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Is There a Link Between Menopause and Alzheimer’s?

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By Deborah Copaken

(This article previously appeared on the Neurotrack page of Medium. It is an abridged version.)

It started with an artichoke. Or rather, it started with my inability to recall the word artichoke, even though I was holding one in my hand. “What did you get for dinner?” my partner Will asked from the other room, and I said, “Salmon and…” My brain went blank. Or rather it went from blank to asparagus, even though I knew that asparagus, while in the correct spiky vegetable ballpark, was wrong.

“Yes?” said Will.

I started to panic. Words are my stock-in-trade. They are how I make my living. If I couldn’t come up with a simple word for the vegetable right there in my own hand, who was I? I carried the mystery object into the room where Will was working. “What is this?” I said. “I can’t remember how to say it.”

He looked alarmed. “You mean… an artichoke?” He smiled. Was this some sort of a joke?

“The brain is in charge of the rest of the body, but pretty much everybody assumes that the rest of the body doesn’t have much of an impact on the brain. And that turns out not to be true.”

My relief was palpable. “Oh my god, yes! Thank you!” And yet I was still disturbed. What just happened? I’d been having what I thought were all the normal issues with word recall, keys and glasses locating, and wait-why-did-I-just-go-into-this-room moments over the last few years, after I turned 50, but this felt different. More disturbing. More urgent.

I immediately Googled “memory loss menopause,” and 13.8 million hits appeared on my screen. Was memory loss an inevitable byproduct of menopause? And if so, why? I started digging. And that’s when I stumbled upon a recent Op-Ed in the New York Times by neuroscientist Dr. Lisa Mosconi, who is studying the link between menopause and Alzheimer’s.

Mosconi is an associate professor of neuroscience in neurology and radiology at Weill Cornell Medical College in New York, where she also serves as director of the Women’s Brain Initiative and associate director of the Alzheimer’s Prevention Clinic.

The question she asked herself, in her research, was a deceptively simple one: Why do twice as many women get Alzheimer’s as men? The statistics with regard to women’s longevity versus men’s cannot explain away this enormous discrepancy. Could menopause?

So on a warm spring day, just after the artichoke incident, I biked from my home in Brooklyn to Mosconi’s office at Weill Cornell. (Exercise, we now know, is one of the key risk reducers for Alzheimer’s when done in conjunction with healthy eating, getting enough sleep, and stress reduction.)

Herewith is a slightly condensed transcript of my conversation with Mosconi, which I’m keeping long not only because nearly everything she said was both fascinating and news to me, but also because I’m assuming if you are a menopausal woman reading this right now (or someone who loves us), you might have lots of questions and/or unnamable artichokes in your life, too.

Deborah Copaken: So. Let’s start at the beginning. How did you get interested in this specific topic? Alzheimer’s in general, but also Alzheimer’s in women, specifically?

Dr. Lisa Mosconi: When I was in college, my grandmother started showing cognitive and behavioral changes, and within a couple of years she was not just herself anymore. She was diagnosed with dementia. It was a very slow and painful process. Everything went backwards. She was up all night and asleep all day. My mom turned into the primary caregiver, and that was devastating for her. Not just emotionally but also really physically.

And she was also trying to hold onto a job. And those were the years when my mom was going through menopause as well. So it really was shocking to witness what was happening to my grandmother and at the same time what was happening to my mom. My grandmother had three siblings; two girls — you know two sisters — and one brother. The two sisters got the same exact thing years later. Her brother did not.

Oh my goodness.

So that was quite shocking, and I was like ‘Oh dear, what if it runs in families?’ I knew nothing about Alzheimer’s. I was nineteen. And so I started doing a lot of research on that. My parents are nuclear physicists. And their students were babysitting me when I was little, but we stayed in touch, and as soon as I mentioned wanting to look at the brain and Alzheimer’s, they said, ‘Volunteer with us. We’ll train you.’

You were nineteen, and you were researching in nuclear medicine already?

A year later, yes, I was twenty.

Okay, so you were still in university, but studying nuclear medicine on the side. As one does. So how old is your mother right now?

Seventy-four.

How’s she doing?

She’s fabulous. She goes to yoga three times a week, she can do headstands, she eats super healthily, she is incredibly intellectually active.

I’ve seen studies that show that instead of just doing brain games such as Sudoku or crossword puzzles, there’s evidence that just staying at your job in your sixties and seventies is good intellectual training if you want to try to avoid cognitive decline. What do you say to that?

There is an association between Alzheimer’s risk and education, and also occupational attainment: having a job that you’re good at. So there’s an association between being good at your job  —  having a job that brings out the best in you in some ways, whether intellectually or in other forms  —  and lower risk of dementia down the line.

There are some studies showing that postponing retirement has also been associated with a lower risk of dementia in later years. And I think it all comes down to cognitive reserve.

Cognitive reserve?

Yes, cognitive reserve. You brain is built of neurons and connections between neurons. And these connections need to be strengthened, because otherwise they will die. There’s a process called pruning, where if you don’t use your dendrites, the connection between neurons, they will atrophy, they will actually withdraw. So it’s really kind of a ‘use it or lose it’ situation in the brain.

Right. Which brings me to my next question, a personal one: I know that writing is good for my brain, but at fifty-three years old, having been a writer my entire life and now going through perimenopause, I find…

Would you want to get your brain scanned?

Yes, let’s do it, that would be fun!

That would be wonderful.

Because what I have noticed, as a writer who obviously needs words to create what I do, I sometimes cannot remember … the other day I could not remember the word … and here I am forgetting it again! It was, oh my God, see, here I go again. It’s not asparagus, but it’s the thing that looks like this, and it’s got the little pointy things…

Artichoke?

Artichoke! Yes. See, I knew it started with an A, and it looks like the top of the asparagus, so that came to mind, but I couldn’t think of the word for artichoke. And it was driving me crazy. I had it in my hands, even, and I couldn’t remember what it was called. And if you hadn’t just said it right now, I would have had to look up vegetables on my phone, I mean literally look up green vegetables pointy leaves and find it on Google. But this happens all the time to me now and I’m thinking that, oh no…

Word finding.

Word finding. Exactly. And I don’t have any history of Alzheimer’s, but I have noticed just in ‘brain abilities,’ let’s call it, I’m losing it. And as a writer, that’s scary.

Well, for sure.

So when I read your op-ed, even though I work in this field, I did not know that women are twice as likely to get Alzheimer’s as men.

Yes.

At the same time, I also know that women’s health is poorly studied. I will give you an example from my own life. So when I had my uterus out, a hysterectomy, I was asked, what do you want: a partial, full or a supracervical? And I was like, I don’t know.

They’re asking you?

They’re asking me! And they said ‘Well, it is believed that the cervix plays a role in sexual pleasure.’ And I was like, seriously, are you kidding me? This was back in 2012. So they took out the uterus, kept the cervix. Five years later, the cervix becomes diseased, has to come out, and when I went to see the surgeon who was going to remove it, she said, ‘Why didn’t you get this out when you got the hysterectomy?’ I said, ‘I was told that it plays a role in sexual pleasure.’ She goes, ‘No, no, that was debunked last year.’ I was like, ‘Why don’t we know these basic things about female health?’ She goes, ‘Welcome to my world.’

I agree. We know even less about women’s brains. I mean, if we can’t even get the cervix right…

We finally just got a 3D model of the clitoris two years ago! Two years ago! So now I know these things about my reproductive organs I should have known years ago. What I’m concerned about now is the brain, women’s brains in particular. So what does your research show? What have you found about menopause, perimenopause and women’s brains?

Well for one, we have known for a good ten years that taking out the ovaries or the uterus increases risk of dementia in women.

Wait, what????

This is true.

This is news to me right now.

Is it?

Yeah.

[At this point, I have to turn off the tape recorder, catch my breath, and curse. Loudly.]

Let’s start again, shall we?

It’s true. There’s a strong association between early menopause and an increased risk of Alzheimer’s in women. And an oophorectomy, which is the surgical removal of the ovaries, increases the risk up to seventy percent.

Seventy percent????!!!!??????

Yeah. If it’s done bilaterally, meaning you have both the ovaries taken out. But then there were other studies showing the risk is also increased when the uterus is removed, regardless of whether the ovaries are still in place.

What?!

The reason being, when you remove the uterus, blood flow to the ovaries is also compromised, you’re disrupting the system. In some ways, the ovaries may or may not be impacted by that. So there is an increased risk of Alzheimer’s also with a hysterectomy. And that’s why many people have been looking into estrogen, and the connection between estrogen and Alzheimer’s.

There was that disastrous clinical trial called the Women’s Health Initiative. For many years, women were given estrogen as soon as they entered menopause, with the idea that lack of estrogen is what causes a lot of the problems during menopause, from increased bone frailty, increased risk of heart disease, increased risk of diabetes and increased risk of dementia. The association was quite well established, so it makes sense to think, well, can I just give you the estrogen back? Right?

Right.

And so many providers did that. It was actually kind of the norm for women with the diagnosis of menopause, which is at least twelve consecutive months without your period, to be put on estrogen and left on estrogen for life. And that was done for so many years before the NIH [National Institutes of Health] started a clinical trial to test the efficacy of these formulations.

So, the Women’s Health Initiative started in 1993, and it was huge. There were like more than fifty thousand women involved in the trials. The trials went on for many, many years and then all of a sudden there were halted because early findings showed an increased risk of pretty much everything: an increased risk of blood clots, an increased risk of stroke, an increased risk of cardiovascular disease. So, it was basically a disaster.

Ugh. Let’s go back to women and Alzheimer’s and your family. So, you have your grandmother and your two great aunts, all of whom get Alzheimer’s. But your great uncle, their brother, doesn’t. Why?

Yes. I wanted to know why this is happening. And everybody was like, it doesn’t matter if you’re a man or a woman, it’s exactly the same. I was like, no it’s not. You can see the patients! They walk in the door, and sometimes there are women who are clearly having a problem, but they do not ‘test’ impaired.

A doctor wouldn’t be able to give them a diagnosis of dementia or mild cognitive impairment because their cognitive performance is still good even though they’re clearly dysfunctional in every other aspect of their lives. But they don’t score impaired. This came out a few years ago, that the tests we were using to diagnose Alzheimer’s were not sensitive enough for women at the early stages. Because women score better than men on cognitive tests and always have.

The cognitive score declines a bit with menopause, and then after menopause, but even women with a diagnosis of early Alzheimer’s may score better than men with the same diagnosis of Alzheimer’s.

So, the doctor can see plaques on the brain, they know these women have Alzheimer’s, but they’re testing well on cognitive exams.

They’re testing fine! We couldn’t see the plaques in the brain until ten years ago, we didn’t have the technology. So, now that we had the technology to find the plaques, we actually understand that we probably misdiagnosed women forever. And that could be one of the reasons why some treatments don’t work that well in women.

There’s also this whole thing, because we catch them too late, that the typical Alzheimer’s drugs work better in men than in women. And one possibility is that men and women with the same symptoms do not have the same brains. The men’s brains are still here, but the women’s brains are down here…

[She holds her right hand up high, representing men’s brains, her left hand down low, representing women’s brains.]

…and that’s why the drug just can’t bring them back up. So there’s an entire field that’s been severely gender-biased, and the bias is just now being revealed. It literally has been only two years that now everybody is talking about it, finally.

That’s great?

Yes it is, but it took me twenty years to get grants to actually look into this discrepancy.

It took you twenty years to get grants to look into this?

It took many years to convince the medical community that Alzheimer’s differs by gender.

I’m reading a book right now, I forget the name cause I probably have Alzheimer’s too, but I’m reading a book right now about women and data bias. [Note: Invisible Women: Data Bias in a World Designed for Men by Caroline Criado Perez.] The author has this part where she talks about how they studied Viagra.

Yes! Female Viagra, which was tested in twenty-three men and only two women!!!

Yeah, but they studied Viagra, and they found that with women, it completely eliminated period cramps for four hours at a time with no side effects. And the doctor that discovered this went back to the NIH, twice, and said, ‘We need further studies on this. This is the holy grail for women,’ and they said, ‘Well, dysmenorrhea [painful menustration, often with abdominal cramps] is not a real issue.’ So we now know everything we need to know about penises and how they get hard, and how Viagra can make them harder, but nothing about how Viagra could be helping the other fifty percent of the population, enormously.

Yes, there are so many things that were just completely disregarded.

Even this desk. This desk is not built for me, and it’s not built for you either. I was at the New York Public Library before I came here, and I was sitting there going, this table, this is made for a six-foot tall man. I can’t type here. It’s too high. I was with my boyfriend, who is six-feet tall, and I was like, you are comfortable at this table, I am not: discuss.

Yes, absolutely, we need pillows! And then the solution for a woman is to sit on a pile of pillows and make it work. We get this all the time, you know, just make it work.

And the same is in medicine. What we found, when we finally got an opportunity to look into that, is that women’s brains age differently than men’s brains.

That seems really important and unknown. What? Women’s brains age differently than men’s brains. How so?

For example…wait, I also want to underline that it’s not that we age worse, but differently. That’s important because…

Because there’s a judgment associated with better and worse, got it.

There’s a judgment, yes. We just age differently, that’s all. And basically what we found  —  and this is a lot of my own research   — is that Alzheimer’s is not a disease of old age.

We tend to associate it with the elderly, because that’s when the clinical symptoms become manifest. But in reality, Alzheimer’s begins with negative changes in the brains at least a decade prior. Most often than not, in middle age. Middle age is considered to be forty-to-sixty years old.

So then the question that we asked was okay, we know that Alzheimer’s affects more women than men, and we know that Alzheimer’s starts in midlife. What happens to women and not to men, in mid-life, that could potentially trigger an Alzheimer’s predisposition and that could potentially initiate Alzheimer’s?

And I was thinking, thinking, thinking, and I said: menopause? It’s the one defining event in a woman’s life that happens to every single woman and does not happen to men. Could that impact the brain?

And my background is in nuclear medicine, which is a branch of radiology, then I work in neurology. Nobody talks about hormones. Nobody talks about menopause as something that could potentially impact your brain, because nobody has done the studies.

So we were like, hmm… we have the population, which is quite unique, because usually people who do brain scans, like I do, look at patients who are sixty and older, whereas I wanted to look at risk factors for Alzheimer’s, so I’ve always been working with people who are younger. Forty to sixty. Because before forty, you shouldn’t have hormonal changes, unless you have a hysterectomy.

But we looked at women without hysterectomy or (ovariectomy) who were forty-to-sixty years old, and we divided them into pre-menopause/regular cycle, perimenopause, when you start skipping your cycle and you start having hot flashes, night sweats…

Yup. That’s where I am. Fun!

…insomnia, some depression, some word-finding issues, cognitive slippage. And then we have men, exactly the same age. And we did brain scans in all of them, and then we looked at the data.

And what we found is that if you are a man, forty-to-sixty years old, your brain is broadly fine. You have high brain activity, you have no Alzheimer’s plaques, and if you do it’s just a few, and your brain is not shrinking. On average, you’re fine. But if you’re a woman, it makes a huge difference whether you’re pre, peri or postmenopausal. If you’re a premenopausal woman you’re broadly the same as a man’s brain, for the same age.

If you’re perimenopausal, we find a dip in brain energy levels, which is really brain glucose metabolism, the way the brain burns glucose to make energy. In some cases, it’s up to twenty percent worse for women, and that gets even worse once they transition to menopause. The scan literally goes from bright red and yellow to green.

What does that mean? What does the red and the yellow mean?

That your brain activity is nice and bright, and then it drops. In some women by as high as fifty percent.

And green is bad?

Well, darker is worse, yes. You want your brain scans… I’ll show you.

Yes, I’d love to see.

[She opens a file on her computer.]

At the same time, we found that the women who show these energy drops, they start accumulating Alzheimer’s plaques. We have at this point hundreds of patients, and we also follow them over time, and we really show the change as women go from pre-menopause to peri-menopause to post menopause. Not all of them. There are some women who are fine, and some women whose brains are much worse.

Because, when women tell you I’m having hot flashes, I’m having night sweats, I can’t sleep at night, I can’t think straight, I have brain fogs, I get confused, I can’t multitask  —  so many women tell me I used to be so good in multitasking, and now I just can’t quite do it as well  —  those symptoms don’t start in your ovaries. They start in your brain! And it’s something that’s been completely overlooked. These are neurological symptoms of hormonal changes.

And we’re associating hormones only with what’s going on in the uterus, right?

Yes. We’re just thinking it’s about not having kids anymore. But that’s not the point. The point is that my brain, in middle age, is changing, and how do I make it better?

Yes. How do you make it better?

Well, it depends.

So there are two separate components, and this is really what I’m trying to clarify. All women experience hormonal changes. For some women, they’re not a big deal. For some women, they range in severity, from mild to severe, and they need to be addressed. For some women, they are so severe, that they can actually trigger Alzheimer’s.

Wow.

Yeah. If you have a predisposition for Alzheimer’s disease.

Genetic predisposition to it, right? Or just any sort of predisposition?

Any sort, because we have patients here who do not have any known genetic predisposition for Alzheimer’s, but they start accumulating Alzheimer’s plaques, and we know that Alzheimer’s is genetic in one percent of the population.

Then about thirty percent has some genetic risk factor that doesn’t cause Alzheimer’s, but they increase your risk, like having a family history or having some specific genes. But the rest of the population has none of this, and they still get Alzheimer’s.

So, the question is why?

One day we’ll find out what causes Alzheimer’s in people. Right now we don’t know, but we do have markers of risk.

So, if I know that you’re at risk, then I’d want you to take action. And then it depends, are you having the symptoms of menopause but not the increase of Alzheimer’s risks? Then we address menopause only. But if you also have a risk for Alzheimer’s then we really need to address that now. Because that’s when your brain is triggering these changes.

Estrogen is a really strong neuroprotective hormone. It’s strongly associated with immune system, it’s a neuroplastic hormone, so if you lose it, your brain starts aging faster.

And is that the same as testosterone in men?

No.

So, what do they have in their bodies that’s equivalent to estrogen that’s keeping their brains plastic?

Men’s brains are more testosterone-driven, but the thing is they also have a little bit of estrogen. The thing is that testosterone can be converted into estrogen at any time.

I did not know that.

Yes, and the other thing is that in men, they go through andropause, which is the male equivalent of menopause, but it’s a slow gradual process that takes a long time. There are men who become first time fathers when they are seventy-five.

Saul Bellow. He became a father at eighty-four.

Then there’s Mick Jagger.

Right, exactly. I’d probably have Mick Jagger’s baby if I still had a uterus.

[She laughs] There are plenty of examples. They’re given a chance, they can still have babies, whereas women can’t.

So unfair!

So, for them their brains are not as nearly affected by that. It’s almost the same as aging. What I think happens is that for men, chronological aging and hormonal aging kinda go hand by hand, slow and steady. Whereas for women, chronological aging is the same as men, but endocrine aging is just: boom!

Endocrine aging?

Yes, endocrine aging, so hormonal aging…

Endocrine aging, meaning you fall off the cliff, basically.

Yes. And we know that in the rest of the body, when you lose your sex hormones  —  your estrogen and progesterone, FSH, all these hormones  —  the rest of your body starts aging faster. Your arteries get harder faster, your bones become more fragile faster, pretty much anything that can age, ages a bit faster than before.

All women know that intuitively that when you’re past forty-five, if you go on a diet, it will take forever to lose the weight because your metabolism changes too.

Yes! I’ve eaten the same as I’ve always have, and I’ve put on like a pound a year since my mid-forties. It’s all sitting here, right in my mid-section, and I don’t do anything different. And I used to be thin and now I’m…

No, you are still thin, but your body changes.

And the shape of it changes, where the fat goes, everything. And I see the number on the scale climb, and I’m like what, why? I’m being nice to you, body! I feed you good food, I exercise.

Yeah, it’s the same for every woman, and it is a consequence of estrogen depletion.

Every woman knows that as you reach menopause, your hair goes dry, your skin goes dry, that’s aging. Nobody ever thought that the same thing would happen in the brain. Now why are we not thinking that? Because, in neurology, we are trained to think that the brain is completely separated from the rest of the body.

The brain is in charge of the rest of the body, but pretty much everybody assumes that the rest of the body doesn’t have much of an impact on the brain. And that turns out not to be true. In every possible discipline. I think people who discovered the microbiome really helped change this view of the brain.

You mean bacteria in the gut?

The bacteria in the gut, yes. They have shown that the microbiome has a huge impact on the health of the brain. So, if your bad bacteria outnumber your good bacteria, that has an impact on the brain. And everyone said that’s impossible, but it’s not.

There are products of these bacteria that can travel up the vagus nerve and affect the permeability of the brain, they can get inside your brain, they can change your production of GABA, which is a soothing, calming neurotransmitter.

So, if GABA is not being produced, you get stressed out and anxious, which is what the bad bacteria do to you. They kinda hijack your brain and then you get all stressed out and you keep doing all the negative things that will put even more bad bacteria into your body.

So, they’ve shown very clearly that your gut health has a strong effect on the health of your brain, but we know that. We know your heart, if your heart is not healthy, your brain is not healthy, because the oxygen can’t get in, the nutrients can’t get in, your iron can’t get in, you get anemia, you feel crappy.

And the same for your ovaries; there’s a feedback loop between the ovaries and the brain, it’s called the HPG axis: a highway that we have inside the body, it connects the brain to the pituitary gland to the ovaries and the thyroid. So hormones can travel back and forth. And that’s how your ovaries are communicating with your brain. And that changes your brain in a big way.

 

 

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More Answers to Your Tax Questions

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Answers to Tax Questions for 2018 Income Tax Returns

By Richard Eisenberg

Next Avenue recently asked readers to send us their top questions about their 2018 tax returns and we would answer as many as we could. In the story published in late March, three tax experts sorted out confusion about: who needs to file; standard deduction vs. itemized deductions; whether certain expenses are tax-deductible and late filing, late payments and extensions.
In this article, four tax pros and an online tax research platform provide answers to your 2018 tax return questions about retirement accounts and investments; inheritances and death and the rules about relocation and state taxes.
Three of the experts work for Wolters Kluwer Tax & Accounting: Principal federal tax analyst Mark Luscombe, senior estate and gift tax analyst Bruno Graziano and senior state tax analyst Brian Plunkett. The fourth is Mark Steber, chief tax officer at the Jackson Hewitt tax preparation firm. The CCH AnswerConnect online tax research platform from Wolters Kluwer Tax & Accounting also helped provide answers.

Retirement Accounts, Investments and Taxes
If my adjusted gross income is over $31,000 (for a single filer), I can no longer deduct anything I put into a traditional Individual Retirement Account (IRA), correct?
“You can put up to $5,500 ($6,500 if you’re 50 or older) into a traditional IRA regardless of the income you earn. You can still deduct all or part of your contributions when you are covered by a company retirement plan if your income is less than $73,000,” said Steber. And, he noted,“you may be eligible for the Saver’s Credit if you are contributing to an IRA and/or a retirement plan through your employer if your income is below $31,500. This credit is in addition to the tax-deferred contributions you are making to either type of plan.”
Luscombe added: “For 2018, eligibility for a deduction for an IRA contribution phases out for single filers at an adjusted gross income of between $63,000 and $73,000.”

In order to reduce my tax burden, am I allowed to deposit funds into my retirement account? If so, what is the max limit and by what date must I make the deposit?
Luscombe noted the $5,500 limit mentioned above, adding that the figure is also the limit for a Roth IRA. But, he added, “the Roth contribution is subject to income limits — phasing out with modified adjusted gross income of between $120,000 and $135,000 for single filers and $189,000 and $199,000 for joint filers.
Contributions for 2018 tax returns can be made until April 15, 2019, said Luscombe. But “for a 401(k) contribution for 2018, those contributions would have have to have been made by December 31, 2018,” he reminded.

I received a 1099 form for a mutual fund investment which shows: ordinary dividends (box 1a), qualified dividends (box 1b), capital gain distribution (box 2a), foreign tax paid (box 7) and foreign source income. I only need to include these dividends and distributions if/when I cash out of the fund, correct?
Not correct.
“Your dividends must be included on your tax return the year you earn them, even if you are reinvesting the directly into the fund,” said Steber. “You will include the dividends you already paid taxes on with the funds you purchased when determining the basis [cost] of your mutual fund distributions when you take money out. So no, you don’t wait to include the money on your taxes; you must include the dividends this year.”
Luscombe said the answer also depends on whether the money was in a retirement account. The reader would only be correct, he said, “if the fund was held within a qualified retirement account. Since you received a 1099, the fund is likely a taxable account and you are subject to tax on these items for the current year even if you did not cash out of the fund.”

I’m retired and 71 years old, receiving 1099-R’s from IRAs going back 20 to 30 years. They were made with both deductible and non-deductible contributions. 8606 forms were submitted to the IRS for the latter, in years made. How do I not pay taxes on the previous taxed nondeductible portions on this year’s tax forms?
“First, total all the IRAs together. Then, total all your previous non-deductible contributions and use Form 8606 to determine the taxable amount of each year’s distributions,” said Steber. “The tax code only allows you to take a pro-rated amount of your non-deductible contributions to your traditional IRA each year.”
Luscombe said: “You should only need the Form 8606 from the most recent past year to determine your cost basis in IRAs, since the 8606 forms carry over the cost basis from year to year.”

How do I figure the cost of my retirement income? I have been receiving Survivor Plan Benefits for 18 years. It is for life. It cost about $95 a month for the three years until he died in 2001.
“A Survivor Benefit Plan appears to refer to a military retirement plan where the service member paid for the cost of a survivor benefit until death in 2001,” said Luscombe, with assistance from the CCH AnswerConnect online tax research platform. “The payments under the Survivor Benefit Plan are taxable to the recipient, with no deduction for the cost since that cost was deducted from the taxable portion of the service member’s retirement pay.”

Inheritances and Taxes
I received a lump-sum inheritance distribution. Is this counted as income or is there someplace else we claim this inheritance?
“Inheritances are excluded from taxable income and the federal government does not impose an inheritance tax,” said Graziano, citing information provided in the U.S. Master Estate and Gift Tax Guide. “There is, however, a federal estate tax that is imposed on the estates of decedents. The current exclusion amount for federal estate and gift taxes is $11.4 million or $22.8 million for a married couple. In addition, some states including Iowa, Kentucky, Maryland, Nebraska, New Jersey and Pennsylvania impose an inheritance tax, which is a tax on the receipt of inherited property.”
Generally, Graziano noted, state inheritance tax rates and exemptions are more favorable to inheritances received by close relatives of the deceased person and to certain types of property, such as a family home or farm.
It’s a good idea to consult the law of the specific state or states you’re dealing with for more specific information, Graziano advised.
But “earnings on the money you inherited, or gain when you sell an item you inherited, are taxable,” said Steber.

My husband and sister-in-law inherited their mother’s house. The real estate agent valued the house at $250,000. It was sold for $195,000. Will they have to pay any income tax on the inheritance?
“Based on the information provided, there is a potential loss when the house was sold. The loss is considered a capital loss, and if neither your husband, sister-in-law or any of your relatives lived in the house after you inherited it and you sold it for the fair market value, you can claim up to a $3,000 loss on your tax return each year,” said Steber. “If the will did not state how to divide the property, it is assumed an equal division.”
Graziano explained, using information from the U.S. Master Estate and Gift Tax Guide, that heirs are entitled to receive what is called a “stepped-up basis” at death on inherited property. (That’s the value of the home at the time of death.)
Graziano recommended getting an appraisal by a qualified appraiser to establish exactly what the date-of-death value of the real estate is. “Just having a real estate agent say ‘the property is worth X dollars’ will probably not be sufficient to satisfy the IRS,” he said.
And, he added, if the home sold for more than the stepped-up basis amount, the heirs may be responsible for a capital gains tax. Its amount would be determined “based on the amount of the gain and the taxpayer’s overall tax situation for the year of the sale,’ said Graziano.

Relocation and Taxes
I moved from Washington state to Idaho in September. Do I have to pay Idaho state income taxes? I am not sure if this move will be permanent.
“State taxes can be tricky,” said Steber. “While Washington state doesn’t have an income tax, you will have to pay taxes on the income you earned while living in Idaho. How you pay your taxes — as a part-year resident or a nonresident — depends on your status, intention and the state laws.”
Plunkett said the answer will also depend on whether you earned income from a job in Idaho after the move. If so, you “will owe Idaho state income taxes on that income,” even if you didn’t officially become an Idaho resident, he noted.
When moving across state lines, it’s generally wise to speak to a tax adviser in your new state about the tax implications.

I moved out of my primary residence in March 2018 and have placed it for sale with a broker. I have also incurred expenses on that house (utilities, taxes, repairs, mortgage interest). The house has not yet sold. Can I deduct all of these expenses this year?
“You may continue to deduct real estate taxes and mortgage interest if you itemize deductions and comply with the new rules,” said Plunkett. (This presumes you still own the house and are paying the taxes and interest, noted Steber.) Among the new tax rules: a maximum deduction of $10,000 per year for state and local taxes, including real estate taxes.
But utilities wouldn’t be deductible, Plunkett added, unless you converted the residence into a rental property or operated a business out of the home. And repairs wouldn’t be deductible. But they could potentially be added to the home’s “cost basis” and then reduce any potential gain on the sale.
Up to $250,000 of gain from a principal residence’s sale ($500,000 for joint filers) can be excluded from taxes if the home was owned by the taxpayer and lived in for at least two of the last five years.

Richard Eisenberg is the Senior Web Editor of the Money & Security and Work & Purpose channels of Next Avenue. He is the author of How to Avoid Mid-Life Financial Crisis and has been a personal finance editor at Money, Yahoo, Good Housekeeping and CBS.
 
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Could It Be a Stroke?

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There are many signs of stroke beyond facial drooping and speech difficulty

About a year and a half ago, my wife, Jules, called me at work to say she needed me to take her to an urgent care clinic. She was recovering from a cold and some minor sinus congestion and was feeling off-balance when she walked. We wondered if that could be due to a sinus or ear infection. She also had numbness in a part of her left leg.
I left work early and drove her to the urgent care clinic, where after an examination, the physician concluded the balance issue probably was due to an ear or sinus infection. She didn’t say much about the leg numbness and sent us home with antibiotics.

Three days later, Jules — who was not working at the time and about to start training for a new job — texted me to come home right away. She was on the floor in our apartment and could barely move. I called 911, and she was taken by ambulance to a hospital emergency room, where the physicians determined she had a stroke in the cerebellum part of her brain.
We Never Considered Stroke

Jules was 54. She had high blood pressure but was on medication. Other than that, she was in good health; pretty active, not overweight and ate a healthy diet.
What’s more, like many people, we knew very little about stroke and its signs and symptoms. We never considered that someone her age could have a stroke. In fact, even the physician who examined Jules at the urgent care clinic missed the stroke, perhaps because of Jules’ age.

“If a person is in their 70s or 80s and experiences sudden balance issues or numbness in a part of their body, the red flags go off,” says Dr. Robert Brown Jr., a neurologist at the Mayo Clinic in Rochester. “But the younger the person is, the less inclined we are to think it’s a stroke.”

Yet, a stroke can happen at any age, and “it’s very important that we make people aware of this because we have early acute treatments for stroke that can work very well,” Brown says.
There are two types of stroke, ischemic and hemorrhagic. Ischemic strokes are much more common, accounting for about 87 percent of all cases. In an ischemic stroke, a fatty deposit, or clot, obstructs a blood vessel supplying blood to the brain. The clot can develop at the location where it eventually blocks the blood vessel, or it can form in another location — usually the heart or large arteries in the upper chest and neck. In the latter case, the clot can break loose and travel to the brain, where it can block a smaller blood vessel.

In a hemorrhagic stroke, a weakened blood vessel in the brain ruptures and bleeds into the surrounding tissue. The American Stroke Association (ASA) and National Stroke Association (NSA) websites offer detailed information, including diagrams and animations, about strokes and how they affect people.

There Are More Signs Than ‘FAST’
In their efforts to raise awareness about stroke, both the ASA and NSA promote the acronym FAST. It stands for Facial drooping, Arm weakness, Speech difficulty and Time to call 911. It’s a great tool, but there are many more signs and symptoms of stroke. In fact, Jules had none of the FAST signs.

“FAST is a great way for people to remember the most common signs of stroke, but it by no means covers all the signs and symptoms,” Brown says. “People should know that if they, or someone they’re with, experiences a sudden onset of having trouble doing something they normally would be able to do, it’s possible that it could be a stroke. Things like sudden confusion; sudden weakness or numbness in the face, arm or leg; trouble with their vision; sudden difficulty walking or speaking or a sudden severe headache.”

Time is Brain
If a stroke is recognized early, there are acute treatments that can be very effective, depending on the type of stroke. As health care professionals say, “time is brain,” meaning the longer a person goes without treatment, the more damage a stroke can cause to the brain. Early recognition and treatment is crucial. Acute treatments include “clot-busting” drugs, and thrombectomy, in which a catheter is threaded from the groin up to the brain to remove a clot in an artery.

“The key is to treat as early as possible,” Dr. Brown says.

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New Things to Know for This Tax Season

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Facebooktwitterpinterestmailby featherYou’ll see many changes from the 2017 tax law when filing 2018 taxes

Ah, tax season. It comes every year, and often feels routine. But this tax season could be very different. It’s the first filing year since Congress passed drastic changes to the tax code in the 2017 Tax Cuts and Jobs Act. So you’re likely to encounter a very different tax return with changes to some beloved tax breaks. And some write-offs you’ve claimed in the past may be gone altogether.

Before you meet with your tax professional or file your 2018 tax return, keep these things in mind:

Income Tax Planning
The 2017 tax law limits deductions for state and local income and real estate taxes to $10,000 annually. This may affect when you will decide to pay your next fourth quarter state and local taxes.

The 2017 tax law also changed the tax brackets for investors. For the years 2018 through 2025, there are new 0 percent, 15 percent and 20 percent tax brackets for long-term capital gains and dividends and they’re indexed for inflation.

Charitable Giving
The 2017 tax law raised the standard deduction to $24,000 for a married couple filing jointly, $18,000 for someone filing as head-of-household and $12,000 for an individual. To itemize deductions, the write-offs must exceed your standard deduction.

Retirement Account Distributions and Roth IRA Conversions
If you are 70 ½ or older and have money in a retirement account, you must take a required minimum distribution (RMD) each year. Some people with traditional Individual Retirement Accounts (IRAs) may want to convert them to Roth IRAs to save on taxes. But under the 2017 tax law, once a Roth conversion is made, it is irrevocable.

Since the long-term benefits of a Roth may or may not outweigh your income tax consequences for keeping your traditional IRA, don’t make a conversion until first discussing the potential action with your financial adviser.

Gifts, Gift Taxes and Estate Taxes
The 2017 tax law says that you can withdraw tax-free from 529 savings plans up to $10,000 a year for education costs for kindergarten through 12th-grade education costs. You can also maximize a gift to a 529 plan in the amount of $75,000 during a single year; for gift tax purposes, that amount can be spread over five years so it won’t exceed the annual gift tax exclusion, which is $15,000 per person in 2018 (or $30,000 per married couple).

When deciding whether to make a gift, your options include: giving it to the person directly, putting it in a Uniform Transfers to Minors account for the person’s benefit (if he or she is a minor), putting it in a trust for that person’s benefit (if the trust is structured to receive annual exclusion gifts) or putting it in a 529 plan for education for the person’s benefit.
The 2017 tax law also raised the federal estate, gift and generation skipping transfer tax exemption from $5 million per person to $11.18 million per person in 2018, indexed for inflation ($11.4 million in 2019). But this increase is set to expire December 31, 2025. This means that as of 2026, unless the law changes, the federal estate, gift and generation skipping tax exemption amounts will revert to the prior $5 million amounts, adjusted for inflation.

Changing State-Tax Residency
The top of the year may be a good opportunity to examine whether to consider changing your state residency. States such as Florida and New Hampshire do not have a state estate tax; other states do, and some of those taxes are quite stiff. There may also be income tax benefits to changing residency to a particular state.

Before relocating, talk with your estate planning attorney and tax professional.

By Katie L.S. Von Kohorn and Meghan E. McCullen

Katie L. S. Von Kohorn is a partner at Casner & Edwards specializing in estate planning, estate and trust administration, charitable giving, and advising exempt organizations. She advises individual clients and generations of families with respect to estate planning, including estate and gift taxes, probate law, estate and trust administration, inter-generational planning, planning with digital assets, and philanthropy. Meghan E. McCullen is an associate at Casner & Edwards specializing in estate planning, tax planning and probate and trust administration.
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The New Aging Family: Older Adults and Parents

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By Kevyn Burger

A decade ago, Dr. Richard Thill moved back into the family home in Anaheim, Calif. to live with his aging parents. Thill was with his mother when she died at age 102 and continues to live with his father, Elmer, who, at 104, is Anaheim’s oldest lifelong resident.

Richard, now 78, and his father both play in a Dixieland band, keep bees and tend to home repair chores. Richard is on duty with his dad, other than the two days a week when he works as a pediatric dentist.

“When I go to the office, I drop him at the senior center. He plays pool, exercises and talks to the people there,” Richard said. “My goal is to keep him home until the end. Everything I have is because of my parents.”

The Thill father-and-son team represents a newly-observed wrinkle in the demographic of aging families: very old parents with “children” who are themselves older adults.

“He sees that my bills are paid, cooks for me and keeps me going,” said Elmer, who is retired from his real estate career but still holds his broker’s license. “I say, he’s just a kid.”

A New Phenomenon with Longevity

While the dynamic is still unusual, instances of families whose intergenerational members are growing old simultaneously have become more frequent and represent new demands for caregiving.

“We’re looking at a new phenomenon with longevity that was once was almost freakish. More baby boomers still have their parents than any previous age cohort,” said Kathrin Boerner, gerontology professor at the McCormack Graduate School at the University of Massachusetts at Boston. “Putting these families on the map is my purpose.”

Boerner is leading the Aging Together Study, funded by the National Institute on Aging, to study these late-life relationships. Her research, which will analyze 120 parent-child families that feature a parent in his or her 90s with a child older than 65, will conclude in the next year or so.

She hopes her findings will shed light on the challenges these older families present, and will inform policymakers and support providers about their particular needs.

“There’s a huge volume of literature on caregiving, but it’s based on middle-aged family members and supports are created with them in mind,” Boerner said. “Caregivers who are much older need different community services. Right now, there’s little designed for this group.”

Boerner has long studied the very old, with previous research on centenarians. But what she’s learning in her in-depth interviews with senior parents-and-children has surprised her.

“An unexpected finding is the subgroup of old parents who are serious support providers to their children,” she said. “We’re used to upstream support, child-to-parent support, but when children are over 65, they may have significant health conditions.”

The Late Sen. McCain and His Mother

Americans had the chance to observe an aging family at the public memorials honoring Arizona Sen. John McCain, who died earlier this year a few days before his 82nd birthday.

McCain’s 106-year-old mother Roberta was photographed in the front row at his funeral gripping the hand of her granddaughter Meghan. The nation watched as the McCain family matriarch, solemn and elegant, mourned the towering figure whom she called “Johnny.”

For his part, the former Senator, presidential candidate and Prisoner of War revered his mother. In his 2005 book, Character is Destiny, McCain wrote, “My mother was raised to be a strong, determined woman who thoroughly enjoyed life, and always tried to make the most of her opportunities…I am grateful to her for the strengths she taught me by example.”

Positive and Negative Aspects of the Relationship

The quality of the lifelong parent-child bond has implications in the final stages of life, according to Boerner’s preliminary research.

“How much the relationship is perceived as a blessing depends on if it has been positive. In many families, these relationships have been difficult and remain so, and they are more likely to be viewed as a burden,” she said.  “It’s quite tragic when you meet a daughter in her 70s who never had a good relationship and confides to you, ‘I thought I would have a time when I was free of this.’”

Approximately 2.5 million Americans are 90 and older, and according to the U.S. Census Bureau,  the over 85 demographic represents the fastest growing part of the aging population. As lifespans continue to expand, so, inevitably, will the number of late-life parents with older children. These relationships are likely to shift in the future.

“My 85 someday is going to feel different than my mother’s 85 does today,” said Cynthia Hancock, gerontology undergraduate coordinator at the University of North Carolina at Charlotte.

“When baby boomers and millennials get to the age of our oldest citizens, they will have a different experience. There will be more of us, we will live longer in retirement, we will be healthier. Our oldest citizens didn’t have fluoride in the water or vaccinations when they were growing up,” said Hancock.

Gerontologist Kerry Burnight sees the potential for “beautiful” relationships that can reduce a late-life risk factor: loneliness, which she calls a public health crisis. She notes that older parents are often the last of their tribe, outliving their siblings, spouses, friends, even other children.

“Research shows us older people who are socially isolated have a significant increase in cognitive impairment and higher risk for stroke and cardiovascular disease,” she said.

As founder and former director of the nation’s first Elder Abuse Forensic Center at University of California, Irvine, Burnight warns that that there is the potential of exploitation in some aging families.

“I don’t mean to be [negative], but after 20 years working with elder abuse, many times I saw an adult child move in largely to mooch off parents and drain their finances,” she said. “We know that financial exploitation can lead to neglect or physical abuse. There always needs to be other family members with eyes on this situation.”

The Need to Consider Impact of Dementia

With longer lifespans for women, mothers-and-daughters are the most common late-life family. The Aging Together study is deliberately broadening its search for participants.

“We’re reaching out to a variety of subjects, from different socioeconomic, racial and ethnic backgrounds,” Boerner said. “We need to hear from sons and fathers, too. Their voices are different.”

As she arrived at the halfway point of her research, Boerner realized that she had also eliminated another type of family that is aging together.

“We designed the study for parents who are cognitively able to do an interview. In the field, I met so many senior children with parents with dementia, and their needs and stories were not part of the research.”

Boerner wrote another grant proposal to add this component to her research. She has only recently gotten word that she received additional federal funding to expand her inquiry.

“We will literally hit the ground with it in the next month,” she said. “This is one of the most challenging situations for these families and it merits study.”

For more information about participating in the study, call 617.901.1082 or email agingtogether@umb.edu.

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Helping a Loved One With Dementia at Family Gatherings

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Facebooktwitterpinterestmailby featherBy Patricia Corrigan 

Contributing Writer, Next Avenue

In many families, holiday or other event gatherings are a collaborative effort. Someone brings the main dish, someone else brings a salad and another person shows up with dessert.

Maybe it’s time, experts say, to assign one dinner guest to keep an eye on your family member who has Alzheimer’s disease or other dementia. Otherwise, that relative may end up sitting alone, staring into the distance, as others mingle after the meal.

“Most people with early or middle-stage Alzheimer’s enjoy being social, and many would enjoy eating a holiday dinner with the family,” says Dr. Suzanne Schindler, a neurologist and a professor at Washington University School of Medicine in St. Louis.

Consider What the Person with Dementia Would Enjoy

When planning the event, Schindler says, it’s important to take these individuals’ needs and wants into consideration. What would they like? What would make them happy? Maybe your mom likes to dance. Encourage the younger children to ask her to dance for a bit. Does your dad enjoy singing? A family sing-along after dinner may be in order.

Someone with mobility issues may prefer to visit quietly with one person at a time, reminiscing about previous holidays. A family photo album may spark that conversation. Sometimes, just sitting together, observing others at the gathering, may be enough.

“You want the person to be engaged, but not too much or too little,” Schindler says. Too little might be seating the person at the back of a room. Too much might be seating the person in the middle of a noisy crowd or in the path of active children.

What topics should be avoided? Current events may be troubling for someone with short-term memory loss. Schindler also cautions against correcting those with dementia, who may say things that are inaccurate, or calling them out for being repetitious. She recommends avoiding any confrontations.

Don’t Make Assumptions About Alzheimer’s

An estimated 5.7 million Americans are living with Alzheimer’s. Yet, many people still are not well informed about this debilitating disease, for which there is no cure. Simply acknowledging that a family member has Alzheimer’s often is emotionally difficult for many people. Beyond sadness, some experience fears that they, too, may develop the disease, though experts say that age is a far greater risk factor than genetics.

Monica Moreno, senior director of care and support for the Alzheimer’s Association, endorses Schindler’s suggestion that before families gather, they talk openly about a loved one’s level of disease, what to expect and how they can help.

“Many people hear the word ‘Alzheimer’s’ and they think of someone who can’t communicate or doesn’t know what’s happening around them,’ Moreno says. “That’s not always the case. Alzheimer’s affects everyone differently, and that’s why we shouldn’t make assumptions.”

Moreno offers these general tips:

  • Consider holding the gathering at brunch or lunch, because some people with dementia experience fatigue or confusion later in the day.
  • Interact directly with the person, rather than his or her caretaker, at the event.
  • Be a good and patient listener, because some people may need longer to formulate their responses to questions.
  • Invite the person to participate in a non-stressful way, perhaps by helping set the table or fold napkins, depending on his or her level of function.
  • Provide a quiet place where the person can spend some down time if needed.

Moreno also recommends keeping your sense of humor, which lightens the mood for everyone and can ease communications. And keep in mind that a specific tip or strategy that doesn’t work one day may well work the next.

The Alzheimer’s Association’s website offers more advice on how to communicate with individuals in the early, middle and late stages of the disease, including a short video.

Try to Interpret Unexpected Behaviors

If your loved one with dementia becomes distressed during a gathering, Moreno recommends trying to redirect him or her. “Change the topic … or invite someone else to join your conversation,” she says. If that doesn’t work, try to understand any behaviors you may witness, because all behaviors are a form of communication.

“A person may try to get up and leave. By doing this, what is he or she saying? Perhaps they need a drink or to go to the bathroom, or perhaps they feel anxious or over-stimulated because the noise level is too loud. It’s helpful to know what triggers may bring on different behaviors,” Moreno says.

And if things get out of control, the Alzheimer’s Association has a Helpline staffed by clinicians who can offer support all day, every day. The number is 800-272-3900.

Have Realistic Expectations as Circumstances Change

As a person’s dementia progresses, his or her ability to interact with other people will change as well. The family will have to adjust to that, and there might come a time when a big gathering is just too much for a loved one with dementia.

For example, my friend Elizabeth wasn’t at her family’s Thanksgiving dinner this year. I wrote about her two years ago  when at 68, she was the youngest person living in a memory care unit after a diagnosis of Alzheimer’s. Now she is in a skilled nursing unit, and Michael, her husband, tells me it’s not easy to keep Elizabeth engaged when he visits every day.

“Elizabeth will not initiate any conversation, and it’s often difficult to even get a reaction to what I say,” Michael says. “We almost always go for a walk on the grounds. We look at the trees and the beautiful fall leaves, and I talk about them. That always provides a good distraction.”

Elizabeth’s and Michael’s family gatherings have always been large. They have three children with families of their own, plus Elizabeth has eight living siblings and Michael has two, all with families. “I don’t bring Elizabeth home for the holidays,” he says. “The crowd would be too much.”

 

 

 

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Should Safety Take Priority Over Independence for Older Parents?

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By Debbie Reslock

Do you lie awake at night in a cold sweat, worried about your dad living alone? What if he falls and can’t get to a phone to call for help? But he maintains he’s fine.

When the goals of safety and longevity clash with those of autonomy and independence, you’ll find the basis of most conflicts between older adults and their children, according to Dr. Leslie Kernisan, a geriatrician practicing in San Francisco.

It’s easy to appreciate both viewpoints. But disputes like these can fracture families. Older adults see visions of a life ending in disappointment and less meaning. Their children see them lying on the bathroom floor or being duped out of their savings.

The Rights of Older Parents Are Clear

These are not elders whose capacity no longer allows them to understand a decision or its consequences. Or children who don’t care. This is what happens with good intentions from both sides.

The problem is where a road lined with those intentions can lead, says Barbara Cashman, a Denver attorney specializing in elder and estate law. It is often a place where older adults are treated as incapable and their children sink under the weight of responsibility for people who refuse to listen.

But if there’s no lack of capacity, the adult has the right to make his or her own decisions, even bad ones, Cashman says. “Even if I decide to give my money away, a judge could say that it’s my money and my choice what to do with it.”

Kernisan agrees. “If there aren’t signs of cognitive issues and there haven’t been any red flags, the older person has the right to make their own decisions — even if they make others uncomfortable,” she says.

Ageism Plays a Role

Why do we see the world from such different perspectives?

Ageism, the stereotyping of a group of people based solely on their age, plays a big role. Most of us have an unfair preconceived view of what it means to be old. So we often assume an older parent is at risk for being taken advantage of or should no longer live alone.

“We don’t value aging,” says Penny Cook, president/CEO of Pioneer Network, an organization supporting changing attitudes toward aging and elders. “Our negative perception helps marginalize older adults. They become ‘less than’ because that helps us cope and then we take on the parental model.”

In the blog, Time Goes By, a reader recently commented about an 80+ friend who wasn’t allowed to sign a contract with a company to do work for her because their policy was that a younger family member needed to be present. This was based solely on a predetermination of an age, not whether the company believed the woman understood what she was signing.

But there is support from the law.

“A neighbor can call Adult Protective Services and say they just saw you on your roof or fall off your front steps,” Cashman says. “They may send a caseworker out, but if they find no evidence of self-neglect and there’s food and heat, you still have the right to stay in your house.”

Don’t Make it a Lose-Lose Situation

This situation is admittedly complicated for grown kids. Cook says one of the hardest things to feel is helpless. “It’s such a difficult place to be in if you can’t help. I have a lot of empathy for kids that are trying to do what’s best,” she says.

But fear and anxiety may unknowingly force parents into keeping secrets because of what a conversation may trigger. Cook talked to someone in her 80s who’d been taken advantage of financially. Even though it was a situation that could have happened to someone at any age, she felt she had to keep it to herself.

Other times, children don’t understand what’s really happening. Says Cashman: “They may think a neighbor is taking advantage of their mom for free day care, but what they don’t see is that she’s really enjoying feeling useful again.”

Parents may be unsure, too, and potentially, scared.

Instead of drawing a line in the sand, look for a compromise, like a housekeeping service, public transportation, meal delivery or home care a couple of days a week if it becomes needed.

Sometimes, adult kids may not realize how important it is to their parents to continue living in their own homes.  Meeting with a card group at their church in Tinley Park, Ill., Teresa Hughes, 75, asked her friends about their decisions to stay in their own homes. Overwhelmingly, the group, ages 75 to 94, didn’t want to leave the homes they loved or their neighborhoods.

Some admitted to loneliness, yet felt moving to a working child’s home could be just as lonely until the son or daughter came home at night.

5 Suggestions for Bridging the Gap

Here are five suggestions for grown children and their parents to find middle ground:

  1. Learn the Pioneer Network principles to shift assumptions about aging. They include being entitled to self-determination and recognizing that risk-taking is a normal part of life.
  2. Talk to each other. Share this article with your parents as a starting point. Recognize if you’re making things more difficult. Work for a solution so you don’t sacrifice your time together.
  3. Address what’s happening. Be honest, Kernisan says, and share your concerns.
  4. Ask how to help your parent keep his or her quality of life. Listen from the heart. And if there’s a crisis, try not to make decisions then.
  5. Be prepared for a bumpy road. Logical arguments often fail to convince people with whom we have emotional relationships, says Kernisan, since we’re not always rational about issues that stir up certain emotions, like our identity, self-worth and autonomy.

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Ways to Talk With a Parent About Signs of Dementia

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Tips from the Alzheimer’s Association for Alzheimer’s & Brain Awareness month

By Emily Gurnon

Michele Foss refers to it as The Great Bacon Incident.

She had gotten a call at her Baltimore home from her mother; both of Foss’s parents still lived in her hometown of Eagan, Minn., just outside of St. Paul.

Her father, Darrell Foss, was frying bacon for the two of them. When he was finished, he drained the grease. But instead of pouring it into an old glass jar as he typically would, he drained it onto the kitchen counter.

“Then when my mom asked him about it, he said, ‘That’s what we do,’” Foss said. “So that was really the trigger of [deciding] hey, we need to talk about this.”

That was in 2015. There had been other indications that her father, now 75, was having cognitive problems, Foss said. Some years earlier, the expert handyman and retired CPA began having trouble figuring his way through fix-it projects.

After the family talked about the need to get him tested, he was diagnosed with mild cognitive impairment, which increases his risk of developing Alzheimer’s disease or another type of dementia.

Having the Conversation About Dementia

It’s hard for adult children to watch parents decline in health as they age. It is even harder, for most of us, to talk with them about the changes we see. When the subject is something as frightening and sensitive as dementia, it can seem almost impossible.

“I think people are worried about hurting a family relationship or hurting someone’s feelings or upsetting people that they care about,” said Ruth Drew, director of family and information services at the Alzheimer’s Association.

But making the decision to broach the subject can help everyone — the parent and other loved ones — because it can lead to a diagnosis, Drew said.

“When you know what you’re dealing with upfront, then you can plan,” she said. “The person [with dementia] can have a voice in what happens next.”

For example, your parent might say: ‘If at some point down the road I am not able to take care of myself, here is what I would want,’ Drew said. “That planning is able to give some comfort and also reduce fear of the unknown,” she added. The alternative — waiting until there is a crisis — makes choices very limited, Drew noted.

More Reasons to Talk

An early diagnosis can lead to better medical treatment, the Alzheimer’s Association says. Even though there is no cure for Alzheimer’s and no drugs to slow the disease, some medications may help with symptoms. And lifestyle changes, like better diet and more exercise, can potentially help preserve brain function.

Your parent may also elect to participate in clinical trials for Alzheimer’s.

Another important reason to get your parent tested if you suspect dementia: You might be wrong.

Other illnesses and conditions can cause dementia-like symptoms that are potentially treatable. They include: Lyme disease; metabolic or endocrine problems; certain medications, including anticholinergics like Benadryl; autoimmune disorders such as Hashimoto’s thyroiditis and late-stage syphilis.

“You always want to find out what you’re dealing with… rather than just assume, well, this person is of a certain age and so they probably have Alzheimer’s,” Drew said.

New Survey Describes Reluctance

The Alzheimer’s Association released results of a new two-question survey May 31, in advance of Alzheimer’s & Brain Awareness Month in June, on difficulties family members have in talking about the disease. The responses are concerning.

Almost 30 percent of the approximately 1,000 adult respondents said they would not talk to a relative about troubling signs of dementia, despite their worries.

A majority said they would be concerned about “offending” a family member (76 percent) or “ruining [their] relationship” with that person (69 percent). And 38 percent said they would wait to talk to their loved one until symptoms worsened.

The online survey was taken last month.

Pam Montana, 63, said in a statement that getting diagnosed early was vital for her.

“It is important for me to face this disease and share my story while I’m able,” said Montana, of Danville, Calif., who speaks publicly as an Alzheimer’s Association early stage adviser.  “That leads to an enormous sense of accomplishment, even with this extremely difficult diagnosis. I want to tell these stories and let others know they are not alone.”

She also wants to demonstrate that having Alzheimer’s does not mean an immediate end to life.

How to Have the Conversation

If you are not sure whether your loved one may have dementia, check these 10 warning signs.

If you remain concerned, the Alzheimer’s Association offers six tips for talking with a loved one.

They include:

  • Have the talk as early in the disease stage as possible
  • Think about who is best to approach your loved one
  • Practice how you will start the conversation
  • Offer support and companionship
  • Anticipate that your loved one may deny the problem
  • Know that the conversation may not go the way you expect

“It’s a very, very hard conversation to have,” Michele Foss said. “You have to come in with a plan.  Because if you just say ‘you have cognitive issues’ and don’t have any plans forward, you don’t take action on it.

“To have a diagnosis means you can make an action plan and to move forward — and the earlier the better,” she said.

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Using Your Own Body Weight to Exercise After 50

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Enjoy great health benefits without the need for special equipment

By Edmund O. Lawler

When she talks to her patients about exercise, Johns Hopkins geriatrician Dr. Alicia Arbaje encounters resistance about two-thirds of the time.

“I’m too old, I’m too sick, I’m in too much pain,” Arbaje says are the reasons most frequently given by patients for not wanting to exercise. Research, she counters, points to overwhelming evidence that regular exercise confers a wealth of health benefits.

Another reason she hears for not exercising: “I don’t have the time.” Arbaje parries that one as well by explaining that a form of exercise that uses nothing more than a person’s own body weight can be done just about anywhere and just about any time.

Unlike using free weights or machine weights, body-weight exercise relies on a person’s own weight to provide resistance and boost muscle strength and flexibility.

Arbaje, associate professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, says yoga-like body-weight exercise, also known as calisthenics, makes things easier for people who don’t have easy access to a gym or don’t have a fancy home gym with specialized equipment.

Building Strength, Boosting the Heart Rate

“It’s important for people over 50 to focus on strength, cardiovascular training and flexibility,” Arbaje says. “Body-weight training can incorporate all of those, particularly the strength and cardio training because it gets the heart rate up. Anything that gets people moving is important.”

People launching an exercise program, especially those who’ve been sedentary, will initially experience some muscle soreness caused by inflammation, Arbaje says. “But your body begins to adjust,” she adds. And while chronic inflammation is associated with many of the leading illnesses, such as heart disease, diabetes, cancer and arthritis, “regular exercise is anti-inflammatory,” Arbaje says.

Before starting a body-weight exercise program, Arbaje recommends people have a conversation with their doctor to determine what they can safely handle. She also recommends someone new to body-weight exercise consult at least initially with a personal trainer. “You can get injured with incorrect form and not being aligned properly, which puts too much strain on certain parts of the body,” she says.

Scales Tip in Favor of Using Body Weight to Exercise

The benefits of using your body weight to exercise, however, far outweigh the risks.

Cognitive function, Arbaje says, improves with any form of exercise. “We’re not exactly sure of the direct link, but it’s most likely related to improved circulation in the brain. Anything that is good for your heart is good for your brain.”

Body-weight exercise done with a partner or with a group in a class has socialization benefits, too. And weight-bearing exercise can improve bone health and help prevent osteoporosis.

Sue Quigley, a 60-year-old banker who lives in the western suburbs of Chicago, had been an avid walker. It was her only form of exercise. But after a bone scan detected osteoporosis in her lower spine, she began exercising with hand weights to maintain and build bone strength.

She only lifted the weights sporadically, however, and realized her exercise routine was not improving her bone health. At the start of this year, Quigley bought a set of instructional DVDs based on Classical Stretch, the long-running public TV fitness show hosted by Miranda Esmonde-White. It regularly incorporates body weight exercise.

Quigley now religiously does the weight-free, full-body Classical Stretch workout five days a week in her home. She believes the 30-minute workout has improved her bone and muscle strength.  “I’m feeling really good,” she says. “I now have some muscle definition in my upper arms, which I didn’t have when I was using my hand weights.”

Mimicking the Movements of Everyday Life

Kinesiologist Angela Russell says body-weight exercises often mimic the multidimensional movements of daily activities, such as walking up stairs, shopping or gardening. At Auburn University at Montgomery, in Alabama, where she is an assistant professor, Russell teaches a lunchtime body-weight exercise class for adults that emphasizes those types of everyday movements.

“Body-weight exercises allow you to maintain a basic level of strength to help you be more functional in everyday life and remain independent longer,” she says. Among the exercises in her classes: crawling, squatting, calf-raises, stand-up pushups against a wall or simply sitting on an exercise ball to enhance core strength.

When people think about strength training, Russell says, weightlifting usually comes first to mind. “But you can load too much weight on the bar and suffer an injury,” she says. “With body-weight training, you eliminate that risk because you’re not guessing how much weight to put on a bar.”

A person’s muscles don’t make the distinction between an exercise done by someone controlling his or her own body weight versus one done with a free weight or a machine weight, Russell says. “For example, similar changes in muscle strength are produced by the pushup, a form of body-weight exercise, versus a bench press, which is done with free or machine weights,” she says.

Consider Your Limitations

Russell does caution, however, that overweight or obese people must be careful. Their extra pounds can put unusual strains on their bones and joints. And even older adults in good physical condition beginning a body-weight training regimen have less flexibility and muscle strength (as well as a higher percentage of body fat) than when they were younger.

Recovery time from a workout will tend to take longer when you’re older, too,, Russell says. “Younger people tend to take a day of rest between workouts. An older adult may need to take two recovery days,” she notes.

Despite a slight injury risk and longer recovery times faced by adults doing body-weight exercising, its convenience is hard to beat. Says Russell: “You can exercise with your own body weight anywhere. All you need is yourself.”

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When Your Parent Doesn’t Know He Has Dementia

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It’s a common aspect of the disorder, but tough on caregivers

By Emily Gurnon for Next Avenue

Both of Kathy Kling’s parents, who are divorced, have Alzheimer’s. Kling recently talked with her mother, Karen Kelly, about her father’s disease. “Oh, I hope I never get it,” her mother replied.

She was diagnosed six years ago.

Kelly, 82, was a champion high school debater, an activist who spearheaded a Supreme Court victory for the disabled, and a Mensa member. Now, she lives in an assisted living community in Spearfish, S.D., frequently repeats herself and blames her memory problems on old age.

Angie O’Leary’s father-in-law, who was 81 when diagnosed with Alzheimer’s, insisted he was fine when family members told him he could no longer drive safely.  “I’ve got this,” he would say, according to O’Leary, a Minneapolis resident. “I’ve been driving for years!”

Not Realizing Having Dementia: A Common Occurrence

People with Alzheimer’s or other forms of dementia often don’t realize they have the illness, said Sandra Weintraub, a professor of psychiatry and neurology and the clinical core leader in the Cognitive Neurology and Alzheimer’s Disease Center at Northwestern University. The medical term for the phenomenon is anosognosia.

“It’s not denial. It’s really a lack of awareness,” she said.

A healthy brain has networks that provide us with insight and awareness of reality. With dementia, those areas stop working well.

“Another mechanism might be that when you lose your short-term memory, you don’t remember that you can’t remember,” Weintraub said.

She recently had a patient who denied he was having any trouble paying his bills. His daughter pointed out that he’d paid one bill three times. She showed him the bank statement that backed her up. His response: “I don’t have any idea how that happened. The bank must have made a mistake.”

Difficulties for Caregivers

This lack of awareness can cause major stress and heartache for caregivers. Ruth Drew, director of information and support services at the Alzheimer’s Association, said she once talked with a daughter whose mother had given her a necklace she’d admired since she was a girl. The daughter wore it the next time she visited her mother — who suddenly accused her of stealing it.

“She didn’t remember giving it to [her daughter],” Drew said. “For that person, what they believe is completely real to them. What we have to learn is, there’s no reasoning with someone who is convinced of something like this. All our ways of communicating with each other… all that goes out the window.”

It’s important for caregivers to remember that their loved one is not intentionally denying the problem — the refusal to recognize dementia is a symptom, just like chest pain can be a symptom of a heart attack.

Trying Creative Approaches

Another family also struggled to cope when their father insisted he was still able to handle the finances. His dementia had made that impossible.

A social worker came up with a new approach, Drew said.

“She told him, ‘Mr. Smith, you have worked hard all your life. Let these kids carry some of the burden.’ And that made sense to him. She put him in the power seat.”

Learning more about Alzheimer’s and other dementias can help you cope, Drew said. Check the website of the Alzheimer’s Association for more information. Find a Brain Health tool kit on the website of the National Alliance for Caregiving.

© Next Avenue – 2018. All rights reserved.

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Celebrating 70 years of ministry and service to the seniors of Clifton and Bosque County, Lutheran Sunset Ministries offers inspired retirement living options at every life stage. Our 32-acre campus is designed as an intimate setting of neighborhoods that accommodate residents at various levels of care. In addition to quality health and wellness opportunities, Lutheran Sunset Ministries provides an enriched lifestyle through innovative programs, interdisciplinary activities, and a focus on physical, intellectual, social and spiritual growth.

Providing the only full continuum of care available in Bosque County—including independent living, assisted living, long-term care, rehabilitation and therapy, memory support, hospice services and companion services—Lutheran Sunset Ministries is a cornerstone of the region. With a state-of-the-art healthcare building, an increase in services and amenities, and a rededication to providing services that allow people to live full and enriched lives, Lutheran Sunset Ministries has created a quality of life unparalleled in the region.

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