Seniors in a War Zone

Mounting evidence suggests that traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) resulting from military exposures increase the risk of developing neurodegenerative diseases such as Alzheimer’s disease (AD). The military population face a unique set of risk factors that may increase the risk of being diagnosed with dementia. Traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) have a higher prevalence in this group in comparison to the civilian population. By delving into the individual relationships between TBI and dementia, and PTSD and dementia, we are able to better explore dementia in the military and veteran populations. While there are some inconsistencies in results, the TBI-dementia association has become more widely accepted. Moderate-to-severe TBI has been found to increase the risk of being diagnosed with Alzheimers disease.

Research reports that Government armed forces and non-state armed groups have unlawfully attacked and killed older civilians and subjected them to summary executions, arbitrary arrest and detention, torture and other ill-treatment, rape, abduction and kidnapping, and the destruction of their homes and other property. Older civilians have been killed and injured by small arms, heavy weapons, explosive weapons with wide area effects and chemical and other banned weapons. In Syria in March 2017, United States aircraft attacked the Omar Ibn al-Khatab mosque near al-Jinah, a village in Aleppo province, where about 300 people had gathered for religious lectures and the Muslim Isha’a, or night prayer. The attack killed at least 38 people. “Mahmoud,” who witnessed the attack, said: “Some were old in their 70s and 80s, some young in their 20s, children. There weren’t any people affiliated with armed groups there, nothing of that sort.”

Sleep problems have been observed to occur in those following TBI, PTSD and deployment. Poor sleep has been associated with possible dementia risk. Although limited studies have focused on the link between sleep and dementia in military and veteran populations, sleep is a valuable factor to study due to its association and interconnection with other military veteran factorsGovernment forces and non-state armed groups have summarily executed older people. In the Central African Republic, where a proliferation of armed groups has been fighting since 2013, Seleka forces executed Dieudonne, a 60-year-old man who had been hiding in a family compound nearby a displacement camp in July 2017. Government forces and non-state armed groups have arbitrarily arrested and detained older civilians. In Ethiopia in July 2021, after Tigrayan forces recaptured most of the Tigray region, authorities arbitrarily arrested and detained older Tigrayans in the capital, Addis Ababa. Amhara forces controlling the Western Tigray zone also detained older people in overcrowded detention sites and subjected them to beatings and other forms of ill-treatment.

Governments and non-state armed groups have subjected older people in their custody to various forms of torture and cruel, inhuman and degrading treatment. Common cases reported include beating and kicking, use of stress positions, and sexual violence, as well as denying medical treatment, food, and water. In Mali, where Islamist armed groups and Malian security forces have engulfed civilians in conflict, a 60-year-old shepherd described his interrogation by Malian soldiers in 2015. Armies, militias, and rebel forces have destroyed and looted older people’s property. Older people have described the devastation of losing everything they have spent their lives working towards. In May 2021, Israeli military airstrikes destroyed four high-rise buildings in Gaza City that contained many homes and businesses. Jawad Mahdi, 68, an owner of a destroyed building who lived there with dozens of family members, said “All these years of hard work, it was a place of living, safety, children and grandchildren, all our history and life, destroyed in front of your eyes.

During hostilities older people have chosen not to flee their homes when fighting neared. They thought they would not be attacked, or wanted to protect their family’s property, or had suffered physically or emotionally from fleeing earlier attacks. In many other instances, older people have been unable to flee because of limited mobility, disability, or because families could not assist their flight. In 2017, Rohingya who fled Myanmar security force atrocities in Rakhine State described security forces pushing older people who could not flee back into burning houses. I think they wanted everyone to leave and those that could not leave they put into the fire. Older people who have been displaced have faced abuse while in flight or in displacement camps. In the Far-North region of Cameroon, the Islamist armed group Boko Haram carried out attacks deliberately targeting civilians.

A story of a person left the house and saw numerous Boko Haram fighters outside. As they ran away for my life, they shot me in the stomach. They found themselve on the ground, an inexplicable pain striking my body. And was bleeding profusely, and had lost consciousness. Displaced older people have also faced barriers to registering for and obtaining humanitarian assistance. In South Sudan in 2017, displaced older people who sought refuge in remote bush areas or on islands were more likely to encounter difficulties getting aid than those who found their way to the Protection of Civilian sites inside UN bases. Other groups have documented similar abuses against older people affected by conflict. For example, Amnesty International has published reports on crimes under international law and other abuses against older people in conflicts in Mozambique, Myanmar, Northeast Nigeria, and South Sudan. HelpAge International, a non-governmental organization working with and for older people, has documented the failure of humanitarian actors to meet humanitarian standards and be inclusive of older people in their responses to conflict driven displacements in Ethiopia, Jordan, South Sudan, Syria, Tanzania, and Yemen. While older people are protected by international humanitarian law and international human rights law during armed conflict, in practice their needs and protections are often disregarded by the parties to the conflict. Governments, non-state armed groups, peacekeeping missions and the relevant United Nations agencies should do more to ensure adequate recognition and protection of older people from abuse during conflict.

The UN Secretary Generals Protection of Civilian reports from 1998 to 2021 have paid little attention to older people with five brief mentions. The Secretary-Generals 2019 report on older people in emergency crises, including those due to armed conflict, addressed barriers to humanitarian assistance but not abuses during conflict itself. Only one UN Security Council resolution, on Sudan in 2007, has condemned violent attacks on older civilians. Because of the heightened risk they may face, older people require special attention by UN agencies and peacekeeping missions, aid organizations, governments, and others who have the ability to aid and offer protection to people in conflict situations and in humanitarian responses to older people displaced by conflict. All parties to armed conflict should protect and prevent abuses against older people and facilitate humanitarian assistance to older people in need. States should end impunity for crimes against older people and ensure their access to justice.

International humanitarian law says nothing about the age at which an individual is considered to be elderly. The Commentary on the Fourth Convention does, however, give an indication: “No limit was fixed for ‘aged persons’. The Conference refrained from naming a definite age, preferring to leave the point to the discretion of Governments. 65 seems, however, to be a reasonable age limit. It is often the age of retirement, and it is also the age at which civilian internees have usually been released. As far as the International Committee of the Red Cross (ICRC) is concerned, this is the threshold adopted for its activities in aid of the elderly. A certain degree of flexibility is, however, essential, and it is quite possible that assistance may be given to persons below the age of 65 but rendered especially weak and vulnerable by a physical handicap.

Protection of elderly members of the civilian population. Under international humanitarian law, the elderly are protected as persons not participating in the hostilities.
On the one hand, they enjoy protection from abusive behaviour on the part of the party to the conflict in whose power they are, being persons protected by the Fourth Geneva Convention. As such, they benefit from all the provisions that set forth the fundamental principle of humane treatment. In situations of non-international armed conflict, they are protected by Article 3 common to the four Geneva Conventions. On the other hand, as members of the civilian population they benefit from the rules of international humanitarian law relating to the conduct of hostilities. These rules, which uphold the principle of distinction between civilians and combatants and prohibit attacks directed against the civilian population, were given written expression in the Additional Protocols of 1977. The elderly also enjoy special protection because of their weakened condition, which renders them incapable of contributing to their countrys war effort.

Although the principle of equality of treatment is enshrined in several provisions of humanitarian law, the law does allow for exceptions whereby more favourable treatment is granted in certain circumstances. Article 27, paragraph 3, of the Fourth Geneva Convention states: ” Without prejudice to the provisions relating to their state of health, age and sex, all protected persons shall be treated with the same consideration by the Party to the conflict in whose power they are, without any adverse distinction based, in particular, on race, religion or political opinion. But it is an uncomfortable truth that while war does not discriminate, the international response does. Time and again, the toll of war on older people is overlooked as they struggle to survive and piece together a new normal. As this conflict unfolds, there are millions of older people confronting the scourge of war, isolated and alone.

One in three of the people needing assistance after the Russians invaded eastern Ukraine in 2014, were over 60, making it the worlds oldest humanitarian crisis. Yet the international community failed to recognise this, failed to identify and respond effectively to meet their specific needs. For many, conflict was not new, having lived through World War II, Soviet rule and the road to independence. Their bodies, minds and communities were already scarred. The local economy was on its knees, poverty and long-term unemployment had rocketed. Younger people had left for work elsewhere, leaving older relatives alone with nobody to care for them. There was no electricity or gas. Untreated chronic health conditions like diabetes and high blood pressure had caused many to lose their independence, develop disabilities and face unnecessary suffering. The fear of intermittent shelling and the risk of landmines was constant.

The contact line exacerbated isolation for so many. Those who lived in non-government-controlled areas, could only access healthcare and pensions by enduring long queues and bureaucracy to cross the line into government held territory. By 2019, more than 450,000 of the 1.2 million pensioners living in areas outside of government jurisdiction were surviving without a basic income because they were required to register as an internally displaced person to receive their pension. Not only were they living in a state of war, they could barely afford basic food supplies or medication.

A survey of more than 1,500 older people in eastern Ukraine at the beginning of March and found that 99% of older people in Donetsk and Luhansk had no plans to leave. For many, mobility difficulties mean leaving is not possible. Many do not have families nearby to help. Worse still, many cannot even reach the local shelters, making them sitting targets. Older people often remain at home in times of conflict. Some may stay because they do not want to be a burden to their families, they want to protect their home, or simply because of moving so many times before. But the body vest of being older is no protection for the barbarity of war. And the hand of assistance frequently fails to reach them in its aftermath. As the war sweeps further into Ukraine, there will be more older people left behind, isolated and in urgent need of food, water, heating, and mental health support. 25% of Ukraine’s population is over 60 years old.

Russias full-scale invasion of Ukraine, which began on 24 February 2022, has been characterized by a flagrant disregard for civilian life and frequent war crimes. Russia has indiscriminately attacked Ukrainian cities, including with banned weapons, committed extrajudicial executions in areas under its control, and targeted clearly marked civilian infrastructure in places like Mariupol. More than 13,000 civilians in Ukraine have been killed or injured a number the United Nations says is likely an undercount – and millions have been forced from their homes. Ukraine, where people over 60 years old make up nearly one-fourth of the population, is one of the “oldest” countries in the world. According to HelpAge International, the proportion of older people affected by the war in Ukraine is higher than that of any other ongoing conflict. This report shows how intersecting challenges, from disability to poverty to age discrimination, are compounded in emergency situations, putting older people at heightened risk.

Often reluctant or unable to flee their homes, older people appear to make up a disproportionate number of civilians remaining in areas of active hostilities, and as a result they face a greater likelihood of being killed or injured. Amnesty International documented several cases in which older people who stayed behind were hit by shelling or sheltered in harrowing conditions. Even when they succeed in escaping such dangers, older people face distinct challenges in displacement. In particular, this report explores how the war has negatively impacted the rights of older people in Ukraine to adequate housing and to full inclusion and participation in their communities. Once displaced by the conflict, older people are often locked out of the rental market by pensions that are well below real subsistence levels, particularly since rental prices have increased at an alarming rate. Support for older people who have disabilities is rarely provided in temporary shelters. As a result, at least 4,000 older people have been given no option but to live in state institutions for older people and people with disabilities. While the goal of this policy is undoubtedly benevolent, it is in conflict with the rights of older people with disabilities, segregating them in isolated settings where they can be subject to abuse.

Those older people who remain in their homes in conflict affected areas often do so because they have no alternative housing options or face greater difficulty evacuating. Many live in partially or fully destroyed housing that is dangerous to inhabit, lacking functional roofs, windows, electricity or heating, and without access to healthcare facilities, grocery stores or pharmacies. Information about evacuation plans, and evacuation routes themselves, are not always accessible to older people or adapted to their needs. In addition to the risk of being killed or injured, older people experienced health emergencies that went untreated as a result of staying in conflict-affected areas.

According to the UN High Commissioner for Refugees (UNHCR), nearly one-third of Ukrainians have been displaced by the conflict: 6.2 million people remain displaced within Ukraine, and 7.8 million are estimated to be refugees across Europe. According to the International Organization for Migration (IOM), about half of internally displaced families have at least one member who is over 60 years old. While there is no reason to believe that older people have experienced more damage to their homes than other groups, many face several intersecting risk factors, including poverty, employment discrimination, disability and health conditions, that make accessing housing more challenging for them in displacement.

Older people are more likely than other groups to have a disability. In the European Union (EU), nearly half of people over 65 report difficulties with at least one personal care or household activity, and the numbers are higher among newer member states in eastern Europe. In Ukraine, more than half of those people registered as having a disability are of pension age. Before the war, many older people with disabilities interviewed for this report had lived in apartments or homes that were adapted to their physical needs, such as with ramps or handrails. Older people with disabilities relied on formal and informal networks of family members, friends, neighbours, paid care workers or social workers to provide them the support they needed at home. Displacement shattered those support systems.

The catastrophic nature of war has deleterious impact on almost all individuals of the affected populations; amongst them older adults are known to be one of the most vulnerable groups. Along with the life changing economic and social adversities, the physical and mental health of the older adults are seriously impaired secondary to war. The consequences are immediate; but most continue long-term in fact, experiences of the war have lifelong impact. In addition, people who are exposed to war in younger age continue to have health related morbidities in the old age. There are enormous needs for protection, support and care of older adults during and in post-war situations. While efforts should be taken to mitigate the devastating effect of the war on all, including the elderly people it is important to prevent war at all costs.

Journal of Geriatric Care and Research 2022, Volume 9, Number 1 Editorial War and older adults consequences and challenges. The catastrophic nature of war has deleterious impact on almost all individuals of the affected populations amongst them older adults are known to be one of the most vulnerable groups. Along with the life changing economic and social adversities, the physical and mental health of the older adults are seriously impaired secondary to war. The consequences are immediate; but most continue long-term in fact, experiences of the war have lifelong impact. In addition, people who are exposed to war in younger age continue to have health related morbidities in the old age. There are enormous needs for protection, support and care of older adults during and in post-war situations. While efforts should be taken to mitigate the devastating effect of the war on all, including the elderly people it is important to prevent war at all costs. Aged, Health, Mental Health, Psychological Stress, War affects every body. It does not discriminate between any sides.

The interconnectedness of the world today is such that the impact of war is felt thousands of miles away even by the people who are not directly related to the war. As lives change, communities become displaced, people migrate, the overall influence of a war could be seen over generations of affected people. War is one of the greatest threats to the health and wellbeing of societies and it often continues to have impact over a life time and beyond. In fact, individual and community health are the immediate casualties of the war and these are often catastrophic in nature for affected populations. One of the major consequences of war is its deleterious effect on the mental health of the population; and the suffering could be intense considering the magnitude of losses. Besides lives and properties, the meaning of life is lost as well for many. Associated economic and social consequences of the war also affect communities and bring additional challenges for healthcare. While the trauma of war impacts everyone, it is the older adults who are one of the most vulnerable groups for the immediate and long-term consequences.

Their lives are irreparably damaged, with significant loss of lives of young generations ahead of them, their own failing health and without any hope of returning to previous socio-economic cultural stability, the psychological stress is catastrophic. Additional stressors along with the death and destruction, there are serious abuses of people, including older adults, during the war. These include arbitrary arrest and detention, abduction and kidnapping, torture, physical injury by various means, rape, executions, and other ill-treatmen in inhuman conditions. Many are confined to places without food and basic necessities. These stressors compound the problems people face during the conflicts. Immediate concerns of people migrate away from the war zones starting with the young and capable ones. Older people usually do not wish to leave their place, for emotional connectedness, and to protect their property but often logistics and health related issues come in the way. Understandably, they are often the last to move from the dangerous conflict areas. During displacement, older people are at particular risk of abuse and neglect because of their mobility issues, diminished vision and chronic illnesses which make the support process more difficult.

In the exile, they are socially isolated, and are often physically separated from their families, which increase their vulnerability further. There are massive concerns about the care and support of people who are displaced to different areas and countries as refugees. There are many practical issues: lack of basic necessities of life, overcrowding, separation from family members with no contact with each other, language and sociocultural differences presenting as barriers for effective support, overstretched health systems not being able to cater to the needs of large number of the displaced people, etc. All these affect elderly refugees harder. There remains a very limited healthcare support system for the older adults who stay back in the war torn regions, due to direct consequences of the destructions, there are damaged health care facilities, inadequate availability of medicines and clinical supply, and fewer numbers of healthcare personnel. All these lead to a highly diminished health service, meagre support and negative health outcomes. There are massive challenges for the health-care of everybody, especially the elderly, who would have an already compromised health status.

The world is aging rapidly, not a new phenomenon. In 2020, one billion people worldwide were 60 years or older about 13 percent of the total population. By 2050, one out of five people will be over 60, and more than 80 percent will live in low-income countries affected by humanitarian crises including conflict, natural disaster, and famine making these numbers a major concern. While the General Assembly of the United Nations has recognized older adults as a vulnerable group in humanitarian crises, traditionally, this population has not been prioritized for humanitarian assistance, and humanitarian responses have largely overlooked their needs. Despite global commitment, evidence still indicates that older adults face formidable barriers to accessing health services in low and middle-income nations during humanitarian crises. A dramatic example is the current war in Ukraine. The conflict in Ukraine is considered the “oldest” humanitarian crisis in the world given the large number of older adults who have been affected by it.

Many comments reflect the reality that in most states and localities, seniors housing and care is not being prioritized for the supplies and support that it needs, despite the fact that these communities are caring for millions of high-risk frail elders. The odds of experiencing recent PTSD symptoms are greater in respondents who report involvement in killing causing severe injury and who observed war atrocities. In women, PTSD is positively correlated with war era child death and spousal separation. Arthritis also exhibits a significant, positive association with killing causing severe injury. Our study provides insights into the burden of conflict upon health among populations of the global south that survived war and are now entering older adulthood. The pattern of results, indicating greatest suffering among those who inflicted or failed to prevent bodily harm or loss of life, is consistent with the concept of moral injury.

Attacks against women human rights defenders are extremely under reported and anonymized in official United Nations statistics. In general, women are much more likely than men to be targeted with sexual and gender based violence and to be subjected to verbal abuse, surveillance, and online violence. While all activists are targeted with defamation, smear campaigns, and online and offline hate speech, the attacks against women human rights defenders typically target their personal behaviour, their moral conduct. It was estimated that in 2020, there were 5.8 million people aged 65 years and over living with the Alzheimer’s sub-type of dementia in the United States.

Fish Diet

Researchers in the Department of Marine Science at Coastal Carolina University in Conway, South Carolina have recently taken a very interesting approach to this controversial trade off between the beneficial, anti-inflammatory omega-3s found in fish and their undesirable contamination with mercury. These researchers reviewed nutritional studies on the anti-inflammatory benefits of omega-3s to arrive at a daily intake recommendation of 500 milligrams for EPA plus DHA combined. Next, they estimated how many servings of fish would be required to meet this recommended level. In the case of canned albacore tuna, for example, they estimated that a person would need to consume 9 servings per month with 7 ounces per serving to provide an average daily amount of 500 milligrams of EPA plus DHA. Using a similar type of logic, they then took the National Academy of Sciences (NAS) recommended safe dose level for mercury, calculated a safe daily intake level of mercury from fish of 6.8 micrograms and estimated how many daily fish servings a person could consume without going over this 6.8 microgram limit. In the case of canned albacore tuna, they determined that only 3 servings of canned albacore tuna could be eaten each month if a person wanted to stay below the 6.8 microgram daily limit for mercury. Based on this logic, they concluded that canned albacore tuna did not provide a good trade-off between omega-3s and mercury since a person would need 9 servings per month to meet the omega-3 recommendation, but would actually have to stop after 3 servings in order to stay below the mercury limit. In fact, these researchers did not find any type of tuna not only canned albacore, but also canned light tuna and wild ahi tuna that was able to meet the omega-3 recommendation without exceeding the mercury limit. They did find other fish, however, that provided the desired amount of omega-3s without going over the mercury limit. These other fish included salmon, trout, shrimp and tilapia.

While we admire the creativity and logic used by these researchers to evaluate the trade-off between omega-3s and mercury in fish, we take a somewhat different approach while using their same logic. Like these marine science researchers, we think it’s important for individuals to minimize their food exposure to mercury, and we like the idea of staying below the NSA limit. However, we also believe there is no reason for a person to depend exclusively on fish for their omega-3s, nor do we believe that all of a person’s omega-3s must be provided in the form of EPA and DHA. Many foods can provide small amounts of omega-3s, and other forms of omega-3s like alpha-linolenic acid, found in many plant foods also help to provide us with anti-inflammatory benefits. For these reasons, we believe that individuals have the flexibility to enjoy tuna and other types of fish by focusing on their overall diet and making sure they get plenty of anti-inflammatory omega-3s from all of their foods combined, while still staying below the mercury limit in their overall diet. From a practical standpoint, this approach means including a variety of omega-3 foods in the overall diet, emphasizing fish that are lower in mercury contamination, and including higher mercury fish on a more limited basis. Wild caught Alaskan salmon, for example, could be eaten during the same week as tuna to help avoid excessive mercury exposure while still reaping the anti-inflammatory benefits of omega-3s. While small amounts of antioxidant nutrients like vitamin C, manganese, and zinc are provided by tuna, it is unusually rich in one particular antioxidant mineral, namely, selenium. This antioxidant is not only concentrated in tuna but is also present in an unusual form called selenoneine. Selenoneine is especially helpful to the tuna as a nutrient for protecting their red blood cells from free radical damage. Interestingly, it is also able to bind together with mercury compounds in the fish’s body including methylmercury, or MeHg and lower their risk of mercury related problems. 

Because there are approximately 2 to 3 milligrams of selenoneine in a 4-ounce serving of tuna, we are likely to get some of this same antioxidant protection whenever we eat tuna. Equally interesting, tuna may turn out to be a fish that even when contaminated with mercury might pose less of a mercury risk to humans than might otherwise be expected due to the presence of selenium in this special form of selenoneine. When you steam or sear or broil fresh tuna at home, this cooking process may also result in some special antioxidant benefits. These benefits are related to the presence of small protein fragments called peptides that may get formed during the cooking process when proteins in the tuna get broken down. Recent studies have shown that some of the protein breakdown products in tuna have strong antioxidant properties, including the ability to protect cell membranes from oxygen-related damage a process called lipid peroxidation. Mackerel is the name for several species of cold water, oily fish. These fish are gaining attention because of their high levels of omega-3 fatty acids, which are beneficial for cardiovascular health. The American Heart Association recommends eating fish at least twice per week. People with heart disease should consume about 1 g per day of omega-3 fatty acids, which are abundant in oily fish. Most fish provide protein, vitamins and minerals, and little saturated fat. They also are excellent sources of the omega-3 fatty acids eicosapentaenoic acid, or EPA, and docosahexaenoic acid, or DHA. Oily fish such as mackerel, salmon, tuna and sardines contain the highest levels of EPA and DHA. The body cannot produce these substances but needs them in order to function properly, as noted by the AHA. Omega-3 fatty acids might reduce the risk of irregular heartbeat, or arrythmia, and they slow the growth of plaque in the arteries.

Studies published in the journal Atherosclerosis in 1985 and 1986 evaluated the effects of mackerel in the diet on various cardiovascular health indicators. Men with mild high blood pressure ate canned mackerel every day in addition to a diet providing specific portions of protein, carbohydrates and fat. Atherosclerosis is a disease in which plaque builds up inside your arteries. Arteries are blood vessels that carry oxygen rich blood to your heart and other parts of your body. Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque hardens and narrows your arteries. This limits the flow of oxygen-rich blood to your organs and other parts of your body.

Climate Change / Seniors

Climate change will increase extreme heat events and lead to higher temperatures throughout the year. Extreme heat exposure can increase the risk of illness and death among older adults, especially people with congestive heart failure, diabetes, and other chronic health conditions that increase sensitivity to heat. Higher temperatures have also been linked to increased hospital admissions for older people with heart and lung conditions. Older adults with limited incomes who own air conditioning units may not use them during heat waves due to the high cost to operate them. Climate change affects the frequency and intensity of some extreme weather events, such as flooding (related to heavy rains, hurricanes, and coastal storms), droughts, and wildfires. Older adults are more likely to suffer storm and flood-related fatalities. For example, almost half of deaths from Hurricane Katrina were people over age 75, while for Superstorm Sandy almost half were over age 65. If an extreme event requires evacuation, older adults have high risk of both physical and mental health impacts. Some of the most vulnerable are people with disabilities, with chronic medical conditions, or living in nursing homes or assisted-living facilities.

Health impacts could be made worse by interruptions in medical care and challenges associated with transporting patients with their necessary medication, medical records, and any equipment like oxygen. Extreme events can also cause power outages that can affect electrically powered medical equipment and elevators, leaving some people without treatment or the ability to evacuate. Climate change worsens air quality because warming temperatures make it easier for ground level ozone to form and can lengthen the season of aeroallergens like ragweed pollen. Changing weather patterns and more intense and frequent wildfires also raise the amount of pollution, dust, and smoke in the air. These changes will increase the number of emergency department visits and hospital admissions, even for healthy older adults. Poor air quality worsens respiratory conditions common in older adults such as asthma and chronic obstructive pulmonary disorder (COPD). Air pollution can also increase the risk of heart attack in older adults, especially those who are diabetic or obese. Illnesses Spread by Ticks or Mosquitoes Climate change and increased temperatures will lead to ticks and mosquitoes expanding their ranges and being present for longer seasons. This means an increased risk of being bitten by disease-carrying ticks and mosquitoes. Lyme disease, which is spread by ticks, is frequently reported in older adults. The West Nile and St. Louis encephalitis viruses, which are spread by mosquitoes, pose a greater health risk among older adults with already weakened immune systems.

Illnesses Caused by Contaminated Water Climate change increases the contamination risk for sources of drinking water and recreational water. Older adults are at high risk of contracting gastrointestinal illnesses from contaminated water. Those already in poor health are more likely to suffer severe health consequences including death. In 2013, almost 28% of adults age 75 and older were described as in fair or poor health, compared to 6% for adults age 18 to 44. The Impact of Location Depending on where they live, some older adults can be more vulnerable to climate change related health effects than others. For example, about 20% of older adults live in an area in which a hurricane or tropical storm made landfall within the last 10 years. The increasing severity of tropical storms may pose risks for older adults living in coastal areas. For older adults residing in cities, factors such as the urban heat island effect, urban sprawl, and neighborhood safety may also present risks. For older adults and people with limited mobility who reside in multi-story buildings with elevators, the loss of electricity during a storm can make it difficult to get food, medicine, and other needed services.
Our Earth is warming. Earth average temperature has risen by 1.5°F over the past century, and is projected to rise another 0.5 to 8.6°F over the next hundred years.

Small changes in the average temperature of the planet can translate to large and potentially dangerous shifts in climate and weather. The evidence is clear. Rising global temperatures have been accompanied by changes in weather and climate. Many places have seen changes in rainfall, resulting in more floods, droughts, or intense rain, as well as more frequent and severe heat waves. The planets oceans and glaciers have also experienced some big changes oceans are warming and becoming more acidic, ice caps are melting, and sea levels are rising. As these and other changes become more pronounced in the coming decades, they will likely present challenges to our society and our environment. Global warming refers to the recent and ongoing rise in global average temperature near Earths surface. It is caused mostly by increasing concentrations of greenhouse gases in the atmosphere. Global warming is causing climate patterns to change. However, global warming itself represents only one aspect of climate change. Climate change refers to any significant change in the measures of climate lasting for an extended period of time. In other words, climate change includes major changes in temperature, precipitation, or wind patterns, among other effects, that occur over several decades or longer.

Evidence consistently suggests that a higher risk of PD is associated with pesticides and that a higher risk of Alzheimers Disease is associated with pesticides, hypertension and high cholesterol levels in middle age, hyperhomocysteinaemia, smoking, traumatic brain injury and depression. There is weak evidence suggesting that higher risk of PD is associated with high milk consumption in men, high iron intake, chronic anaemia and traumatic brain injury. Evidence also suggests that a higher risk of A D is associated with high aluminium intake through drinking water, excessive exposure to electromagnetic fields from electrical grids, DM and hyperinsulinaemia, obesity in middle age, excessive alcohol consumption and chronic anaemia. Evidence consistently suggests that a lower risk of PD is associated with hyperuricaemia, tobacco and coffee use, while a lower risk of A D is associated with moderate alcohol consumption, physical exercise, perimenopausal hormone replacement therapy and good cognitive reserve. Weak evidence suggests that lower risk of PD is associated with increased vitamin E intake, alcohol, tea, NSAIDs, and vigorous physical exercise, and that lower risk of Alzheimers Disease is associated with the Mediterranean diet, coffee and habitual NSAID consumption. Humans are largely responsible for recent climate change

Over the past century, human activities have released large amounts of carbon dioxide and other greenhouse gases into the atmosphere. The majority of greenhouse gases come from burning fossil fuels to produce energy, although deforestation, industrial processes, and some agricultural practices also emit gases into the atmosphere. Emissions at sunset Greenhouse gases act like a blanket around Earth, trapping energy in the atmosphere and causing it to warm. This phenomenon is called the greenhouse effect and is natural and necessary to support life on Earth. However, the buildup of greenhouse gases can change Earths climate and result in dangerous effects to human health and welfare and to ecosystems. The choices we make today will affect the amount of greenhouse gases we put in the atmosphere in the near future and for years to come. Warmer average temperatures will lead to hotter days and more frequent and longer heat waves. These changes will lead to an increase in heat-related deaths in the United States reaching as much as thousands to tens of thousands of additional deaths each year by the end of the century during summer months. These deaths will not be offset by the smaller reduction in cold-related deaths projected in the winter months. However, adaptive responses, such as wider use of air conditioning, are expected to reduce the projected increases in death from extreme heat.

Research graphics showing projected changes in the coldest night of the year, hottest day of the year, wettest day of the year, and longest dry spell. Projected changes in several climate variables for 2046 to 2065 with respect to the 1981 to 2000 average for the RCP6.0 scenario. These include the coldest night of the year and the hottest day of the year. By the middle of this century, the coldest night of the year is projected to warm by 6°F to 10°F over most of the country, with slightly smaller changes in the south. The warmest day of the year is projected to be 4°F to 6°F warmer in most areas. Also shown are projections of the wettest day of the year and the annual longest consecutive dry day spell. Extreme precipitation is projected to increase, with an average change of 5% to 15% in the precipitation falling on the wettest day of the year. The length of the annual longest dry spell is projected to increase in most areas, but these changes are small: less than two days in most areas. Exposure to extreme heat can lead to heat stroke and dehydration, as well as cardiovascular, respiratory, and cerebrovascular disease. Excessive heat is more likely to affect populations in northern latitudes where people are less prepared to cope with excessive temperatures.

Certain types of populations are more vulnerable than others: for example, outdoor workers, student athletes, and homeless people tend to be more exposed to extreme heat because they spend more time outdoors. Low-income households and older adults may lack access to air conditioning which also increases exposure to extreme heat. Additionally, young children, pregnant women, older adults, and people with certain medical conditions are less able to regulate their body temperature and can therefore be more vulnerable to extreme heat. Urban areas are typically warmer than their rural surroundings. Large metropolitan areas such as St. Louis, Philadelphia, Chicago, and Cincinnati have seen notable increases in death rates during heat waves. Climate change is projected to increase the vulnerability of urban populations to heat related health impacts in the future. Heat waves are also often accompanied by periods of stagnant air, leading to increases in air pollution and associated health effects. In 2016, the U.S. Global Change Research Program produced a report that analyzed the impacts of global climate change on human health in the United States. The report finds that:

Climate change is a significant threat to the health of the American people.
Climate change can affect human health in two main ways: first, by changing the severity or frequency of health problems that are already affected by climate or weather factors and second, by creating unprecedented or unanticipated health problems or health threats in places or times of the year where they have not previously occurred.
Every American is vulnerable to the health impacts associated with climate change, but some populations will be especially affected. These groups include the poor, some communities of color, limited English proficiency and immigrant groups, indigenous peoples, children and pregnant women, older adults, vulnerable occupational groups, people with disabilities, and people with medical conditions.

Water resources are important to both society and ecosystems. We depend on a reliable, clean supply of drinking water to sustain our health. We also need water for agriculture, energy production, navigation, recreation, and manufacturing. Many of these uses put pressure on water resources, stresses that are likely to be exacerbated by climate change. In many areas, climate change is likely to increase water demand while shrinking water supplies. This shifting balance would challenge water managers to simultaneously meet the needs of growing communities, sensitive ecosystems, farmers, ranchers, energy producers, and manufacturers. In some areas, water shortages will be less of a problem than increases in runoff, flooding, or sea level rise. These effects can reduce the quality of water and can damage the infrastructure that we use to transport and deliver water. The water cycle is a delicate balance of precipitation, evaporation, and all of the steps in between. Warmer temperatures increase the rate of evaporation of water into the atmosphere, in effect increasing the atmosphere’s capacity to “hold” water. Increased evaporation may dry out some areas and fall as excess precipitation on other areas. Changes in the amount of rain falling during storms provide evidence that the water cycle is already changing. Over the past 50 years, the amount of rain falling during very heavy precipitation events has increased for most of the United States.

This trend has been greatest in the Northeast, Midwest, and upper Great Plains, where the amount of rain falling during the most intense 1% of storms has increased more than 30%. Warming winter temperatures cause more precipitation to fall as rain rather than snow. Furthermore, rising temperatures cause snow to begin melting earlier in the year. This alters the timing of streamflow in rivers that have their sources in mountainous areas. As temperatures rise, people and animals need more water to maintain their health and thrive. Many important economic activities, like producing energy at power plants, raising livestock, and growing food crops, also require water. The amount of water available for these activities may be reduced as Earth warms and if competition for water resources increases. Increased droughts are projected for hotter and drier regions such as the interior west, while increased flooding is projected in hotter and wetter conditions in the northeast and coasts. The Colorado River system is a major source of water supply for the Southwest. It supplies water for 33 million people in the cities of Los Angeles, Phoenix, Las Vegas, and Denver. Recent droughts, reductions in winter precipitation and snow pack, and warmer, drier springs have caused water supplies in Colorado River reservoirs to decrease. Expected climate change impacts on Colorado River water supply include:

Increased year-to-year changes in water storage in reservoirs are possible, even under current conditions. Decreased hydropower. For every 1% decrease in streamflow in the Colorado River Basin, there is a 3% decrease in hydroelectric power generation for the region. Reductions in river discharge and runoff from snow melt. Annual snow melt runoff could also shift to earlier in the spring.

As a society, we have structured our day-to-day lives around historical and current climate conditions. We are accustomed to a normal range of conditions and may be sensitive to extremes that fall outside of this range. Climate change could affect our society through impacts on a number of different social, cultural, and natural resources. For example, climate change could affect human health, infrastructure, and transportation systems, as well as energy, food, and water supplies. Some groups of people will likely face greater challenges than others. Climate change may especially impact people who live in areas that are vulnerable to coastal storms, drought, and sea level rise or people who live in poverty, older adults, and immigrant communities. Similarly, some types of professions and industries may face considerable challenges from climate change. Professions that are closely linked to weather and climate, such as outdoor tourism, commerce, and agriculture, will likely be especially affected. Different groups have different abilities to cope with climate change impacts. People who live in poverty may have a difficult time coping with changes.

These people have limited financial resources to cope with heat, relocate or evacuate, or respond to increases in the cost of food. Older adults may be among the least able to cope with impacts of climate change. Elderly person with facial hair wiping his brow, presumably in heat distress. Elderly people are particularly prone to heat stress. Older residents make up a larger share of the population in warmer areas of the United States. These areas will likely experience higher temperatures, tropical storms, or extended droughts in the future. The share of the United States population composed of adults over age 65 is also projected to grow from 13% in 2010 to 20% by 2050. Young children are another sensitive age group, since their immune system and other bodily systems are still developing and they rely on others to care for them in disaster situations. Human societies have adapted to the relatively stable climate we have enjoyed since the last ice age which ended several thousand years ago. A warming climate will bring changes that can affect our water supplies, agriculture, power and transportation systems, the natural environment, and even our own health and safety.

Alzheimer’s / Gum Disease

Gum disease (gingivitis) and periodontal disease (periodontitis) have been connected to Alzheimer’s through the Porphyromonas gingivalis species of bacteria. This bacterium commonly presents itself in gum and periodontal disease and has been shown to move from the mouth to the brain. It releases enzymes that destroy nerve cells and can lead to Alzheimer’s disease. This means gum disease and periodontal disease can increase your risk factor for Alzheimer’s, particularly if you go untreated.

What You Can Do To Prevent It
With this information, one of the best ways to reduce your risk for Alzheimer’s is to take care of your oral health. Reducing plaque buildup and keeping your gums healthy is key for keeping porphyromonas gingivalis from getting into your bloodstream. If you have or suspect you have gum disease, seek out treatment from a dentist immediately. Outside of that, the two biggest things you can do to keep your mouth plaque free are:

Hygiene
Your daily oral hygiene routine is your first line of defense against plaque buildup. Brushing twice a day and flossing once a day is the best way to keep your mouth clean. For more information on the four pillars of a good oral hygiene routine, read here.
Preventive Care
Hygiene isn’t the only component to your oral health routine. Preventive care, particularly your regular cleanings and exams, is an important part of maintaining your oral health and reducing plaque buildup in your mouth. There are different kinds of cleanings, so make sure you consult with your dentist regularly and get the preventive treatment that is right for your mouth!
The research was compiled from three different studies. One study of middle-aged children of Alzheimer’s parents looked at healthy lifestyle factors as a way to delay the onset of the disease. A second study of Japanese Americans showed that people were much less at risk for developing Alzheimer’s after drinking fruit juice three times a week.

The third study followed 109 pairs of identical twins in Sweden to find any lifestyle factors associated with developing dementia. This study found that twins who had periodontal disease earlier in life were four times more likely to develop Alzheimer’s. Researchers believe gum disease is a sign of inflammation, which may play a role in the destruction of brain cells.

Regular dentist visits are important for prevention of gum disease. Your dentist can remove tartar, which is plaque buildup that can irritate the gums and lead to tooth loss. Dentists also can detect early signs of gum disease. However, prevention begins at home. Brushing and flossing twice daily, eating right and avoiding tobacco will help prevent gum disease. Treatment procedures of P. gingivalis–mediated diseases such as periodontitis and peri-implantitis focus on the eradication of oral pathogens at the site of infection, usually by surface debridement procedures followed by adjunctive therapies, including the use of antiseptics or/and antibiotics.

Dementia is one of the main causes of disability among elderly people. It is a progressive neurodegenerative disease that affects elderly people’s ability to perform daily living activities. Alzheimer’s disease is the main subtype of dementia and causes declining memory, reasoning, and communication skills. They also have behavioural and psychological symptoms, such as depression and aggression. It is essential for them to maintain good oral health, as oral health is an important and integral part of their general health. Neglecting oral health allows dental diseases to develop, and these diseases are difficult and costly to treat. However, dental diseases can be treated with ambulatory care rather than hospitalisation and emergency care. Elderly people should establish daily oral hygiene care routines during the early stages of Alzheimer’s disease. They should have regular dental examinations and early minimal interventions to prevent the need for extensive and complicated procedures. Maintaining oral health becomes challenging, however, when Alzheimer’s disease progresses to the middle and late stages. Because elderly people might forget or lose interest in keeping their teeth healthy, caretakers and community health workers may need to take over this task. The purpose of this paper is to provide an overview of oral health and the importance of oral care for elderly people with Alzheimer’s disease. The paper also discusses appropriate dental interventions and techniques for maintaining good oral health and helping people with Alzheimer’s to enjoy a satisfactory quality of life.

The NIA Intramural Research Program team used nationally representative, publicly available data from the National Health and Nutrition Examination Survey (NHANES), a large population study performed by the CDC’s National Center for Health Statistics. The team examined whether gum disease and infections with oral bacteria were linked to dementia diagnoses and deaths using restricted data linkages with Medicare records and the National Death Index. The team compared different age groups at baseline, with up to 26 years of follow-up, for more than 6,000 participants. The NHANES participants had received a dental exam for signs of gum disease. In addition, the participants received blood tests for antibodies against causative bacteria. The team analyzed antibodies against 19 oral bacteria for an association with the diagnosis of Alzheimers, diagnosis of any kind of dementia, and death from Alzheimers. Of these 19, Porphyromonas gingivalis is the most common culprit of gum disease. In fact, a recent study suggests that plaques of beta-amyloid protein, a major hallmark of Alzheimers disease, may be produced as a response to this infection.

The analysis revealed that older adults with signs of gum disease and mouth infections at baseline were more likely to develop Alzheimers during the study period. Among those 65 years or older, both Alzheimers diagnoses and deaths were associated with antibodies against the oral bacterium P gingivalis, which can cluster with other bacteria such as Campylobacter rectus and Prevotella melaninogenica to further increase those risks. As Alzheimers progresses, the person with dementia may forget how to brush his or her teeth or forget why it’s important. As a caregiver, you may have to assist or take a more hands-on approach. Proper oral care is necessary to prevent eating difficulties, digestive problems and infections. The researchers also spotted gingipain and bacterial DNA in the cortices of three A D brain samples and in six of seven non-demented controls, consistent with common P gingivalis infection in older adults. To assess CNS infection in living people, they devised an assay to test for fragmented bacterial DNA in cerebrospinal fluid, and reported results in a small sample. Of 10 people clinically diagnosed with AD, seven tested positive, albeit at DNA levels down to a thousandth of those found in the mouth.

In the brain, the proteases appeared primarily in neurons, and some co-localized with phospho-tau and intraneural Aβ. The former could potentially contribute to tau pathology, the researchers believe, as gingipains cut up tau in P. gingivalis-infected SH-SY5Y cells. In vitro digestion of tau with gingipains revealed dozens of cleavage sites and fragments known to be increased in CSF in A D, or implicated in tangle formation. The interaction with Aβ is consistent with that peptide’s proposed antimicrobial function. In the early stages of Alzheimers, dental care focuses on prevention. Getting check-ups and cleaning and flossing teeth regularly can prevent the need for extensive procedures later on, when the person with dementia may be less able to tolerate them. During the middle and late stages of Alzheimers, oral health may become more challenging. The person may forget what to do with toothpaste or how to rinse, or may be resistant to assistance from others.
Loss of appetite may be a sign of mouth pain or ill fitting dentures.

Keep the teeth and mouth clean. Very gently brush the person’s teeth, gums, tongue and roof of the mouth at least twice a day, with the last brushing after the evening meal and any night time liquid medication. Allow plenty of time and find a comfortable position if you must do the brushing yourself. Gently place the toothbrush in the persons mouth at a 45 degree angle so you massage gum tissue as you clean the teeth. If the person wears dentures, rinse them with plain water after meals and brush them daily to remove food particles. Each night, remove them and soak in a cleanser or mouthwash. Then, use a soft toothbrush or moistened gauze pad to clean the gums, tongue and other soft mouth tissues. Try different types of toothbrushes. You may find that a soft bristled childrens toothbrush works better than a hard bristled adults brush. Or that a long handled or angled brush is easier to use than a standard toothbrush. Experiment until you find the best choice. Be aware that electric dental appliances may confuse a person with Alzheimers. Floss regularly most dentists recommend flossing daily. If using floss is distressing to the person with Alzheimers, try using a “proxabrush” to clean between teeth instead.

Be aware of potential mouth pain. Investigate any signs of mouth discomfort during mealtime. Refusing to eat or strained facial expressions while eating may indicate mouth pain or dentures that don’t fit properly. For most people, teeth cleaning may just be a normal part of your daily routine. But what if the way you clean your teeth today, might affect your chances of getting Alzheimers disease in years to come. There is an increasing body of evidence to indicate that gum (periodontal) disease could be a plausible risk factor for Alzheimers disease. Some studies even suggest your risk doubles when gum disease persists for ten or more years. Indeed, a U S study published in Science Advances details how a type of bacteria called Porphyromonas gingivalis or P gingivalis which is associated with gum disease, has been found in the brains of patients with Alzheimers disease. Tests on mice also showed how the bug spread from their mouth to brain where it destroyed nerve cells.

The first phase of gum disease is called gingivitis. This occurs when the gums become inflamed in response to the accumulation of bacterial plaque on the surface of the teeth. Gingivitis is experienced by up to half of all adults but is generally reversible. If gingivitis is left untreated, “sub-gingival pockets” form between the tooth and gum, which are filled by bacteria. These pockets indicate that gingivitis has converted to periodontitis. At this stage, it becomes almost impossible to eliminate the bacteria, though dental treatment can help control their growth. The risks of gum disease are significantly increased in people with poor oral hygiene. And factors such as smoking, medication, genetics, food choices, puberty and pregnancy can all contribute towards the development of the condition. Though it is important to remember that gum disease is not just the work of P gingivalis alone. A group of organisms including Treponema denticola, Tanerella forsythia and other bacteria also play a role in this complex oral disease. Subsequent studies have also found this bacteria which is responsible for many forms of gum disease can migrate from the mouth to the brain in mice. And on entry to the brain, P gingivalis can reproduce all of the characteristic features of Alzheimers disease.

Having good dental hygiene, a healthy low sugar diet and regular dental checks up can help prevent gum disease. Existing research shows that other types of bacteria and the Herpes type I virus can also be found in Alzheimers disease brains. People with Downs syndrome are also at a higher risk of developing Alzheimers disease, as are people who have had a severe head injury. Research also shows that several conditions associated with cardiovascular disease can increase the risk of Alzheimers disease. This suggests there are many causes with one endpoint and scientists are still trying to figure out the connection. This also occurs alongside plaque buildup in the grey matter of the brain and whats known as “neurofibrillary tangles”. These are the debris left from the collapse of a neurons internal skeleton. These occur when a protein can no longer perform its function of stabilising the cell structure.

The latest research adds more evidence to the theory that gum disease is one of the things that can lead to Alzheimers disease. But before you start panic brushing your teeth, its important to remember that not everyone who suffers from gum disease develops Alzheimers disease and not all who suffer from Alzheimers disease have gum disease consult with your dentist.

To find out who is “at risk”, scientists now need to develop tests that can show the dentist who to target. Dental clinicians can then advise those people as to how they can reduce the risk of developing Alzheimers disease through better management of their oral health. But until then, regularly brushing your teeth and maintaining good oral hygeine is recommended. Contact your local dental society to find the names of professionals who have experience working with people with dementia or with elderly patients.

Coordinate care. Provide the dentist with a list of all health care providers who are caring for the person with dementia, as well as a list of all medications. Certain medications can contribute to dry mouth and other oral health issues. Keep up with regular dental visits for as long as possible. This will help prevent tooth decay, gum problems, pain and infection. Dentists should provide guidance on the maintenance of oral health, as the techniques used to provide this support vary depending on the elderly people concerned.

People may be able to avoid or at the very least, delay Alzheimers by avoiding gum (periodontal) disease, among other healthy lifestyle measures such as increasing exercise and drinking fruit and vegetable juice. New research suggests that even though family history may predispose a person to developing Alzheimers, various behaviors if started early enough in life may help delay the onset of the disease. It is best to begin introducing healthy habits early in life, researchers say, although studies have shown that even middle aged people can benefit from the lifestyle changes. Nearly 5 million Americans have Alzheimer’s, and with the vanguard of the baby boom generation turning 60 this year, the number of cases is expected to increase 70 percent by 2020. The connection between your oral health and your overall health can’t be overstated. Taking care of your teeth can help serious medical conditions such as diabetes and heart disease. But more and more research is showing that your oral health can be a factor for neurological conditions particularly Alzheimers disease. Alzheimers affects over fifty million people worldwide and is the 6th leading cause of death in the United States. While there is no cure for Alzheimers or clear prevention strategies, medical research has identified many risk factors for Alzheimers and other types of dementia.

End Life Notes

Dementia causes the gradual loss of thinking, remembering, and reasoning abilities, which means that people with dementia at the end of life may no longer be able to make or communicate choices about their health care. If there are no advance care planning documents in place and the family does not know the persons wishes, caregivers may need to make difficult decisions on behalf of their loved one about care and treatment approaches. When making health care decisions for someone with dementia, it’s important to consider the persons quality of life. For example, medications are available that may delay or keep symptoms from getting worse for a limited time. Medications also may help control some behavioral symptoms in people with mild-to-moderate Alzheimers or a related dementia. However, some caregivers might not want drugs prescribed for people in the later stages of these diseases if the side effects outweigh the benefits. It is important to consider the goals of care and weigh the benefits, risks, and side effects of any treatment. You may need to make a treatment decision based on the person’s comfort rather than trying to extend their life or maintain their abilities for longer. As a caregiver, you will want to understand how the available medical options presented by the health care team fit with the needs of both the family and the person with dementia. You might ask the health care team questions such as:

Who can help me with end-of-life care for my loved one living with dementia?
How will your suggested approaches affect their quality of life?
What are my options if I can no longer manage the care of my loved one at home?
How can I best decide when a visit to the doctor or hospital is necessary?
Should I consider hospice at home, and if so, does the hospice team have experience working with people living with dementia?
Being there for a person with dementia at the end of life
As dementia progresses, caregivers may find it hard to provide emotional or spiritual comfort to a person who has severe memory loss. However, even in advanced stages of dementia, a person may benefit from such connections.

Sensory connections targeting someone senses, including hearing, touch, or sight may also bring comfort. Being touched or massaged can be soothing. Listening to music, white noise, or sounds from nature seem to relax some people and lessen agitation. Just being present can be calming to the person. Palliative or hospice care teams may be helpful in suggesting ways for people with dementia and their families to connect at the end of life. They also may be able to help identify when someone with dementia is in the last days or weeks of life.

Signs of the final stages of dementia include some of the following:
Being unable to move around on ones own
Being unable to speak or make oneself understood
Eating problems such as difficulty swallowing
Though palliative and hospice care experts have unique experience with what happens at the end of life and may be able to give a sense of timing, its hard to predict exactly how much time a person has left.

Caring for people with Alzheimers or another dementia at the end of life can be demanding and stressful for the family caregiver. Depression and fatigue are common problems for caregivers because many feel they are always on call. Family caregivers may have to cut back on work hours or leave work altogether because of their caregiving responsibilities. It is not uncommon for those who took care of a person with advanced dementia to feel a sense of relief when death happens. It is important to realize such feelings are normal. Hospice care experts can provide support to family caregivers near the end of life as well as help with their grief. If you are a caregiver, ask for help when you need it and learn about respite care. Many Americans die in facilities such as hospitals or nursing homes receiving care that is not consistent with their wishes. It’s important for older adults to plan ahead and let their caregivers, doctors, or family members know your end-of-life preferences in advance. For example, if an older person wants to die at home, receiving end-of-life care for pain and other symptoms, and makes this known to health care providers and family, it is less likely he or she will die in a hospital receiving unwanted treatments. If the person is no longer able to make health care decisions for themselves, a caregiver or family member may have to make those decisions. Caregivers have several factors to consider when choosing end-of-life care, including the older persons desire to pursue life-extending treatments, how long he or she has left to live, and the preferred setting for care. Respite care provides short-term relief for primary caregivers. It can be arranged for just an afternoon or for several days or weeks. Care can be provided at home, in a healthcare facility, or at an adult day center.

Respite services charge by the hour or by the number of days or weeks that services are provided. Most insurance plans do not cover these costs. You must pay all costs not covered by insurance or other funding sources. Medicare will cover most of the cost of up to 5 days in a row of respite care in a hospital or skilled nursing facility for a person receiving hospice care. Medicaid also may offer assistance. Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person’s current care by focusing on quality of life for them and their family. Palliative care is a resource for anyone living with a serious illness, such as heart failure, chronic obstructive pulmonary disease, cancer, dementia, Parkinson’s disease, and many others. Palliative care can be helpful at any stage of illness and is best provided soon after a person is diagnosed. In addition to improving quality of life and helping with symptoms, palliative care can help patients understand their choices for medical treatment. The organized services available through palliative care may be helpful to any older person having a lot of general discomfort and disability very late in life. A palliative care team is made up of multiple different professionals that work with the patient, family, and the patients other doctors to provide medical, social, emotional, and practical support. The team is comprised of palliative care specialist doctors and nurses, and includes others such as social workers, nutritionists, and chaplains. A persons team may vary based on their needs and level of care. To begin palliative care, a persons health care provider may refer him or her to a palliative care specialist. If he or she doesn’t suggest it, the person can ask a health care provider for a referral.

Not all end-of-life experiences are alike. Death can come suddenly, or a person may linger in a near-death state for days. For some older adults at the end of life, the body weakens while the mind stays clear. Others remain physically strong while cognitive function declines. It’s common to wonder what happens when someone is dying. You may want to know how to provide comfort, what to say, or what to do. End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illness and need significant care for days, weeks, and even months before death. The end of life may look different depending on the persons preferences, needs, or choices. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room. When possible, there are steps you can take to increase the likelihood of a peaceful death for your loved one, follow their end-of-life wishes, and treat them with respect while they are dying.

Generally speaking, people who are dying need care in four areas: physical comfort, mental and emotional needs, spiritual needs, and practical tasks. Of course, the family of the dying person needs support as well, with practical tasks and emotional distress. Discomfort during the dying process can come from a variety of sources. Depending on the cause of the discomfort, there are things you or a health care provider can do to help make the dying person more comfortable. For example, the person may be uncomfortable because of:

Pain
Breathing problems
Skin irritation, including itching
Digestive problems
Temperature sensitivity
Fatigue

Not everyone who is dying experiences pain. For those who do, experts believe that care should focus on relieving pain without worrying about possible long-term problems of drug dependence or abuse.

Struggling with severe pain can be draining and make the dying person understandably angry or short-tempered. This can make it even harder for families and other loved ones to communicate with the person in a meaningful way.

Caregivers and other family members can play significant roles in managing a dying persons pain. But knowing how much pain someone is in can be difficult. Watch for clues, such as trouble sleeping, showing increased agitation, or crying. Don’t be afraid of giving as much pain medicine as is prescribed by the doctor.

Pain is easier to prevent than to relieve, and severe pain is hard to manage. Try to make sure that the level of pain does not get ahead of pain-relieving medicines. Tell the health care professionals if the pain is not controlled because medicines can be increased or changed. Palliative medical specialists are experienced in pain management for seriously ill patients; consider consulting with one if they’re not already involved see What Are Palliative Care and Hospice Care.

Many people find solace in their faith. Others may struggle with their faith or spiritual beliefs. Praying, reading religious texts, or listening to religious music may help. The person can also talk with someone from their religious community, such as a minister, priest, rabbi, or imam. Family and friends can talk to the dying person about the importance of their relationship. For example, adult children may share how their father has influenced the course of their lives. Grandchildren can let their grandfather know how much he has meant to them. Friends can share how they value years of support and companionship. Family and friends who can’t be present in person can send a video or audio recording of what they would like to say, or a letter to be read out loud. Sharing memories of good times is another way some people find peace near death. This can be comforting for everyone. Some doctors think that dying people can still hear even if they are not conscious. Always talk to, not about, the person who is dying. When you come into the room, identify yourself to the person. You may want to ask someone to write down some of the things said at this time — both by and to the person who is dying. In time, these words might serve as a source of comfort to family and friends. There may come a time when a dying person who has been confused suddenly seems to be thinking clearly. Take advantage of these moments but understand that they are likely temporary and not necessarily a sign of getting better. Sometimes, a dying person may appear to see or talk to someone who is not there. Resist temptation to interrupt or correct them, or say they are imagining things. Give the dying person the space to experience their own reality. Sometimes dying people will report having dreams of meeting deceased relatives, friends, or religious figures. The dying person may have various reactions to such dreams, but often, they are quite comforting to them.

You should there always be someone in the room with a dying person. Staying close to someone who is dying is often called keeping a vigil. It can be comforting for the caregiver or other family members to always be there, but it can also be tiring and stressful. Unless your cultural or religious traditions require it, do not feel that you must stay with the person all the time. If there are other family members or friends around, try taking turns sitting in the room. Providing support for practical tasks need to be done at the end of life care both to relieve the person who is dying and to support the caregiver. A person who is dying might be worried about who will take care of things when they are gone. A family member or friend can offer reassurance. “I’ll make sure your African violets are watered,” “Jessica has promised to take care of Bandit,” “Dad, we want Mom to live with us from now on which may help provide a measure of peace. You also may remind the dying person that their personal affairs are in good hands.

Everyday tasks can also be a source of worry for someone who is dying and can overwhelm a caregiver. A family member or friend can provide the caregiver with a much needed break by helping with small daily chores around the house such as picking up the mail, writing down phone messages, doing a load of laundry, feeding the family pet, or picking up medicine from the pharmacy. Caregivers may also feel overwhelmed keeping close friends and family informed. A family member or friend can help set up an outgoing voicemail message, a blog, an email list, a private Facebook page, or even a phone tree to help reduce the number of calls the caregiver must make. Family and friends may wish to provide primary caregivers relief while they are focusing on the dying loved one. Keep in mind that the caregiver may not know exactly what is needed and may feel overwhelmed by responding to questions. If the caregiver is open to receiving help, here are some questions you might ask:

How are you doing? Do you need someone to talk with?
Would you like to go out for an hour or two? I could stay here while you are away.
Who has offered to help you? Do you want me to work with them to coordinate our efforts?
Can I help maybe walk the dog, answer the phone, go to the drug store or the grocery store, or watch the children for you?
Providing comfort and care for someone at the end of life can be physically and emotionally exhausting. If you are a primary caregiver, ask for help when you need it and accept help when it’s offered. Don’t hesitate to suggest a specific task to someone who offers to help. Friends and family are usually eager to do something for you and the person who is dying, but they may not know what to do.

In the end, consider that there may be no “perfect” death so just do the best you can for your loved one. The deep pain of losing someone close to you may be softened a little by knowing that, when you were needed, you did what you could. Palliative care can be provided in hospitals, nursing homes, outpatient palliative care clinics and certain other specialized clinics, or at home. Medicare, Medicaid, and insurance policies may cover palliative care. Veterans may be eligible for palliative care through the Department of Veterans Affairs. Private health insurance might pay for some services. Health insurance providers can answer questions about what they will cover. Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimers disease or a related dementia. Legal and medical experts encourage people recently diagnosed with a serious illness particularly one that is expected to cause declining mental and physical health to examine and update their financial and health care arrangements as soon as possible. Basic legal and financial documents, such as a will, a living trust, and advance directives, are available to ensure that the person’s late-stage or end-of-life health care and financial decisions are carried out. Older couple filling out legal and financial paperwork for people with Alzheimers disease. A complication of diseases such as Alzheimers and related dementias is that the person may lack or gradually lose the ability to think clearly. This change affects his or her ability to make decisions and participate in legal and financial planning. People with early-stage Alzheimers or a related dementia can often understand many aspects and consequences of legal decision-making. However, legal and medical experts say that many forms of planning can help the person and his or her family address current issues and plan for next steps, even if the person is diagnosed with later stage dementia.

There are good reasons to retain a lawyer when preparing advance planning documents. A lawyer can help interpret different state laws and suggest ways to ensure that the love one and families wishes are carried out. Its important to understand that laws vary by state, and changes in a loved one situation for example, a divorce, relocation, or death in the family can influence how documents are prepared and maintained. Life changes may also mean a document needs to be revised to remain valid.

Legal, Financial, and Health Care Planning Documents
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Families beginning the legal planning process should discuss their approach, what they want to happen, and which legal documents they’ll need. Depending on the family situation and the applicable state laws, a lawyer may introduce a variety of documents to assist in this process, including documents that communicate:

Health care wishes of someone who can no longer make health care decisions.
Financial management and estate plan wishes of someone who can no longer make financial decisions.
Learn how to get your affairs in order.

Advance directives for health care are documents that communicate a loved ones health care wishes. Advance directives go into effect after the person no longer can make decisions on their own. In most cases, these documents must be prepared while the person is legally able to execute them. Health care directives may include the following:

A durable power of attorney for health care designates a person, sometimes called an agent or proxy, to make health care decisions when the person with dementia can no longer do so.
A living will records a persons wishes for medical treatment near the end of life or if the person is permanently unconscious and cannot make decisions about emergency treatment.
A do not resuscitate order, or DNR, instructs health care professionals not to perform cardiopulmonary resuscitation (CPR) if a person’s heart stops or if he or she stops breathing. A DNR order is signed by a doctor and put in a person’s medical chart.
Durable Power of Attorney for Health Care
Gives a designated person the authority to make health care decisions on behalf of the person with dementia

Describes and instructs how and when the person wants different types of end of life health care. Instructs healthcare professionals not to perform CPR in case of stopped heart or stopped breathing. In addition to these, there may be other documents for specific health care procedures including organ and tissue donation, dialysis, brain donation, and blood transfusions. For more information about advance directives for health care, see Advance care planning: Health care directives. Get permission in advance from loved one with dementia to have his or her doctor and lawyer talk with a caregiver as needed. Advance permission can also be provided to others, such as Medicare or a credit card company, bank, or financial advisor. This can help with questions about care, a bill, or a health insurance claim. Without consent, the caregiver may not be able to get needed information. Advance directives for financial and estate management must be created while the person with Alzheimers or a related dementia has “legal capacity” to make decisions on their own, meaning they can still understand the decisions and what they might mean. These directives may include the following:

A durable power of attorney for finances names someone to make financial decisions when the person with Alzheimers or a related dementia no longer can. It can help avoid court actions that may take away control of financial affairs.
A will indicates how a person’s assets and estate will be distributed upon their death. It also can specify:
Arrangements for care of children, adult dependents, or pets
Gifts
Trusts to manage the estate
Funeral or burial arrangements
Medical and legal experts say that the newly diagnosed person with Alzheimer’s or a related dementia and his or her family should create or update a will as soon as possible after diagnosis.

A living trust addresses the management of money and property while a person is still living. The trust provides instructions about the persons estate and appoints someone, called the trustee, to hold titles to property and money on the person’s behalf. Using the instructions in the living trust, the trustee can pay bills or make other financial and property decisions when the person with dementia can no longer manage his or her affairs.

A living trust can:

Cover a wide range of property including cars, homes, jewelry, bonds, cash, etc.
Provide a detailed plan for property transfer or sale
Avoid the expense and delay of probate in which the courts establish the validity of a will
State how property and funds should be distributed when the last beneficiary dies
Overview of Legal and Financial Documents
Durable Power of Attorney for Finances

A will gives a designated person the authority to make legal and financial decisions on behalf of the person with dementia. A living trust indicates how a persons assets and estate will be distributed among beneficiaries after his or her death. Gives a designated person (trustee) the authority to hold and distribute property and money for the person with Alzheimers or a related dementia. Health care providers cannot act as legal or financial advisers, but they can encourage planning discussions between patients and their families. Doctors can also guide patients, families, the care team, attorneys, and judges regarding the patients ability to make decisions. Discussing advance care planning decisions with a doctor is free through Medicare during the annual wellness visit. Private health insurance may also cover these discussions. An elder law attorney helps older adults and their families interpret state laws, plan how wishes will be carried out, understand financial options, and learn how to preserve financial assets.

Its a good idea to ask about a lawyers fees before making an appointment. The National Academy of Elder Law Attorneys and the American Bar Association can help families find qualified attorneys. Also, a local bar association can help identify free legal aid options. See the resources at the end of this article for more information. Geriatric care managers are trained social workers or nurses who can help people with dementia and their families. Start discussions early. The rate of decline differs for each person with dementia, and his or her ability to be involved in planning will decline over time. People in the early stages of the disease may be able to understand the issues, but they may also be defensive, frustrated, and/or emotionally unable to deal with difficult questions. The person may even be in denial or not ready to face their diagnosis. This is normal. Be patient and seek outside help from a lawyer or geriatric care manager if needed. Remember that not all people are diagnosed at an early stage. Decision-making may already be difficult by the time the person with dementia is diagnosed.

Gather important papers. When an emergency arises or when the person with dementia can no longer manage their own affairs, family members or a proxy will need access to important papers, such as a living will or financial documents. To make sure the wishes of the person with dementia are followed, put important papers in a secure place and provide copies to family members or another trusted person. A lawyer can keep a set of the papers as well. Review plans over time. Changes in personal situations such as a divorce, relocation, or death in the family and in state laws can affect how legal documents are prepared and maintained. Review plans regularly, and update documents as needed. Reduce anxiety about funeral and burial arrangements. Advance planning for the funeral and burial can provide a sense of peace and reduce anxiety for both the person with dementia as well as his or her family. Problems managing money may be one of the first noticeable signs of dementia. To provide support, while also respecting the loved ones independence, a family member or trusted friend can help:

Watch for signs of money problems – Trouble paying for a purchase or a pile of unopened bills may indicate money issues. Start a conversation about available services to help older adults with their expenses. Giving the person small amounts of cash to have on hand and limiting credit cards may help manage spending.
Set up automated bill payments – Arrange for utilities, mortgage, rent, or other expenses to be paid through automatic deductions from a bank account. This will make sure that bills are paid correctly and on time.
Protect against scams or fraud – To lower the risk of telemarketing schemes, help place the persons phone number on the National Do Not Call Registry. Consider registering the person for fraud alerts through their bank, credit card company, a national credit bureau or other credit monitoring service. Learn more about common scams and frauds.
As the disease progresses, a family member or trustee can take additional steps to:

Establish consent to manage finances — To prevent serious problems, consider being named as a legal proxy to access and manage the persons financial affairs.
Plan for in-home and long-term care costs — Consider options for a personal care assistant or home health care aide and their costs, including possible Medicare or Medicaid support. If the person needs more care, consider assisted living communities and nursing homes.
Legal and Financial Planning Resources for Low-Income Families
Families who cannot afford a lawyer can still plan for the future. Samples of basic health planning documents are available online. Area Agency on Aging officials may provide legal advice or help. Other possible sources of legal assistance and referral include state legal aid offices, state bar associations, local nonprofit agencies, foundations, and social service agencies. It is estimated that nearly 500,000 new cases of Alzheimers disease will be diagnosed this year in the United States. Every 3 seconds, someone in the world develops dementia. Get the facts about Alzheimers disease the most common form of dementia.

Alzheimers is not a normal part of aging. Alzheimers disease is an irreversible degeneration of the brain that causes disruptions in memory, cognition, personality, and other functions that eventually lead to death from complete brain failure. Age is the greatest risk factor for Alzheimers disease. The percentage of people with Alzheimers increases with age: 5% of people age 65 to 74, 13% of people age 75-84, and 33% of people age 85 and older have Alzheimers and dementia. Alzheimers is a growing epidemic. An estimated 6.5 million Americans older than 65 have Alzheimers disease. By 2050, the number of people age 65 and older with Alzheimers and dementia is projected to reach 12.7 million, unless scientists develop new approaches to prevent or cure it. However, estimates based on high-range projections of population growth provided by the United States Census suggest that this number may be as high as 16 million. Almost 10% of United States adults age 65 and older have dementia, while another 22% have mild cognitive impairment. There is a disproportionate burden of dementia and mild cognitive impairment among older Black and Hispanic adults and those with lower levels of education.
Each day, thousands of American families are forever changed by this disease. Every 65 seconds, someone in America develops Alzheimers. By mid-century, someone in America will develop the disease every 33 seconds. Alzheimers is on the rise throughout the world. Worldwide, at least 50 million people are believed to be living with Alzheimers disease or other dementias. According to the United Nations, that is more than the population of Colombia. If breakthroughs are not discovered, rates could exceed 152 million by 2050.

Biblical Health

Through scripture, we can find Gods guidance to good health, as it is rated of high importance. These bible verses expose us to God’s rules for good physical, mental, and spiritual health. It’s really all about Biblical health, which is about finding balance in all aspects of life and seeking to improve each and every area without letting one lag behind. Essentially, every area of your life falls into one (or more) of these categories, and, YES, it should be your goal to master every discipline. SO WHETHER YOU EAT OR DRINK OR WHATEVER YOU DO, DO IT ALL FOR THE GLORY OF GOD. – 1 CORINTHIANS 10:31
When you bring God into your healthy eating, it changes everything. Striving to honor Him in your food and drink choices will bring not only a heart change, but it will also change your choices.

Spiritual – Having a thriving relationship with your Creator.
Physical – Maintaining a strong, healthy body.
Mental – Being intellectually sound and having the Mind of Christ.
Emotional – Being at peace and enjoying a balance of healthy feelings.
Financial – Having enough to provide for your family and to be BIG givers.
Occupational – Truly enjoying the work of your hands.
Social – Fostering deep, mutually beneficial relationships with friends, family and people that you encounter every day.

1 Corinthians 6:19-20
Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore honor God with your bodies.

3 John 1:2
Dear friend, I pray that you may enjoy good health and that all may go well with you, even as your soul is getting along well.

1 Corinthians 10:31
So whether you eat or drink or whatever you do, do it all for the glory of God.

1 Timothy 4:8
For physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come.

Proverbs 17:22
A cheerful heart is good medicine, but a crushed spirit dries up the bones.

Proverbs 31:17
She sets about her work vigorously; her arms are strong for her tasks.

Ephesians 5:18
Do not get drunk on wine, which leads to debauchery. Instead, be filled with the Spirit.

Proverbs 20:1
Wine is a mocker and beer a brawler; whoever is led astray by them is not wise.

Deuteronomy 7:12-15
If you pay attention to these laws and are careful to follow them, then the LORD your God will keep his covenant of love with you, as he swore to your ancestors. He will love you and bless you and increase your numbers. He will bless the fruit of your womb, the crops of your land your grain, new wine and olive oil the calves of your herds and the lambs of your flocks in the land he swore to your ancestors to give you. You will be blessed more than any other people; none of your men or women will be childless, nor will any of your livestock be without young. The LORD will keep you free from every disease. He will not inflict on you the horrible diseases you knew in Egypt, but he will inflict them on all who hate you.

Jeremiah 33:6
“ ‘Nevertheless, I will bring health and healing to it; I will heal my people and will let them enjoy abundant peace and security.

Acts 27:34
Now I urge you to take some food. You need it to survive. Not one of you will lose a single hair from his head.”

Deuteronomy 28:53
Because of the suffering your enemy will inflict on you during the siege, you will eat the fruit of the womb, the flesh of the sons and daughters the LORD your God has given you.

Leviticus 11:1-4
The LORD said to Moses and Aaron, “Say to the Israelites: ‘Of all the animals that live on land, these are the ones you may eat: You may eat any animal that has a divided hoof and that chews the cud. ‘There are some that only chew the cud or only have a divided hoof, but you must not eat them. The camel, though it chews the cud, does not have a divided hoof; it is ceremonially unclean for you.

Revelation 14:12
This calls for patient endurance on the part of the people of God who keep his commands and remain faithful to Jesus.

Proverbs 16:24
Gracious words are a honeycomb, sweet to the soul and healing to the bones.

Proverbs 4:20-22
My son, pay attention to what I say; turn your ear to my words. Do not let them out of your sight, keep them within your heart; for they are life to those who find them and health to ones whole body.

Proverbs 3:7-8
Do not be wise in your own eyes; fear the LORD and shun evil. This will bring health to your body and nourishment to your bones.

Exodus 15:26
He said, “If you listen carefully to the LORD your God and do what is right in his eyes, if you pay attention to his commands and keep all his decrees, I will not bring on you any of the diseases I brought on the Egyptians, for I am the LORD, who heals you.”

Whether you eat, drink or whatever you do, do all for the glory of God. Our bodies are around 60% water, give or take. It is commonly recommended to drink eight 8-ounce glasses of water per day (the 8×8 rule). Although there is little science behind this specific rule, staying hydrated is important. Water Helps to Maximize Physical Performance If we do not stay hydrated, physical performance can suffer. This is particularly important during intense exercise or high heat. Dehydration can have a noticeable effect if you lose as little as 2% of your body’s water content. However, it is not uncommon for athletes to lose up to 6-10% of their water weight via sweat. This can lead to altered body temperature control, reduced motivation, increased fatigue and make exercise feel much more difficult, both physically and mentally. Optimal hydration has been shown to prevent this from happening, and may even reduce the oxidative stress that occurs during high intensity exercise. This is not surprising when you consider that muscle is about 80% weight.

1 Corinthians 10:31
All throughout the Bible, references are made to the medicinal properties of foods and herbs. Representing health and longevity from Almighty God, the importance of diet and of preparing and eating food was oftentimes seen as a spiritual act. If you want to consume some of the most common foods mentioned for their health properties in the Bible, then you’ll want to try these top 10 healing Bible foods.

Acceptable Biblical foods:

Trees whose edible yield is bearing seeds or is seed. To put it simply, this kind of food is mostly fruits. All fruits are acceptable in the Biblical diet, just as long as they come from seeds. Fruits from fruit trees are okay to eat, as well as anything that grows on a vine, a shrub or anything with a woody bark tissue.
Plants whose edible yield is bearing seeds or is seeds. This classification refers to anything that may grow on plants that are not necessarily trees. Examples of seed-bearing plants include squash, tomatoes, corn and beans.
Field plants — Field plants or “plants of the field” are the next thing on the list, which can consist of herbs, roots and green, leafy vegetables.
Clean meat — Now this one’s a little detailed because the definition of clean meat is pretty complex. According to Leviticus, clean meat is defined as the meat of every animal that has the hoof cloven in two and chews the cud. Examples of clean meat include the ox (cattle), buffalo, sheep, goat, deer, gazelle, antelope and mountain sheep, just to name a few. Examples of unclean meat include pig, camel, hare and rock badger. The Bible also instructs us not to eat the blood of animals or to eat any meat that has been sacrificed to idols.
As for seafood, everything with fins and scales are allowed, but whatever doesn’t have fins such as shellfish is prohibited. For birds, everything is allowed except eagles, vultures, kites, ravens, ostriches, seagulls and owls. It is also noted that all winged insects are considered unclean.

1. Olives and Olive Oil — Then it shall come about when the Lord your God brings you into the land which He swore to your fathers, Abraham, Isaac and Jacob, to give you, great and splendid cities which you did not build, and houses full of all good things which you did not fill, and hewn cisterns which you did not dig, vineyards and olive trees which you did not plant, and you eat and are satisfied. (Deuteronomy 6:10-11)

The Jews were the elite olive merchants of their day. During antiquity, this precious commodity was used for its healing capabilities, for cooking, to light lamps, for soaps, for cosmetics and even for currency. Olive oil was considered so sacred to ancient culture that it was even used to anoint kings and priests. Hence, the Hebrew for Messiah, Moshiach, meaning “anointed one!”

Research has been conducted that proves regular consumption of olives and olive oil contributes to heart, brain, skin and joint health. They have even been linked to cancer and diabetes prevention.

2. Pomegranate — For the Lord your God is bringing you into a good land, a land of brooks of water, of fountains and springs, flowing forth in valleys and hills; a land of wheat and barley, of vines and fig trees and pomegranates, a land of olive oil and honey. (Deuteronomy 8:7-8)

Tasty, messy and just recently gaining ground in the American market these past few years, several research studies have shown that pomegranates contain strong anti-inflammatory, anti-oxidant, anti-obesity and anti-tumor properties. According to researchers, “Many beneficial effects are related to the presence of ellagic acid, flavonoids, anthocyanins, and flavones, which seem to be its most therapeutically beneficial components.” Subsequently, pomegranates are being considered valid treatment options for chronic diseases such as cancer, insulin resistance, intestinal inflammation and obesity.

3. Fermented Grapes — May he kiss me with the kisses of his mouth! For your love is better than wine. (Song of Solomon 1:2)

I can’t make a list of top Bible foods without including grapes. Several epidemiological studies have shown that moderate alcohol intake, particularly drinking red wine, may lower the risk of cardiac mortality due to atherosclerosis. The general recommendation is no more than one (five ounces) of red wine per day except for men under the age of 65 who may be able to have two drinks per day.

When grape juice is fermented, natural anti-oxidant and flavonoid properties are exemplified through a substance called resveratrol. Consequently, researchers have focused much of their attention on evaluating the health benefits of resveratrol in recent years, which has been linked to chronic disease prevention and treatment including diabetes and obesity.

4. Flax — An excellent wife, who can find? For her worth is far above jewels. She looks for wool and flax and works with her hands in delight. (Proverbs 31:10,13)

One of the most important plant fibers in the Bible, flax has been used to make linen for as long as recorded history. Although it has been widely replaced by cotton in recent years, flax remains one of the most important fiber plants in the world and one of the top Bible foods.

Having a rich history of medicinal use dating back to Babylon in 3000 B.C., flax seeds have been wholeheartedly embraced by natural health and medical circles alike because it provides a natural, vegan source of omega-3 essential fatty acids, lignans and fiber. Subsequently, research show that flax seeds may be able to help fight against cancer, lung disease and heart disease.

5. Sprouted Grain Bread — Take wheat and barley, beans and lentils, millet and spelt; put them in a storage jar and use them to make bread for yourself. (Ezekiel 4:9).

In the Book of Ezekiel, God gave the prophet Ezekiel a recipe for what has proven to be the perfect bread as science has recently shown us that it creates the “complete protein,” one that contains all essential amino acids. The main reason that Ezekiel bread is healthier than other breads is because the grains and legumes are soaked and sprouted, which makes them easier to digest — and as a result, is the only bread to make this list of top Bible foods.

Harvesting “sprouted grains” happens right after the seed has started to sprout, but before it has developed into a full-grown plant. During this critical growth state, the young shoot digests a portion of the starch to fuel its growth. Subsequently, because the grain’s starch has been utilized, the level of vital nutrients — including proteins, vitamins and minerals — are enhanced. Additionally, research studies have suggested that iron and zinc actually become more “bioavailable,” (more easily absorbed) after sprouting.

6. Raw Goat Milk — The lambs will be for your clothing and the goats will bring the price of a field. There will be goats’ milk enough for your food, for the food of your household, and sustenance for your maidens. (Proverbs 27:26-27)

Raw milk is filled with the vitamins and minerals that contribute to a healthy dental fluid flow and help maintain strong teeth. Loaded with calcium, vitamin K2, magnesium, phosphorus and fat-soluble vitamins, researchers have carried out a comparative study on the properties of cows’ milk compared to those of goats’ milk and have discovered that goats’ milk may be even more beneficial.

Unlike cows’ milk, scientists from the University of Granada has revealed that data concerning goats’ milk suggests that it could prevent diseases such as anemia and bone demineralization. Additionally, goats’ milk has properties that help with the digestive and metabolic utilization of minerals such as iron, calcium, phosphorus and magnesium.

7. Lamb — Now you shall eat it [the unblemished lamb] in this manner: with your loins girded, your sandals on your feet, and your staff in your hand; and you shall eat it in haste — it is the Lord’s Passover. (Exodus 12:11)

Due to the significance of the Passover Lamb and equating that role to Christ, lambs are the most revered animal in history, and the most honored food in the Bible (and the only meat earning a spot in the top 10 Bible foods). Lamb is the meat of young sheep that are generally one year old or younger. Due to slaughtering the animal at such a young age, the marble fat content is considerably lower than older varieties of meat, which contributes to heart health and helps prevent again obesity. Rich in protein, vitamin B12, vitamin B6, niacin, zinc and other vital nutrients, it is arguably the healthiest red meat on the planet.

On a side note, make sure to purchase local, organic, grass-fed varieties when possible. Grain-fed factory farmed animals are loaded with genetically modified corn feed, countless additives and are simply not worth the risk.

8. Bitter Herbs (coriander and parsley) — They shall eat the flesh that same night, roasted with fire, and they shall eat it with unleavened bread and bitter herbs. (Exodus 12:8)

Scholars are not in complete agreement which plants the authors of Bible were referring to when writing about “bitter herbs,” but coriander and parsley generally make the list.

Coriander is the seed of the powerful anti-oxidant and natural cleansing agent cilantro. Traditional medicine has long used and labeled coriander as an anti-diabetic plant and scientific research confirms its helpful effects on blood sugar. Coriander also appears to be helpful for high blood pressure and heavy metal detoxification amongst other positive health effects.

Parsley is another health-promoting herb and a rich source of several crucial vitamins, including vitamin A, vitamin C and potassium.

9. Vegetables — Please test your servants for ten days, and let us be given some vegetables to eat and water to drink. (Daniel 1:12)

Instead of eating the tasty dainties of the Babylonians, Daniel and his friends requested to live on a vegetarian diet. When it was time for them to be presented to the king, Nebuchadnezzar and all of the leaders were astounded to see that the four young Jewish friends were more fit and looked better than the other young men who ate the Babylonian fare. Often referred to as the Daniel diet or the Daniel fast, history and biblical text actually support that Daniel continued his vegetarian lifestyle throughout his entire life.

Of all the food groups, vegetables are arguably the most nutrient-dense and safest to eat. There’s relatively no risk in consuming too many of them; whereas, if you eat fruit all day, you run the risk of spiking your blood sugar or developing dental caries because of the excess sugar.

Vegetables are so effective at healing that, according to the National Cancer Institute, cruciferous veggies (broccoli, cabbage, collards, kale, radish etc.) can help prevent cancer because they are rich in glucosinolates – a large group of sulfur-containing glucosides. Known to break down during chewing and digestion, these powerhouse chemicals can slow down and even reverse cancer cells growth. Additionally, it has also been reported that glucosinolates can treat the following health concerns:

Inflammation
Bacterial and viral infections
Carcinogenic toxicity
Tumor angiogenesis (blood vessel formation)
Tumor metastasis (tumor migration)

10. Raw Honey — Have you found honey? Eat only what you need that you not have it in excess and vomit it. (Proverbs 25:16)

It’s no wonder raw honey is referred to as “liquid gold.” The medicinal applications to the skin and internal body seem limitless. First of all, raw honey is loaded with key nutrients. Research has also shown that honey contains the disease-fighting antioxidant flavonoids like pinostrobin, pinocembrin and chrysin.

In addition to being a fantastic replacement to energy drinks for athletes and people needing a little boost, raw honey also supports the growth of probiotics in gastrointestinal tract including (Bifidobacteria). Another fascinating quality of honey is its ability to improve allergy symptoms. However, be sure to purchase the local variety, as it will contain indigenous pollen species unlike generic store bought brands. The four classifications of food (trees that yield seed, plants that yield seed, field plants, clean meat) is the foundation of a Biblical diet. There are also other important things you should consider when starting or following a Biblical diet:

Water, sunshine and exercise. These three are absolutely key to good health. You should always remember to drink lots of water, get lots of exercise and go outside. I recommend one quart water daily for every 50 pounds of weight. Also, it’s important to drink high quality water.
Eat safe, clean meat. This means abstaining from certain kinds of meat and seafood such as pork, lobster, clams and mussels, shrimp and catfish.
Eat foods that are in season. The Bible states that everything has a season. This should also be our attitude when it comes to picking out the things we eat. Lean towards eating fruits, vegetables and herbs that are in season, as they’re fresher and better for your health.
Eating raw. Eating uncooked raw food is very much encouraged. Some vegetables may need to be cooked, but a majority of them can be enjoyed raw.
Unprocessed real whole foods. What you eat should ideally be consumed in the way that it was found in nature. This means that we should stay away from preservatives, processed foods, or those produced with lots of contact with hormones, fertilizers and pesticides.

A diet high in unprocessed food, fruit and vegetables is ideal for weight loss. Natural and raw fruits and vegetables carry fewer calories and are easier to digest then other processed foods. A longer lifespan some of our ancestors that went on the Biblical diet went on to live for 120+ years. Although we may not reach that age, studies show that a diet high in fruits and vegetables lead to little or no health complications, thus indicating a longer lifespan. When our bodies are in a state of imbalance due to poor dietary habits, we immediately feel it. We can feel sickly, sluggish and depressed. Eating right can increase energy, balance hormones and improve our mood. Eat your meals at regular intervals, and do not use animal fat or blood. “Feast eat at the proper time” (Ecclesiastes 10:17). “This shall be a perpetual statute … you shall eat neither fat nor blood” (Leviticus 3:17). Note: Science has confirmed that most heart attacks result from high cholesterol and that the use of fats is largely responsible for high levels of cholesterol. It looks like the Lord knows what He is talking about after all.

(Proverbs 23:2). In Luke 21:34, Christ specifically warned against “carousing” (intemperance) in the last days. Overeating, a form of intemperance, is responsible for many degenerative diseases. Don’t harbor envy or hold grudges. These kinds of sinful feelings actually disrupt body processes. The Bible says that envy is “rottenness to the bones” (Proverbs 14:30). Christ even commanded us to clear up grudges that others might hold against us (Matthew 5:23, 24). “A merry heart does good, like medicine” (Proverbs 17:22).
“As he thinks in his heart, so is he” (Proverbs 23:7). Put full trust in the Lord. “The fear of the Lord leads to life, and he who has it will abide in satisfaction” (Proverbs 19:23). Trust in the Lord strengthens health and life. “My son, give attention to my words for they are life to those who find them, and health to all their flesh” (Proverbs 4:20, 22). Health comes from obedience to God’s commands and from putting full trust in Him.

Balance work and exercise with sleep and rest. “Six days you shall labor and do all your work, but the seventh day is the Sabbath of the Lord your God. In it you shall do no work” (Exodus 20:9, 10). “The sleep of a laboring man is sweet” (Ecclesiastes 5:12). “In the sweat of your face you shall eat bread” (Genesis 3:19). “It is vain for you to rise up early, to sit up late” (Psalm 127:2). “For what has man for all his labor, and for the striving of his heart with which he has toiled under the sun? Even in the night his heart takes no rest. This also is vanity” (Ecclesiastes 2:22, 23). Keep your body clean. “Be clean” (Isaiah 52:11). The subject in Matthew 15:1–20 is eating without first washing the hands (verse 2). The focus here is not eating, but washing. The scribes taught that eating any food without a special ceremonial washing defiled the eater. Jesus said these ceremonial washings were meaningless. In verse 19, He listed certain evils: murders, adulteries, thefts, etc. Then He concluded, “These are the things which defile a man, but to eat with unwashed hands does not defile a man” (verse 20).This Scripture passage is referring to foods “which God created to be received with thanksgiving” (verse 3) by His people. These foods are the clean foods listed in Leviticus 11 and Deuteronomy 14. Verse 4 makes it clear that all creatures of God are good and not to be refused, provided they are among those created to be “received with thanksgiving” (clean animals). Verse 5 tells why these animals (or foods) are acceptable: They are “sanctified” by God’s Word, which says they are clean, and by a “prayer” of blessing, which is offered before the meal. Please note, however, that people who try to “sanctify themselves” while eating unclean foods will ultimately be destroyed (Isaiah 66:17).

“Everyone who competes for the prize is temperate in all things” (1 Corinthians 9:25). “Let your gentleness be known to all men” (Philippians 4:5). A Christian should completely avoid things that are harmful and be moderate in the use of things that are good. Habits that injure health break the command “You shall not murder” by degrees. They are suicide on the installment plan. Avoid anything harmful to the body (1 Corinthians 3:16, 17). This might surprise you, but medical science confirms that tea, coffee, and soft drinks that contain the drug caffeine and other harmful ingredients are damaging to the human body. None of these contains food value except through the sugar or cream added, and most of us already use too much sugar. Stimulants give a damaging, artificial boost to the body and are like trying to carry a ton in a wheelbarrow. The popularity of these drinks is due not to flavor or advertising, but to the doses of caffeine and sugar they contain. Many Americans are sickly because of their addiction to coffee, tea, and soft drinks. This delights the devil and damages human lives. “Every man should eat and drink and enjoy the good of all his labor it is the gift of God”
(Ecclesiastes 3:13). Unhappy scenes at mealtime hinder digestion. Avoid them. “Loose the bonds of wickedness undo the heavy burdens share your bread with the hungry, and bring to your house the poor who are cast out; when you see the naked cover him, and your healing shall spring forth speedily” (Isaiah 58:6–8). This is too plain to misunderstand: When we help the poor and needy, we improve our own health.

But if you truly love the Lord, you will be eager to obey His health laws because that’s the way He has designed for you to achieve optimal health, happiness, and purity. “He became the author of eternal salvation to all who obey Him” (Hebrews 5:9). Jesus said, “If you love Me, keep My commandments” (John 14:15). When we truly love the Lord, we won’t try to dodge His health laws (or any other commandments) or make excuses. This attitude actually reveals the true heart in the other things of God. “Not everyone who says to Me, ‘Lord, Lord,’ shall enter the kingdom of heaven, but he who does the will of My Father in heaven” (Matthew 7:21).

Genesis 1:29-30
And God said, See, I have given you every plant yielding seed that is on the face of all the land and every tree with seed in its fruit; you shall have them for food.
And to all the animals on the earth and to every bird of the air and to everything that creeps on the ground—to everything in which there is the breath of life I have given every green plant for food. And it was so.

Consult your Doctor first before trying this

The Lord promises in Jeremiah 33:6 that He will provide health and healing. He is our source of health and we are able to depend on His word for strength and restoration.

Brain Health and Dementia

Recent research findings present recommendations for lifestyle modifications aimed at dementia prevention. Providers can play a key role in promoting these protective modifications. A public health approach to dementia could prevent up to 30% of worldwide dementia cases over the next 20 years. Various studies that call attention to modifiable lifestyle factors and their role in the manifestation of dementia symptoms are reporting decreasing prevalence rates of dementia. Prevention is commonly discussed in terms of risk reduction in modifiable lifestyle factors such as the management of cardiovascular risks, diabetes management, and level of educational attainment, among others.

A natural decline in brain function comes with age; nonetheless, dementia is not a normal part of aging. This decline may be explained by the varying degrees of brain health and cognitive reserve, the capacity of the brain to maintain function despite age-related damage. The variation in cognitive reserve and the development of dementia can be attributed to different risk factors. Brain health is commonly attributed to 70% lifestyle and 30% genetics. Research is escalating to support minimizing individuals’ risks for the development of dementia rather than searching for the silver bullet.

In 2015, the Institute of Medicine released a call for action to enable health care providers, family members, communities, and individuals to take actions in their daily lives that may ward off the impact of cognitive issues and dementia, thus leading to more independent lives. Since June 2017, there have been numerous publications that have addressed lifestyle factors that decrease individuals’ risks for late-life cognitive decline and dementia. This article aims to summarize the findings of the recently published National Academy of Sciences, Engineering, and Medicine’s report, “Preventing Cognitive Decline and Dementia: A Way Forward,” and the Lancet Commissions’ report, “Dementia Prevention, Intervention, and Care.” The reports were published within one month of each other but put forth different recommendations for lifestyle modifications for dementia prevention, which will be outlined and discussed below.

Cognitive training is a broad term that is used to examine a general set of cognitive functions such as memory, speed of processing, and problem-solving, that may or may not be computer based. At this time there is no evidence that commercial computer-based cognitive training offers advantageous long-term cognitive effects. The effects appear to advance to short-term benefits that apply only to the cognitive skill or domain that was specifically targeted in the training. Further research in this area is warranted to investigate whether cognitive training can prevent or delay cognitive impairment or dementia.

• Blood pressure management for people with hypertension lacks sufficient evidence to determine how much impact it has on preventing dementia because neurocognitive effects appear after 10 or more years following the diagnosis of hypertension. Nonetheless, control of high blood pressure in middle age (ie, ages 35 to 65) when brain changes related to dementia begin to occur might have an impact in reducing dementia in later life.
• Increasing physical activity has numerous documented health benefits, and aerobic exercise and strength training were underlined in the report. A simple rule of thumb to guide behavior change is to strive to increase what an individual is currently doing with regard to physical exercise.

In sum, more longitudinal research is needed to understand how the aforementioned interventions (cognitive training, high blood pressure management, and increased physical activity) may benefit people across various ages and disease stages with a focus on cognitive decline, mild cognitive impairment, and dementia. Ultimately, the goal is to prevent cognitive decline to enable people to live longer, healthier lives. The report concludes, “There is good cause for hope that in the next several years much more will be known about how to prevent cognitive decline and dementia.”

Prevention Is Better Than a Cure
Education is the second most important modifiable risk factor; a lack of education is common among 40% of dementia patients. Lower levels of education are associated with a 59% increase in the risk of dementia and are directly related to up to 19.1% of cases of dementia. A low educational level results in greater vulnerability to cognitive decline because it results in less cognitive reserve, which is the capacity to maintain the brain functions despite brain pathology. Evidence is currently lacking to determine whether higher levels of education diminish the risk of dementia.

• Midlife hypertension increases the risk for dementia by 57.3%. If hypertension is controlled, approximately 2% to 5% of dementia cases in the general population could be avoided. Hypertension produces chronic endothelial damage, impairs cerebral blood flow regulation, and increases the risk for stroke and vascular dementia. It is also important to point out that adequate control of hypertension (<150/90 mm Hg) can reduce the progression of cognitive decline and incidence of dementia.
• Midlife obesity is one of the components of metabolic syndrome. Metabolic syndrome can produce insulin resistance and an increase in concentrations of insulin in the bloodstream. This can lead to diminished insulin levels in the brain, provoking decreased amyloid clearance and a greater risk of developing dementia. People with obesity also have higher blood glucose levels and higher inflammatory markers, both which have been proposed as pathways for cognitive decline. Obesity is present in 2% of all dementia cases.
• Hearing loss has only recently been established as a risk factor for dementia and is the main modifiable risk factor for dementia. Hearing loss has been associated with a 94% increase in the risk of dementia. Subsequently, among 100 dementia cases, up to 23 can be attributed to hearing loss, and hearing loss has a prevalence of 31.7% in patients with dementia. The mechanism underlying cognitive decline associated with peripheral hearing loss is not yet clear, and it has not been established whether correcting it can prevent or delay the onset of dementia. A recent systematic review and meta-analysis published online by Loughrey and colleagues in December 2017 further highlighted the relationship between hearing loss as a modifiable risk factor for cognitive decline, cognitive impairment, and dementia.
• Debate continues about the direction of causation for depression: Is depression a prodromal symptom or an independent risk factor for dementia? It is reasonable that dementia risk increases due to depression’s impact on stress hormones, neuronal growth factors, and hippocampal volume.
• As previously stated, higher blood glucose levels have been proposed as a possible pathway for cognitive decline. It has been determined that diabetes confers a 50% risk increase for developing dementia. Additionally, 6.4% of people with dementia suffer from diabetes. It is important to point out that diabetes is a risk factor for stroke and endothelial dysfunction, which, in turn, can contribute to developing dementia.
• Studies have reported that physical activity has a significant protective effect against cognitive decline, with a high level of exercise being the most protective factor, reducing the risk of dementia by 38%. In older people without dementia, physical exercise improves balance and reduces falls, improves mood, reduces mortality, and improves function.
• Smoking increases the risk of dementia by 60% but is an easily preventable risk factor. Smoking is present in 27.4% of all dementia cases, and if smoking cessation occurred, there would be a decrease in up to 13.9% of all dementia cases. It has been proven that smoking is related to cognitive impairment due to vascular pathology and the neurotoxins contained in cigarettes.
• Social isolation is a new risk factor identified by this report and may be a preclinical symptom of dementia. Individuals who are socially isolated are at an increased risk for hypertension, coronary heart disease, and depression. Additionally, social isolation can result in cognitive inactivity, which is associated with low mood and a more rapid decline in cognition.

As older adults express concern about their brain health, health care professionals are viewed as trusted sources of information. In addition to practitioners gaining an understanding of lifestyle factors that contribute to dementia risks, it is important for providers to be aware of existing networks and institutions that focus on diminishing the impact of dementia and provide accessible information to the public. The following are resources made readily available to providers.

Global Brain Health Institute
Launched in 2015, the Global Brain Health Institute (GBHI) is a leader in the global community dedicated to protecting the world’s aging populations from threats to brain health. Located across two sites the University of California, San Francisco and Trinity College Dublin the GBHI works to reduce the scale and impact of dementia in three ways: by training and connecting the next generation of leaders in brain health through the Atlantic Fellows for Equity in Brain Health program; by collaborating in expanding preventions and interventions; and by sharing knowledge and engaging in advocacy.

GBHI brings together a powerful mix of disciplines, professions, backgrounds, skill sets, perspectives, and approaches to develop new solutions. GBHI strives to improve brain health for populations across the world, reaching into local communities and across its global network. By focusing on working compassionately with people in vulnerable and underserved populations to improve outcomes and promote dignity for all people, the Atlantic Fellows for Equity in Brain Health, based at GBHI, provides innovative training, networking, and support to emerging leaders who are focused on bringing transformative change to improve brain health and reduce the impact of dementia worldwide. It is one of six global Atlantic Fellows programs to advance fairer, healthier, and more inclusive societies. Health care professionals from a variety of disciplines are encouraged to engage with the GBHI training, collaboration, and expertise offered through its recognized leaders in a range of disciplines, fellows, and senior fellows.

Global Council on Brain Health
Information regarding brain health and dementia is rapidly evolving as new research becomes available. Practitioners are challenged to stay up to date with relevant information to provide to their patients. The Global Council on Brain Health offers evidence-based recommendations for people to consider adopting into their daily lives. A collaborative of AARP, the council consists of scientists, health professionals, scholars, and policy experts from around the world working in broad areas of brain health. The intent of the council is to offer practical brain health advice to the public, health care providers, and policy makers based on the current research evidence from a consensus of interdisciplinary experts.

To date, the council has published reports on the following brain health topics: nutrition and brain health, cognitively stimulating activities, social engagement and brain health, sleep and brain health, and physical activity and brain health. The reports offer advice that older adults can utilize to adopt a brain healthy lifestyle. Full-length reports are available as resources for practitioners and brief reports can be distributed to patients interested in gaining practical up-to-date brain health recommendations. Additional information can be found at http://www.aarp.org/health/brain-health/global-council-on-brain-health. This information is beneficial for providers to be prepared to respond to patient queries related to brain health and dementia.

Conclusion
Dementia is commonly referred to as the public health challenge of the 21st century. Recent research is mounting to provide an opportunity—that changes in lifestyle earlier in life can have a profound impact on later life. Understanding the importance of prevention earlier in the disease progress (because it is known that changes occur for up to 20 years in the brain and body before an Alzheimer’s disease diagnosis) is an initial first step emphasized by both reports.

Additionally, nonpharmacological interventions such as cognitive brain training and socially based interventions may offer encouraging evidence toward the prevention of cognitive decline and dementia. The prospect for dementia prevention is growing across multiple disciplines, and a growing body of research will influence future decision making by health care providers and patients. For now, though, it’s important to emphasize that it is possible to live a brain-healthy life with dementia. It is never too early nor too late to adopt healthy lifestyle modification(s) to maximize brain health and wellness.

Dementia Depression

Depression and cognitive impairment are both common conditions in old age, and frequently occur together. However, accurate figures of the co-occurrence are not available. The inter-relationship between the two clinical entities is still complex and not well understood. Clearly depression can be a psychological reaction to cognitive decline, and thus may also appear as an early symptom in dementing individuals. However, recent data suggest that depression, and in particularly late-life depression, can also be a risk factor for Alzheimers disease (A D). The relationship between the two clinical entities should be seen in view of observations of white matter changes both in A D and in depression. Since these white matter changes are thought to frequently reflect vascular changes, the concept of “vascular depression” has been advanced. Vascular changes in the brain occur commonly in demented individuals and conversely depression is frequent co-occurrence in vascular disease.

Additionally neurotransmitter loss may occur in both, particularly monoaminergic disturbances which is characteristic of depression but may occur also in A D. The same is true for hippocampal atrophy, which is characteristic of A D but has also been described in depression. Although dementia is primarily considered a memory disorder, there are significant neuropsychiatric manifestations sufficient to cause decline in ability to carry out social or occupational functioning independently. Depressive symptoms are extremely common in demented patients, and may be present very early in the course of the disease. Depression and dementia are common in older people and their association is very complex. The reported prevalence of comorbid depression or depressive symptoms in individuals with dementia has been quite variable, likely due to differences in methods of assessment, diagnostic criteria, stages of dementia, and other factors. Little empirical evidence is available to guide the clinicians in the selection of treatment.

Comorbid depression complicates diagnosis, affects treatment approaches and outcomes, and decreases the quality of life of affected individuals as well as their caregivers. The coexistence of depression and dementia has emerged as a significant public health problem leading to increased health care utilization and costs. Most people feel low or sad from time to time. This is not the same as being depressed. Depression is a condition that can last for several weeks or months. When a person has depression a number of negative feelings can dominate their life, including sadness, hopelessness and a loss of interest in things they used to enjoy. At least one in five people in the UK will have depression at some time in their lives. However, it is more common in people with dementia, particularly if they have vascular dementia or Parkinsons disease dementia. Depression is often diagnosed when a person is in the early stages of dementia. However it can develop at any stage. Depression can also come and go. If a person has had depression in the past, they are more likely to have it again if they develop dementia.

Depression often has more than one cause.

The causes vary a lot from person to person including:

A history of traumatic or upsetting events other health conditions or disabilities particularly heart problems, breathing difficulties, chronic pain or hormonal problems side-effects of medications – including certain sleeping pills, steroids, beta-blockers and drugs used to treat Parkinson’s disease
not having enough meaningful things to do, social isolation or a lack of social support not getting enough good-quality sleep bereavement this can make a person more vulnerable to depression, although grief itself is not normally thought of as a type of depression feeling stressed about issues such as money, relationships or the future drinking too much alcohol. These causes can be similar for everyone whether they have dementia or not. However, if a person in the early stages of dementia has depression, it might be directly linked to them worrying about their memory and the future.

People with vascular dementia often have more insight and awareness of their condition than people with Alzheimers disease. This may explain why it’s more common for people with vascular dementia to have depression. The diseases that cause dementia can also sometimes cause depression. People who live in a care home seem to be at particular risk of developing depression. This is why good staff training and regular visits from family members and friends can help to improve their wellbeing. Depression can affect people in different ways. There are also different levels of depression doctors talk about people having ‘mild’, ‘moderate’ or ‘severe’ depression. Common symptoms include feeling sad, hopeless or irritable for much of the time. A person may lose interest or pleasure in activities they once enjoyed, or they may feel worthless, guilty or have low self-confidence. People with depression can have disturbed sleep, such as waking in the very early morning. They may also struggle to think clearly or concentrate, or they may become more forgetful. Older people who have depression may have slightly different symptoms than younger people. They are likely to feel more agitated and to have more health anxiety (worries about their own health. They are also more likely to have more physical symptoms, such as aches and pains.

It is common for people with dementia to have anxiety. It can make symptoms of dementia worse particularly symptoms that affect a persons attention, planning, organising and decision-making. Depression can drain a persons energy and make them feel hopeless. It could even make them think about ending their own life. This is why depression should be taken very seriously. It should not be dismissed as a person just feeling ‘a bit down’. As well as having negative feelings, if a person with dementia has depression, it can make problems with their thinking and memory worse. Depression may also make any changes in their behaviour worse. They may be agitated and aggressive. They may also have problems sleeping or refuse to eat. For people in the later stages of dementia, symptoms of depression often include tearfulness and weight loss. Some symptoms of depression are similar to symptoms of dementia. This includes being withdrawn and having problems with memory and concentration. However, there are key differences between the symptoms of depression and dementia.

Depression tends to develop much more quickly than most types of dementia over weeks or a few months. It is common for people with dementia to have problems with their speech and awareness of where they are and what time it is. This is unusual in depression. A person with depression may sometimes say they can’t remember something but then remember when they are prompted. However, a person with dementia (particularly Alzheimers disease) is likely not to remember recent events. They may also try to cover up their memory loss. A person with severe depression may have problems with their reasoning or memory. However, this is likely to be because they have poor concentration. Their problems with reasoning or memory should get better with treatment or when the depression lifts. This does not happen with dementia. A person who has depression should be offered a range of treatments, depending on how long they’ve had it and how severe it is. If they have mild depression they may be offered a support group or self-help (activities and techniques they can do by themselves). If they have more severe or persistent depression their Doctor may prescribe an antidepressant medication, as well as (or followed by) referring them for a talking therapy.

The difficulties people with dementia may have with their mental abilities can make it harder to treat depression. This could include difficulties with their attention, communication, memory or reasoning. To have the most benefit, some types of talking therapy need a person to have these mental abilities intact. This includes cognitive behavioural therapy (CBT). There’s no reason why a person with dementia can’t benefit from talking about their thoughts and feelings with a professional counsellor or therapist, at least during the earlier stages of the condition. Antidepressant drugs are widely used to treat depression. However they don’t seem to be as effective in people with dementia. As a result, treating depression in a person with dementia can be more about improving their quality of life through:

Care and support that matches their needs, personality and preferences dealing with any underlying issues that may be the cause of depression, such as loneliness, or treating pain generally helping them live as positively as possible. If a person has depression they should be offered a range of treatments, depending on how long they have had it and how severe it is.

Routines, activities and surroundings
People with dementia who have depression may benefit from:

Having a daily routine they find reassuring
Doing regular physical activity, such as walking, cycling, tai chi or Pilates
Doing regular activities with other people social isolation can make depression worse
Spending time doing reminiscence and life story activities, such as making a scrap book or photo album about their life
Having more one-to-one interaction with another person some people enjoy talking, holding hands or gentle massage
Changes to their environment for example, reducing bright lights and loud noises or avoiding large groups of people.

These ways of managing depression should ask a counsellor, psychotherapist or doctor it can be very helpful to ask a professional for advice. Support groups can also be very helpful. They can give people a chance to talk to others who are going through a similar experience. Depression is sometimes caused by a person having low levels of certain chemicals in their brain (known as ‘neurotransmitters’). Antidepressant medication can increase the levels of some of these chemicals. This can help to improve a persons mood over weeks and months. A person with dementia who has depression is likely to be offered antidepressant medication if the depression is severe or it hasn’t responded to other types of therapy. However there isn’t much evidence that these drugs are effective for treating depression in people who have dementia. If the person wants to try complementary or alternative therapies to manage their depression they should speak to their doctor first. These include aromatherapy, massage and bright light therapy.

Most alternative therapies are unlikely to conflict with conventional treatments. However some may interact with other drugs like cannabidiol (CBD) oil. That is why they should always check with their doctor first. Depressive symptoms are quite common in older people. However, sustained and disabling major depressive episodes are more common in those with dementia than in age-matched controls without dementia. The incidence of depression may be 30% in vascular dementia and in Alzheimers disease, and over 40% in the dementia associated with Parkinsons and Huntingtons diseases. Practitioners caring for people with dementia should be alert to major depression as this will require specific management strategies.

People with dementia of any type have a high incidence of major depression. The occurrence of a first major depressive episode in an older adult is a risk factor for developing dementia. Management of depression in a person with dementia should be enthusiastic with an aim to optimise quality of life. Non-pharmacological and pharmacological strategies are both important in treating depression in dementia and management of these patients requires a collaborative approach. Selective serotonin reuptake inhibitors are the first-line pharmacotherapy for depression in dementia, although they are less likely to be effective in older people. Depressive symptoms are quite common in older people. However, sustained and disabling major depressive episodes are more common in those with dementia than in age-matched controls without dementia.

The symptoms and signs of major depression in dementia are often no different from depression occurring in any other group. Mood is most commonly low but can be irritable, angry, or anxious. Disturbed biological rhythms in sleep, appetite and energy are common and patients may be negative, hopeless or even nihilistic. Ideas of worthlessness, guilt and self-harm also occur. Overall cognitive ability may decline significantly due to the depression alone. Attributing cognitive impairment to the dementia or the depressive disorder may be difficult until an adequate trial of treatment for depression has occurred. Some signs of dementia may strongly resemble those of a major depression such as social withdrawal, lack of interest in self or others, low initiative and poor motivation. The diagnosis of the depression may be made more difficult when the dementia has not been recognised before. Apathy is a particularly confounding sign for diagnosis, and specialist assessment may be needed. Also there are some individuals whose cognitive style has always been essentially negative and depressive, rather than this being a recent change. This may only be revealed by reliable family informants.

Typically a major depressive episode develops over weeks to a few months, and is a significant new impairment for the person. Conversely, the dementia alone may develop insidiously over months or years and be slow in progression. The onset of the first major depression in an older adult may be the first sign of dementia that is developing or at risk of developing. Diagnosis of the dementia will be difficult until the depressive episode has remitted or at least improved. For the older person who shows a significant decline in cognition and function, the differential diagnosis must include dementia and a depressive disorder. These are not mutually exclusive. Investigations that include haematological, endocrine and other biological tests, and neuroimaging, are relevant to both diagnoses. For someone with a known dementia, of any severity, who exhibits some of the symptoms and signs of major depression, the clinician should consider and investigate for:

New or deteriorating physical illness and the possibility of delirium
A major depressive episode
A phase of acute deterioration in the dementia
The impact of prescribed and non-prescribed medicines and substances.8 Alcohol, marijuana, opioids and many prescribed drugs with sedative properties, can contribute to depressed mood and aggravate cognitive impairment.

Experts estimate that up to 40 percent of people with Alzheimers disease suffer from significant depression. Fortunately, there are many effective non-drug and drug therapies available. Treatment of depression in Alzheimers disease can improve a persons sense of well-being, quality of life and individual function. Men and women with Alzheimers experience depression with about equal frequency. But identifying depression in someone with Alzheimers can be difficult. There is no single test or questionnaire to detect the condition, and diagnosis requires careful evaluation of a variety of symptoms. Dementia itself can lead to certain symptoms commonly associated with depression, including

Apathy
Loss of interest in activities and hobbies
Social withdrawal
Isolation
The cognitive impairment experienced by people with Alzheimers often makes it difficult for them to articulate their sadness, hopelessness, guilt and other feelings associated with depression.

Depression in Alzheimers doesn’t always look like depression in people without the disorder. For example, depression in Alzheimers is sometimes less severe and may not last as long or recur as often. Also, people with Alzheimers and depression may be less likely to talk openly about wanting to kill themselves, and they are less likely to attempt suicide than depressed individuals without dementia. What’s more, depressive symptoms in Alzheimers may come and go, in contrast to memory and thinking problems that worsen steadily over time. The first step in diagnosis is a thorough professional evaluation. Side effects of medications or an unrecognized medical condition can sometimes produce symptoms of depression. Key elements of the evaluation will include

A review of the person’s medical history
A physical and mental examinations
Interviews with family members who know the person well
Because of the complexities involved in diagnosing depression in someone with Alzheimers, it may be helpful to consult a geriatric psychiatrist who specializes in recognizing and treating depression in older adults.

To facilitate diagnosis and treatment of depression in people with Alzheimers, the National Institute of Mental Health established a formal set of guidelines for diagnosing the condition. Although the criteria are similar to general diagnostic standards for major depression, they reduce emphasis on verbal expression and include irritability and social isolation. For a person to be diagnosed with depression in Alzheimers, he or she must have either depressed mood (sad, hopeless, discouraged, or tearful) or decreased pleasure in usual activities, along with two or more of the following symptoms over a two-week period:

Social isolation or withdrawal
Disruption in appetite that is not related to another medical condition
Disruption in sleep
Agitation or slowed behavior
Irritability
Fatigue or loss of energy
Feelings of worthlessness or hopelessness, or inappropriate or excessive guilt
Recurrent thoughts of death, suicide plans, or a suicide attempt

The most common treatment for depression in Alzheimers involves a combination of medicine, support and gradual reconnection to activities and people the person finds pleasurable. Simply telling the person with Alzheimers to “cheer up,” “snap out of it,” or “try harder” is seldom helpful. Depressed people with or without Alzheimers are rarely able to make themselves better by sheer will, or without lots of support, reassurance, and professional help.

Non-Drug Approaches
Schedule a predictable daily routine, taking advantage of the persons best time of day to undertake difficult tasks, such as bathing
Make a list of activities, people or places that the person enjoys now and schedule these things more frequently
Help the person exercise regularly, particularly in the morning
Acknowledge the persons frustration or sadness, while continuing to express hope that he or she will feel better soon
Celebrate small successes and occasions
Find ways that the person can contribute to family life and be sure to recognize his or her contributions
Provide reassurance that the person is loved, respected and appreciated as part of the family, and not just for what she or he can do now
Nurture the person with offers of favorite foods or soothing or inspirational activities
Reassure the person that he or she will not be abandoned
Consider supportive psychotherapy and or a support group, especially an early-stage group for people with Alzheimers who are aware of their diagnosis and prefer to take an active role in seeking help or helping others

Physicians may prescribe antidepressants for people with Alzheimers who have depression. Dementia itself is not a disease, but a constellation of symptoms caused by diseases and disorders that affect the brain, including Alzheimer’s disease (A D), Parkinson’s disease (PD), diffuse Lewy body disease, strokes, and others. Dementia involves progressive loss of memory and other cognitive functions, such as problem solving and emotional control. The earliest diagnosable stage of dementia, mild cognitive impairment (MCI), does not always lead to dementia; for those who do develop dementia, abilities to independently perform basic activities of daily living (ADLs) and instrumental activities of daily living (IADLs) are generally impaired as the condition progresses.

Behavioral and psychological symptoms of dementia (BPSD), also frequently referred to as neuropsychiatric symptoms of dementia, affect up to 95% of those with dementia during the course of the illness. Symptoms of depression are especially common in MCI and throughout the course of dementia. Reported prevalence of depression or depressive symptoms in persons with dementia ranges from 0% to 96%, while moderate to high rates of depression or its symptoms are consistently reported for persons with MCI The wide range of prevalence for depression in dementia is due to several factors, including differences in researchers focus on symptoms versus specifically defined depressive disorders, diverse study samples varying in causes of dementia, stage of illness, country of residence, and placement of patient, as well as variation in the instruments used to assess depressive symptoms and disorders. The understanding of the nature of psychological impairment in dementia of Alzheimer type (DAT) continues to develop. Memory impairment is the most heavily investigated topic and a number of studies are reported which all have the common theme of placing the source of the impairment at the input of the memory system. In addition, psychological assessment continues to attract attention and work relating to other functions such as spatial ability and mood is also described.

Alzheimers disease is the most common type of dementia and is typically seen in older adults. Symptoms of Alzheimers include problems with memory, communication, comprehension, and judgment. Changes in personality may also occur. There is no cure, but symptoms can be managed through the use of behavioral strategies and medication.
It’s a progressive disease that impairs your cognitive ability and interferes with your ability to function. Common symptoms include:

Memory loss
Inability to problem-solve
Lack of judgment

While no two cases of Alzheimers follow the same path, the progression of A D generally falls into three primary stages based on signs and symptoms. Three stages of Alzheimers disease recognized by the National Institutes of Health (NIH), how they interfere with activities of daily living (ADL), and what stage 3 of Alzheimers is like depending on the severity of dementia. Alzheimers staging involves activities of daily living and how much the disease interferes with them.

ADLs are the routines you go through every day, such as:

Eating
Dressing
Bathing/showering
Hygiene and grooming (brushing your teeth and hair)
As A D progresses through the stages, ADLs become more and more difficult.

Differing Definitions
There are multiple definitions of Different healthcare practitioners and organizations use different criteria for Alzheimers stages. Some may identify five or seven different stages. The NIH recognizes three stages, with the final stage divided into three severity levels.

Stage 1: Preclinical Alzheimers
In stage 1, your brain may have begun to change. For example, imaging studies may reveal changes in nerve cells and the build-up of amyloid-ß (beta), an abnormal protein that forms masses in the brain called plaques. During this stage, you may have no symptoms or symptoms that are too mild to notice. Your ADLs remain unimpaired. Stage 1 can last for many years or even decades. This stage is most often diagnosed in research studies, not in clinical practice.

Stage 2 is called mild cognitive impairment (MCI). It’s defined as:
More memory problems than are normal for your age
Symptoms still don’t have a significant impact on ADL
Symptoms of MCI are usually mild and involve problems in cognition—brain-based abilities required to learn, form and retrieve memories, problem-solve, and pay attention.

The first symptoms of Alzheimers vary from person to person. You may experience:

Memory loss
Difficulty recalling known words
Vision problems
Impaired reasoning or judgment

These problems may lead to behaviors such as:
Wandering and getting lost
Forgetting to pay bills
Missing appointments
Losing things
Repeatedly asking the same questions
Most people are diagnosed during this stage. Symptoms necessary for a diagnosis of MCI include:

Concern about a change in cognition (compared to your previous level of function)
Impairment of one or more cognitive functions, such as problem-solving or memory, that’s greater than expected for your age and education level
Ability to perform ADLs, although they may have started becoming more difficult

Stage 3: Not everyone with MCI will go on to develop the third and most severe stage of Alzheimer’s disease. This stage involves problems with the brain, including:

Loss of normal neuron (brain cell) connections
Death of nerve cells due to amyloid plaques and other factors
Alzheimers or dementia is classified by its severity.

Mild Dementia
In mild Alzheimers, symptoms are severe enough to interfere with ADLs. They include:

Worsening memory loss, when compared to MCI
Poor judgment
Making bad decisions
Declines in motivation and spontaneity
Taking longer than normal to perform daily tasks

This leads to problems and behaviors such as:
Repeating the same questions or stories over and over
Having difficulty balancing the checkbook, managing money, and/or paying bills
Getting lost in familiar places
Wandering away from home
Losing things and finding them in very odd places (such as the cell phone in the refrigerator)
Mood and Personality Changes
During mild dementia, other people may start noticing changes in mood and personality, especially increasing anxiety and aggression.

Moderate Dementia
The hallmark sign of moderate dementia is that supervision becomes increasingly necessary. Symptoms interfere more with ADLs and involve:

Worsening memory loss and confusion
An inability to learn anything new
Worsening language problems (reading, writing, remembering words)
Trouble calculating numbers
Problems thinking logically
Heightened problems with focus
Declining attention span
Trouble organizing thoughts
An inability to cope with stress or new situations
In addition, the following symptoms are notable in the moderate dementia stage:

Difficulty with multi-step tasks (such as following a recipe)
Trouble recognizing people (including close friends and family members)
Symptoms of paranoia (severe fear), delusions (believing things that are untrue), and hallucinations (seeing things that aren’t there)
Angry outbursts
Impulsive behavior
Inappropriate language
Restlessness, anxiety, and agitation
Wandering getting lost in familiar places (such as a persons own neighborhood)
Impulsive behavior such as undressing at inappropriate times or places or using vulgar language
Inappropriate outbursts of anger
Repetitive movements or muscle twitches

Severe Dementia
People with severe dementia are completely dependent on others for care and require 24/7 supervision. Symptoms from the moderate stage grow worse.

Additional symptoms may be:

Trouble eating and swallowing
Weight loss
Inability to communicate
Skin infections
Loss of bowel and bladder control
Constant sleeping or being bedridden
Inability to walk
Seizures
Eventually, the body shuts down and death occurs.

Alzheimers didn’t used to be diagnosable until memory loss and other symptoms became apparent. Now, studies have found changes in the brain may start 20 or even 30 years before the first symptoms begin. With the early stages better recognized, people are getting an earlier diagnosis. That means they can start treatments and preventive measures that may stave off symptoms and the progression to later stages. Alzheimers disease involves three stages: preclinical disease, mild cognitive impairment, and dementia. The dementia stage is divided into mild, moderate, and severe categories. As the disease advances, symptoms of memory loss and other cognitive declines become more apparent and more likely to impair activities of daily living. Consult with your doctor.

RACIAL DISPARITIES IN ALZHEIMERS DISEASE For Black/Africian Americans and Hispanic Americans

Atlanta Georgia – Current reports state that Alzheimers is the sixth leading cause of death for all Americans, and the fourth leading cause of death for older Black/African Americans. Additionally, it notes that Black/African American elders are two to three times more likely to have Alzheimers disease compared with Whites. With evidence of this magnitude, we realize an investment to stop, prevent or cure Alzheimers must be accelerated. There is a clear and urgent need to promote informed decisions about health dementia-related preventive behavior in the African American community. The Emory ADRC will strengthen its capacity via educational initiatives and screening and detection efforts by developing culturally sensitive educational materials that are consistent with several objectives of the National Alzheimers Project Act (NAPA) signed into law by President Obama.

Over the years we have used established and innovative strategies to provide information and education regarding early detection and diagnosis issues related to caregiving, and developments in research to reduce racial disparities by:
Disseminating information to the community about risk factors for cognitive impairment that include how to identify early warning signs of memory loss. Offering cognitive screening opportunities to facilitate the diagnosis of disorders that impair thinking.
Providing continuing education hours for nurses, social workers and allied health care professionals. Through internal and external support the Emory ADRC has gained traction and momentum to effect changes in knowledge, attitudes, and behaviors so that individuals become proactive and informed consumers regarding their cognitive health.
As the US elderly population continues to expand rapidly, Alzheimers disease poses a major and increasing public health challenge, and older African Americans may be disproportionately burdened by the disease. Although African Americans were generally underincluded in previous research studies, new and growing evidence suggests that they may be at increased risk of the disease and that they differ from the non-Hispanic white population in risk factors and disease manifestation.

This article offers an overview of the challenges of Alzheimers disease in African Americans, including diagnosis issues, disparities in risk factors and clinical presentation of disease, and community-based recommendations to enhance research with this population. Racial and ethnic differences in the prevalence of Alzheimers and other dementias. Although there are more non-Hispanic whites living with Alzheimers and other dementias than any other racial or ethnic group in the United States, older Black/African Americans and Hispanics are more likely, on a per-capita basis, than older Whites to have Alzheimers or other dementias. Most studies indicate that older Black/African Americans are about twice as likely to have Alzheimers or other dementias as older Whites. Some studies indicate Hispanics are about one and one-half times as likely to have Alzheimers or other dementias as older Whites. Recent studies suggest the increased likelihood for Hispanics may be slightly lower than this, depending upon the specific Hispanic ethnic group observed (for example, Mexican Americans compared with Caribbean Americans).

The higher prevalence of Alzheimers dementia in minorities compared with Whites appears to be due to a higher incidence of dementia in these groups. Variations in health, lifestyle and socioeconomic risk factors across racial groups likely account for most of the differences in risk of Alzheimers and other dementias. Despite some evidence that the influence of genetic risk factors on Alzheimers and other dementias may differ by race, genetic factors do not appear to account for the large differences in prevalence or incidence among racial groups. Instead, health conditions such as cardiovascular disease and diabetes, which are associated with an increased risk for Alzheimers and other dementias, are believed to account for these differences, as they are more prevalent in Black/African-American and Hispanic people. Socioeconomic characteristics, including lower levels of education, higher rates of poverty, and greater exposure to adversity and discrimination, may also increase risk in Black/African-American and Hispanic communities. Some studies suggest that differences based on race and ethnicity do not persist in rigorous analyses that account for such factors. There is evidence that missed diagnoses of Alzheimers and other dementias are more common among older

Black/African Americans and Hispanics than among older Whites. Based on data for Medicare beneficiaries age 65 and older, Alzheimers or another dementia had been diagnosed in 10.3 percent of Whites, 12.2 percent of Hispanics, and 13.8 percent of Black/African Americans. Although rates of diagnosis were higher among Black/African Americans than among Whites, according to prevalence studies that detect all people who have dementia irrespective of their use of the health care system, the rates should be even higher for Black/African Americans. There are fewer data from population-based cohort studies regarding the national prevalence of Alzheimers and other dementias in racial and ethnic groups other than Whites, Black/African Americans, and Hispanics. However, a study examining electronic medical records of members of a large health plan in California indicated that dementia incidence determined by the presence of a dementia diagnosis in members’ medical records was highest in Black/African Americans, intermediate for Latinos (the term used in the study for those who self-reported as Latino or Hispanic) and Whites, and lowest for Asian Americans. A follow-up study with the same cohort showed heterogeneity within Asian-American subgroups, but all subgroups studied had lower dementia incidence than Whites.

A recent systematic review of the literature found that Japanese Americans were the only Asian-American subgroup with reliable prevalence data, and that they had the lowest prevalence of dementia compared with all other ethnic groups. Alzheimers disease continues to be a large and growing public health problem for caregivers and families, health services workers, and policy makers. Occurrence of the disease is strongly related to age, and because the population ages sixty-five and older is growing at a rapid pace, the number of people with dementia is expected to increase significantly in the coming decades. At the same time, the United States is becoming increasingly diverse, particularly among the elderly. In 2010 the US Census Bureau indicated that 20 percent of the US population ages sixty-five and older was a racial or ethnic minority. Current projections suggest that by 2050, 42 percent of the nations older adults will be members of minority groups. Among those ages eighty-five and older, 33 percent are projected to be a minority.

Alzheimers Facts 2019