TIME Innovation

We Were Wrong About Fat

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

These are today's best ideas

1. We were wrong about fat.

By Eliza Barclay at NPR

2. Want to boost graduation rates for poor students? End merit-based college scholarships.

By Meredith Kolodner at Hechinger Report

3. Here’s how the iPhone will help scientists study the unique health needs of LGBT Americans for the first time.

By Stephanie M. Lee in Buzzfeed

4. We can fight cholera by crowdsourcing better maps.

By Tom Gorman in Ozy

5. Does air pollution cause dementia?

By Aaron Reuben in Mother Jones

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

This Adam Sandler Movie Has Inspired a Method of Dementia Care

Sony Pictures

One facility is using a technique from "50 First Dates"

One home for people suffering from Alzheimer’s disease and dementia is using a method inspired by an Adam Sandler movie to help jog residents’ memories at the start of each day.

In the 2004 film 50 First Dates, actor Adam Sandler’s character creates a video that actress Drew Barrymore (whose character loses her memory each day) plays each morning to remind her who she is and what happened to her. The Hebrew Home at Riverdale in New York City has family members of its residents doing the same thing as Sandler’s character, the Associated Press reports, recording videos of themselves providing messages and anecdotes for the patients to watch every morning.

“[The film] was fluff, but it made me think,`How could that translate to our residents with memory loss?'” Charlotte Dell, director of social services at the home told the AP.

The Associated Press notes that people with Alzheimer’s present differently and that one technique may not work for everyone.

[AP]

 

MONEY Aging

A Sad Lesson From My Mother’s Decline

senior woman staring out window
Getty Images

A diagnosis of dementia spotlights the importance of protecting against devastating outcomes.

Lessons of financial awareness and self-sufficiency began early for me. I was just 13 and my sister was 11 when our father left us. My mother was 35 at the time and had no work experience and only a high school diploma. She had dedicated her married life to our family and supporting my father’s career.

She never had access to our household finances, ever. In the blink of an eye she was faced with having to learn how to provide for the three of us. She found a retail position, making little more than minimum wage. My sister and I did what we could to help, both working full-time in addition to going to school.

When my mother was 53, I was 31 and married with two young children. My sister and I started to notice Mom’s increasingly odd behavior. She got lost while driving familiar places, acted like a child, and forgot to bathe and wash her clothes, among other worrisome behavior. We thought perhaps she was dealing with depression and we sought professional help. She was prescribed antidepressants and went to counseling. Over the next year she continued to decline, and lost her job as a customer service representative.

Shortly thereafter, she was a target of a financial scam. She initiated three outgoing wire transfers totaling nearly $30,000, her life’s savings. To her, in her increasing confusion, it was great news! She had won the Mexican lottery! We only learned of it from a bank teller who was suspicious of the wire instructions. (If a loved one is exhibiting early signs of dementia, it’s very helpful to get to know the local bank branch staff and title accounts so they can alert family if they notice odd or uncharacteristic behavior by a longtime customer).

She soon could not pay her mortgage and we were forced to sell her home. She moved in with us. I was able to find an adult daycare to care for her while my husband and I were at work. So on we went day by day. I’d drop my kids off at school and mom off at daycare, at my expense.

Several years later, when she needed around-the-clock care, we looked for a facility that approved Medicaid, since she had no resources to pay for long-term care. This was a painful, difficult lesson – and one that I share with my clients: The time to purchase long-term care is when you don’t need it. My mother would hate knowing that my sister and I are paying out of pocket for preventative care and day-to-day expenses.

Dementia may have a long life cycle. Today my mother is 68. She has not recognized my sister or me for over six years. We have seen firsthand how 13 years in long-term care facilities can devastate a family both financially and emotionally.

There was a time when we had resources to purchase protection again these risks, and we didn’t. Dementia or other disabilities can happen at any age, and the lessons have been painful on many levels. A proud woman, my mother never expected to be financially dependent on anyone. It is a painful lesson for all of us. But if there is a silver lining, it’s this: As a financial adviser, I have been able to help others avoid making a similar mistake.

As the Baby Boomer generation ages, some estimate that as many as one in three individuals will suffer some form of cognitive dysfunction, from mild impairment to full-blown dementia. Our family wasn’t ready for this. Is yours?

———

Margaret Paddock, who oversees U.S. Bank’s wealth managers and financial advisers in the Minneapolis/St. Paul market, is quick to advise her clients to make preparations for catastrophic care and provisions for situations that are hard to envision, but which can come to pass.

TIME neuroscience

Alzheimer’s May Be Caused by Misfiring Immune System, Study Suggests

Breakthrough may lead to innovative approaches to treatment

New research suggests that deprivation of an amino acid called arginine may contribute to Alzheimer’s disease — a finding that could help usher in new treatment strategies for patients suffering from the debilitating illness.

A team at Duke University focusing on the immune system found that cells designed to protect the brain from infection will uncharacteristically consume arginine during the early stages of Alzheimer’s, according to Agence France-Presse.

“Our approach is recognized as unique and opens new avenues to think about what causes Alzheimer’s disease and new ways to treat the disease,” senior author Dr. Carol Colton told TIME.

The team was also able to block the arginine consumption process using a drug called difluoromethylornithine, which is used to treat cancer. But according to Colton, they eventually need to find a more suitable agent.

Nevertheless, the mice that underwent the therapy performed better on memory tests.

“The response to this potential new mechanism … is favorable,” Colton said. “[We are] cautiously optimistic.”

The next step for researchers will be to test older mice that already have an advanced form of Alzheimer’s.

The study was published in the April 15 issue of Journal of Neuroscience.

In 2013, Alzheimer’s affected as many as 5 million Americans and in 2050 the number is projected to rise to 14 million people, according to the Center for Disease Control and Prevention.

MONEY retirement planning

The Smart Way to Choose a Retirement Community

The decision to move to a retirement community is never easy. But new pricing information can help you plan.

Moving into a retirement community is a complex and often emotional decision, especially if health issues are a reason. Figuring out the finances of this move adds to the challenge. But by understanding the expenses you’ll need to pay, seniors and their families can make the best possible choices.

The good news is more cost data is now available. A Place for Mom, a senior community placement service, just released what it claims is the first pricing survey of these residences—one that is does not rely primarily on data reported by the communities themselves. Its Senior Living Price Index is based on reports from seniors it has placed. The company works with 20,000 residences around the country and advises an average 50,000 families a month.

The prices are listed by category of residence—independent living, assisted living and memory care (for those with dementia) —as well as by region. (The prices for independent living do not include health care expenses, but they are included for assisted living and memory care.) The survey only covers larger communities—those with more than 20 residential units.

Here are the top-level results for each type of community by region, showing average monthly prices:

  • Independent Living — $2,520 (U.S.); $2,532 (West); $2,362 (Midwest); $2,765 (Northeast); $2,587 (South)
  • Assisted Living — $3,823 (U.S.); $3,771 (West), $3,825 (Midwest); $4,315 (Northeast); $3,562 (South)
  • Memory Care — $4,849 (U.S.); $4,787 (West); $4,958 (Midwest); $5,779 (Northeast); $4,345 (South)

Clearly, senior living can be expensive. But keep in mind, these are averages covering a wide range of prices, says Edward Nevraumont, chief marketing officer at A Place for Mom. So look at these figures as just a starting point. And be sure to consider future price hikes, which are likely to outpace inflation, thanks to rising demand for living units.

Prices don’t tell you everything you need to know about a residence—other factors can be just as important, though harder to compare. There are communities geared to a wide range of preferences, budget levels, and health status. Some provide a full range of food services and on-site healthcare. Some are tightly regulated (nursing homes), while others are less so (independent living). “In our space, people have no idea of what they’re even looking for,” says Nevraumont.

That’s largely because families tend to wait till the last minute to start planning a move—typically when an aging family member is having health issues. The average person working with A Place for Mom adviser is 80 years old vs. 77 a few years ago. Of the clients the company helps place, five of every eight are single women, while two are men, and one is a couple. The average length of stay is 20 months.

For those considering a senior community, Nevraumont offers these tips:

Start shopping before a move is needed. Aside from the research that you’ll need to do, many residences have waiting lists that are months long. You’ll also need to have a conversation with all the affected family members to avoid potential conflicts.

Expect the move to take time. You may think you’ll be able to get Uncle Matt into a new apartment in a couple of weeks. The actual process takes an average of three months—or longer, if you’re on a waiting list.

Keep cash on hand. No getting around it—senior living communities are costly, especially for those with serious health care needs. So you’ll need to build a cash cushion to tap for those bills. “For both your emotional sanity and your financial sanity,” Nevraumont said, “figuring out this stuff early is really important.”

For more advice on choosing a retirement community, take a look at this checklist from AARP.

Philip Moeller is an expert on retirement, aging, and health. He is co-author of The New York Times bestseller, “Get What’s Yours: The Secrets to Maxing Out Your Social Security,” and a research fellow at the Center for Aging & Work at Boston College. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

Read next: The Secrets to Making a $1 Million Retirement Stash Last

TIME medicine

A Simple 3-Part Test May Predict Alzheimer’s

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Chris Parsons—Getty Images

Dementia is a part of aging, but how do doctors separate normal brain decline from the first signs of Alzheimer’s? A new test that any physician can perform in their office may help

Diseases like Alzheimer’s start years, even decades, before the first symptoms of memory loss shows up. And with rates of those diseases rising, experts say that more primary care physicians—not neurology experts—will have the task of identifying these patients early so they can take advantage of whatever early interventions might be available.

“If we had a simple blood test, a cholesterol test for Alzheimer’s disease, that would help,” says Dr. Ronald Petersen, director of the Alzheimer’s Disease Research Center at the Mayo Clinic, “but we don’t.” But Petersen has a potential solution, and according to a new paper released Wednesday in the journal Neurology, his Alzheimer’s test has promise.

Petersen and his team wanted to develop a test that any physician can administer to patients, without the need for any new technology or expensive equipment. Petersen believes that the test they came up with could become a useful tool for any physician, even those without special training in the brain. “What we are trying to do is give them some help so they can be as efficient as possible without ignoring these important cognitive issues,” he says.

In the first phase of the test, his researchers simply collected information from 1,500 patients’ medical charts—their age, family history of Alzheimer’s, factors such as diabetes or smoking that have been linked to Alzheimer’s, and whether the patient had ever reported problems with memory.

In the next phase they studied the results of the patient’s basic mental exam as well as of a psychiatric evaluation, because depression and anxiety have been connected to Alzheimer’s.

And another factor that emerged as important in developing the disease—how quickly the participant could walk a short distance. “We were a little surprised,” says Petersen. “But what’s nice about it is that it’s a nice non-cognitive, motor factor so it’s looking at another aspect of brain function.”

MORE: This Alzheimer’s Breakthrough Could Be a Game Changer

Petersen suggests that every physician should get this information on their patients at age 65; that way, they can have a baseline against which to compare any changes as their patients age. Only if they show such changes — a slower walk, for example, or worsening signs of depression or memory issues — should they move on to the third phase of the test, which is a blood analysis. That would look for known genetic factors linked to Alzheimer’s, including the presence of certain versions of the ApoE gene.

Currently, the only way to truly separate out those on the road to Alzheimer’s is to conduct expensive imaging tests of the brain, or to do a spinal tap, an invasive procedure that extracts spinal fluid for signs of the amyloid protein that builds up in the disease. “We have either expensive techniques or invasive techniques and it’s not practical to do them from a public health screening standpoint,” says Petersen.

MORE: New Test May Predict Alzheimer’s 10 Years Before Diagnosis

While his test is a possible solution to that problem, he acknowledges that the results need be repeated before it’s recommended on a wide scale to physicians across the country. But those who scored higher on the test of risk factors had a seven-fold higher chance of developing mild cognitive impairment than those with lower scores.

For now, even if doctors identify patients around age 65 who might be at higher risk of developing cognitive impairment, there isn’t much they can do to interrupt the process. But they can direct them toward clinical trials of promising new drugs to address Alzheimer’s dementia, which may slow the cognitive decline considerably.

TIME neuroscience

A Drug Has Been Found That Reverses a Precursor to Alzheimer’s

Researchers now want to proceed to substantial clinical trials

Researchers at John Hopkins University have found that low doses of a drug more commonly used to treat epilepsy can reverse a condition that increases the risk of developing Alzheimer’s disease.

According to statements issued Wednesday, the epilepsy drug, called antiepileptic levetiracetam, calms hyperactivity in the brain — a well-documented symptom of people with amnestic mild cognitive impairment, which is a condition that heightens the possibility of developing Alzheimer’s disease.

The team, lead by neuroscientist Michela Gallagher, now wants to pursue substantial clinical trials.

“What we want to discover now, is whether treatment over a longer time will prevent further cognitive decline and delay or stop progression to Alzheimer’s dementia,” Gallagher said.

The researchers studied 84 people with an average age of 70. Participants received various doses of the drug, as well as a placebo, and the scientists used imaging technology to map brain activity.

MONEY Aging

Handling Family Finances When Dad Is Losing His Grip

family of piggy banks
Sean McDermid/Getty Images

When the person in charge of family finances has dementia or Alzheimer's disease, a difficult transition is required.

A client’s daughter told me recently that she was beginning to notice her father having difficulties with memory and comprehension.

I had known that her father’s health had deteriorated somewhat, but he still seemed relatively sharp mentally up until the last conversation I’d had with him, around Christmas time.

The client’s wife has never been very involved in the family finances, and his son lives out of town. The daughter has been playing caretaker for some time. Now it seemed we needed to have a more in-depth conversation with everyone involved regarding family finances, longevity and what happens after the patriarch has passed away or can’t function as financial head of the household.

The loss of a loved one is unbearable, but far worse is losing a loved one to cognitive conditions such as Alzheimer’s disease or dementia. These decisions may cause personality changes. In some cases, a client may become belligerent or paranoid, especially when dealing with financial issues.

It is always preferable to have a client himself or herself acknowledge that something is wrong, but this may not always be the case. For this reason, financial advisers need to have a plan in place to address situations such as this one.

The first step is to get the family involved. Most of the time, the spouse or children will already be aware of the issue.

In this particular case, I could not discuss financial details with the daughter without a financial power of attorney. Fortunately, we were able to schedule a time for father, mother and daughter to meet and discuss family finances.

What if someone refuses to admit that he is losing his mental acuity? We dealt with this a few years back with another client. He was going through a divorce at the time — a process which may have either contributed to, or resulted from, his mental decline. We ended up being a part of an intervention involving the client, his children, his business partner and his pastor. The pastor referred him to a psychiatrist; luckily, the client pursued treatment that helped.

The key to handling many of these situations is having a ready stable of referable professionals in all aspects of life. In addition to the colleagues we deal with on a regular basis, such as lawyers and accountants, it is helpful to have contacts in the arenas of medicine and psychology.

Solid and consistent documentation is a standard in our industry, but it becomes absolutely imperative when dealing with cognitively questionable clients. Keeping communication records protects everyone involved and can go a long way to explaining client actions to family members if they are unaware of the problem.

Things don’t always go so smoothly. In some situations, you must fire the client. We have had to have these tough conversations in the past. It would be nice to say that we are always able to help facilitate a changing of the guard, but many of these personality issues are beyond our control. When cutting ties, it is important to do it with an in-person meeting. We’re honor-bound to do what’s best for the client, but it is also important to protect our practice. If we are unable to make progress, it may be best for clients to find someone who can better help them.

I’m very thankful the daughter came to me, rather than my having to reach out and have what could have been an unpleasant conversation. At this point we have now gathered financial powers of attorney and reviewed updated wills and trusts, coordinating with the family attorney. The mother and daughter are much more aware of the family financial situation and are not nearly as fearful about the future. I expect the daughter will take a more active role in the management of the family’s finances. We want to make sure that everyone involved is aware of, and on board with, the transition.

———-

Joe Franklin, CFP, is founder and president of Franklin Wealth Management, a registered investment advisory firm in Hixson, Tenn. A 20-year industry veteran, he also writes the Franklin Backstage Pass blog. Franklin Wealth Management provides innovative advice for business-minded professionals, with a focus on intergenerational planning.

TIME medicine

Antipsychotics Frequently Prescribed to Adults with Dementia Despite Risks

TIME.com stock photos Health Prescription Pills
Elizabeth Renstrom for TIME

The drugs can increase the risk of death for certain people with dementia

Antipsychotic drugs are being over-prescribed to men and women with dementia, according to a new report from the federal government.

The report published on Monday shows that around one third of older adults with dementia living in nursing homes had been prescribed an antipsychotic in 2012, as well as 14% of older adults with dementia who lived outside a nursing home. The U.S. Government Accountability Office (GAO) discovered the numbers when reviewing Medicare’s prescription drug program.

The high number of prescriptions is a concern since the U.S. Food and Drug Administration (FDA) has warned that antipsychotic drugs can increase the risk of death for certain people with dementia. The officials note that while the Department of Health and Human Services (HHS) has taken steps to address the use of antipsychotic drugs in nursing homes, it still has more outreach to do to educate people about the hazards of prescribing the drugs.

The report shows that patients with dementia are often given the drugs at a hospital, possibly to treat the irritation and mood swings caused by the disorder, and then the drugs continue to be used when the patients enter a nursing home. The drugs are most often prescribed when facilities have low staff numbers.

“Educational efforts similar to those provided for nursing homes should be extended to other settings,” the GAO study’s authors write. The agency recommends more education be provided for caregivers working with patients living at home or in assisted facilities.

TIME Aging

These Common Mood Changes Can Signal Early Alzheimer’s

The vast majority of people with Alzheimer’s disease will experience changes like depression and anxiety. But a new study published in the journal Neurology shows that behavioral changes like these start well before they begin to have memory loss.

The researchers looked at 2,416 people over age 50 without cognitive issues. After following them for seven years, researchers found that 1,218 people developed dementia.

Those with dementia had twice the risk of developing depression earlier—far before their dementia symptoms started—than people without the disease. They were also more than 12 times more likely to develop delusions. The symptoms appeared in consistent phases: first, irritability, depression, and nighttime behavior changes; followed by anxiety, appetite changes, agitation and apathy. The final phase was elation, motor disturbances, hallucinations, delusions and disinhibition.

Though the researchers were able to make the connection, they still cannot confirm for certain whether the changes in the brain that cause one shift in behavior are the same changes that cause memory loss. But understanding when symptoms related to Alzheimer’s disease appear could one day lead to earlier interventions.

Read next: The Science Behind Why Dogs Might Just Be Man’s Best Friend

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