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Flourishing in Later Life – Cognitive and Emotional Health.

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Presentation on theme: "Flourishing in Later Life – Cognitive and Emotional Health."— Presentation transcript:

1 Flourishing in Later Life – Cognitive and Emotional Health

2 Cognitive and Emotional Health – An Idea Whose Time Has Come? Hugh Hendrie MB ChB DSc Professor, Department of Psychiatry, Indiana University School of Medicine

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

4 IU Center for Aging Research Critical Evaluation Study Committee [NIA, NIMH, NINDS] Hugh C. Hendrie, Committee Chair Indiana University Marilyn Albert John Hopkins Sujuan Gao Indiana University David Knopman Mayo Clinic KristineYaffe Univ. of California at San Francisco Meryl Butters University of Pittsburgh Lenore Launer NIA Intramural Bruce Cuthbert NIMH Emmeline Edwards NINDS Molly Wagster NIA

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

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

7 IU Center for Aging Research An Idea Whose Time Has Come?

8 IU Center for Aging Research Positive Psychology Martin Seligman Studies the strengths and virtues that enable individuals and communities to thrive Pleasant life Good life Meaningful life

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

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

11 IU Center for Aging Research Conceptual framework for the ESS Well-Being Module PersonalInterpersonal Feeling (having, being) Satisfaction Positive affect Negative affect Optimism Self esteem Belonging Social support Social approval Social progress Functioning (doing) Autonomy Competence Interest in learning Goal orientation Sense of purpose Resilience Caring Social engagement Altruism

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

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

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

15 IU Center for Aging Research The Model: Moving Science into Public Health Practice - Developing the Road Map Create/expand the science and knowledge base Create/sustain social/environmental demands Build and strengthen capacity Intermediate outcomes Long-range outcome Adapted from Orleans CT. Helping pregnant smokers quit: meeting the challenge in the next decade. Tobacco Control 2000; 9(supple 3): III6-III11

16 IU Center for Aging Research Developing the Road Map Convened a Steering Committee Public health research meeting 4 Workgroups – Expert panels –Developed 42 recommended actions External feedback (n=40) Concept mapping –Engage a large group of stakeholders to organize the recommendations in a way that make sense to all groups Rating (importance and action potential) –49% participation rate (N=140) Sorting –73% participation rate (N=20)

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

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

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

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

21 IU Center for Aging Research Healthy Brain To see ourselves as others see us. To be, or not to be. E = mc 2

22 IU Center for Aging Research Maintaining Brain Health Model 1 (Spartan)

23 IU Center for Aging Research Maintaining Brain Health Model 2 (Dionysian) Enjoy yourself!!

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

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

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

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

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

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

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

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

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

33 Society-wide strategies to alter behavior Smoking Alcohol Sexual Behavior Illicit Drugs

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

35 IU Center for Aging Research “ Mens Sana in Corpore Sano” Juvenal Satire X

36 IU Center for Aging Research Review References Hendrie et al. Alzheimer’s and Dementia ; Fratiglione et al. Lancet Neurol 2004; 3: Launer. Ageing Res. Rev 2002;1(1):61-77 Jedrziewski et al. Alzheimer’s and Dementia 2005;1(2):61-77 CDC/AA. Alzheimer’s and Dementia Special supplement (2) Brayne Carol. Perspectives. Nature 8: 2007,

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


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