I have discussed the elements necessary to maintain good cognitive health throughout aging and, possibly slow the progression of dementia. I stumbled upon my own answer this September and I am feeling mentally sharper than ever, along with being sore and calloused.

It turns out that I have had a 33 year desire to row. This is a long buried desire of my subconscious.

When I was a freshman at Northeastern University, I followed a new friend down to the Charles River where we were excited observers of the Head of the Charles Regatta. At the time I do think I was equally impressed with the spectators as with the athletic rowers. Rowing is a preppy sport and this was 1980, The Preppy Handbook had just been published that month and everyone had not only read it, they were living it. Pink and green pants with alligators were everywhere and everyone had a perfect picnic basket on a blanket by the river. http://www.amazon.com/Official-Preppy-Handbook-Lisa-Birnbach/dp/0894801406

But I did also notice the rowing and I was enthralled. The synchronicity of 9 people in one shell, skimming across the water. I caught my breath. It looked like a perfect meditation. It looked effortless.

It is not effortless. The Baboosic Lake Rowing Club on Baboosic Lake in Amherst, NH is a new, non-profit club and I live around the corner from the beach on which these shells are launched. Hence my stumbling in to my long lost desire and my effort to prevent my cognitive decline. And I still stumble.

As the research states, it is good to learn something new to maintain mental acuity. Rowing is technical and did not come naturally to me. I went home after the first morning to tearfully tell my 16 year old that his mother was the worst one on the team. Being on the team, by the way, just meant passing a swim test. He calmly told me that to be good at something we have to stick with it and keep practicing. He has always been a good listener.

Legs, back, arms, arms, back, legs. These elements move separately to grab the most water, but smoothly. We are fast away with our arms, rock forward to 11 o:clock with our trunk, and slide slowly up the recovery, then send the boat away with our quadriceps, hinging back to the 1 o:clock position, then pinching off the stroke with our arms. We feather the oars as they rise out of the water, and with luck, or practice, hear that click and then click, back to square to catch the water. The oars, as if on a rubber band throughout the movement, stay 4-5 inches off the gunwales, setting the boat so we don’t rock side to side.

Timing is everything. We must enter and exit the water together or again the boat rocks to one side, oars on one side high in the air and on the other, dragging on the water. We are a team, but each responsible for our own stroke. Our coach Jim says each one must trust everyone else on the team to do what is right and in turn we are equally responsible. Hmmm. This sounds like a metaphor.

Further research on Alzheimer’s care and prevention of dementia indicate that learning a new language is one suggested activity to staying mentally young. Rowing fits the bill for me. This sport has its own language. Port, starboard, stern and bow are the sides, back and front of the boat. Don’t let it bother you that the front, the bow is behind you because you face away from where you are going. A “sweep” is a rower who rows with one oar, which we do. I row port which is on the left of the boat facing the bow but on my right when I am sitting in the boat. A sculler rows with 2 oars, thank goodness I don’t have to figure that out. One is enough.

The coxswain tells us what to do. The average age in our boat is about 48 (sorry team if I am off here) but our coxswain is 15. Please take note how the 15 and 16 year old in this story are the shining stars.

We always listen to her. She says “check it down” we square our oars in the water and stop the boat. She says “weigh enough” and we stop what we are doing. On the water this means holding the oars at that perfect spot above the water for the perfect set, and then dropping them on the water together. Smack. I hear it is supposed to sound great when it happens and I am excited for the moment when we do hit it together. On the beach this means we stop walking while the boat is sitting on our shoulders or overhead and wait for the next command. This boat is heavy, by the way.

But the point is less the muscles I am developing and more, I have learned a new language. Check that off my list of things to do for cognitive excellence. Of course, being physically active also goes a long way in maintaining our overall health and hopefully you can see how I am accomplishing this with my new preppy sport.

Out this spring is the news that socialization is critical to healthy aging. In fact, social isolation is as likely to contribute to early death as smoking 15 cigarettes a day. But I am not socially isolated. I am on a team. I am no longer alone in the basement trying to convince myself that my workout is more important than my family’s laundry. I am one of 9 people who sit in a shell of a boat together. We talk before we get in the boat, we talk a little as we carry the heavy boat and flip it over to set it in the water. We mostly follow directions and work together. But there is the basic sense of support that you get on an adult team. We are happy when we make progress. We congratulate each other. We enjoy the gorgeous mist rising off the lake at 6 in the morning as the sun comes up and the water invites us across. I am not socially isolated.

So rowing is my long lost sport, my new addiction, and my answer to the risks of cognitive decline with aging.

We are going to our first race on Sunday. We will take either first or second place of the two master’s teams racing. We will come away smarter, happier, and, I think, proud of our ability to listen to a 15 year old tell us what to do.

The bank, grocery store, hardware store, hairdresser. The doctor and dentist. Church or temple. The butcher, the baker, the candlestick maker. What if you had no way to get there? Wherever “there” is for you today, there is no doubt that giving up driving will impact your sense of helplessness.

It is not surprising that the discussion regarding the end to driving is met with panic and resistance. There is a lot of emotion tied up in this topic. The Society of Certified Senior Advisors lists fear of dependency above fear of death. Being unable to move about your community without assistance is the beginning of that stage seen as dependency.

Especially in New Hampshire where, according to the U.S. Department of Transportation, Bureau of Transportation Statistics, only 0.6% of workers use public transportation. http://www.rita.dot.gov/bts/sites/rita.dot.gov.bts/files/publications/state_transportation_statistics/new_hampshire/pdf/entire.pdf

To put ourselves in the proverbial shoes of the elderly, let’s compare this to a good New England Nor’Easter. As romantic as it seems, three days into a blizzard and many folks have cabin fever. We can’t wait to get back on the road. We are desperately in need groceries because we forgot to stock up. Even worse, we need our hair done (note a bit of sarcasm, but let’s face it ladies, this can make or break our day). More seriously, what if we are in need of chemotherapy to treat cancer and can’t get there. (Seniors Helping Seniors of NH recently had a call from someone who no longer drives, lives on his own, and has been diagnosed with cancer. His comment that a ride was going to determine his longevity was heart wrenching.) Now let’s say this is not just a three day blizzard, but the snowstorm of your life- the moment someone tells you that you will no longer drive again.

In a perfect world we would find that each aging person decides on their own, and prior to reaching a point of being dangerous, to give up the keys to the car. But we don’t live in a perfect world. One thing we do know is that there is no specific age when driving should end. Making this all the more difficult a conversation.

If you find that you are facing this discussion with your family member, remember first that this will be emotional. The anger, denial or frustration that you hear is likely that fear of dependency. A reminder that many things are beginning to feel more out of control. Recognize that the end to independent driving for a senior will require planning for transportation. It is not enough to just say “mom you can’t drive anymore.” Think ahead about ideas that will create improved quality of life while limiting or ending driving.

Seniors Helping Seniors of Southern and Seacoast NH specializes in improving quality of life. Many of those receiving our loving senior care were resistant at first and had some anger that they could not drive any longer. What is remarkable to observe is how the heart softens as a relationship develops. What began as a weekly ride to the hairdresser and grocery store, or the doctor and lab, or to dialysis or chemotherapy, evolves in to a dynamic and lasting friendship. Because the end of driving resulted in the beginning of a meaningful relationship with someone who understands.

Fran’s husband was recently hospitalized and the doctors have determined that he will not be able to return home. He is facing the end of his life. With her husband recently hospitalized and now facing the end of life, Fran, a wife of 65 years hopes that “God will take her quickly after he goes.” Fran describes the emptiness of living alone with the picture of being alone at her table for lunch when she “looks up from her plate and the room is empty. I am alone at the table and it feels awful.”

Two studies have revealed that social isolation is a predictor of premature death. To emphasize, not just a predictor but as good a predictor as alcoholism and a 15 cigarette per day smoking habit. Whoa! Can living alone really have that kind of impact on mortality? Apparently it can.

Is there a difference between loneliness and social isolation? Yes. Loneliness is a feeling. It is subjective and often leads to emotions of sadness and a sense of helplessness.

Social isolation, on the other hand can be measured objectively based on an individual’s contact with others. Social isolation in the elderly can be caused by many factors, some of which come with aging and the times we live in, including family living far away, divorce and death, loss or surrender of independent driving, as well as poor health and low income.

Seniors rank relationships with family and friends second only to health according to a study done in 2000. http://www.health.gov.bc.ca/library/publications/year/2004/Social_Isolation_Among_Seniors.pdf

And findings of the longest running studies done on health and happiness? It turns out that “supportive relationships are critical. In particular, the giving of support to others had the biggest impact on longevity and life happiness.” http://www.resilience.org/stories/2013-05-03/the-importance-of-supportive-relationships

If you have a friend or family member who is aging alone you can make a difference.  Face to face visits are vital and arranging for relationships that are give and take will assist in providing a sense of being valued.  Our elderly have a lifetime of support and advice to offer.

Fran is doing better than she expected as she has twice daily visits from providers of Seniors Helping Seniors of Southern and Seacoast NH. Arriving to make breakfast and do some housekeeping in the morning, and again to prepare dinner and clean up in the evening, the providers may share meal time by bringing their own dinner, increasing Fran’s desire to eat, but providing the social interaction so necessary for well-being. Supervision is provided for changing in and out of pajamas but the reminiscing about past travels with her husband, early days in the home and during his service in WWII are of greater value. Fran wants and needs to look back and reflect. Even greater, she is now giving while receiving as she sees how she contributes to the lives of those senior providers visiting. They share their stories and reassure Fran that she gives them greater purpose at this stage of their life. This is truly the essence of the phrase “it is in the giving that we receive the most in life.”

During my 4 hour orientation and in many of my presentations I show a 2 and ½ minute video titled “What is That?” It is a clip made in Greece with sub titles and it gives a quick look at living with someone with Alzheimer’s Disease. Many people who see it react at first with some anger towards a son who sits with his father. His father asks him over and over again “what is that?” and soon the son has had it. The question is easy to answer, it’s just the repetition, the over and over and over again that drives him crazy.

We have had numerous calls to Seniors Helping Seniors of NH for assistance with a parent who has been diagnosed with some form of dementia. These calls all come from loving and caring people. But they are people who need a break. One woman who works from home describes the constant interruption for the same question, 50 to 100 times a day, the same question and the same interruption.

Another wonderful daughter calls because if she does not get out tonight she just might drive herself off a bridge. And she wants to stay alive to take care of her mother for as many years as she has left.

The very first secret to great care giving is to get help. This can be through a business like Seniors Helping Seniors of NH where you know that you will have senior care providers who have passed background checks and gone through many qualifying interviews and training, or it can be through a friend or an adult day program. Either way, make sure that when you get help it is great help.

What does that look like? First, great care giving comes from a caring heart. A wonderful caregiver is not in this for the money but for the love. They understand that it is through giving that we receive.

One of our providers writes that it is a blessing to fix a breakfast for the 88 year old woman who she visits each morning because that 88 year old woman is going through a hard time with her husband just admitted to the hospital. How many times have we fixed breakfast in our lives and how often do we consider it a blessing?

A great caregiver looks first at who the person is and then at their diagnosis. He or she wants to know about the family they raised, the work they did, and things that make them an individual, unique and wonderfully made. They look at pictures and get clues if the story can no longer be told first hand. They ask family questions. And then they may sing that favorite song, they may read from that favorite book, they may just sit quietly together. And they will answer the same question over and over with love and patience.

We have such a strong association with Alzheimer’s Disease as a disease of the elderly. This is something we put off thinking about now, and with the humanness we are born with, go even further in our arrogance and think “not me.” But what if it is you? What if that forgetfulness is more than stress, more than fatigue, more than the changes that come with normal aging? What if you begin to not only forget details, but entire events? And what if you are only 48?

It is easy to say that you should walk in someone’s shoes to understand them better but often we do not get that opportunity. Often when someone is diagnosed with Alzheimer’s Disease they have also accumulated numerous other age related maladies and/or the AD has progressed to the point that they can no longer describe the losses because they are no longer aware of the losses.

Alzheimer’s Disease (AD) is a disease that will have an impact on our lives. We are living longer and so are our friends and relatives. 1 in 10 over 65; 1 in 7 over 75; 1 in 2 over 85. These are grim statistics but it is the truth. More than 5 million Americans have Alzheimer’s Disease and by 2050 there will be 16 million people diagnosed. 70 percent of those with Alzheimer’s live at home.

For these reasons it is important to take the time to read and listen to the story of this woman and her husband. She is giving the gift of insight to millions who will have this disease or have a loved one with it. A chance to put on her shoes for a minute. For more click here.

What is it that you want to do but just can’t get to? What is it that calls your name and leaves you thinking “when I have more time” ?

Today I exited Route 95 at the Portsmouth traffic circle and, traveling less than a mile in an arc, I entered a community that recalls a different era, though now slightly updated. These homes, I have to imagine were developed out of the need for homes for those returning from WWII. The United States had an economy that was better than ever and Americans were seeking a better life. People moved out of cities and sought homes in newly designed suburbs—a term coined from sub and urban, to mean less than a city.

The homes I drive by today are classic post WWII.

A post-war house, thought of as a home built in the late 1940s throughout the 1970s, is tagged for having a sameness to them, where they’re indistinguishable from the rest of the neighborhood. But what they lack in originality, they make up in their dependable sturdiness.

These homes are rooted in American history, possibly some of the few home styles you learned about in high school. They were built as the American soldiers returned from fighting in World War II. Government legislation, such as the Federal Housing Administration and Servicemen’s Readjustment Act, helped to fuel the housing industry — which had been flagging in the 1930s and 1940s — and suddenly millions of Americans across the country were buying up single-family houses. http://www.frontdoor.com/home-styles/all-about-post-war-architecture

Although not originally from New Hampshire, the 509 Bombardment Wing is famous for the singularity of its mission—to drop the Atomic bomb. The group made history Aug. 6, 1945, when the B-29 “Enola Gay,” piloted by Col. Paul W. Tibbets, Jr., dropped the first atomic bomb on Hiroshima, Japan. http://www.whiteman.af.mil/news/story.asp?id=123062208

The 509th BW moved its personnel and equipment to Pease AFB, N.H. in August 1958. A perfect fit for the post war home built just under Route 95 and on the street I am traveling. This home has standard cement stairs painted gray and an iron railing painted white. A rose bush gives the home its own touch.

The woman I meet with in one of these homes spent all of her married years an Air Force wife. She is small and walks slowly on swollen legs. A curve to her back so she is bent forward, and although it is already 75 degrees and headed towards 80 today, she wears 2 long sleeve shirts and a silky housecoat.

In works, she put her husband and children first. She tended to her home and her community. And all of that time her heart was in the church. She shares with me today that her husband once joked that she should bring her bed on down to the church because Jesus Christ was her first love. She tells me that she has been given the gift of healing, that she is the vessel and that God still heals today.

When I ask her what her goals and objectives are in hiring Seniors Helping Seniors of NH she states that she wants help with the cleaning. She has to crawl up the basement stairs when she returns from doing laundry so she is certain she will not fall. Vacuuming, dusting, oven cleaning. Arthritis and diabetes make these chores difficult.

Her goal: To work for the Lord. Her interest: Evangelizing. I tell her she is lucky I live an hour away or I would be at her home every day. We pray together and both feel blessed.

One of the most interesting and troubling aspects of dementia is the idea that there can be a complete shift in reality in the mind of the person diagnosed. As family members and caregivers, how we react to and interact in that shifting reality is paramount to what might be seen as a good day or a bad day.

What comes to mind first, and in fact is listed first in every list of dementia symptoms, is the memory loss. First the short term, and then the long term memory fades.

Other symptoms: Problem solving and difficulty planning even routine tasks is noted by family, friends, and co-workers. Visual perceptual changes can become apparent and a dark rug can look like a hole in the floor. Someone with a dementia will have confusion about time and place, not just getting the year wrong but also thinking they are 40 years younger than they are. Misplacing things is not uncommon and the person with dementia may even hide things in unusual places, often to keep them safe. And there may be changes in personality and in mood.

But most intriguing to me is the idea of a changed reality.

Last summer we would help my mother down the 150’ path to the deck over-looking the lake on which she has spent more than 50 summers. Looking mostly at her feet the entire walk down the path she was aware of the risks ahead, rocks, tree roots, leaves. A gravel strewn path through the woods. Gravel we put down to smooth out the uneven route to the water she knows so well. And as we approached the deck she would, at times, look up and ask “whose lake is this?” And when we replied that it was “our” lake, her answer was “oh, but we must be further down on the lake.” So even though she had just walked a mere 150’ from her house, to her deck, on her lake, it was not, in her mind, familiar.

There are classic examples of women with dementia certain that a doll is their child and days are spent nurturing the baby. A man who takes apart all of the sinks in a facility because he was a plumber and he is fixing the plumbing problems for everyone. People who look in mirrors and can’t identify who the old person is looking at them since they are, in their mind 40 or 50 years younger. Many memory care units take all of the mirrors down.

We finished the summer on the lake in Maine and I offered to help drive my mother and father back to Florida. This is a trip they have made for the past 21 years and this was the first time they needed any help.

Best to follow a familiar routine so we headed out and the plan was to stay at Hampton Inns along the way. Numerous stops were made as all 3 of us benefited from breaks for food and the restroom. Each time we stopped my mother would tell someone that there were 2 more cars with my sisters and their families following us. And each time my father and I would share the truth. No, we were the sole car in the “caravan.”

We checked in to a Hampton Inn in Delaware and went out to dinner, again stating to the hostess that that it was just the 3 of us despite my mother’s claim to needing a bigger table. At 9:30 pm my parents went to their room and as I entered the door to my room next door they asked me to wake them at 6:30 the next morning to get an early start on the next leg of the trip south. I slept well and went next door at 6:30. Mom proceeded to tell me how she heard knocking on the door in the middle of the night. Assuming it was 6;30 and me coming to wake them she got up to let me in. Instead she was confronted by a naked man, yelling that he had to get in their room. Mom said dad went to the door, pushed him and raised his flashlight to hit him but her retreated. And she said “luckily it was all caught on video camera so everyone knows we are telling the truth.”

I turn to dad thinking mom had really lost it. But no. He confirms. A naked man did get locked out of his room and my parents just happen to be the hotel guests across the hall! Reality meets dementia.

Once on the road again my father picks up the phone to make a reservation for a Hampton Inn in South Carolina. From the back seat my mother says “Make sure you get the naked man discount.”

Picnics, parades and fireworks, the things that Independence Day brings to mind as we approach July 4th. We really have no connection to the battle for independence that went on so long ago. Because although our independence was declared on July 4th (really it was July 2nd) 1776, there was a great deal that went in to achieving independence following the declaration.

And do we give much thought to the battles that have been fought since then so that we might continue to live in independence? Probably not.

I am in a great position to acknowledge the heros of the long ago battles as through my job with Seniors Helping Seniors of New Hampshire I am blessed to hear the stories of service in the name of independence. Sometimes they come from the service man himself and sometimes from a surviving wife or child.

I have met a widow and son who shared the story of the father serving in the Navy during WWII. He was in charge of locating and detonating mines before the ship ran them over and was blown up. At one time during this process something did not work right and the missile that would detonate the mine was jammed. Realizing just in time he acted quickly to stop the ship from moving further forward. Consequently the ship’s captain fell and broke his nose. The story goes that the serviceman was court-martialed however reason prevailed and it was acknowledged that a captain’s broken nose was better than the deaths that would have occurred had the ship continued forward.

Another gentleman tells of his family’s escape from Germany in 1939 on the last boat to reach Israel safely. In 1948 he served in the Israeli Defense Force in that country’s War of Independence. He was 19 and his sister was 16, both firing machine guns in the name of freedom.

And another senior we serve, so thin now his pants fall when he stands up but rightly proud to have served on the beaches of Normandy.

We visit daily with a woman who cannot recall the names of her children or how long she was married but she gazes at the flag folded and framed and hanging on the wall in the living room with the proud knowledge that the man she loved served his country.

These and others of the generation serving in WWII and Korea are now in another fight for independence. A battle to maintain their dignity and respect as they face old age and all of the complex conditions that come with it. The men and women who served in Vietnam are not far behind them.

As we all begin to face the task of caring for our aging parents, relatives, and neighbors we must remember that they deserve the fireworks, the parade and the special seat at the picnic. They fought for independence and they fight for independence still.

I was struggling to reach the higher branches with the extending tree saw and clipper when my 16 year old son, Mitchell came out to see what I was doing. I had stood and stared at these low hanging branches of the neighbor’s oak tree from various angles, both on the path and from the kitchen window and today was the day I was done with them. They obstruct the sunlight and I get the lion’s share of the acorns in the fall to pick up. So I had decided to cut these branches off and let the light in.

Mitchell is taller and stronger, a fact that sneaks up on you as a mother. One day you just realize your child is bigger, stronger, better than you are at these types of jobs. After clipping one branch he was ready for the rest. He liked the challenge of getting through a bigger branch farther away and controlling the swing of the now 15’ saw as it broke through and the limb came down. Bigger, stronger, better.

So I watched him, proud, and with time to think about this. I got to thinking about neurological pruning and life and aging.

When we are born we have more than 100 billion neurons which are the nerve cells of the brain. This is more than we will ever have as we go through a process of creating connections, strengthening connections, and also discarding connections in our brain. These connections are called synapses and except for the synapses that govern basic functions like breathing, heart rate, sleeping and eating, they develop after birth. They develop in response to our experiences and represent learning. By the time we are 3 years old we will have ONE THOUSAND TRILLION synapses! By the time we are teenagers we will have discarded half of these. Some parents will argue that it is more than half but that is another blog.

I have always liked the example of patching a weak eye of a child. The weaker eye is patched in order for the child to use it, creating connections in the brain, or synapses, before they are discarded and that eye remains weak.

This process of discarding synapses or connections is called pruning. It is extremely important so that we can function without being overwhelmed. We prune synapses to let the sunlight in and reduce the amount of useless “stuff” or acorns that fall on our life. Our lives actually become richer and fuller as our brains organize.

It would be great if we could treat this neurological pruning process like a bonsai. Select a small branch here, something we no longer need, a small branch there, an activity that does not fit and keep the basis of what will create longevity and a desirable shape to the tree of our life.

In fact to a certain degree we can. When we prune a tree in our yard or a prized bonsai in its pot we choose to keep the portions that are going to create value and we cut away that which does not contribute. So, what do we keep?

• Intellectually stimulating activities like Crossword puzzles Sudoku, Learning something new like a language, Reading

• Physical activity such as walking, hiking, swimming

• Maintaining and engaging in relationships with family and friends.

• Eating healthy

• Spiritual engagement

Those are the branches to keep. Exercise our brain, exercise our body, slow down the pruning of synapses.

What do we prune away? Many experts feel that our 50s and 60s are a time to give up unhealthy habits. Overdrinking, smoking, overeating.

I would bet if we took the list of things to keep as a basis and built our lives around these we would find fewer acorns and more sun on the path.

Courtesy of Inmagine Google Images