But as an ever-growing number of us face this challenge, learning what to do is essential.

Among strategies that work, the most effective and popular is the “Validation” method, a practice pioneered by geriatric social worker and researcher Naomi Feil in the 1980s. With it, you focus on validating the person’s experience—to empathize, even if what the person is expressing doesn’t make sense.

In my grandmother’s case, Feil told me, that might have been to ask how tall the giraffes were or how my grandmother felt upon seeing them. (First, of course, you work with physicians to be sure underlying physical problems have not simply impaired the person’s vision.)

“You match her emotions,” Feil said. “You communicate that you know that it’s real and meaningful for her, [that] she’s not psychotic or hallucinating.”

“Validation was one of the first approaches,” says Mary A. Corcoran, an associate dean at George Washington University School of Medicine and Health Sciences. In fact, the Validation method was the basis for a series of six training DVDs for health care workers that 50

CMS developed and distributed to each of the nation’s more than 15,000 nursing homes.

People hoping to maintain or improve communication with those who have cognitive problems can use principles of the Validation method on their own, Feil says.

These approaches can help with issues related to repetitive statements or questions, angry outbursts, false accusations, or the longing to go home. In each instance, Feil advises caregivers to “center,” by focusing on their breathing. Breathe in through the nose, she says, count to eight, and then exhale. Repeat this six times. It’s a different take on the adage about counting to 10.

In the case of someone who repeatedly asks a question, Feil suggests you “imagine the opposite.” If the patient keeps asking what time you’ll leave, for instance, ask, “What will happen if we don’t? Are you worried?

Do you think we’ll be late?”

Feil suggests using “polarity”—ask “What would be the worst thing that could happen?” In listening to the response, recognize that you are looking for what’s behind the answer: What is causing the anxiety?

What are the underlying concerns?

Once you understand what the worries are, you can try to ease or dispel them.

If you are feeling frustrated with your loved one, take a minute, Feil says, and move. Just go up and down the stairs (if you can), or do something else physical to release your own tension.

She recommends finding someone to talk to, perhaps by joining an Alzheimer’s support group. Not talking about what is happening, Feil says, can lead caregivers to “blow up and not be able to use any of these techniques.”

Patients with dementia can sometimes experience angry outbursts.

Center yourself, Feil suggests, and then look closely at the person: Observe her eyes, her facial muscles, anything to distract you from your own reaction.

Try to rephrase what the person has said. “Pick up her emotion,” Feil says. “Reflect it. Then you have some communication.”

Caregivers can feel hurt and confused by accusations that they have stolen or hidden a patient’s belongings. For some, these items symbolize some other aspect of life.

Feil suggests that these patients may really be saying, “ ‘I’ve lost my youth, my husband, my money, my power, my control.’ It’s a coping method, blaming others.”

Right: Two friends; the woman on the right has Alzheimer’s disease, Boston, Massachusetts.

Credit: age fotostock/SuperStock

51

Feil recommends, however, resisting the temptation to just say anything to get the other person to stop. That, she says, can be patronizing. At some level, the patient will feel belittled.

Instead, Feil recommends listening and allowing emotions to be expressed. Try reminiscing about the object, the time or place or people it represented.

Finally, if you are at a loss trying to respond to someone who simply wants to “go home,” ask specific questions. “Where would you like to go?” Feil suggests. “Who do you want to see the most? What would you do first?” If they are disoriented about a long-dead loved one, ask, “When did you last see him? What did he say to you? Talk about that person and reminisce.”

In advanced stages of the disease, when people simply cannot speak, Feil urges people to turn to music and touch, which connect to our most basic instincts.

Lisa Snyder, a social worker at the Shiley-Marcos Alzheimer’s Disease Research Center at the University of California at San Diego and the author of Living Your Best with Early-Stage Alzheimer’s, urges care52

givers to acknowledge the power of nonverbal signals.

“Sometimes, as cognitive thinking abilities become comprised, the person becomes more attuned to body language, and picks up on stress or irritation,” she says. “They can read our body language. The person is looking for cues, and you have to attend to that.” Watch what you might be expressing, and do your best not to project negativity.

“It’s so important to know that [people with dementia] aren’t infants, they’re not their disease. They are people with needs, and you can communicate with them. You need to go where they are; they won’t come to you. Their world makes sense to them, and they often are very creative. The idea in Validation is to keep communicating with the person, wherever they are.”

Janice Lynch Schuster is the senior writer for the Altarum Institute Center for Elder Care and Advanced Illness in Washington, DC, and an author of Handbook for Mortals: Guidance for People Facing Serious Illness. A longer version of this article first appeared in The Washington Post in April 2013.

BOOKS

THE FUTURE OF THE MIND

I

The Scientific Quest to Understand, Enhance, and Empower the Mind

n a not-too-distant future, Michio Kaku envisions machinebrain interfaces (MBIs) that will permit paraplegics to walk with the aid of exoskeletons and will manufacture words for those who cannot speak; humans will be able to move things with their minds and interact with their environment simply by thinking. We will be able to converse telepathically with one another. A bit farther into the future, Kaku sees a time when memories can be recorded and shared among people, stored for the future, and even downloaded back into the brains of Alzheimer’s sufferers and others whose memories have degenerated.

A bit farther into the future yet, and information and knowledge, like other languages, will be downloaded directly into our brains.

This is not wild conjecture.

Kaku systematically describes the

explosion of research and understanding about the brain that has occurred in the last twenty years. Our understanding of the brain’s complex mechanisms and processes, and our proficiency in technologies will help us improve our lives and treat the malfunctions of the mind. He clearly summarizes the research on the brain— where we currently stand in terms of what can and can’t be done, and what the long-term implications of our discoveries are. All in all, the book is a fascinating introduction into the science of the brain.

But what does a theoretical physicist know about the mind?

In this latest book, Kaku offers not his own research, but presents the work of many others, offering clear descriptions and examples, and making science accessible for everyone.

53

FUN & GAMES FOR KIDS Solutions on page 62

Zig-Zag Word Search Matching Game Each butterfly has a twin. Which one of these butterflies is different from the rest?

54

Words go left, right, up, down, but not diagonally and can bend at a right angle. There are no unused letters in the grid, every letter is used only once.

Family & Food Maze It’s baby’s first birthday and time for a celebration! Help each family member at the table find their way to their favorite food.

Connect-the-Dots Draw a line from dot number 1 to dot number 2, then from dot number 2 to dot number 3, 3 to 4, and so on. Continue to join the dots until you have connected all the numbered dots. Then color the picture!

55

FUN & GAMES Solutions on page 63

Crossword Puzzle

ACROSS 1. Standards 6. Ailing 10. Senate position 14. Writer Jong 15. Yours, in Tours 16. Yard tunneler 17. Central nervous system 18. Sat on the back of a horse 19. Wight or Man 56

20. Annoyance 23. From an Aegean island 27. Pennies 28. Vivacity 29. Father or mother 34. Taboos 36. Pack animal 37. Fish eggs 40. In spite of

43. Santa 44. Bullwinkle, e.g.

45. Conger catcher 46. To a greater extent 48. That’s !

49. 1980s attorney general 53. Didn’t exist 55. Advertisements 60. Per 61. even keel 62. Klondike territory 67. Years in old Rome 68. Attention-getter 69. Self-respect 70. Aggregate 71. London district 72. Fungal infection DOWN 1. Kan. neighbor 2. Eight-time Norris Trophy winner 3. Narrow inlet 4. AT&T rival 5. Capital of Yemen 6. Puppeteer Tony 7. Like not 8. Musical ending 9. Capital of the Ukraine 10. Strike 11. Red fluorescent dye 12. Ration out 13. Ages between 13 and 19

21. Econ. indicator 22. Broadway opening 23. Medicinal shrub 24. Crazy as 25. Devilfish 26. pronounce you...

30. Detest 31. Charlotte 32. Some Art Deco works 33. Heston’s org.

35. Cook just below the boiling point 37. Lunar valley 38. a million 39. “Snowy” bird 41. Likewise 42. Letter opener 47. Have title to 49. Woman in charge of a household 50. Minneapolis suburb 51. 2, 4, 6, 8, etc.

52. Big rigs 54. Exodus origin 56. Outstanding 57. Not many words 58. Scarf 59. A big fan of 63. Altdorf’s canton 64. Family 65. Form of poem, often used to praise something 66. PBS benefactor 57

FUN & GAMES Solutions on page 63

Easy as ABC Easy as ABC—also known as ABC End View or Last Man Standing—is a logical puzzle played on a square grid. The objective is to fill the grid with the letters A through G. Each row and each column must contain only one instance of each letter. The clues outside the grid show which letter comes across first from that direction. www.sudoku-puzzles.net

Sudoku Sudoku—also known as Number Place—is a logicbased, combinatorial numberplacement puzzle. The aim of Sudoku is to enter a number from 1 through 9 in each cell of a grid. Each row, column, and region must contain only one instance of each number. www.sudoku-puzzles.net

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HOROSCOPES

by Chris Flisher M AY/JUNE 2014

ARIES (March 21–April 19) By now your direction may be clearer and the bubbling activity of the cosmos may have settled somewhat. Your ruling planet, Mars, is moving forward and by the end of July it will clearly be in gear, guiding your every move. This may come as a great relief to you since you rarely sit still for long. As Mars zips by in opposition to Uranus you may expect a delightful surprise as Venus sweetens the conversations and brings some welcome relief to what has been an arduous time for you.

TAURUS (April 20–May 20) By now much of the turbulence of the last few months should have steadied and you can now prepare for moving forward in a positive and expansive manner.

You may witness some surprise changes happening in your daily routine, which can be anything from moving to a new dwelling to starting a new venture such as joining a group and the like. This time presents a wonderful opportunity to deepen your knowledge with

intriguing classes and research.

Whatever changes your make in your daily schedule should prove to be stimulating.

GEMINI (May 21–June 21) This may be a very active time for you and your quick-thinking mind. You love group activities with lots of conversations about interesting topics and this period should be perfect for such gatherings. You may have several pleasant, unexpected encounters with new people. One area you would do well to investigate would be your finances. This should be a great time for making changes to your portfolio or your estate. You may have a good grasp of this topic, but a little outside advice could help you make wise choices.

CANCER (June 22–July 22) Jupiter and Mercury will be in Cancer and you may appear to be the life of the party as the spotlight shines favorably on you.

Others will feel a natural warmth from you and your significant 59

partner may benefit the most from your bright attitude. Your home life may be changing as a surprise announcement may deliver news of a new family member on the way or a new engagement of some sort involving younger family members.

This may provide an opportunity for you to step in with your creative skills and prepare for such an event.

LEO (July 23–Aug. 22) Significant new patterns may be emerging in your daily chores.

You may decide to introduce a new “family member” such as a fourlegged friend or perhaps a chirping canary. It may seem simple at first glance, but having the responsibility for another creature can be incredibly rewarding and purposeful. It may open up a whole new world as people recognize you as a pet-lover and new friendships are quite likely as you share something in common with others. It may have been a while since you had this in your daily world, but a low-maintenance pet may fit the bill.

VIRGO (Aug. 23–Sept. 22) This should prove to be quite an enjoyable and engaging period 60

where group events are especially fulfilling. You may decide to pursue a hobby that puts you in touch with others who share the same desire.

The underlying motive may be an expression of your creativity that may have been under wraps for some time. This may be the perfect time to revive a part of your life that you may have hidden for a while or gave up due to other time constraints. See this as a time for awakening that inner child in you.

LIBRA (Sept. 23–Oct. 22) You may be witnessing a flurry of activity as the universe sends you bolts of energy and rapid changes. This can be a fabulous time for self-expression through your career or daily life. Random encounters with people may be filled with coincidence and sudden realizations out of the blue. This very pleasing climate may bring about changes in your significant relations such as friends and lovers who can sense a revived spirit in your daily mode. You may also be working on changing the landscape of your very basic home life.

SCORPIO (Oct. 23–Nov 21) You are quite a sleuth and when matters require a dedicated person to do lengthy investigations, you are a natural. Mysteries are such a large part of your makeup that you may find it hard to ignore clues and overheard comments. When you put this talent to work you can be quite a boon to a friend who could use your natural abilities to worm their way through a complex set of instructions. Legal issues and insurance claims can be cumbersome for many, but you seem to rise to the occasion with a surprising zeal.

SAGITTARIUS (Nov. 22–Dec. 21) You may in the midst of a highly charged creative period in your life. As such, it may be wise to keep a notebook handy for when those ideas come flashing through.

This type of insight may be useful especially around the house where you envision new changes to shake up your daily routine.

Collaboration may be favorable, especially if you can engage your partner or a close friend.

Conversations between you

and others may be extremely helpful for getting your thoughts together. Just having a second opinion may be all you need.

CAPRICORN (Dec. 22–Jan. 19) Expect to see a lot of positive activity with significant relationships during this period. You may be having great conversations about deep topics that, in turn, may inspire you in highly unusual ways.

When this type of alignment occurs you may be highly creative regarding home and work life. You may even feel restless and eager to make a long-standing change. Like pulling into a foreign train station you may depart from this period renewed, curious, and enthusiastic.

This can signal a marvelous time for reinventing yourself into something completely different.

AQUARIUS (Jan. 20–Feb. 18) You may be very interested in humanitarian activities especially if they are health-related. You may decide to offer your time to help further a cause for a friend or organization that could use your special skill set. This may be a wonderful combination of activities that shake 61

you out of a routine and present you with new people. You may be in a unique position to leave a very profound impact on an organization that could benefit from your expertise. This opportunity may seem perfectly suited to you, so seize the chance if it comes along.

PISCES (Feb. 19–March 20) Peer groups and business associates may be singing your praises as you work towards a

transition of sorts. These types of relationships may have been vital at different points in your career and the impressions you made have been significant. Yet, despite that, you may feel much inspired to blaze a new path and that may include something closer to your heart.

Writing and being creative are the first areas that may resonate with you as you look to find an outlet that satisfies you at the same time that it restores your sense of self. Š 2014 Chris Flisher

FUN & GAMES SOLUTIONS Matching Game Solution 7 (1 and 8, 2; 5 and 9; 3, 6 and 10; 4 and 11)

Zig-Zag Word Search Solution

Family & Food Maze Solution Grandpa: mushrooms Son: French fries Father: pizza Baby: carrot Mother: watermelon Daughter: cake Grandma: cheese

Connect-the-Dots Solution

62

Crossword Puzzle Solution

Easy as ABC Solution

www.sudoku-puzzles.net

Sudoku Solution

www.sudoku-puzzles.net

63

BRUCE ERIC KAPLAN, THE NEW YORKER COLLECTION/THE CARTOON BANK

THE L AST L AUGH

“Remember thoughts?”

Give or Take Ten Years

W

hile at a reception party, a young man struck up a friendly conversation with a much older woman.

Eventually, the woman asked the man to guess her age.

“You must have some idea of how old I am,” she urged, as he hesitated.

“I have some idea,” he said. “I just don’t know whether to make it ten years younger because of the way you look, or ten years older because of your intelligence.”

64

It’s time to change the conversation.

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