How to Promote Brain Health:
The Healthy Aging Checklist, Part 1

“Doctor, what do you recommend for healthy aging?”

“My mom is getting older and I want to help her stay healthy. What should we be doing?”

On this blog, I usually write about how to manage or avoid specific senior health challenges. But in real life, I often get asked the questions above. After all, many people want advice on how to be healthier, or stay healthy.

That’s because we all intuitively know that maintaining good health is key to maintaining what is most important to us as we age: our ability to be physically and mentally capable, so that we can remain active, engaged in our lives, and as independent as possible.

We also know that poor health can bring on pain and other symptoms, as well as disabilities that can jeopardize how we live our usual lives. In fact, most “aging” problems that seniors and families struggle with — like difficulties with mobility, memory, or independence —  track back to underlying health problems.

So it’s good to know how to maintain one’s health as one ages, in order to keep our minds and bodies working well for as long as possible.

Furthermore, healthy aging isn’t just about forestalling aging or disability. It’s also about knowing how to make the best of things even once you do have chronic diseases or chronic disabilities of the mind or body. I call this optimizing health, for better health while aging.

It means optimizing one’s health — and health care — so that the brain and body work at their best for now and for the future. And the beauty of this is that the same key things work, whether you are a “healthy” older person with no particular health problems versus someone who has chronic conditions or even an “uncurable” disabling disease such as Alzheimer’s.

In this series of posts, I’m going to tell you how to do this.

The Healthy Aging Checklist

For the healthiest aging, do this:

• Promote brain health and emotional well-being.
• Promote physical health.
• Check for and address common senior health problems (e.g. falls, pain, memory problems, depression, isolation, incontinence, polypharmacy, etc).
• Learn to optimize the management of any chronic conditions.
• Get recommended preventive health services for older adults.
• Address medical, legal, and financial advance care planning.

There you have it. If you do those six things for your older relative — or for yourself — you’ll have set up an excellent foundation for optimizing health right now, preventing or delaying health problems, and being prepared to better navigate the future emergencies and health declines that will probably crop up.

You may be wondering just how to implement each item.  So, I’m creating a cheatsheet for each part, and I’ll cover each of them in a blog post.

Like everything I suggest, it’s based on the approach I take with patients when I practice, and it’s grounded in the geriatrics approach to healthcare for older adults, as well as in clinical research.

In this post, we will cover what to do to promote brain health, and also emotional well-being, which is intimately related to brain health and brain function.

Let’s get to it!

How To Promote Brain Health: 8 Key Things To Do

For better brain health while aging, I recommend you prioritize these eight approaches. There are three unhealthy things to avoid — or at least minimize — and five healthy things to do.

Note that although it’s ideal to do these before a person develops memory problems, these do also promote better brain function in people diagnosed with Alzheimer’s or another dementia.

1. Avoid brain-slowing medications. 

Why: Several types of commonly-used medications diminish brain function in the short-term, and are linked to higher rates of Alzheimer’s in the longer-term. Learn to identify these medications, so that you can avoid them, or at least use them only as a last resort when the likely benefits outweigh the risks.

Note: Common health problems often treated with risky medications include anxiety, insomnia, over-active bladder, vertigo, and allergies. (See resources below for more.) In many cases, such problems can effectively be treated with non-drug approaches, or with safer medications.

For more information:

• 4 Types of Brain-Slowing Medication to Avoid if You’re Worried About Memory
• 7 Common Drugs That Are Toxic For Your Brain
• How You Can Help Someone Stop Ativan

2. Avoid chronic sleep-deprivation.

Why: Chronic sleep-deprivation can cause irritable mood, worse thinking, and many other problems. Fortunately, most sleep problems can be treated if properly identified.

Note: If you have anxiety or frequent insomnia, it’s very important to learn to sleep without sedatives or sleeping pills. This usually requires a big effort in the short-term, but is worthwhile for long-term brain health and will reduce fall risk as well. Clinical studies have shown that older adults who depend on tranquilizers can successfully wean off of them. (See resources below for links to these studies.)

For More Information:

• How Sleep Affects Health, & Changes with Aging
• 5 Top Causes of Sleep Problems in Seniors, & Proven Ways to Treat Insomnia

3. Avoid delirium.

Why: Delirium is a state of worse-than-usual mental function, brought on by some kind of illness or stress. Studies have found that delirium is associated with acceleration of cognitive decline. In older adults, delirium is often brought on by the stress of hospitalization or serious illness. Although not all delirium can be avoided or prevented, seniors and families should be careful about elective surgeries, and can learn ways to reduce the chance of developing delirium.

For more information:

• 10 Things to Know About Delirium
• Hospital Delirium: What to Know & Do

4. Pursue positive social activities, purposeful activities, and whatever activities nourish the soul.

Why: Loneliness and boredom are harmful to brain health and emotional health. Studies find that older adults feel better when they are socially engaged, and also when they feel a sense of purpose. This may also help prevent or delay cognitive decline.

For more information:

• The Brain Fights Back: New Approaches to Mitigating Cognitive Decline
• Higher purpose in life tied to better brain health
• Social relationships and risk of dementia

5. Find constructive ways to manage chronic stress. 

Why: Chronic stress is an important quality of life issue. It also can change the brain, and has been linked to changes in cognitive function.

Note: To manage chronic stress, it’s best to combine general approaches (such as improving sleep, exercising, meditation, relaxation strategies, etc) with approaches that can help you cope with your specific source of stress, such as caregiving coping skills or relationship counseling.

For more information:

• Perceived Stress and Change in Cognitive Function Among Adults Aged 65 and Older
• Chronic Stress Can Damage Brain Structure and Connectivity
• Mindfulness-Based Stress Reduction for Family Caregivers: A Randomized Controlled Trial
• Stress Management: How to Reduce, Prevent, and Cope with Stress

6. Seek treatment if any signs of depression or chronic anxiety.

Why: Although studies find that many people feel happier as they age, it’s still quite common for seniors to experience late-life depression. Chronic anxiety is also common, and can co-exist with depression. These problems dimish quality of life, and also have been linked to cognitive decline. Fortunately, they are treatable.

Note: It’s most common for these problems to be treated with medication. However, a number of non-drug treatments are available for depression and anxiety, such as cognitive-behavioral therapy, and these can be as effective as medication. These are often safer for older adults in that there’s less risk of side-effects or interactions with any treatment for other health problems, so it’s often worthwhile to ask about non-drug treatments.

For more information:

• Depression in Older Adults and the Elderly
• Anxiety Disorders, Risk Factors and Diagnosis
• Does Depression Contribute to Dementia?

7. Stay physically active and exercise regularly.

Why: Regular physical activity has been shown to benefit brain health as well as mood. Studies have found that exercise can help treat depression or anxiety, and is also linked to a lower risk of developing a dementia such as Alzheimer’s.

Note: The CDC resource below clarifies how much exercise to get. But research has also shown that even less-than-recommended exercise brings health benefits. So remember: it’s better to do a little bit every day than nothing at all!

For more information:

• CDC.gov: How much physical activity do older adults need?
• National Institute on Aging Go4Life.gov: Try These Exercises

8. Address risk factors for cardiovascular disease.

Why: Cardiovascular disease includes cerebrovascular disease, which means brain health problems related to blood vessels in the brain. Reducing cardiovascular risk factors helps preserve good blood flow to the brain. This reduces the risk of a major stroke, and may help prevent the smaller brain vessel blockages that cause vascular dementia.

The main cardiovascular risk factors to address are high blood pressure, high cholesterol, diabetes and pre-diabetes, smoking, obesity, and physical inactivity. Exercise is a safe and effective way to help treat most of these risk factors, but medications or other approaches may also be necessary.

Note: There has been some debate as to how intensively to treat some of these risk factors, e.g. what is ideal blood pressure for older adults, or when to treat high cholesterol with statins.  It’s important to balance the likely benefits of intensive treatment with the likely risks. You can do this by asking about a treatment’s “number-needed-to-treat” (NNT) and “number needed to harm” (NNH); the New York Times articles linked to below explain this further.

For more information:

• 10-year Cardiovascular Disease Risk Calculator
• Cerebrovascular disease: Risks and prevention
• 6 Steps to Better High Blood Pressure Treatment for Older Adults
• Can This Treatment Help Me? (NYTimes on NNT)
• How to Measure a Medical Treatment’s Potential for Harm (NYTimes on NNH)

2 Optional Extra Ways to Promote Brain Health

Here are two additional approaches you can try, as part of promoting brain health for healthier aging. Both of these approaches are covered in the Institute of Medicine’s (IOM’s) groundbreaking and very comprehensive 2015 report on cognitive aging, and for both of these approaches, the IOM concluded that the research results are promising but not yet conclusive.

9. Eat based on the Mediterranean Diet.

Why: Several studies over the past few years have indicated that a “Mediterranean diet” is associated with many positive health outcomes. In a large well-done randomized trial, a Mediterranean diet reduced cardiovascular disease in older adults, and was also linked to maintaining better cognitive function.

Note: The medical literature on dietary vitamins and supplements for cognitive health is mixed. I personally believe it’s more useful to focus on maintaining a diet that is generally healthy for the body, such as the Mediterranean diet, than it is to focus on taking specific foods or vitamins for brain health.

For more information:

• How to Follow the Mediterranean Diet for Senior Health, & Related Research Findings
• Summary on Dietary Interventions in Cognitive Aging (IOM Report page 126)

10. Consider brain training games if you enjoy doing them.

Why: Mentally challenging activities have been linked to brain health, and studies have found that older adults can improve certain cognitive abilities through brain-training programs. However, brain-training seems to mainly improve one’s ability to do the brain task that is being practiced, and the overall value of the cognitive improvements has been debated.  Hence, the IOM concluded that brain training is promising but in the absence of more research, one should be cautious about the claims being made by those selling cognitive training programs.

Note: I cannot endorse any specific programs, but will say that BrainHQ and Lumosity are particularly well-established companies who often collaborate with clinical researchers. You can read about research studies related to these programs here and here.

For more information:

• Do Brain Workouts Work? Science Isn’t Sure
• Cognitive training shows staying power (refers to ACTIVE study which used BrainHQ exercises)
• Summary on Cognitive Stimulation and Training in Cognitive Aging (IOM Report, page 190)

For More In-Depth Information on Cognitive Aging and Promoting Brain Health

If you want to go beyond the information presented in my brain health cheatsheet, an excellent resource is the aforementioned Institute of Medicine (IOM) report on Cognitive Aging.

This report was published in 2015 and is freely available online. The full report is 318 pages, and covers just about all the relevant scientific knowledge and research on brain health and how to preserve it.

You can find a report brief, additional resources including an action guide for individuals and families, and a link to the full online report here: Cognitive Aging: Progress in Understanding and Opportunities for Action.

You can also read my article summarizing what I found most important in the report here.

How Are You Doing on Promoting Brain Health & What Will You Do Next?

Don’t panic if you realize you aren’t doing most of the eight things I recommend.

Do, however, give yourself credit for any items you are doing well on. And then make a plan to improve just one thing, and pick one little next step. It might be committing to walk 20 minutes every day. Or scheduling an appointment with the pharmacist to review medications.

Whatever it is, pick one thing and schedule it. And then commit to reviewing the cheatsheet and taking one more action next month.

If you take an action at least once a month, you’ll eventually be on track for maintaining better brain health while aging.