Moving Forward: It’s only normal aging

There has been a lot of talk recently about how old is too old to serve in public office. It is a complicated question and I have no intention of answering it.

Instead, I’d like to look at what is normal aging and what it means for the vast majority of seniors who are fortunate enough to experience only normal cognitive decline.

First, what specifically do we mean when we use the term cognitive functioning?  

Experts agree perception, memory, learning, attention, decision making and language abilities are the core components that make up cognition.

As we age, most of us experience some degree of age-associated memory impairment. Generally, these memory lapses do not disrupt daily life, do not affect one’s ability to complete tasks, and do not disrupt the ability to continue to learn.

Classic examples are forgetting the names of acquaintances or occasionally forgetting an appointment. How about that film star whose career you know well, except you cannot remember her name. Or you’ve been looking all over the refrigerator for the jam, only to discover that you put it on the counter five  minutes ago. And we won’t even talk about those pesky misplaced keys. 

It’s annoying, but not alarming. 

There are numerous ideas and tips to help with forgetfulness. As we age, we may discover that writing down shopping lists minimizes trips to the IGA. And with iPhones, we no longer need to remember phone numbers, just like with Google Maps, we need not memorize directions.

Harvard Medical School suggests seven ways to keep your memory sharp.  

Nothing from this list will be surprising, because there are no magic bullets.

1. Keep learning: Learn a new language, join a book group, play chess or bridge, do crossword puzzles. Right here is an advertisement for the Shelter Island Library and Senior Center where these activities are available.

2. Use all your senses: Remember the scent of a flower or a meal you just ate. Pet a dog. Listen to a bird. According to research, the pairing of senses (particularly odors) brings recall of memories that might not have otherwise occurred.

3. Believe in yourself:  No, this is not hokey new-age stuff. If you think your memory is going, it will become a self-fulfilling prophecy, and you will no longer push yourself to remember. Memory takes work.

4. Economize your brain use: Make lists, use a calendar, designate a place for your glasses, keys, etc. Use your cognitive bandwidth for important and creative things, not the things that can easily be written down.

5. Repeat what you need to know: If you’re being introduced to John, say his name immediately as in “Hi, John, it’s nice to meet you.” When you learn a new word while studying a language or seeing it in a book, say it out loud. And if someone is teaching you something that you don’t understand at first (like some annoying computer thing), ask them to repeat it.

In addition, spend time with family and friends. Laughing, exercising and singing all help cognition. Loneliness leads to cognitive decline.

Often older people complain of trivial memory issues, but claim that their long-term memory and depth of experience serves them better than when they were younger. This is because normal cognitive decline mostly affects thinking speed and attention, but the depth of thinking remains unimpaired. It is not uncommon for a 75-year-old to work a crossword puzzle faster than her younger daughter. This is because vocabulary often increases with age, and the skills of puzzle-mastery increase with experience. Similarly, with figuring out complex work or social problems — if you’ve been there before, it is easier to do it again. 

A recent New York Times article says, older people are often better decision-makers, because they can recognize patterns and are more attuned to the effects of their decisions.  

Sometimes what looks like cognitive decline may be something else and is reversible and treatable. For example, when older people become depressed, their thinking can become foggy or slow. Anti-depressants prescribed by a psychiatrist are often helpful. If someone has suffered the loss of a loved one, their thinking often becomes impaired as they are flooded with fears and emotions that interfere with normal thinking processes. As they begin to deal with their grief, their cognitive functioning usually returns. A visit to a hospital with general anesthesia can also bring on cognitive decline, but after a certain time period, this is usually reversed. Stress, anxiety, alcohol, and an under-active thyroid are also causes that can be reversed with proper treatment. Even a combination of various medications can create a toxic hit to memory. This is why medical professionals need to know about all medications, including over-the-counter ones.

So, what is normal age-related forgetfulness and what is not? Some older adults have a condition called mild cognitive impairment (or MCI). The National Institutes of Health suggest that these people have more difficulty remembering things and less than optimal functioning, but they can still live normally. Signs include  more forgetfulness, trouble following a conversation, missing appointments or social events, and difficulty making decisions. 

Unlike with dementia, a person with MCI can generally take care of themselves. Adults with MCI are more prone to develop dementia, but it is not a foregone conclusion. According to the Mayo Clinic, about 1-3% of older adults develop dementia every year while 10-15% of people with MCI will develop it.

The American Academy of Neurology estimates that MCI is present in the following age groups: 8% of people aged 65-69, 15% of people aged 70-79, 25% of people aged 80 to 84, and 37% of people 85 or older. Estimates for dementia are 2% among adults aged 65-69 and double every five years. Of those in ages 90 and older, the statistics are approximately one in three. Therefore, with approximately 1/3 of nonagenarians having MCI, and another 1/3 having dementia, that leaves approximately 1/3 of adults at age 90 fortunate enough to have no serious mental decline.

Assuming we aspire to become one of those nonagenarians or perhaps even a centenarian, we need many factors in our favor. Should we live that long, we can work the margins by maintaining physical, emotional, and “brain” health. 

Aging is a fact of life. But it can bring joy and fulfillment.

Nancy Green is a member of the Shelter Island Health and Wellness Alliance and is a proud septuagenarian.