AARP report: 6 Pillars of Brain Health – lifestyle changes and community policies

Published in RINewstoday on April 4, 2022

The Washington, DC-based AARP releases its latest Global Council on Brain Health (GCBH) report citing strong scientific evidence that behavior changes and lifestyle habits can positively impact one’s brain health – yet many adults struggle to implement such simple changes.

In a new report released last month, “How to Sustain Brain Healthy Behaviors: Applying Lessons of Public Health and Science to Drive Change,” GCBH outlines how individuals age 50 and over, communities, and policymakers can all take steps to support brain health.

The World Health Organization predicts that the number of people living with dementia is expected to grow to 82 million by 2030 and skyrocketing to 152 million by 2050. The GCBH report notes to lower this expected trajectory it will take “effective behavior and cultural changes, initiated and driven by all the pertinent actors working in concert at all levels of society.”

The 38-page report and its recommendations are based on a review of the current state of science and the consensus of 20 experts from across the world in an array of disciplines, notes the report. GCBH is an independent collaboration of scientists, health professionals, scholars and policy experts from all over the world who are working in the area of brain health related to human cognition to promote brain health.

GCBH’s 38-page report, released March 15, 2022, provides tips to support brain-healthy behavior. Over the past six years, the GCBH has issued reports on broad topics taking a look at whether adults’ behavior and lifestyle style habits could affect their brain health as they grow older.

“While we encourage people to make good decisions, the GCBH recognizes that an effective strategy to enhance brain health must be framed broadly, and that individual choices are made in a larger social and environmental context… Simply putting research findings forward and expecting people to change their behaviors and sustain healthy lifestyles accordingly is unrealistic,” say the report’s authors. 

Calls for Supporting Positive Brain Health

In the latest GCBH report, the authors share what they have learned about how to persuade and motivate people to maintain brain-healthy lifestyles, and how community policies can be shaped to promote this vital goal. 

“We know what works to support brain health – this report focuses on how to make that happen,” says Sarah Lenz Lock, GCBH’s Executive Director. “Our experts have identified specific, practical tips to help older adults, communities and policymakers support the habits that are good for brain health. We show that change is possible, and why supporting brain health for an aging population makes good health and economic sense for communities and society as well as individuals,” Lock says.

“We describe why implementing programs designed to promote brain health for older adults makes good health and economic sense for communities and societies as well as individuals. GCBH experts advise individuals to set specific goals, be realistic about what they choose, and approach their goals step by step,” says the report’s authors. 

“We encourage community-based organizations to create opportunities for peer-to-peer coaching. And we urge policymakers to raise public awareness that people can take steps to help themselves. These and many other recommendations along with a framework for achieving change for individuals, community organizations and policymakers are provided in the final report approved by the GCBH Governance Committee,” they add. 

The GCBH report also calls for addressing the disparities in health and access to care that undermine the cognitive well-being of underserved communities including many African Americans and Hispanics.

Hearing loss, high blood pressure, obesity, and depression are among the health issues that may be linked to cognitive decline and should be properly managed with access to health care.

The Six Pillars of Brain Health

After a careful analysis of scientific findings, GCBH’s report notes that “evidence continues to mount” that people may be able to lower their risks for cognitive decline by engaging in healthy lifestyle behaviors, referred to as the six pillars of brain health.

Specifically put:

“Be social” and continue to maintain and expand your social network.  Keep tabs on family and friends and don’t isolate yourself from others. 

  • Find new interests and hobbies to “engage your brain” and to stimulate your thinking. 
  • Meditate, relax, and maintain a consistent schedule to “manage stress.”
  • Don’t forget the importance of “ongoing” exercise” and schedule at least 2.5 hours of moderate to vigorous exercise a week.  
  • Achieve “restorative sleep” by at least getting 7-8 ours of restful sleep daily.
  • Finally, “eat right” by choosing a nutritious, heart healthy diet to limit high blood pressure, of fish, poultry, nuts, low-fat dairy, vegetables, whole grains, fruits, and vegetable oils. 

The GCBH recommendations urge people to avoid smoking and not drink alcohol.  But if you drink, limit alcohol to more than one drink a day for women and two drinks a day for men.

The Brain-Heart Connection is examined in GCBH’s report.  Hypertension is a serious risk to brain health that can lead to stroke, mild cognitive impairment, or dementia. With knowledge of this, the report notes that people can lower blood pressure by increasing physical activity and reduce overeating, excess drinking, smoking and even reducing sodium (salt) intake.

The GCBH report provides simple, easily obtainable steps to make successful behavioral changes to improve brain health.  Specifically, people can:

Set a goal, identify a specific action you want to take on.

Be thoughtful and realistic about the goals you choose.

Find something that is fun and choose what is enjoyable for you.

Re-purpose some of your free time.

Rethink your environment to reduce the temptations and encourage better choices.

Celebrate the wins.

Learn from the setbacks.

Involve friends and family with common goals to reinforce healthy choices; and

Pick a good start time. 

While brain health behavior changes can be achieved by individuals, these changes require the support health care providers, employers, and community organizations.  Health care providers can help their patients improve their lifestyle habits and make healthy choices to reduce risks and alleviate the symptoms of disease. Employers can promote healthy behaviors too by creating healthier work environments, offering wellness initiatives, health screenings, immunizations, supporting healthy sleep by minimizing shift work, not requiring employees to respond to emails 24/7 and respecting vacations and breaktimes.  These all can promote better brain and mental health, says the GCBH report.

Mission-driven organizations, like AARP, the Arthritis Foundation, and the Heart Association, can also provide individuals with needed information and tools to access their own wellness and motivate a person to make positive behavior changes.

Finally, policymakers can set goals to improve the public’s brain health with a focus on building equity, fighting the sigma of dementia, and implementing best practice to improve brain health from around the world. They can also become aware of how public policies in other areas, such as the built environment, nutrition, and education, can have a lifelong impact on brain health. Some specific examples of successful public health policies include seat-belt laws and smoking cessation requirements.

“A chasm remains between what researchers are discovering about brain health and how little this knowledge has been applied for the public good. Progress will require the combined actions of individuals and communities, reinforced by public policies that facilitate healthy lifestyles,” says the report’s authors. “By applying lessons of public health and science, we can improve brain health for the benefit of individuals, communities and countries around the world,” they say, noting that this report lays out the steps needed to achieve this goal.

The full report on “How to Sustain Brain Healthy Behaviors” is available by going to https://www.aarp.org/content/dam/aarp/health/brain_health/2022-03/gcbh-behavior-change-report-english.doi.10.26419-2Fpia.00106.001.pdf.

To obtain all of the GCBH’s past reports on brain health, go to https://www.aarp.org/health/brain-health/global-council-on-brain-health/resource-library/.

To see how staying socially active impacts brain health, go to https://thriveglobal.com/stories/spumoni-s-where-everybody-knows-your-name-study-says-being-socially-active-may-improve-cognitive-functioning-2/

National Aging Coalition pushes to bring back House Aging Committee in DC

Published in RINewsToday on March 28, 2022

In 1992, aging advocacy groups fought unsuccessfully to keep the House Select Committee on Aging  (HSCoA) from being eliminated. The House had pulled the plug on funding for the HSCoA as a cost-cutting measure and to stream-line the legislative process at the end of the 102nd Congress without much notice in the Democratic rules package adopted in Jan.1993 during the beginning of the 103rd Congress.

As the dust settled after the dissolving of the HSCoA, Congressman Michael Bilirakis (R-FL), a former committee member, stated in an article, “Congress Eliminates Committee on Aging,” published March 31, 1993, in the Tampa Bay Times,” I honestly don’t’ think other committees would cover all aging issues.” AARP agreed with Bilirankis’s assessment. “Seniors need a specific forum,” said Tom Otwell, spokesperson for AARP. “The population is getting older, and issues are certainly not going away,” he said. 

During its 18 years of existence, its Congressional oversight on a myriad of aging issues included Social Security, Medicare, nursing homes, aging bias and elderly housing. This oversight influenced the introduction and passage of major legislation enhancing the quality of life of America’s seniors. 

Thirty years later, the Washington, DC-based Leadership Council on Aging Organizations (LCAO), representing 69 national aging advocacy groups, recognized the opportunity to bring back the HSCoA by endorsing H. Res. 583, a resolution introduced in the 117th Congress by Congressman David Cicilline (D-RI) to reestablish the HSCoA when introduced Aug. 10, 2021.  The Rhode Island Congressman has also introduced this resolution during the last three congresses.

H. Res. 583 would reestablish the HSCoA without having legislative jurisdiction, this being no different when the initial permanent committee previously existed. The 214-word resolution would authorize a continuing comprehensive study and review of aging issues, such as income maintenance, poverty, housing, health (including medical research), welfare, employment, education, recreation and long-term care. These efforts assisted the House’s 12 Standing Committees in the creation and advocacy for legislation they drafted. At press time, the resolution has been referred to the House Rules Committee for consideration.

According to the Congressional Research Service, it’s quite simple to create an ad hoc (temporary) select committee in the House chamber. All it takes is a simple resolution that contains language establishing the committee – giving a purpose, defining membership, and detailing other issues that need to be addressed. Salaries and expenses of standing committees, special and select, are authorized through the Legislative Branch Appropriations bill. 

Calling for co-sponsor support

While supporting Cicilline’s proposal, LCAO went one step further by calling on House lawmakers three weeks ago, in correspondence, to become co-sponsors. LCAO asked its members to co-sponsor the bill in order to drive the House Democratic Caucus to approve it and bring it to the House floor for a vote. As a House committee, it only needs the House’s approval, where there is now a majority of Democrats.

The time is ripe for the HSCoA to be reestablished, say LCAO. “Every day, 12,000 Americans turn 60. By 2030, nearly 75 million people in the U.S. – or 20% of the country – will be age 65 and older. As America grows older, the need for support and services provided under programs like Social Security, SSI, Medicare, Medicaid, and the Older Americans Act also increases,” noted in correspondence signed by 30 Coalition members.

LCAO stressed that the HSCoA worked effectively in partnership with the House’s 12 Standing Committees with jurisdiction over aging programs and services. “The House Aging Committee, which flourished in the 1970s under chairperson Claude Pepper, partnered and magnified the work of the standing committees in a team effort and a bipartisan manner, holding many joint hearings with them and helping to pass the end of mandatory retirement 359-2 in the House and 89-10 in the Senate, as well as protecting Social Security, exposing nursing home abuses and setting transparency standards, expanding home health care benefits as a way older persons could often delay or avoid the need for being forced into nursing homes and so much more. Ways and Means, Education and Labor, Energy and Commerce and Space, Science and Technology were just some of the Committees who benefited from the partnership and appreciated the House Aging Committee’s help in reaching senior citizens,” stated LCAO. 

As seniors now settle into living in a post-pandemic world, passage of H. Res. 583 becomes even more important. “Historically, the HSCoA served as a unique venue that allowed the open, bipartisan debate from various ideological and  philosophical perspectives to promote the consensus that, in turn, permeated pandemic, and the coronavirus continues to take its toll, exacerbating the problem of social isolation and family separation across generations.  Addressing the needs of older Americans in a post-pandemic world will require vigilant oversight and action,” noted LCAO.

Op Ep tells the story and the need for passage of Cicilline’s resolution 

Robert Weiner, former Clinton White House spokesman and Chief of Staff of the HSCoA under Congressman Claude Pepper,(D-FL) and Ben Lasky, senior policy analyst at Robert Weiner Associates News and Public Affairs, recently penned an op-ed for the Miami Herald which calls for the passage of Rhode Island Congressman David Cicilline’s H. Res. 583, to reestablish the HSCOA. With threats of Social Security “reforms” (cuts) and the mishandling of Covid in nursing homes which led to hundreds of thousands of deaths, the Committee is needed once again.

Weiner and Lasky say the largest part of Pepper’s congressional legacy, especially as he grew older, was chairing the HSCoA, which featured banning mandatory retirement (with Colonel Sanders as a witness), protecting nursing homes, expanding home health care, and protecting Social Security with solvency through 2034.

“Pepper’s bill that banned mandatory retirement passed 359-2 in the House and 89-10 in the Senate,” they said.

They argue, “The elderly are now threatened with Social Security reforms,” (meaning cuts). Senior citizens also disproportionately died from Covid in nursing homes in Florida, New York and around the country. More than 200,000 have died in nursing homes. Forbes called ‘The Most Important Statistic’ the fact that 42% of US Covid deaths in the first five months of the pandemic happened in nursing homes and assisted living facilities. That number later went down to around 33%. When standards, distance standards, vaccines, and transparency started to kick in (under pressure in many facilities), it got a little better but for many it was too little too late. Tens of thousands died because health care workers failed to follow the transparency, staffing, and safety standards that Pepper had passed into law in nursing homes.”

They continue, “Once vaccines became widely available in 2021, a majority of nursing home workers remained unvaccinated for six more months. Nursing homes and assisted living facilities were let off the hook by governors from Ron DeSantis (R-FL) to Andrew Cuomo (D-NY) for hiding their number of Covid deaths.”

Weiner and Lasky assert, “Older voters vote Democratic and Republican. It’s close. In 2020, while Joe Biden won the popular vote by 7 million, Donald Trump won the senior vote 52% to 47%. It’s not a matter of party. Seniors’ quality of life is not political.”

They conclude, “With Pepper’s legacy as the guide, pandemic deaths, nursing homes, home care, Social Security, and Medicare would be improved by Sunlight of Oversight.”

For the benefit of America’s seniors, House Speaker Nancy Pelosi and her leadership team must consider giving H. Res 583 their political support and blessing, calling for a vote in House Rules Committee, if passed allowing for swift consideration on the floor.  As Weiner remembers, “the last HSCoA was so well received and successful because of the strong relationships and bonds to the Standing committees and successful outreach to seniors.” The former HSCoA staff director notes that during his tenure membership grew from 29 to 50 members. “After the committee began, in just a few years, everyone wanted to be on it.” 

AARP’s Otwell’s observations that the nation’s population is getting older, and the issues are not going to go away  and that “Seniors ‘need a specific forum” are true even 29 years later. House lawmakers must pass H. Res. 583 for America’s seniors to give them this specific forum that they deserve.

To read the Miami Herald Op Ed, go to www.miamiherald.com/opinion/op-ed/article259629314.html

Bill would (re)create a RI Department of Healthy Aging

Published in Pawtucket Times on March 21, 2022

There are new efforts on Smith Hill to transform the state’s Office of Healthy Aging (OHA) into a department making it far more visible and effective as an advocate for the state’s growing senior population.  H. 7616, introduced by Rep. Lauren H. Carson (D-District 75, Newport), would expand the office in the Department of Human Services (DHS) into a full-fledged state department, expand its director’s authority, and appoint local senior centers as hubs for service delivery, with authority to bill Medicaid for transportation services.

The RI Department of Elderly Affairs (DEA) was created by law in 1977 and remained a department until 2011, when the legislature changed it to a division within the Department of Human Services (DHS). In 2019, the department was re-named the Office of Healthy Aging (OHA), shifting narratives and perceptions associated with growing older. At press time, the Office of Healthy Aging remains a division under the Department of Human Services. 

“Rhode Island should invest much more than we do in services that enable people to age in place and safely remain in their communities. Those services are far more cost-efficient overall, and encourage an active, more fulfilling lifestyle for people as they age”, says Carson in a statement announcing the introduction of the bill on March 2, 2022. “Considering that a quarter of our population consists of seniors, and that ratio is growing as the Baby Boomers join them, now is the time,” she adds.

At press time, the bill has been sent to the House Finance Committee, and its cost has not yet been determined and there is no companion measure introduced yet in the Senate.

“Working cooperatively with the senior centers operating around the state, we could make it much easier for people to access the support they need as they age, and really make the quality of life much better for the entire older population of our state,” says Carson expressing the importance of the state’s senior centers.

H. 7616 would authorize the new Department of Healthy Aging to protect and enable seniors to stay healthy and independent by providing meals, health programs, transportation, benefits counseling and more. Under the bill, the department would provide professional development to agencies and programs that provide services to seniors in the state and become a clearing house to help those agencies and businesses assist senior centers, which would serve as hubs for the delivery of services from the state.

In particular, H 7616 directs the new department to manage and develop a multi-tiered transportation system that works with the Department of Human Services, the Department of Transportation, senior centers and with all existing modes of public transportation to develop transportation plans that suit the elderly population of each municipality. The director would be enabled to authorize senior centers to bill Medicaid for transportation they provide.

The legislation also seeks to have the new department develop and submit to the General Assembly a funding formula to meet the requirements the new law sets forth, including input from seniors and the caregivers and allocating funding to each municipality based on its senior population, with restrictions that the funding be used only for senior programs.

Carson explains that this bill is intended to start important dialogue among state lawmakers, state officials and aging organizations about appropriately providing for Rhode Island’s aging population.

 “Whether or not we pass this bill this year, we have to address the needs of our growing older population. Leaving those needs unmet has a much greater price tag than decent locally administered basic programs would. Our whole state would be better served by investments that keep seniors safe with support in their community,” Carson said.

OHA and Aging Advocates Give Their Two Cents

Nicole Arias, a spokeswoman for OHA, says “we look forward to any future discussions and collaborations with community members, partners, and legislators.” When asked if the Rhode Island Advisory Commission on Aging, charged with advising the governor on aging policies and problems impacting older Rhode Islanders, Chair James Nyberg stated the commission also plans to review and discuss the bill at an upcoming meeting. 

“Our office looks forward to participating in dialogue that empowers and supports our aging residents and championing essential quality of life items such as healthy housing and reliable transportation. While our office is still unpacking H 7616, we appreciate Rep. Carson and the bill’s cosponsors for advocating on behalf of our senior residents,” says Lt. Gov. Sabina Matos, who over sees the state’s Long-Term Care Coordinating Council (LTCCC). The group works to preserve senior’s quality of life in all settings and coordinates state policy concerning all sectors of long-term care for seniors.

Bernard J. Beaudreau, Executive Director of the Senior Agenda Coalition of Rhode Island, says his group strongly supports any and all efforts that increase the state’s programs and services to address the growing needs of our aging population, especially those with low and moderate incomes.  The state-wide coalition calls for the reinstatement of OHA to a full department, but not without the commensurate expansion of funding and services that are needed for this important state government function.   

“When the Department of Elderly Affairs was reorganized to be a division of the Department of Human Services, we were concerned that it signified a diminishing of the importance of senior needs in the state budget.  While from a management perspective, the division within the larger Department of Human Services could streamline the delivery of services, there would still be the need to increase staffing and programs to meet the growing needs,” says Beaudreau. This did not happen in the ensuing years.

“Restoring the OHA to a department status will strengthen its position at the budget table and elevate the importance of programs supporting older residents of our state. We hope that will make a difference,” says Beaudreau.

“The legislation proposed by Rep. Carson elevates the conversation about the importance of age-friendly policies that enable Rhode Islanders to choose how we live as we age,” said AARP Rhode Island State Director Catherine Taylor. “AARP Rhode Island looks forward to being part of this conversation and continuing to advocate fiercely at both the state and local levels for enhanced home and community-based supportive services, accessible and affordable housing and transportation options, and full inclusion of people of all ages and abilities in community life,” she said. 

According to Maureen Maigret, policy consultant and chair of the Aging in Community Sub-committee of Rhode Island’s Long-Term Care Coordinating Council, H 7616 is a very significant bill that will help to stimulate a long due discussion as to how the state should fund senior programs and services in light of the state’s growing age 65 and older population. This age group is projected to represent at least one in five of  the state’s residents by 2040.

Maigret recalls that the state’s Department of Elderly Affairs was created by law in 1977 and remained a cabinet level department until 2011 when the Rhode Island General Assembly changed it to a division within the Department of Human Services as part of the enacted budget bill.  Eight years later, lawmakers would change the agency’s name from the division of elderly affairss the OHA. The enacted law placed OHA in the Department of Human Services for administrative purposes and called for the OHA Director to be appointed by and to report to the Governor with advice and consent of the Senate.

When Maigret left her position of Director of Elderly Affairs (serving from 1991 to 1994), its budget for FY1995 was $13.9 million (state funds) and it had at least 60 full-time employees. The state’s  FY2022  budget for OHA stands at $12 million (state funds) with 31 authorized employees, she said.

Maigret warns that the existing OHA is under-resourced both in state funding and human resources. She calculates that Rode Island spends about fifty dollars per older person (age 65 and older) when taking into account state funding for senior services and its population age 65 and over.

“We could do so much more to support our older adults by addressing service gaps especially for those not poor enough to meet our strict Medicaid income eligibility rules which require older adults to have income less than $13,600 and assets less than $4,000 single and $6,000 for a couple,” Maigret says. Funding for local senior centers and programs in Rhode Island municipalities should be calculated by at least $10 per person aged 65. 

Maigret urges state lawmakers to support local transit assistance efforts, to increase funding for caregiver support programs, and to expand information services to provide assistance to seniors to assist them to find subsidized home maintenance and chore service programs.  Better funding should be allocated to support volunteer programs that provide companionship and other services to reduce social isolation,“ she says.

“I suggest reverting the OHA to a full department as called for in H 7616 only if there is a concomitant increase funding and resources, says Maigret, noting that one source of funding could be available from  the Perry/Sullivan law (that the Governor’s budget proposes to defer for FY2023.),  These state funds could be used to allow OHA to truly provide the needed supports and services to older adults to live full and healthy lives as intended in the department’s creation,” she says.

“Older adults suffered greatly during the COVID pandemic – 90% of the deaths were individuals 60 and over, claims Vin Marzullo, a well-known aging advocate who served as a federal civil rights and and national service administrator. “We must provide greater attention and care for this vulnerable population,” he says. 

“Since the proposed legislation to elevate the OHA to department status was initiated by the Rhode Island House, I would hope that former House legislator, Marie Cimini, would welcome and embrace this legislation to become a premiere agency for the Governor, quips the West Warwick resident. He notes that Cimini was recently nominated by Gov. Dan McKee for the position of Director of the state’s Office of Healthy Aging.  This nomination requires Senate confirmation.

The other cosponsors of the H 7616 include Rep. Deborah Ruggiero (D-Dist. 74, Jamestown, Middletown), Rep. James N. McLaughlin (D-Dist. 57, Cumberland, Central Falls), Rep. Terri Cortvriend (D-Dist. 72, Portsmouth, Middletown), Rep. June S. Speakman (D-Dist. 68, Warren, Bristol), Rep. Edith H. Ajello (D-Dist. 1, Providence) and Rep. Brandon Potter (D-Dist. 16, Cranston).

Hopefully the upper chamber will see the wisdom in considering a companion measure to  H. 7616.  Let the debate begin. 

For more details about OHA, go to https://oha.ri.gov/