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Flourishing in Later Life Cognitive and Emotional Health

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Emmeline Edwards. NINDS. Molly Wagster. NIA. IU Center for Aging Research ... Baby Boomers come of age. Concerns about the cost of health care/aging population ... – PowerPoint PPT presentation

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Title: Flourishing in Later Life Cognitive and Emotional Health


1
Flourishing in Later Life Cognitive and
Emotional Health
2
Cognitive and Emotional Health An Idea Whose
Time Has Come?
  • Hugh Hendrie MB ChB DSc
  • Professor, Department of Psychiatry, Indiana
    University School of Medicine

3
Cognitive and Emotional Health In the Elderly
Project
  • Goals
  • to assess the state of longitudinal and
    epidemiological research on demographic, social
    and biological determinants of cognitive and
    emotional health
  • to determine how these pathways reciprocally
    influence each other

IU Center for Aging Research
4
Critical Evaluation Study Committee NIA, NIMH,
NINDS
IU Center for Aging Research
5
Conclusions from CEHP Review
  • Widespread public interest
  • A different set or combination of risk factors
    (or different emphases) may be identified than
    those from illness-focused research
  • Research in brain health maintenance should be
    pursued with vigor
  • Health promotion and disease prevention are
    complimentary
  • Cognitive and emotional health must be studied
    simultaneously

IU Center for Aging Research
6
  • Cognition
  • Upper Classes
  • Men
  • Hard Science
  • Neurology
  • Health System
  • White
  • Stiff Upper Lip
  • White Mans Burden
  • Emotion
  • Lower Classes
  • Women
  • Soft Science
  • Psychiatry
  • Mental Health System
  • Minorities
  • Cry Baby
  • Savages

IU Center for Aging Research
7
An Idea Whose Time Has Come?
IU Center for Aging Research
8
Positive Psychology Martin Seligman
  • Studies the strengths and virtues that enable
    individuals and communities to thrive
  • Pleasant life
  • Good life
  • Meaningful life

IU Center for Aging Research
9
International Interest in Well Being
  • Felicia Huppert
  • Co-Director of the Well Being Institute
  • University of Cambridge

IU Center for Aging Research
10
A well-being module for the European Social
Survey (ESS)
Winner of the 2005 Descartes Prize Europes top
award for science
  • ESS is a cross-national time-series survey
    conducted every 2 years on community residents
    aged 16
  • Round 1 2002/2003 23 participating countries
  • Round 2 2004/2005 26 participating
    countries
  • Round 3 underway includes a 54-item personal
    and social well-being module

IU Center for Aging Research
11
Conceptual framework for the ESS Well-Being Module
IU Center for Aging Research
12
Psychological approaches to improving well-being
  • Behavior
  • Regular exercise
  • Other lifestyle habits
  • Being kind to others
  • Cognition
  • Interpreting events in a positive light
  • Savoring the moment
  • Belief in change (growth mind set)
  • Motivation
  • Striving for valued goals
  • Intristic motivation

IU Center for Aging Research
13
Relationship between mental health in the
individual and the population
  • The mental health of individuals is influenced by
    the characteristics of the population in which
    they live
  • Populations thus carry a collective
    responsibility for their own mental health and
    well-being
  • Interventions are unlikely to succeed if they do
    not involve population-wide changes

IU Center for Aging Research
14
The Healthy Brain Initiative A National Public
Health Road Map to Maintaining Cognitive Health
  • A call to action and a guide for implementing a
    coordinated approach to moving cognitive health
    into public health practice

Available at www.cdc.gov/aging and www.alz.org
IU Center for Aging Research
15
The Model Moving Science into Public Health
Practice - Developing the Road Map
Create/expand the science and knowledge base
Create/sustain social/environmental demands
Build and strengthen capacity
Intermediate outcomes
Long-range outcome
Adapted from Orleans CT. Helping pregnant smokers
quit meeting the challenge in the next decade.
Tobacco Control 2000 9(supple 3) III6-III11
IU Center for Aging Research
16
Developing the Road Map
  • Convened a Steering Committee
  • Public health research meeting
  • 4 Workgroups Expert panels
  • Developed 42 recommended actions
  • External feedback (n40)
  • Concept mapping
  • Engage a large group of stakeholders to organize
    the recommendations in a way that make sense to
    all groups
  • Rating (importance and action potential)
  • 49 participation rate (N140)
  • Sorting
  • 73 participation rate (N20)

IU Center for Aging Research
17
Priority Actions
  • Determine how diverse audiences think about
    cognitive health and its associations with
    lifestyle factors
  • Disseminate the latest science to increase public
    understanding of cognitive health and to dispel
    common misconceptions
  • Help people understand the connection between
    risk and protective factors and cognitive health
  • Initiative policy changes at the federal, state,
    and local levels to promote cognitive health by
    engaging public officials
  • Include cognitive health in Healthy People 2020,
    a set of health objectives for the nation that
    will serve as the foundation for state and
    community public health plans

IU Center for Aging Research
18
Priority Actions
  • Conduct systematic literature reviews on proposed
    risk factors (vascular risk and physical
    inactivity) and related interventions for
    relationships with cognitive health
  • Conduct controlled clinical trials to determine
    the effect of reducing vascular risk factors on
    lowering the risk of cognitive decline and
    improving cognitive function
  • Conduct controlled clinical trials to determine
    the effects of physical activity on reducing the
    risk of cognitive decline and improving cognitive
    function
  • Conduct research on other areas potentially
    affecting cognitive health, such as nutrition,
    mental activity, and social engagement
  • Develop a population-based surveillance system
    with longitudinal follow-up that is dedicated to
    measuring the public health burden of cognitive
    impairment in the United States

IU Center for Aging Research
19
SocioDemographic/Political Trends
  • Baby Boomers come of age
  • Concerns about the cost of health care/aging
    population
  • Dissatisfaction with the sole use economic
    indices to determine policies
  • Concerns about global ecology

IU Center for Aging Research
20
Brain Health Current State of the Art
  • Two models for preserving brain health
  • Cautionary Notes

IU Center for Aging Research
21
Healthy Brain
To be, or not to be.
To see ourselves as others see us.
E mc2
IU Center for Aging Research
22
Maintaining Brain Health Model 1 (Spartan)
IU Center for Aging Research
23
Maintaining Brain Health Model 2 (Dionysian)
  • Enjoy yourself!!

IU Center for Aging Research
24
The Current State of the Art Cautionary Notes
  • A paucity of large scale prevention trials, both
    efficacy and effectiveness
  • Problems of complex models, publication bias, and
    confounders in observational studies
  • Blame the victim" implications for health care
  • Public acceptance -The worried well or
    increasing skepticism
  • Need for comprehensive approach

IU Center for Aging Research
25
The Current State of the Art Cautionary Notes
  • A paucity of large scale prevention trials, both
    efficacy and effectiveness
  • Problems of complex models, publication bias, and
    confounders in observational studies
  • Blame the victim" implications for health care
  • Public acceptance -The worried well or
    increasing skepticism
  • Need for comprehensive approach

IU Center for Aging Research
26
Confounders
  • Theyre a bit posh, they get plenty of exercise,
    they work, they have strong social supports, and
    more
  • Ben Goldacre
  • The Guardian, December 22, 2007

IU Center for Aging Research
27
The Current State of the Art Cautionary Notes
  • A paucity of large scale prevention trials
  • Problems of complex models, publication bias and
    confounders in observational studies
  • Blame the victim
  • Public acceptance -The worried well or
    increasing skepticism
  • Need for comprehensive approach

IU Center for Aging Research
28
Health Disparities
  • Poorer and disadvantaged people have poorer
    access to
  • Safe spaces for exercise
  • Good sources of nutrition
  • Preventive health care
  • Overall health care services
  • Quality health care services
  • Cherry and Reid

IU Center for Aging Research
29
The Current State of the Art Cautionary Notes
  • A paucity of large scale prevention trials
  • Problems of complex models, publication bias and
    confounders in observational studies
  • Blame the victim
  • Public acceptance -The worried well or
    increasing skepticism
  • Need for comprehensive approach

IU Center for Aging Research
30
Hypochondriasis Health Variation (Hendrie
Syndrome)
  • Diagnostic Criteria
  • (Two or more criteria)
  • Ruminations about health status gt 2 hrs. per day
    (Confirmatory evidence spouse, relatives,
    friends, refuse to engage in conversations about
    health)
  • Consulting with health professionals gt1 per week
    (Confirmatory evidence gt two personal physicians
    take early retirement)
  • Monitoring numbers gt every 30 minutes per day
    (or alternatively phobic avoidance of
    sphygmomanometers or other instruments)
  • Engaging in health games gt 2 per day (e.g.
    balancing, deep breathing, brain games)
  • Exercising with gt three braces (alternatively
    guilt about not exercising)
  • Modifications of diet gt2 per week to correspond
    with the latest news headlines
  • Ingestion of gt 1 vitamin (or other dietary)
    supplement per day

IU Center for Aging Research
31
Hypochondriasis Health Variation (Hendrie
Syndrome) (continued)
  • Severe Form
  • Hiring personal health advisor

IU Center for Aging Research
32
The Current State of the Art Cautionary Notes
  • A paucity of large scale prevention trials
  • Problems of complex models, publication bias and
    confounders in observational studies
  • Blame the victim
  • Public acceptance -The worried well or
    increasing skepticism
  • Need for comprehensive approach

IU Center for Aging Research
33
Society-wide strategies to alter behavior
  • Smoking
  • Alcohol
  • Sexual Behavior
  • Illicit Drugs

34
Components of a Strategy for Brain Health (each
intervention component tested for efficacy and
effectiveness)
  • National commitment
  • Development of a supportive infrastructure
  • Inclusive, persuasive, non coercive approach
  • Realistic goals, congruent with those of other
    disciplines
  • Integration with health services
  • Community as well as individual targeting
  • Development of a national surveillance system
  • (NB All approaches will be influenced by advances
    in treatment)

IU Center for Aging Research
35
Mens Sana in Corpore Sano Juvenal Satire X
IU Center for Aging Research
36
Review References
  • Hendrie et al. Alzheimers and Dementia 2006 2
    12-32
  • Fratiglione et al. Lancet Neurol 2004 3343-353
  • Launer. Ageing Res. Rev 20021(1)61-77
  • Jedrziewski et al. Alzheimers and Dementia
    20051(2)61-77
  • CDC/AA. Alzheimers and Dementia Special
    supplement 1 2007 3(2)
  • Brayne Carol. Perspectives. Nature 8 2007,
    233-237

IU Center for Aging Research
37
Review References
  • Gilbert, Daniel Todd. Stumbling on Happiness.
    Knopf Canada. 2007.
  • Huppert, F, Baylis, N, Keverne, B. The Science of
    Well Being. Oxford University Press. 2005

IU Center for Aging Research
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