Taking the responsible view of life:
I wrote "I hope they know... The Essential Handbook on Alzheimer's Disease and Care" to focus families and loved ones on finding personalized solutions to preserve and protect the best quality of life for the longest period of time. Together with the necessary information you will need early on, there are answers to the most difficult questions that will come up over the course of the illness. Most families miss out on critical community resources and the most innovative and internationally accepted care practices today, unless they have help in finding them. This one book can save time and provide solutions and be shared by the entire family as a guide. Each chapter will set the standard from which the family can discuss and create plans for optimal care from the time of diagnosis through the end stages.
The benefits of Art and Music Therapy, simple home design changes, intimacy needs and changes to sexuality, failing driving skills, assistive technologies for the memory impaired, advance directives, living wills and help from hospice, are just a few of these essentials that are not included in any other single book of its kind, offering both holistic and traditional care solutions.
Likely, we already know someone with this disease, or will, at the rate of a new diagnosis every 70 seconds. The book is a helpful resource for anyone, even if your own family has not been affected. Improving the way we care for Alzheimer's patients as we care for the caregiver is my commitment. What you can offer with knowledge can make the difference.
"Humanitarianism drives people to save lives, alleviate suffering and promote human dignity. Anyone can make it their duty to promote human welfare in the face of suffering. Learn what it takes to offer the best in care and you will be the best care giver for your loved one - many are the daily acts that shine bright with human compassion.
- Zoë A. Lewis M.D. FACP, DAAHPM
On Aging and Alzheimer's - Monthy Articles
Please notify Dr. Z. Lewis if reprinting.
March, 2009
The truth is, care givers, doctors, and nurses get frustrated with the needs families often have because they are at a loss to know where to begin with help. Even when needs have been identified, and solutions offered, families are often lost in the maze of information that may be offered with limited guidance, bringing still more questions. I reasoned at the time I dedicated my resources and life to write this book, one simple holistic guide could make a big difference for families. I recalled my early years in practice when I was delivering my medical services in the form of 'primary care' employed as an internist, terms like quality of life support with integrative techniques, especially music and art therapy were still unknown to me, let alone known by families and patients as viable options in care giving for behavioral problems. These strategies have worldwide recognition. (Both music and art therapy disciplines are organized in international associations). As my staff and I did our research, we became aware that these were only a few of the emerging care areas used to support people and their families dealing with Alzheimer's disease.
Prevention or postponement of the disease is a new frontier. At the current stage of knowledge, it is impossible to predict who will get Alzheimer’s disease. It can strike anyone irrespective of gender, creed, culture or socioeconomic status. It is said that the rate of occurrence of Alzheimer’s disease doubles every five years for those between 65-85 years of age. If its onset were delayed by just five years, the number of cases worldwide would diminish remarkably. Keeping our wits seems less a reality in this century for baby boomers counting on longevity unless we do something.
Serious attention is being paid to the risk factors and preventive measures that may be taken to postpone the onset, if not prevent the appearance, of Alzheimer’s disease. Diet and lifestyle once again seem to be the factors we can target. The use of spices and certain foods high in antioxidants are among the newest strategies. Turmeric, a main ingredient in curry, contains curcumin, a bioactive phytochemical that some researchers believe may, at least in part, explain why Alzheimer's is so uncommon in India compared to Western countries. Curcumin, a naturally occurring phytochemical in turmeric and it is the earthy spice that gives curry its intense yellow color.
I am working on my next book, “Keep Your Wits! Seasoning for Reasoning”, to help readers, this time, to discover foods, flavors and inspiration for a healthier brain. That is our new frontier - prevention, while we wait for a cure.
"We're really going to have to do a better job of dealing with Alzheimer's disease. We're going to have to find better treatments and preventions,” says Bill Thies, chief medical and scientific officer of the Alzheimer's Association says. This comes after the report out in March, The 2009 Alzheimer's Disease Facts and Figures, indicates that an estimated 5.1 million Americans over 65 now have Alzheimer's with a new diagnosis made every 70 seconds. Simply remaining active, both mentally and physically, the current best practice recommendations, does not seem to be enough to prevent Alzheimer’s disease. Just consider the facts and the famous among us associated with the disease. I Googled the list, Famous people with Alzheimer's, and here is what I got:
Joe Adcock, baseball player
Mabel Albertson, actor
Dana Andrews, actor
Rudolph Bing, opera impresario
James Brooks, artist
Charles Bronson actor, film director
Abe Burrows, author
Carroll Campbell, Former Republican Senator
Joyce Chen, chef
Perry Como, Singer entertainer
Aaron Copland, composer
Willem DeKooning, artist
James Doohan, actor
Thomas Dorsey, singer
Tom Fears, professional football player and coach
Louis Feraud, fashion designer
Arlene Francis, actor
Mike Frankovich, film producer
John Douglas French, physician
Barry Goldwater, Senator of Arizona
Rita Hayworth, actress
Raul Silva Henriquez, Roman Catholic cardinal, and activist
Charlton Heston actor and political activist
Mervyn Leroy, director
Jack Lord, actor
Ross MacDonald, author
Burgess Meredith, actor
Iris Murdoch, author
Edmond O’Brien, actor
Arthur O’Connell, actor
Marv Owen, baseball player
Molly Picon, actor
Otto Preminger, director
Bill Quackenbush, professional hockey player
Ronald Reagan, 40th President of USA
Harry Ritz, performer
Sugar Ray Robinson, boxer
Norman Rockwell, artist
Simon Scott, actor
Irving Shulman, screenwriter
Betty Schwartz, Olympic gold medal winner in track events
Kay Swift,composer
Alfred Van Vogt, science fiction writer
E.B. White, author
Harold Wilson, British Prime Minister
These are only a few of the names, but notice in this growing list, the inclusion of former Presidents, Prime Ministers, Olympians, scholars and athletes. You too might well be worried, 'what chances do I have?', as you read down the list , considering ongoing mental and physical activity are considered preventative - 'what happened for them?'
Of course we aknowledge there are numerous factors implicated in the development of this disease, but chronic anxiety and stress with deleterious hormonal changes that accompany cortisol elevation associated with chronic stress are under investigation and may be a major factor. Stress is the byproduct of the modern lifestyle. On a biochemical and molecular level, the strategy for dealing with stress today is no different than is was for our prehistoric ancestors. I would imagine running from a preditor beast is as stressful as one can imagine. Yet, it is the chronic, daily and unremitting stress for many that has become part of the modern way of life. This modern lifestyle may be one of the factors leading to many diseases including Alzheimer’s and cardiovascular disease. Quite simply, chronic stress has a biochemical substrate for causing disease.
As an internist delivering primary care, I focus on natural solutions for the prevention of disease. Yoga and Pranayama, (a controlled breathing technique) may offer a benefit by reducing stress. Yogis tout health benefits and wellness from a steady yoga practice. Medical scientists and the skeptics among us want research and science as proof. I was surprised to be informed by the editors of numerous healthcare magazines, (even those targeting yoga and the natural life style) - “Can't prove it, we are not interested”. I believe there is an association between chronic stress and illnesses including cardiovascular and Alzheimer’s disease. Yoga and pranayama have been studied as stress reduction techniques and have been shown to improve blood pressure and reduce the symptoms associated with stress. There are no direct studies linking yoga, pranayama or other stress reduction methods – to the prevention of dementia, including Alzheimer’s disease,. Perhaps this is the direction we could be pointing for future investigations as some of the preliminary work in this field does suggest benefits. I am not a yoga salesperson or fanatic, but reason that if there is limited or emerging research to suggest any benefit, more attention should be given in academic circles. In the meanwhile, if yoga and pranayama appear to be beneficial for the modest reduction in stress associated symptoms, including hypertension, it may offer a preventative measure against diseases linked to chronic stress like Alzheimer's disease and other dementias.
Selected Research Investigating Yoga and Stress Reduction
Here is what we do know, and perhaps could be the basis for future investigations:
The Annals of Behavioral Science, October 2004, reported how yoga can reduce cortisol levels. In the June 2004 the Journal of Clinical Psychology cited that caregivers for people with dementia (including Alzheimer’s disease) improved physical and emotional functioning after practicing yoga. The February and August 2005 studies published in the Journal of Alternative and Complementary Medicine analyzed the breathing techniques of a specific yoga practice, (Hatha Yoga), and the authors maintain it reduced stress, including post-traumatic stress disorder. The Mindfulness-based Stress Reduction Program (MBSR), popularized by Jon Kabat-Zinn and the Center for Mindfulness in Medicine, Healthcare and Society at the University of Massachusetts Medical School, has been well studied around the world. Add to that the work of Dr. Herbert Benson of the Benson-Henry Institute for Mind Body Medicine (BHI), affiliated with Harvard Medical School. Yoga is one of the strategies they use to help people to manage the negative effects of stress.
The most substantial report to date, ‘Meditation Practices for Health: State of the Research in June 2007’ - funded by The National Center for Complementary and Alternative Medicine for The Agency for Healthcare Research and Quality, (part of the U.S. Department of Health and Human Services) concluded that many uncertainties surround the practice of meditation, but that TM®, Qi Gong and Zen Buddhist meditation significantly reduced blood pressure. It was also determined that yoga helped reduce stress. Studies also show if we reduce high levels of cortisol, we reduce the damaging effects of stress.
Pranayama - What does it mean?
In a Yogic point of view, Pranayama, is the science of breath control. It consists of series of exercises especially intended to meet the body's needs and keep it in health. Pranayama comes from the following words:
Prana - "life force" or "life energy"
Yama - "discipline" or "control"
Ayama - "expansion", "non-restraint", or "extension"
Thus, Pranayama means "breathing techniques" or "breathing control". It is intended for yoga practitioners to help and prepare them in their process, but it can be used by anyone to increase the amount of oxygen to the brain, thereby maintaining brain health and vitality. Simply by practicing deep and systematic breathing through Pranayama, we reenergize our body and restore balance.
Benefits of Pranayama
- Pranayama develops our concentration and focus. It fights away stress and relaxes the body. Controlling one's breathing also results to serenity and peace of mind.
- Pranayama offers a better self-control. Through concentration, one can better handle temper and reactions. Mind can function clearly, avoiding arguments. Self-control also involves control over one's physical body.
- Pranayama leads to spiritual journey through a relaxed body and mind.
After years in a regular yoga and pranayama practice, I can’t say whether my 'perceived' reduction in stress is going to be effective in reducing my risk for Alzheimer’s disease or other illnesses related to chronic stress. My practice is certainly beneficial to my overall "sense" of wellness. I see no harm in recommending these natural preventative activities and techniques as part of a plan of health and prevention, together with a plan of appropriate diet, citing the research to date for the skeptics.
I watched the first of the four episodes last night. I can say the power of a documentary film with mass media distribution portraying accurate, unsentimental real life stories will do more for the American public’s education about this disease than my book, others books, speakers, TV shows, and organizations with panels of experts or news reports. The first night was a powerful collection of stories and was exemplary in details of behavior, emotions, with accurate inartistic and " reality based" portrayals of “how it is" from the time of early diagnosis to the very end and death. I was greatly moved and think millions will feel the same. At least viewers will get the big picture of what this disease does to our aging. Bravo and thank you HBO and the producers.
June 26, 2009
What we need to know now on healthcare reforms for older adults: "Debunking the Financial Myths"© Zoë A. Lewis, M.D., FACP
Ever hear this? -"It's the old people that no longer contribute to society and rack up billions in health care costs - they are the real problem causing soaring healthcare costs today." It is a scary thought that healthcare may be " rationed" and if scapegoats exist, they would likley be those that cannot care for themselves, relying on advocacy groups to protect them. I will reprint an article that centers the arguments surrounding the myths of aging and healtcare costs. Sources are cited at the end.
NEW YORK (September 20, 2007)— Myth or fact: soaring medical costs in the United States can be blamed on the rapidly growing 65+ population? Myth, says a new report "Myths of the High Medical Cost of Old Age and Dying" from the International Longevity Center-USA (ILC-USA). According to the report, despite public perception, health care cost associated with aging is “quite limited”.
The Seven Myths
The "Myths of the High Medical Cost of Old Age and Dying" identifies and dispels seven myths about caring for older people at the end of life.
Myth 1: The growing number of older people has been the primary factor driving the rise in America’s health care costs. Fact: Population aging is not the principal determinant of rising health care costs.
Myth 2: As the population ages, health care costs for older Americans will necessarily overwhelm and bankrupt the nation. Fact: Population aging need not impose a crushing economic burden, especially if we start now to conduct the necessary research and develop policies on health care at the end of life.
Myth 3: Putting limits on health care for the very old at the end of life would save Medicare significant amounts of money. Fact: Limiting acute care for the very old at the end of life would save only a small fraction of the nation’s total health care bill. The proportion of Medicare spending attributable to beneficiaries in the last year of life has remained stable over the past two decades.
Myth 4: Aggressive hospital care for the aged is futile; the money spent is wasted. Fact: Many older people who receive aggressive care survive and do well for an extended period.
Myth 5: It is common for older people to receive heroic, high-tech treatments at the end of life. Fact: Only a fraction of people over age 65 receive aggressive care at the end of life. The older people are, the less likely they are to receive aggressive care when dying.
Myth 6: Medicare covers everything that older adults need in terms of their health care. Fact: Medicare does not cover several essential components of health care for older Americans. For example, Medicare pays for custodial services only in the setting of acute illness; it does not pay for long-term care.
Myth 7: If all older patients had living wills or other kinds of advance directives, it would resolve dilemmas of how aggressively to provide care. Fact: Living wills and other forms of advance directives are not a panacea. They often have little impact on or relevance to end-of-life decision-making. Physicians and health care professionals need to be trained in communicating and advising patients and families about their options, potential outcomes, and time-limited trials, especially in the face of advancing medical technology.
To download the full report or purchase a hard copy visit www.ilcusa.org or email publications@ilcusa.org. The "Myths of the High Medical Cost of Old Age and Dying" is part of the ILC-USA’s project on Ageism In America with generous support from the Open Society Institute.