As estates practitioners know well, the medication that an individual takes could reflect underlying conditions that affect mental capacity. High doses of pain medications or other medication prescribed to treat serious physical ailments may also impact a person’s cognition.
A recent article on Considerable highlights the impact that certain common medications may have on mental capacity. An estimated 25% of seniors take “anticholinergic” drugs to treat a variety of common issues, including allergies, insomnia, and asthma. These medications are known to target acetylcholine, a chemical messenger that plays an important role in concentration, cognition, and memory. Some drugs (including over-the-counter medications as well as those for which a prescription is required) impact acetylcholine levels more than others and, when they are taken together, can have a cumulative effect. As a result, high doses of anticholinergic drugs, which are often believed to have only inconsequential side effects, can interfere with brain messaging and result in symptoms consistent with dementia.
The article refers to a patient whose score on a Mini-Mental Status Examination increasing from 11 to 28 out of 30 after a readjustment of her medication, which included common antihistamines and medication for mood and gastrointestinal issues. Further research is being conducted on the short-term and long-term effects of anticholinergic use, as there is concern that prolonged use may cause irreversible cognitive decline.
As our readers know, due to the nature of capacity standards and importance of reviewing capacity on a case-by-case basis at the time of the relevant decision or instructions, it may be worthwhile to consider whether medication, even that commonly prescribed to seniors, may be a contributing factor.
Thank you for reading.
Other blog entries that may be of interest:
There are constantly new studies suggesting different ways to slow both physical and mental aging. This month alone, the news has featured research suggesting the following:
- Aging with pets in place can increase life satisfaction overall, and research suggests that pets may be associated not only with less loneliness, stronger social support systems, and increased participation in the community, but also better cardiovascular health, lower cholesterol, and lower blood pressure.
- A study from the University of Leeds suggests that tickling may slow down aging. The study involved the use of electrodes on the participants’ ears to simulate a tickle-like tingling sensation. Two weeks of 15-minute daily tickling therapy were believed to improve the balance of the autonomic nervous system.
- People who are optimistic may live longer. For groups of both women and men, those who were optimistic long-term had a better chance of living to age 85 (and beyond). Optimism has been linked with goal-setting and healthier habits and, accordingly, fewer optimistic people are believe to die prematurely from stroke, heart disease, or cancer.
- Consistent with previous research, a new study by the University of Iowa has linked exercise to a healthy aging brain. Even a single bout of exercise was considered to improve cognitive function and working memory in older participants.
While there may be nothing to prevent aging altogether and/or to totally eliminate the risk of suffering from Alzheimer’s disease or other age-related cognitive decline (absent any major scientific breakthrough), in general, taking health and wellness more seriously from an earlier age may improve quality of life and independence down the road.
Thank you for reading.
Other blog posts that may be of interest:
Your annual physical is approaching, and you’re still averaging three to four alcoholic drinks per night – despite the fact that you told your doctor last year that you were going to cut back.
At your appointment, your doctor reviews her notes and asks how the drinking is going. You surprise yourself by blurting out a complete lie – that you’re now going drink-free every other night and have effectively cut your drinking in half.
Your doctor is pleased, and she begins her examination. In your mind, you move on too, but with one perplexing question: why did you lie?
More common than you think
First, if you do lie to your doctor, you’re not alone. In a recent survey carried out by the University of Utah, about 80% of respondents admitted they lie to – or conceal information from – their doctor on issues that could have health implications. The people most likely to do this were women, younger patients, and those who rated their own health as poor.
The top three reasons?
- Not wanting to be judged or lectured
- Not wanting to hear how harmful their behaviour is
- Not wanting to be embarrassed.
This recent CBC article has more information on the research.
A new approach
Whether you blame this lying on preachy doctors who scare people into not fessing up, or on cowardly patients who don’t own up to their behaviours, one point is crystal clear: lying to your doctor does nothing to advance your health needs.
With more health professionals now available online (either by email, chat or video conference), we now have the tools to move to a more non-judgmental “health coaching” model, with regular check-ins on areas of concern.
For example, a regular smoker will still have an annual physical with their doctor, but rather than dealing with the issue of smoking annually in a single (dreaded) conversation, the doctor diverts the behavioural elements to a nurse practitioner with experience in smoking cessation who provides online coaching on a regular basis. Even if the smoking continues, the nurse practitioner can encourage the person to adopt other behaviours that at least move the needle on health (“hey, how about walking to work twice a week – is that doable?”). And with electronic medical records, they can add any changes to your file, so that your doctor stays in the loop.
In short, we free up doctors to focus on physical health needs at annual physicals (such as blood pressure and heart and lung functions) and rely on encouraging, non-judgmental health coaches to focus on behaviours that may be harming our health (such as risky sex, poor eating, gambling or drug and alcohol issues).
Some of these models exist today in various forms. So, if you’re tired of your own “dance with the truth” at your annual physical, ask your doctor about health coaching alternatives.
Thanks for reading.
Let me give you the bad news first: some people are naturally more resilient than others – and life can be tough if your resilience falls in the low end of the range.
Now the good news: your level of resilience isn’t static. You can grow it – with the right brain fertilizer – to become mentally stronger in the face of adversity. This recent New York Times article discusses some of the ways it can be done.
The article is just one of many to explore the link between greater (and lasting) resilience and activities such as mindfulness, social stimulation, and physical activity. It also sets out a great definition of resilience, courtesy of Huda Akil, a neuroscientist at the University of Michigan:
“Active resilience happens when people who are vulnerable find resources to cope with stress and bounce back, and do so in a way that leaves them stronger, ready to handle additional stress, in more adaptive ways.”
In our line of work, the “vulnerable” part mentioned in the above definition is often death, and the estate dispute that follows. From our observations, while death is one of life’s certainties, dealing with it is anything but. In estate disputes, some people are able to cope with the family death and the dispute over assets. Others crumble under the weight of grief and anger. What we’ve seen in many cases is that a higher level of resilience can make a positive difference to outcomes.
How to increase resilience
So, what’s the magic “brain fertilizer” that can increase our resilience? As it turns out, it’s not really magic at all. Better health equals greater resilience, so exercising and good nutrition go a long way to improving resilience. A strong social network also plays a key role. After that, much of it involves shifting our way of thinking – which is where a trained therapist can make a huge difference.
Take a look at the American Psychological Association’s 10 ways to build resilience and consider the opportunities you may have to bounce back stronger the next time adversity comes your way.
Thanks for reading!
This is an actual headline from an October 23, 2018 post on “Tennessean”, which is part of the USA Today Network.
Apparently, the doctor borrowed $300,000 some time ago from a long-time patient who was also a friend and the administrator at the doctor’s clinic. When the patient later requested repayment, the doctor diagnosed her with dementia in an apparent attempt to escape the debt. The doctor forwarded the diagnosis to the patient’s daughter, who in turn forwarded the letter to the patient’s financial company. The patient was then denied access to her assets.
The doctor later admitted that the diagnosis of dementia was based solely “on observation”, and that she did not use any testing methods or obtain a second opinion.
A later assessment by a psychologist stated that the patient had no indication of dementia.
As a result of disciplinary action that was brought against her, the doctor voluntarily retired her licence.
In an interview with the Tennessean, the doctor said that she was “set up” by a vindictive patient, and that she retired after state attorneys “presented her with an unwinnable legal case.” The doctor said that she borrowed the money 20 years ago and that she had been making repayments.
The doctor said that the patient did in fact “exhibit erratic behavior and signs of memory loss”. She said that the patient “later misled the psychologist so the dementia diagnosis would not be confirmed.”
What is not clear from the report is how the doctor could have expected to avoid the debt by having the patient declared incapable. Surely the patient’s daughter or someone else on her behalf could have taken steps to enforce the debt. That is, however, assuming that they knew about it.
A takeaway is to ensure that your legal and financial affairs are in order and are well documented, so that someone can step in and protect your assets and enforce your rights in the event that you are found to be incapable, legitimately or not.
Another takeaway may be to be careful when getting medical assistance in Tennessee. The headline to another story posted October 11, 2018 reads: “This pain clinic nurse gave a patient 51 pills a day. And she kept her licence.” (For the record, the pills consisted of 32 tablets of methadone, 8 Roxicodone, 4 Soma, and 6 Xanax throughout the day, topped off with 1 Ambien.)
Have a great weekend.
Have you followed the wellness industry lately? The New York Times recently published a lengthy feature on Gwyneth Paltrow and her wellness company Goop. In it, the author describes a number of the “therapies” she learned about in the course of interviewing Paltrow and writing the article.
These ranged from more conventional wellness tips (healthy eating, cleanses, meditation) to far more radical ideas (bee-sting therapy, psychic vampire repellent, and jade eggs for vaginal therapies). It’s a fascinating (and somewhat disturbing) article. You can read it here.
Paltrow is by no means the only wellness guru out there promoting what she calls “radical wellness.” There are many – with many products and treatments to purchase if you are willing to give them a try. And despite the lack of scientific evidence that these treatments work (one woman recently died from bee-sting therapy) and the resounding criticism of many alternative treatments from the medical community, alternative wellness is flourishing.
Why is that? I can see three reasons:
- Social media makes it easier than ever for wellness “ideas” to go viral;
- Many people are suffering from a mental or physical condition that conventional therapies haven’t cured – and are desperate for answers; and
- The placebo effect results in many claims that a treatment “works” – and those good news stories are fed into the social media cycle.
Of course, some therapies may in fact work – but how can you tell truth from fiction? While there are hundreds of scientific studies that prove the health benefits of things like exercise, healthy eating and meditation, alternative therapies typically have only anecdotal evidence to back them up.
All to say, before you wade into a swarm of bees, get the facts first. This U.S. website lists five reliable online medical resources (such as the Mayo Clinic) that you can trust for information.
Thanks for reading!
We’re almost 19 years into the new century, so it seems a little late to be talking about the “new” 21st century version of retirement. Or does it?
For those in their 50s or 60s approaching retirement, I don’t think so. If you’re getting close to retirement, you likely have parents who retired in the last century. Pre-internet, pre-smartphone, pre-Amazon delivery on demand. There’s a good chance that at least one parent is still alive, and, like it or not, our “vision” of retirement is shaped by those living it now.
And those living it now made retirement decisions based on life in the 20th century. We may consciously want a different type of retirement, but subconsciously we can be influenced by our parent’s retirement path, whether we know it or not.
So, how could your retirement decisions be different than those of your parents? Here are a few things to consider.
- Shrinking distances: Many retirees want to be in close proximity to their children and grandchildren – and that has influenced many in choosing a home location, even within the same city. But the emergence of advancements like self-driving cars (coming soon), discount airlines, and video calls has made it easier to connect. You may have a much broader radius for home location than you think.
- Enhanced services: In today’s Amazon era, just about anything can be delivered to our doorstep. In Ontario, even the government-controlled liquor store can deliver to your home. This not only decreases your need to be living near certain retail locations, it could allow you to stay in your own home much longer than previous generations. Virtual health care (via text or video conference) has also emerged as a service that brings health care to you rather than the other way around.
- Longevity: Life expectancy gains have slowed a bit recently (as noted by the Canadian Investment Review) but lifespans continue to increase and medical advancements will continue to improve health as we age. For you, it means planning for a longer, healthier life (think 90s, not 80s). This fact can influence many factors, from ability to pursue a second career, to the asset allocation for your retirement savings, to your ability to gift money to family members during your lifetime.
The 21st century has been with us for while – and there are more options out there than you may have realized for your retirement. Make sure your plans reflect it.
Thanks for reading!
We’re lucky in Canada – our healthcare system pays for doctor bills and hospital visits, and many employer-sponsored benefit plans provide for supplementary health insurance. Even better, universal care is actually expanding in places, such as the recent introduction of free pharmacare for those age 24 and under in Ontario.
But don’t get lulled – there are costs to healthcare. With our comprehensive public coverage, it can be easy to think that your costs will be covered if you were in an accident or experienced a serious illness. But many of us simply aren’t aware of what won’t be covered. For example, out-of-pocket costs could include loss of income (especially if you are self-employed), expensive uninsured prescription drugs and medical supplies, childcare during recovery, or even home renovations to accommodate the illness. And psychological therapy fees represent another potential cost, as mental illness is one of the leading causes of disability in Canada.
So, what can you do to ensure that you are financially prepared for a sudden, serious bad health event? Here are three options to consider:
- An emergency fund/line of credit: You may need access to cash quickly if a health emergency arises and having a “rainy day fund” for unplanned or unexpected expenses is ideal for that purpose. A line of credit also serves this purpose, although it involves taking on debt and all the costs that that entails.
- Disability insurance coverage to replace income: Disability insurance replaces a portion of your income if you are unable to work due to an illness or disability. Disability policies vary widely, so even if you have coverage at work, it’s worth checking whether additional personal coverage could be beneficial.
- Critical illness insurance to cover other costs: This insurance provides a tax-free lump sum benefit upon the diagnosis of a serious illness, such as cancer, heart attack, stroke, blindness, paralysis, kidney failure and multiple sclerosis. Unlike disability insurance, the payment is not linked to your inability to return to work, and you have complete freedom to use the money any way that you wish, including paying for treatment outside of Canada that may not be covered by provincial healthcare.
Of course, rule number one is to stay healthy. But in the event you don’t, be prepared financially. A little planning can go a long way.
Thank you for reading … Have a great day,
A recent report on the healthista.com website discusses ways to avoid or slow the progress of dementia.
First, the bad news: In the UK, one person is diagnosed with dementia every three minutes. One in twenty people develop dementia under 65, and after turning 65, a person’s risk of developing dementia doubles every five years.
Now the good news: there are various things that we can do to reduce the risk of developing dementia. These include:
- Stimulate your brain. This means doing more than “brain training”. Social interaction is seen as the key. Also, taking up new hobbies, interests and intellectual challenges is more beneficial than doing the things that you have always done.
- Develop a “cognitive reserve”. A high cognitive reserve, based on higher education, a complex lifetime occupation and high levels of social engagement helps maintain brain health. Lawyers, social workers, teachers and doctors were better protected from Alzheimer’s than shelf-stackers, machine operators and labourers.
- Take Aspirin. Long term use of aspirin is associated with a reduced risk of Alzheimer’s. Low doses of aspirin, traditionally associated with heart health, was found to lead to better memory and cognitive function.
- Take fish oil. This one is a bit controversial. Some studies have shown that fish oil slows the decline of cognitive function. However, a Cleveland Clinic post has suggested the research is not conclusive on the benefits of fish oil, and suggests that you should simply eat more fish.
- Help your heart, help your brain. The same processes that cause heart attacks and strokes are also associated with the development of dementia. Conversely, the lifestyle factors that help your heart can also help maintain cognitive function.
- Drink, eat and exercise. Drink champagne: one to three glasses a week. The phenolic compounds found in the grapes used to make champagne have the ability to increase spatial memory, improve cognitive function and promote learning and memory retention. Further, regular moderate exercise can prevent the onset of dementia. Even better is engaging in a sport, as this adds a social element, as well. Finally, a healthy diet, such as the Mediterranean diet, has been found by a number of studies to slow cognitive decline and lower the risk of developing Alzheimer’s.
More good news: in the next ten years, it is expected that research will reveal more specific actions that can help prevent Alzheimer’s and dementia.
Have a great weekend.
We all know exercise is good for you. However, a survey of recent studies compiled by Business Insider shows that it is really, really good for you.
The article confirms that the best sort of exercise is aerobic exercise, or “cardio”. Exercises that increase the heart rate have been shown to be the most beneficial for body and mind.
The article refers to various studies showing the diverse ways in which cardio can be beneficial. These include:
- lower the risk of dementia;
- protection of your immune system from age-related decline;
- increased muscle tone;
- improved heart and lung health;
- the reversal of some heart damage associated with aging;
- improved mood and reduced stress;
- change the microbial makeup of your gut, reducing inflammation;
- the lowering of bad cholesterol levels;
- prevention or management of diabetes;
- improved look and feel of your skin;
- reduction of the symptoms of depression
- increased brain connectivity, thereby reducing the likeliness of cognitive impairment;
- reduction of the adverse mental impact of chemotherapy; and
- an increase in the size of brain areas linked to memory.
The article contains links to the studies supporting the conclusions.
Now get out there and move!