Have you ever noticed it seems to take a life-threatening health incident, like a heart attack, before people will change their everyday eating or exercise habits? According to the two experts interviewed for this story, it’s an all-to-common phenomenon.

For many people, until they face a major setback — such as a breathing problem, a stroke or double bypass surgery — they resist making meaningful changes for their health. Why does it take a near-death experience or major medical problem to get people to take care of themselves? Why can’t they change prior to the breakdown?

It often takes willpower, a strong desire to adapt, a plan and support from others for a person to alter their behavior.

Changing Longtime Health Habits Is Tough

“Some people need a brush with death or something major before they make huge changes to their lifestyle,” says Dr. Andrew Freeman, director of clinical cardiology at National Jewish Health in Denver. Cardiovascular diseases are the number one killer in the U.S., followed by cancer, so “it behooves us to make changes now,” he says.

“Some people need a brush with death or something major before they make huge changes to their lifestyle.”

Freeman emphasizes that three-quarters of chronic diseases (including obesity, diabetes and high blood pressure) can be triggered by lifestyle choices. And that means people can opt to minimize their chances of developing them or, through unhealthy habits, fall victim to them.

Most people get stuck in habitual practices and many are unwilling to change. If you’re turning 60 and have been rewarding yourself with hamburgers and milkshakes on a regular basis and dining on brisket of beef at grandma’s house, it’s tough to relinquish that, Freeman explains.

Many people who have developed unhealthy habits know what they need to change, but resist and avoid doing anything about it, explains Marion Jacobs, a Laguna Beach, Calif.-based psychologist and author of Take Charge Living.

Fear of Failure

Overwhelmed by fear that they won’t be able to change, too many people are paralyzed to do anything about their health conditions, Jacobs says.

Change can be unnerving. Some wonder: Will people still accept me when I cut back on drinking? Even if I have to give up pizza and ice cream, yet, will I continue to have health issues anyway?

“They have negative feelings about changing because they have some core belief that they can’t do it,” Jacobs says. Many people were raised on negative messages throughout childhood that they’re stupid or can’t follow through. Because of that, they get stuck and think they can’t alter their behavior.

“If you keep listening to your feelings, you won’t change. Your feelings are telling you that you can’t change. But feelings are feelings; they’re not facts,” Jacobs says.

Habit-Changing Health Tips From Experts

You don’t have to wait for a visit to the emergency room to start doing something about your bad health habits, though. Jacobs recommends the following:

• Start with a detailed plan for what you need to do to make some changes.
• Anticipate where the traps and potholes might be along your journey and devise a response to overcome them.
• Consider getting professional help or enlist assistance from a support group for people who want to lose weight or exercise more.
• Develop a core support group, including others such as your spouse, friends or family — people who will not undermine you or tell you that dieting or exercising is a waste of time.
• Practice mindfulness or meditation as a way of calming yourself and supporting your efforts.
• Understand that change doesn’t happen overnight; there will be setbacks. But if you stick with it, you can change before a life-threatening incident happens.

Making lifestyle changes is a complex, multifaceted process with many steps along the way. Freeman uses motivational interviewing to learn what makes each client tick and encourage them to change. Here are a few more recommendations from Freeman for making positive changes.

• Ask yourself this question: What are you living for and what motivates you the most? For example, is it your ability to travel or maybe the opportunity to spend time with your grandchildren? Then, think about how your current habits might take those opportunities away from you if, for example, you end up developing cardiovascular diseases that lead to a stroke, heart attack or heart failure.
• Take a realistic inventory of your diet. After decades of dining on cheese, hot dogs, French fries and pasta, it’s hard to relinquish those tasty treats. “Most people tell me they only eat these foods once in a while,” Freeman says, but the so-called occasional dining really adds up to five times a week. You don’t have to go cold turkey on all delectable foods. Tomato pizza, without the cheese, is tasty, and lower in cholesterol, for example. Freeman recommends avoiding processed foods and developing a plant-based diet, which helps reduce cholesterol and weight. And while you’re working on this, Freeman advises you to remember: “It takes two weeks for the human brain to change habits.” So, be patient with yourself.
• Empty your refrigerator and pantry of unhealthy foods. Some people need to symbolically “clean out their lives” to change them. Throw out your cream cheese and potato chips and even make it a meaningful event to signify that you’re starting fresh.

By Gary M. Stern

Gary M. Stern is a New York-based freelance writer who has written for the New York Times, Wall Street Journal, Fortune.com, CNN/Money and Reuters.  He collaborated on Minority Rules: Turn Your Ethnicity into a Competitive Edge (Harper Collins), a how-to guide for minorities and women to climb the corporate ladder.

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When your health insurance claim is denied or your health insurer refuses pre-approval for care you need, you may think your hands are tied. But there’s actually a lot you can do to try getting that decision reversed.

All health insurance policies have an appeals process. An appeal can be challenging, though. In fact, Ruth A. Carnes, an appeal nurse at Mercy Medical Center in Baltimore, says “for people with no medical background, [appeals] can be very overwhelming.”

Pursuing a health insurance appeal takes effort and time, too. But it’s probably worth it. According to Jennifer Obenchain, case management director at the Patient Advocate Foundation in Hampton, Va., 65% of appeals are successful.

Key to Success for a Health Insurance Appeal

The key to success: Stay cool.

“The impact of an impending bill that could destroy someone’s life, lead them to lose their homes or ruin their credit creates overwhelming anxiety that often drives people to act irrationally,” says Susan Null, principal at Systemedic, a medical billing and patient advocacy company in New City, N.Y.

Your goal is to prove the insurer is contractually obligated to pay for the service, not the hardship that’s been created for you.

So, remain focused on the necessary and appropriate steps in the appeal process instead of letting emotions rule.

You may be upset, but don’t assume this is war.

Dr. Magda Lenartowicz, medical director at SCAN Health Plan, a Medicare Advantage insurance plan in Long Beach, Calif., says health insurers are willing to work with patients. “We can often help track down information and walk them through the process, which eliminates the stress of trying to figure it out on their own.”

Remember: Your goal is to prove the insurer is contractually obligated to pay for the service, not the hardship that’s been created for you. “Appealing to emotion will not win an appeal,” says Null.

Making Your Argument

Instead, focus on presenting a logical argument.

To increase your chances of winning an appeal, start immediately after receiving the bill or denial. “Too many people start the dispute process years down the road when the bills have already been sent to collection,” says Null.

If your quarrel is due to a billing error on the statement — a common cause for denials — phone your insurer. “Ask what is the quickest way to resolve the issue,” advises Carnes.

Obenchain points out that there may be “missing medical records or mismatched billing codes.” If either is the problem, call your health care provider and ask the office to send the insurer the correct records or billing codes.

If there isn’t an easy fix, scrutinize the denial letter. The Affordable Care Act requires health insurers to provide a written denial with an explanation and clear deadlines. This is your roadmap for moving forward.

Levels of Appeal for a Health Insurance Denial

There are several levels for appeal. The first is what’s known as reconsideration. This generally involves a peer-to-peer phone review between your doctor and a doctor at the insurer. It’s up to you to get this line of appeal started, though.

If this is unsuccessful, the next step is an internal appeal, reviewed by a medical director. If this is denied, the final step in the appeals process is what’s known as an independent external review with a third-party board-certified physician.

Throughout the appeal process, it’s critically important that you remain organized.

“The biggest mistakes that patients seem to have with appeals are the deadlines and staying on top of the requirements,” says Obenchain. So, document every call and keep every piece of paper you receive related to your problem. Write a timeline with what happened, when and who you talked with on each call.

Also, write down the appeal deadlines and tick them off when you meet them.

Writing an Appeal Letter

If your phone calls haven’t been effective, you’ll need to write a letter explaining why the denial was incorrect.

The Patient Advocate Foundation has sample appeal letters on its site that you can use as templates. The foundation also has booklets describing each step in the appeal process.

In your letter, include documentation from your physician (such as case notes and a letter explaining why treatment is necessary), test results and details on how you know the insurance plan covers this treatment. You could also include information from experts (such as journal articles) for additional weight.

Carnes says your letter should “describe your medical condition briefly and the impact it has had on your life. Be pleasant and brief, not conveying your frustration or becoming threatening.”

She recommends asking your doctor to review your letter and make any revisions necessary, and to also submit his or her own letter.

Send everything by certified mail, return receipt requested.

Null says that if your doctor won’t cooperate, “you have no choice but to use that against them and in your defense.” Point out any errors your doctor made that led to the denial.

Because appeals are technical, you may want to get some help. The Patient Advocate Foundation provides free appeals assistance if you’ve been diagnosed with a chronic, life-threatening or debilitating disease.

Another option is to work with a professional patient advocacy company. It might cost between $125 and $300 for an initial review and then you’ll be billed hourly.

My husband and I hired a patient advocate when my son’s claim was denied. My husband’s employer had switched insurers and the new one denied pre-authorization for a treatment my son had been receiving. The insurance change also meant switching doctors to keep us “in-network.” The new doctor refused to even take the peer-to-peer call from the insurer. Our patient advocacy company received records from the doctor, crafted the appeals letter and ultimately got the treatment approved.

If Your Appeal Fails

If internal and external appeals fail to overturn the insurer’s decision, you’re not necessarily out of options.

Talk with the hospital or your doctor for assistance. As a last resort, you can also consider hiring an attorney. That will be an additional expense, of course. But if the insurance denial means huge costs, a lawyer may be worth the money.

By Brette Sember

Brette Sember is the author of many books about divorce, child custody, business, health, food, and travel. She writes online content and does indexing and editing.

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Caregivers, both professional and personal, often suffer from compassion fatigue — a syndrome also known as “secondary trauma stress.” But navigating any close, personal relationship also can lead to emotional stress and burnout.

As a self-described former “black-belt people pleaser,” the Venerable Tenzin Chogkyi, a Buddhist nun, says: “Burnout may be a reflection of a society that so often looks to women to comfort those in need to the point of ignoring their own needs, or it may be misplaced expectations. But compassion doesn’t mean doing whatever anybody wants you to do 24/7. People can extend compassion to others without losing their own identity or an awareness of their own needs.”

How? By establishing compassion boundaries.

“We’re not talking about putting up a brick wall, but something more on the order of a permeable cell membrane, a boundary that can move as needed to allow for more sustainable relationships,” says Chogkyi, who is also an activist and Buddhist retreat leader and teacher in Soquel, Calif.

“Your feelings come from whether your needs are being met, and so much of our humanity is impacted when our needs are not met.”

Chogkyi changed from being that black-belt people pleaser, and has the credentials to prove it. Through the Center for Compassion and Altruism Research and Education (CCARE) at the Stanford University School of Medicine, Chogkyi has completed Compassion Cultivation Training (CCT™), an international program developed by contemplative scholars, clinical psychologists and researchers at Stanford. She also completed the CCT™ teacher-training program, which now has more than 400 graduates.

Compassion May Save Our Species

Dr. James Doty, a clinical professor of neurosurgery at Stanford, founded CCARE in 2008. He says that acts of compassion “result in pleasure, decrease stress and promote the immune system.” He also thinks they may be what will save our species if we reject exclusionary policies when dealing with our fellow humans.

“If you look at most of the problems in the world, they are a result of the ever-decreasing lack of empathy and compassion,” Doty says, “especially the idea of populism or the ‘Me First’ attitude.” That narrative, he adds, “depersonalizes and objectifies others, as if they were less than human.”

Chogkyi has seen evidence of that. “In my teaching, I’ve found that some hold back from showing compassion to anyone not in our ‘group,’ people who don’t necessarily look, behave or think like we do,” she says. “It is imperative to extend the scope of our compassion beyond those whom we identify with personally.”

Also, some people think that extending compassion will make them soft or allow people to take advantage of them. That’s why establishing compassion boundaries is such a useful skill.

Eager to learn more, I recently attended a daylong workshop facilitated by Chogkyi and Sunil Joseph, a longtime student of a communication philosophy and practice called “nonviolent communication,” on how to set these boundaries in such a way that we can, as Joseph says, “hold ourselves with care while helping others.”

Step Up, Speak Out and Set Limits

During the workshop, held at the Tse Chen Ling Center in San Francisco, participants learned it is important to step up, speak out and set limits that allow us to give what we can — but not give so much that either person is harmed emotionally.

In discussion and role-play exercises, Joseph and Chogkyi illustrated how this practice can:

• Provide clarity in relationships
• Allow us to own our integrity
• Put a stop to a cycle of reactiveness that can leave both parties angry

“In Buddhism, we talk about balancing both wisdom and compassion,” says Chogkyi. “Just as a bird needs two wings to fly, we need both wisdom and compassion. Many of us need training in wise compassion, and the permission to manifest it in our actions.”

At the workshop, Joseph recalled an argument with his father. “I grew up in urban India, where we didn’t know what boundaries were,” he said. “Years later, one day in the car, I just snapped after hearing another of my father’s controlling remarks. There was a sudden shift from what I always thought I should do to what my needs were.”

Joseph was prepared for the difficult conversation that followed. Since 2004, he has studied and taught nonviolent communication techniques to help people realize when they are saying “yes” when what they really want to say is “no.”

He says, “Your feelings come from whether your needs are being met, and so much of our humanity is impacted when our needs are not met. Just knowing that helps you get out of blaming.”

A Boundary Successfully Changed

What was the result of Joseph’s conversation with his father?

“After I said what I had to say, I stayed with my father in his need for respect,” Joseph says. “Our conversation opened something for both of us, and changed a boundary. At first, having a challenging conversation can feel like going backwards. But acknowledging and expressing your own needs can move a relationship to a new place. It’s hard work, but it can be a beautiful process.”

How do you begin? Once you have acknowledged your own needs and the importance of the consideration due them, Chogkyi and Joseph recommend negotiating what might move the relationship forward.

“Identify what’s working,” Chogkyi says, “and know that it’s okay to be clear about what you’re capable of giving and what you can do — and what you can’t.”

It’s fine to say you want to be heard, respected and acknowledged, and do try to keep nervous laughter bottled up. “Don’t try to negate the seriousness of the conversation,” Chogkyi says. “Maybe all along you’ve been trying to do what you think other people want, but how do you really know? Sometimes, people are happier when you assert yourself, and thrilled to learn how to find a better balance.”

Joseph and Chogkyi add that what’s most important is to start the conversation. “It’s easy to feel overwhelmed at first,” Chogkyi says. But just keep showing up, because if you get the balance right, you don’t have to burn out.”

By Patricia Corrigan

Patricia Corrigan is a professional journalist, with decades of experience as a reporter and columnist at a metropolitan daily newspaper, and a book author. She now enjoys a lively freelance career, writing for numerous print and on-line publications. Read more from Patricia on her blog.

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(Editor’s note: This article is part of an editorial partnership between Next Avenue and The American Federation for Aging Research (AFAR), a national nonprofit whose mission is to support and advance healthy aging through biomedical research.)

On July 20, America commemorated the 50th anniversary of the Apollo 11 moon landing. Not only was the mission arguably one of the greatest human achievements of all time, it set the course for discoveries on how the body ages in space, and back on earth.

Neil Armstrong and Michael Collins were 38 years old and Buzz Aldrin was 39 during the first moon landing. Since then, astronauts on active missions have been considerably older. Moreover, their missions are considerably longer — weeks and months, compared to the early missions that lasted several days.

Among the older scientists who have spent more time in space, Peggy Whitson celebrated her 57th birthday there and performed two space walks at that age. She is only the seventh oldest person to spend time in space. The record holder, of course, was the late astronaut and former Senator John Glenn, who, at 77, orbited the earth 134 times in a 10-day mission in 1998. Glenn, who for a time served on AFAR’s board of directors, is known for being the first American to orbit the earth, in 1962.

During Glenn’s 1998 mission, he participated in a series of tests on the aging process. Later, the aging population was one focus of his work as a U.S. senator, and he vigorously promoted the relationship between healthy aging and physical exercise, balanced nutrition and social engagement.

Space travel has taught us what accelerates the aging process, and what can slow it.

Older astronauts exemplify how we are living longer, in general, and how social and professional engagement are key factors in staying healthier for longer. Still, space travel poses health hazards to astronauts at any age, and these hazards parallel the aging process.

Health Hazards of Space Travel

The first health hazard associated with space flight is weightlessness. Our bodies are designed to thrive with the downward pull of earth’s gravity. When it’s not there, muscles (including our most important muscle, the heart) and bone quickly lose strength, spinal columns become unstable (back pain is a particular problem faced by astronauts), and the distribution of fluids in our bodies goes quickly out of whack leading to problems with balance, eyesight, arteries and the immune system.

Second, our body’s important 24-hour light-dark cycles are disrupted. Astronauts orbiting the earth experience our normal 24-hour day every 90 minutes. Consequently, they sleep less with worse sleep quality than they do on Earth. In fact, sleep medications are the second most common medications (after anti-nausea drugs) taken by astronauts on board the International Space Station.

Third, astronauts are exposed to higher levels of damaging radiation than those of us on the ground, having lost most shielding of the earth’s atmosphere.

Astronaut Scott Kelly, who recently spent a year aboard the Space Station at 50 years of age, experienced the radiation-equivalent of 50 years of exposure on Earth, which led to increased damaged to his DNA.

DNA damage, of course, can lead to cancer as well as other health problems. Several studies have also reported reduced speed of mental acuity among astronauts in space, although what this is due to is not clear.

If all this sounds familiar — weakening muscles, bones and heart, compromised vision, balance and immune function, increasing DNA damage, reduced speed of mental function — it should. These are the very signature of aging.

Exercise, Once Again, Turns Out to Be Key

Space travel has taught us about what accelerates the aging process, and what can slow it. Through these space studies with older astronauts, we’ve learned that much, although not all, of the accelerated aging effects of space flight return to normal after the return to Earth.

Some of the same therapies that help us resist aging on Earth, also appear to work in space. Specifically, much (but not all) of the muscle and bone decay involved in space flight can be prevented by exercise.

American astronauts on the International Space Station exercise at least two hours per day. (Whether this amount of exercise also preserves brain function as it does on Earth isn’t yet known.) And because of the similarities between aging and the rigors of space flight, our rapid recent progress in discovering new ways to slow aging is likely to help preserve astronaut health on longer space flights as well.

So, as our thoughts turn from the glorious remembrance of Apollo 11 to the prospects of future permanent settlements on the moon and landings on Mars, it is comforting to know that the same research that will prolong the health of the aging Earth-bound population may also preserve the health of our new pioneers in space.

It’s inspiring to see how NASA continues its commitment to studying how aging faster in space can help us age better on Earth, helping advance the biomedical research that’s working to help us all live healthier for longer.

By Steven N. Austad

Steven N. Austad, Ph.D., is the scientific director of the American Federation for Aging Research, the co-principal investigator of the National Institute of Aging’s Nathan Shock Centers of Excellence Coordinating Center, and a distinguished professor and department chair in the Department of Biology at the University of Alabama at Birmingham. His current research interests include figuring out why organisms age at different rates, particularly in especially long-lived organisms such as quahog clams and hydra. He is also interested in studying indicators of animal healthspan as well as the effects of rapamycin on mouse healthspan. He is author of more than 190 scientific articles and more than 100 newspaper columns on science. His book Why We Age: What Science Is Discovering About the Body’s Journey Through Life, has been translated into eight languages. Follow him on Twitter @StevenAustad.@AFARorg

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Diana Zwinak, 53, was a teacher in a rural district outside Chicago when she developed Hashimoto’s thyroiditis, an autoimmune disorder where antibodies chronically attack the thyroid. “Basically, my thyroid stopped functioning,” says Zwinak. Her doctor’s recommendation: “You have got to get rid of some of your stress.” The stress she was under was causing her adrenal system to shut down.

Zwinak’s doctor told her point-blank that she was taking years off her life. So, Zwinak did what many people faced with this news don’t — she took a good look at her stress and made a major change in her life.

Ask anyone who is trying to get their psoriasis under control, manage heart disease or suffering with anxiety and you’ll hear that managing stress is one of their toughest goals.

She realized that teaching was no longer bringing her joy but, instead, contributing to her constant stress. On top of that, Zwinak was commuting an hour and a half each day.

“So, I took my doctor’s advice and I resigned within the week,” she says.

Conditions like eczema, irritable bowel syndrome, anxiety, heart disease, thyroiditis and dozens of others have a component in common: Stress is often the trigger.

Ask anyone trying to get psoriasis under control, manage heart disease or suffering with anxiety, and you’ll hear that managing stress is one of their toughest health goals.

What if your health, like Zwinak’s, literally depended on de-stressing?

Too Much Stress Causes Health Problems

Zwinak’s doctor was shocked but proud that her patient took immediate action to reduce the stress in her life. “I don’t regret the decision,” Zwinak says. She has since gone on to create a business that helps teachers who are feeling demoralized or burned out to regain their enthusiasm.

“When people are stressed, they cannot participate in a healthy lifestyle,” says Dr. Nieca Goldberg, medical director of the Joan H. Tisch Center for Women’s Health at New York University’s Langone Medical Center.

In fact, Goldberg says, people under great stress may drink too much, smoke or overeat in efforts to cope, which further worsens their health.

Goldberg mentions one heart condition for which stress plays a significant role: stress cardiomyopathy, or a stress heart attack.

“These are patients who come in with classic heart attack symptoms but whose EKGs (electrocardiograms) and test results show their arteries are clear,” she says. What’s happened is stress has brought on the symptoms of a heart attack, and “stress is an associated risk factor in heart disease,” Goldberg adds.

Goldberg, like Zwinak’s doctor, often tells patients they need to de-stress. She says, “people are welcoming when I bring it up,” and most say no one had ever told them it was that important.

“We all experience stress on a daily basis. It’s not stress that’s the problem; it’s what we do with it that causes health and psychological issues,” says Susan Petang, a certified mindful lifestyle and stress management coach and author of The Quiet Zone: Mindful Stress Management for Everyday People.

How to Address Your Stress

If your medical condition is worsened by stress, the first step is to identify your stressor. It could be work, a relationship or even your health condition that’s causing a vicious stress cycle —meaning that dealing with the condition stresses you out, which, in turn, worsens the condition.

Making changes related to stressors, like reducing work hours, distancing yourself from a stressful relationship or joining a support group for your health condition can put you on a stress-free path. But those kinds of changes might not be enough. You might also need to try one or more of Goldberg’s recommendations:

• Cognitive behavioral therapy (CBT). It’s a common type of talk therapy in which you work with a mental health counselor to uncover your stressors and develop a strategic plan. CBT implements relaxation techniques, helps you adjust unrealistic expectations and change thought patterns and self-talk that contribute to your stress.
• Breathing exercises. Deep breathing exercises send signals to the brain to help you calm yourself. A relaxation breathing app on your phone — such as Breathe2Relax — can teach you how.
• Exercise. Physical activity has been shown to slash stress by releasing relaxing brain endorphins, which reduce the perception of fear, anger and other stressful emotions.
• Yoga. Yoga combines a non-judgement philosophy (against yourself and others) with a body-mind connection. Yoga can help you reduce stress through movement and breathing to enhance your mood and reduce anxiety.

Petang has these additional suggestions to reduce stress and prevent the worsening of health conditions:

• Develop a meditation practice. “Mindfulness and meditation are being used to treat many disorders and diseases, and have been shown to create new, beneficial neural pathways in the brain,” Petang says. Meditation desensitizes the neural connections that make us feel upset and reactionary when something negative happens.
• Manage expectations and accept reality. By dealing with unrealistic expectations and learning to accept things as they are, you can reduce stress.
• Develop an attitude of gratitude. There is always something for which we can be grateful in every situation, even if it’s only that we had the strength to survive it.

“I am grateful to my doctor, who had the wisdom to tell me about the toll that ‘everyday’ stress was taking on my body, and to myself for having the courage to do what was right, even though it seemed like such a gamble at the time,” Zwinak says.

By Jennifer Nelson

Jennifer Nelson is a Florida-based writer who also writes for MSNBC, FOXnews and AARP.

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When is Alzheimer’s disease not Alzheimer’s disease? It’s a riddle that finally has an answer.

Researchers recently pinpointed another form of cognitive decline with many of the same hallmarks as Alzheimer’s, but which actually involves different brain processes.

This newly discovered dementia may partly explain why some people haven’t been helped by current Alzheimer’s drugs or why some drugs being tested haven’t been as successful as scientists have hoped.

Despite the lack of diagnostic tools for LATE, this study helps explain why certain medications don’t seem to work for people who are told they have Alzheimer’s.

The disorder, dubbed “LATE,” stands for limbic-predominate age-related TDP-43 encephalopathy. Like Alzheimer’s, LATE affects short-term memory and causes cognitive impairment. It also shares some of the same disease traits as frontotemporal dementia.

However, LATE affects a different brain protein than those associated with Alzheimer’s and mostly occurs in people older than 80, according to a working paper developed by researchers at the University of Kentucky Sanders-Brown Center on Aging in Lexington for the National Institutes of Health. It was published in the journal BRAIN.

Figuring out whether someone has Alzheimer’s or LATE can be difficult. There’s no blood test yet for LATE; it can only be diagnosed with certainty during an autopsy.

Same Symptoms, Different Biomarkers

“We found a large proportion of people during life who had some of the symptoms of Alzheimer’s disease didn’t have the biomarkers of Alzheimer’s disease,” says Dr. Peter Nelson, who led the University of Kentucky study.

LATE has probably affected clinical trials, because people may be getting treated for a disease they don’t have, Nelson says.

“We need to get better at diagnosis and to be a lot more savvy about the fact that there are multiple different conditions underlying this clinical syndrome that we call dementia,” he says.

While Alzheimer’s is the most common type of dementia — affecting an estimated 5.8 million people in the U.S., according to the Alzheimer’s Association — there are other forms of dementia leading to cognitive impairment. These include vascular dementia, frontotemporal dementia, Lewy body dementia and Parkinson’s with dementia.

“We approach them differently, we treat them differently and they respond differently,” says Dr. Sami Barmada, a physician specializing in dementia at the Cognitive Disorders Clinic at the University of Michigan in East Ann Arbor, Mich. “Now we have another entity that we can discuss with patients.”

An Alzheimer’s diagnosis can usually be made through biomarkers in a patient’s spinal fluid or through a type of brain scan called positron emission tomography (PET). The disease leaves telltale signs of protein fragments, known as amyloid plaques, or tangles of another protein called tau, in certain areas of the brain.

But the University of Kentucky study found that some people who experienced short-term memory loss lacked these proteins. Instead, they had buildup of another brain protein: TDP-43.

A Great Need for Dementia Diagnostic Tools

For now, determining whether someone may have the LATE form of dementia is more a process of elimination than a definitive diagnosis, after testing eliminates conditions like Alzheimer’s or Parkinson’s.

“While you can’t say it definitely is there, the chances of it being LATE, go way up,” says Dr. Barmada, who is also an assistant professor of neurology at the University of Michigan Medical School.

Despite the lack of diagnostic tools for LATE, this study helps explain why certain medications don’t seem to work for people who are told they have Alzheimer’s.

“They may exhibit symptoms of Alzheimer’s, but underneath the hood, there’s a fairly good chance — especially in people over 80 — that maybe it’s something else,” Barmada says.

An increasingly aging population puts more people at risk for some type of dementia, according to the University of Kentucky report. However, many gaps exist in our understanding and diagnosis of LATE, such as identifying biomarkers or more precise brain imaging.

The lack of diagnostic tools will have a massive impact on our public health system, Nelson says. “It’s causing so much strain, not only on patients, but on the caretakers; it’s brutal,” he says. “It’s something we really need to address.”

More research funding is necessary to help define risks and features of LATE to better diagnose and eventually treat the disease in progress, Nelson says.

Adding to this challenge is that LATE-type dementia can develop alongside Alzheimer’s.

“We need to get more older people into clinical trials so we can develop therapies to have any hope,” Nelson says. “Having really well-trained clinicians is important, too, and there aren’t as many as are needed.”

In the meantime, what can you do if you suspect a loved one may have LATE rather than Alzheimer’s dementia?

If you feel that person isn’t responding well to a medication for Alzheimer’s, don’t be afraid to question whether it could be something else, Barmada says.

And, he cautions, existing Alzheimer’s therapies can only slow progress of the disease in some people; they can’t prevent or cure it.

What Can You Do to Help Prevent Dementia?

Regular physical activity, proper sleep and challenging our brains daily at every age can help slow memory loss over time, experts say.

Additionally, ask your health provider for a medication check-up. “You don’t need to be on medications that aren’t going to help you or are going to cause side effects,” Barmada says.

Other lifestyle changes, like lowering high blood pressure and cholesterol and controlling blood sugar, can help change the prognosis for some forms of dementia.

Improving your heart health is another thing you can change right now. It’s known to lead to better brain health, Nelson says.

Someday, we will likely have personalized therapies tailored to specific types of dementia, as we do with many cancer drugs, Nelson says. We may even have preventive therapies for those at risk.

But, as Nelson’s report concludes, it will take extensive and proactive collaboration between academic researchers, pharmaceutical companies, clinicians and consumers to push those efforts along.

By Liz Seegert

New York-based journalist Liz Seegert has spent more than 30 years reporting and writing about health and general news topics for print, digital and broadcast media. Her primary beats currently include aging, boomers, social determinants of health and health policy. She is topic editor on aging for the Association of Health Care Journalists. Her work has appeared in numerous media outlets, including Consumer Reports, AARP.com, Medical Economics, The Los Angeles Times and The Hartford Courant.

@lseegert

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Looking for relief from garden-variety stressors? Feeling mired in one of life’s larger challenges? Weary of sweating the small stuff? The recently published results of a five-year study show that people who learn stress-intervention skills — and then practice them daily — develop more positive approaches to life.

“The skills, known as a positive emotion regulation intervention, are not specific to any particular kind of stress,” says Judith Moskowitz. “We’ve seen that individuals in all kinds of challenging life circumstances with high levels of depression and stress have the ability to experience positive emotions, and doing that helps them cope better. The same skills also help with daily hassles.”

“When you’re hyper-focused on things that are stressful, you don’t notice the good things.”

A medical social science professor at Northwestern University’s Feinberg School of Medicine, Moskowitz developed the intervention program taught in the study. Based in Chicago, she also is the director of research for Northwestern’s Osher Center for Integrative Medicine and president-elect for the International Positive Psychology Association.

Caregivers Found Relief

As reported in a recent issue of the journal Health Psychology, 170 participants in Moskowitz’s six-week, randomized controlled trial showed a decrease in depression by 16% and in anxiety by 14%.

Those who took part in the study were caring for loved ones with dementia, but Moskowitz says the results bode well for anyone who decides to put into practice some of the strategies, all of which are backed by research.

“I want to emphasize that these skills are designed to help increase positive emotions. That’s not to say that anyone needs to deny or suppress negative emotions, because they are important,” Moskowitz says. “But it’s also important to experience positive emotions alongside negative ones, and that’s what these skills are designed to help people do.”

Choose from a ‘Buffet of Options’

Because different solutions work for different people, Moskowitz offers what she calls “a buffet of options” — eight ways to help cultivate more positive emotions. “Individuals may want to give each option a try,” she says, “and then pick one or two to stick with as a habit.” Here are the eight proven skills:

1. Identify one positive event each day. “Humans have evolved to pay attention to what’s going wrong. Things that are stressful draw your attention so you can do something about it,” Moskowitz says. “But when you’re hyper-focused on things that are stressful, you don’t notice the good things. Making time to do that helps you take a step back, get some distance.”
2. Talk with someone about the positive event or share it on social media. “This is a way to savor or capitalize on something good,” Moskowitz says. “You don’t have to share it. You could just think about it again, and remember how great it was.” Examples might include preparing a good meal or watching a beautiful sunset.
3. Write in a gratitude journal every day. This is a second way to notice the good moments in the day. “In your gratitude journal, you can write about events or write that you are grateful for the sunshine or for clean water,” Moskowitz says.
4. Reflect on a personal strength and how you’ve used it recently. When you’re under stress, your thoughts may spiral downward and lead to self-criticism. “Instead, recall good things about yourself,” Moskowitz says. “Maybe tell yourself you are a great friend or that you’re someone smart who can come up with a plan to deal with your stress.”
5. Set a small daily goal and note your progress. “When you feel as though you’re making progress — even if you aren’t necessarily achieving success — that increases positive emotions,” Moskowitz says. “Find the sweet spot of goal setting, something that’s not way beyond what’s possible.”
6. Develop a “positive reappraisal” habit to reframe a troubling daily activity in a more positive light. “How we interpret an event determines our emotional reaction to it. But there’s almost always a positive reappraisal that you can pull out of any situation, even when you start small,” Moskowitz says.
7. Perform an act of kindness every day. This simple practice gets you outside yourself. Moskowitz notes that she always walks her shopping cart back to the storefront and also makes way for drivers attempting to merge onto the highway. Complimenting a stranger on a pretty scarf or a welcoming smile counts, too.
8. Concentrate on the present moment. “When you’re upset, instead of rehashing what already happened or rehearsing what might happen next, pay attention instead to what’s happening in the present, what your thoughts and experiences are right now,” Moskowitz says. “When we’re more mindful, we’re more aware of positive events.”

Meditation Can Help You Master Mindfulness

That last one can be tricky. To master mindfulness and respond thoughtfully to life rather than just react, Erin Olivo recommends meditation.

“It’s a tool for achieving mindfulness, and research shows that meditation reduces our sense of stress,” she says. “You can take up a formal practice, where you sit on a cushion, or an informal practice, where you bring mindfulness to your daily activities.”

Olivo is a licensed clinical psychologist in New York City with more than 22 years of experience treating patients who are dealing with stress, anxiety and depression. She also is the author of Wise Mind Living: Master Your Emotions, Transform Your Life.

Olivo practices mindfulness while in the shower. “I might want to ruminate about anything I’m worried about or try to do a lot of planning instead of just being in the shower. But I remind myself to be present, and not let my thoughts launch me into my day,” Olivo says.

“This focused approach also works while washing dishes or even brushing your teeth,” she says, adding that if your mind wanders, gently bring it back to the moment.

“The more we bring mindfulness into our lives, the more impact it has,” Olivo says. “Think of it as a muscle you are developing — a way to help yourself.”

By Patricia Corrigan

Patricia Corrigan is a professional journalist, with decades of experience as a reporter and columnist at a metropolitan daily newspaper, and a book author. She now enjoys a lively freelance career, writing for numerous print and on-line publications. Read more from Patricia on her blog.

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About three years ago, Barbara Casson, now 65, observed that while other families did activities together, her small family didn’t have many occasions for shared activities, especially with relatives in different states.

“I really think that’s important for families to have common experiences, not just when you get together and ask a series of questions like you’re being interviewed,” said Casson, who lives in Columbus, Ohio. “We were never going to travel together.”

Fortunately, they found another way to connect. “One of the kids said we should do a book club because we all love to read,” said Casson, who’s an English teacher-turned-school principal.

Casson and her son, daughter-in-law and daughter each chose a book to discuss in their club. That Christmas, they exchanged their book club picks as gifts. (Casson’s ex-husband later joined the book club; her daughter-in-law took a hiatus during graduate school, then rejoined.)

Family Book Clubs

Meeting in person, on Skype or by phone as needed, the family has discussed a variety of booksincluding humor, history and fantasy novels.

“The best thing about a book club is it introduces you to things it wouldn’t occur to you to read,” said Valerie Moore, 37, of Chicago. Moore is Casson’s daughter-in-law and is pursuing her Master’s  in library science.

“The process of deciding what a family book club might look like could be lots of fun.”

Casson admits that they haven’t loved every book; even her son admits his chosen title on the history of cotton read like a textbook.) But the club has sparked more interesting conversations. “It gave us a lot of things to talk about separately from ‘How’s your job? How’s the dog?’” Casson said. “I’ve always enjoyed my kids intellectually.”

For instance, The Round House by Louse Erdrich prompted discussions about Native American tribal law, an area the group hadn’t previously considered. “We’re getting to talk about all kinds of different things that never would have come up otherwise,” Moore said.

Other families have formed inter-generational book clubs, too.

Several years ago, my brother suggested that my mom and I read the same books and discuss them as a way to stay connected since we’re scattered across the country. Our long-distance book club has ebbed and flowed as we’ve navigated job changes, moves and other life events. But we’ve read and discussed fiction and nonfiction titles by Harper Lee, Jhumpa Lahiri, Robert Kiyosaki and Sheryl Sandberg, among others.

Benefits of Family Members Reading Together

Tobi Jacobi, a professor of English and director of the Community Literacy Center at Colorado State University, has participated in a mother-daughter book club with her daughter through her public library. The two also read and discussed a book by Malala Yousafzai, the youngest Nobel Prize laureate, on their own.

“That was really fabulous, because at the time my daughter was grappling with ‘What are the limitations on girls?’ and there are so many mixed messages on what girls can do and what they can’t do,” Jacobi said. “It really made space for us to be able to talk about that through Malala’s experience.”

Jacobi has also worked with community partners to run inter-generational book clubs at places like GED (General Education Development) and ESL (English as a Second Language) centers for people who might not view themselves as readers. For those groups, taking literacy outside of school provides “access to a reading experience that wasn’t connected to a grade,” Jacobi said.

As part of Jacobi’s other literacy work, an inter-generational book club through a group called Grandparents Raising Grandchildren encouraged grandparents, some of whom were thrust into a parental role due to issues such as drug addiction, to read with their grandkids.

“That gives a way to flatten the relationship that might exist where one person is in more of an authority role,” Jacobi. “There, the kids’ voices might be valued.”

Stretching the Limits on Choosing Books

In families that don’t struggle with literacy, grandparents or other relatives still might enjoy revisiting classics or exploring new literary worlds as they connect with younger generations. If a book club includes kids, Jacobi recommended. give them input on the books chosen and the parameters around the book club.

“The process of deciding what a family book club might look like could be lots of fun,” she said. “Are there limits on the kinds of books or can we stretch our understanding of what makes a book? Lots of people feel that classics are important to read, but what about moving into another format like poetry or graphic novels?” (The latter has gotten very popular with young readers.)

Once you’ve chosen a book, don’t assume you have to buy multiple copies.

“There are lots of opportunities to check out books in a group way,” Jacoby said. “Our public library has sets of fifteen books that you can check out, so it does become more accessible.”

Even if you’re not keen on someone else’s chosen title, it might surprise you, by opening up a new author or genre. “We all fall into our habits of things we enjoy reading and that’s not bad,” said Moore. “But it doesn’t expand what we might be interested in.”

By Susan Johnston Taylor

Susan Johnston Taylor of Austin, Texas, has written for publications including The Atlantic, The Boston Globe, Entrepreneur, Fast Company and U.S. News & World Report.

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The big statistic most of us hear about stroke is that our risk doubles every decade after age 55. But earlier this year, actor Luke Perry and director John Singleton died of stroke. Perry was 52, Singleton just 51.

Last year, Olympic sprinter Michael Johnson — once known as “the fastest man in the world”— survived a stroke at age 50. So, it appears waiting until age 55 to think about stroke could be deadly.

Are More Midlife Adults Having Strokes?

A 2017 study by researchers at the University of Michigan and the Veterans Affairs Healthcare System’s Department of Neurology in Ann Arbor, Mich., found that among people age 45 to 54, the rate of hospitalization for the most common type of stroke rose more than 20% from 2003 to 2012.

But the study’s finding doesn’t necessarily mean that more people are having strokes younger, says Dr. Koto Ishida, medical director at the New York University Langone’s Comprehensive Stroke Center. “Rates aren’t necessarily increasing, but awareness is,” she says.

About 80% of first-time stroke victims of any age have high blood pressure.

In 2003, the American Stroke Association launched a warning signs awareness campaign. With increased awareness, more potential stroke victims know to seek help sooner.

Also, Ishida says, diagnostic methods changed during the Michigan study’s time period, so some 2012 stroke victims might have been classified as something else in 2003.

One thing that does seem to be happening in people at younger ages: more risk factors for stroke, including obesity, high blood pressure, elevated cholesterol, coronary artery disease and diabetes. The Michigan study found that the number of stroke victims age 45 to 54 with three to five risk factors rose by more than 70%.

“We’re definitely seeing these risk factors younger,” says Ishida. “We call many of them ‘silent killers.’ A lot of people come to us in their forties and fifties believing they were healthy until now. But you could’ve had high blood pressure for ten years and not known it.” About 80% of first-time stroke victims of any age have high blood pressure.

Stroke Risk and Prevention

Because risk factors like high blood pressure or cholesterol don’t show symptoms until something like a stroke hits, an annual physical exam is the most important thing people can do to prevent one, Ishida says. That gives your doctor the chance to monitor you and help you lower elevated blood pressure or cholesterol to a less risky level.

There are some risk factors that you can’t change, however, like your family history. “Younger strokes and younger risk factors run in families,” Ishida says, adding that you should tell your doctor if younger people in your family have died of stroke, so they will know to start screening you sooner.

Race also matters when it comes to stroke: The risk of stroke among blacks is nearly twice as high as for whites, and blacks tend to have strokes younger.

Gender is another factor: The Michigan study found that among people age 45 to 54, nearly 30% more men than women were hospitalized for stroke.

But the good news is, up to 80% of strokes in the U.S. are preventable, according to the Centers for Disease Control and Prevention (CDC). These lifestyle changes can lower your risk of stroke:

• Quit smoking. Smokers are two to four times more likely than non-smokers to have a stroke.
• Lose weight. Obesity increases your risk for high blood pressure, diabetes and other key risk factors for stroke.
• Drink less alcohol. It can raise your blood pressure. The CDC recommends men have no more than two drinks a day, and women just one.

‘BE FAST’ Could Save a Life

Stroke is the fifth-leading cause of death in the U.S., but far more people survive stroke than die of it. As many as nine out of 10 survivors have some paralysis immediately after.

Thanks to medical advances in emergency treatment, recognizing a stroke immediately could make the difference between a full recovery and decades of living with a stroke-related disability. But for people under 55, stroke isn’t often top of mind.

“Every minute when you have complete blockage of blood flow to the brain, two million brain cells are irreversibly killed,” Ishida says. “If you wait and come in the next morning, it takes treatments off the table.”

The sudden onset of symptoms is a hallmark of stroke — there aren’t a lot of other things that happen so quickly, says Ishida. A sudden severe headache can be a symptom, but otherwise there usually isn’t much pain. “That’s a downside for us in the stroke world,” Ishida says. “Pain is a good motivator to get people to the ER.”

The American Stroke Association and National Stroke Association both suggest the acronym “FAST” to help you remember the key symptoms of stroke:

• Face: Try to smile. Is one side droopy?
• Arms: Lift both arms. Is one side weaker than the other?
• Speech: Are you having trouble getting words out, slurring or having difficulty understanding others?
• Time: Get treatment as quickly as possible. If the answer is Yes to any of the above questions, call 911 immediately.

While FAST is handy, it’s far from complete. Ishida likes to add the word BE before FAST to cover more possible signs:

• Balance: Are you feeling dizzy or struggling to keep your body steady?
• Eyes: Do you have a sudden problem with one or both eyes or double vision?

Whatever you do, don’t attempt to treat symptoms yourself. The two primary types of stroke have identical symptoms but do virtually opposite things to your brain.

The most common type, ischemic, happens when a blood clot cuts off blood flow to your brain.

Hemorrhagic strokes happen when a weakened blood vessel ruptures and blood floods into surrounding brain tissue. Since you don’t know what type of stroke you’re facing, guessing at treatment could be catastrophic.

Bottom line, says Ishida: “If you’re having sudden onset of one of those symptoms, stroke should be top of mind, no matter your age.”

By Debbie Koenig

Debbie Koenig is a writer and the author of the cookbook Parents Need to Eat Too: Nap-Friendly Recipes, One-Handed Meals & Time-Saving Kitchen Tricks for New Parents. She lives in Queens with her family.

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I spoke to Gawande the day his documentary film about end of life was to premiere on PBS’s Frontline. The movie is based on his bestselling book, Being Mortal. Both the show and the book add to a growing national conversation about aging well and living fully when you have limited time. More and more, the focus is on what those facing their own mortality want — not just which treatments will extend life.

“We tend to assume that safety and health are paramount, without asking: ‘Are you lonely? What would you like?’ And if the Alzheimer’s patient wants to eat 40 cookies, that’s not necessarily good for him — but I want to say, ‘So what?’ That’s living,” Gawande said.

Gawande has a unique vantage point as both surgeon and son. His father’s life — and death — were the inspiration for his examination into end-of-life issues. He also drew from experience treating patients and from about 200 interviews he conducted to create a systematic approach that gives patients a feeling of relief and sense of control.

Now, through his research lab, Gawande is training doctors to ask the five questions and testing and measuring what changes for patients when they do. The goal is to scale the approach so it becomes part of routine end-of-life care for patients.

Here are excerpts of our conversation, edited for length:

Next Avenue: Can we rely on medicine and doctors to help patients focus on living as they choose? 

Gawande: I don’t think it’s going to come through medicine. I don’t think we’ll make it better because doctors require it to be better. It will be because patients and families realize there’s a better way to deal with the last days of our lives. That doesn’t mean you give up on getting the treatments you want; it means you look at the priorities that are most important to you. That’s what we have not followed through on.

What’s an example of discovering priorities?

There are several stories in the film and book. One is about a woman who has been under treatment for two years for a cancer we know isn’t curable. We finally ask about what really matters to her, to make sure she gets to be able to do it if time runs out. We learn that she wants to take her grandchildren to Disney World — but by this time, it is too late. She dies just a few days later. If we had known and known soon enough how important this was to her, we could have ensured that it happened.

It’s fundamentally about what patients want?

A lot of these moments hinge on the fact that people do have priorities in addition to living longer. The most reliable way to know what those are is to ask, and we don’t ask. We ask less than a third of the time.

It’s amazing, with the documentary, to have the camera in rooms, to see the conversations doctors, patents and families do have — and don’t have.

Up until now, your Checklist Manifesto was probably your best-known work. That’s about the list you created to make sure surgeons followed a system to operate on the right limb, for instance, and to ensure communication on the surgical team. Is this new approach to end-of-life similar?

I see it as completely similar. It’s really a series of questions that we need to be comfortable asking one another. It needs to be normal to ask these questions, especially when someone is faced with a serious illness, and especially when we know that we’re aging and becoming frail.

We need to know:

• What is your understanding of where you are and of your illness?
• Your fears or worries for the future
• Your goals and priorities
• What outcomes are unacceptable to you? What are you willing to sacrifice and not?
• And later, what would a good day look like?

Asking these allows everybody to understand what the goal really is — what are you really fighting for? It’s for a life that contains certain things.

When I asked my dad these questions, he was very clear that he wanted a social life and he didn’t want aggressive treatment that would prevent him from being social. So if his tumor was going to make him a quadriplegic, he didn’t want to be on a ventilator or have a feeding tube.

When should families and doctors use this list?

The conversation has to happen well before the end. Too often, a crisis is when we have this conversation. And you need to ask repeatedly — people change their minds.

How does using your list change care in a broader sense?

I run a research center, Ariadne Labs (a collaboration between the Harvard School of Public Health and Brigham and Women’s Hospital in Boston), where we devise and run tests on a large scale.

I practice at Dana-Farber Cancer Institute, so for this end-of-life approach, we are working with doctors there to train them in asking these questions. We have doubled the number of conversations people are having. And the results of the doctors who have the conversations vs. the ones who don’t is that the anxiety levels of the patients with trained doctors drops.

These are people with great experience; many of the doctors have been practicing for 10 or 20 years. But the norm is to give people facts, the pros and cons, data. But the palliative care people are telling us that it’s what people tell you is their understanding of the facts — along with their and hopes and fears — that really matters.

This is not just a conversation doctors have; any family can have it, too. It’s not just about the last weeks of life, it’s about the last decade. We are all going to spend a significant part of life with our health getting worse, we’ll get frail and have more illness — and that is a victory. We get an extra 20 years after age 65, the bonus years. What’s acceptable to us and what’s not? That’s the conversation that has to become normal in our country and in the world.

How do you train the doctors?

The way we’ve done it, and we have to figure out how to scale it, is the doctors have their normal type of conversation with an actor playing a patient. Then we have them use the questions, and see how it feels. It gives them practice getting the words out and teaches them to be silent a little more and to let the patients have their say.

When I first tried this myself, one doctor told me I was an explain-a-holic. I had to learn to take no more than half the time talking and to ask the patients what they understood and what were their concerns.

What if you try to have this conversation with a parent and they don’t want to discuss it or haven’t thought about any of these things?

It’s normal that the first time you raise it, someone’s going to say, ‘That’s not relevant right now,’ or ‘We don’t need to think about that.’

Thinking about mortality is anxiety provoking. But — you’ve opened the door. You don’t have to have that conversation the very first time you bring it up. You started it, and often, they are processing and later become ready and willing to talk about it.

But it’s still awkward to bring it up.

I’m hoping the film and book gives people a reason to talk. In the book, I talk about the man who says he will be OK as long as he can eat chocolate ice cream and watch football — and that experience became part of the conversation I had with my dad. I mentioned it, and he said, ‘Well, that wouldn’t be enough for me. I’ll tell you what I want…’ That opened the door.

You will get shut down, but another moment will come.

Note: Follow Gawande’s ongoing Twitter conversation based on the Frontline special, by searching for #whatmattersmost

By Sue Campbell

Sue Campbell is the former Editorial and Content Director for Next Avenue. Follow her on Twitter @SuePCampbell.@SuePCampbell

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