Misc. Mental Musings

This format eliminates birth challenges, drug abuse, and fatal accidents, traumatic events which disproportionately afflict the younger cohort of society.  As shown, the COVID anomaly aside, failure of the cardiovascular and respiratory systems, along with various cancers, predictably account for the vast majority of deaths. 

 

It’s a misnomer that life expectancy in the United States, in stark contrast to the rest of the developed world, is declining.  This oft-stated fact is an anomaly cause by the ongoing opioid crisis sweeping the nation.

 

Such overdose deaths are disproportionately skewed to middle age individuals, ranging from 25 to 55.  Thus, the number of life years lost is substantial, thereby imparting a large influence on the national average.  Tragic, to be sure, but not a sign that the entire medical profession is regressing.  [REF]

 

Longevity is a burgeoning field of science worthy of its own separate discussion.  Recent breakthroughs in AI and LLM research are allowing many elements of bodily degradation to be slowed, and in some cases reversed.  Some ambitious academics have postulated civilization is less than a decade from eternal life.

 

At the very least, it’s likely babies born today can expect to hit the century mark, and possibly much longer.  Whether all individuals will have the financial means or innate desire to become immortal is an entirely different conversation.

 

The topic of death and dying is a broad field of medicine, with specialists in all manner of realms.  The best part about these individuals is job security.  Sure, optometrists and oncologists, gastroenterologists and gynecologists, are important to society.  But none of these specific ailments are mandated to occur over a lifetime.  Every person will die eventually.

 

People have different opinions on what traits constitute functional versus fetal, intrigued versus impaired, dozing versus deceased.  Despite our extensive vocabulary of spoken and written words, humans still struggle to define life and death, of both the spirit and the soul. 

 

Improving well-being of the elderly continent in the U.S. will be crucial in the future.  Empowering aging individuals to monitor and refine their physical and mental functioning can help old folks remain healthy, and minimize hospital stints.  Substantial money and resources are consumed in the final stages of life, especially amongst the highest-risk segment of population.  [REF]

 

While slightly cynical, regular functional assessments can help seniors make crucial life decisions.  When to take away the keys, and start taking the bus.  When to leave one’s own home, and move into a rest home.  When to go on electronic life support, or even pull the plug.

 

This subject matter is difficult to discuss, but the importance cannot be understated.  It’s impossible to quantify how many elderly die from avoidable accidents, due to mental and physical impairment.  Staying sharp and strong during one’s sunset years is vital for vitality.  Relatively speaking, of course.  [REF]

 

Physical

In his book “Outlive”, Peter Attia defines 10 physical abilities that are desirable to maintained until age 100, and hopefully well beyond, to promote a healthy lifestyle.  These exercises are meant to simulate tasks important for functioning in everyday life as one ages.  Remaining physically heathy later in life can reinforce independence and enjoyment.

 

The compiled activity list below is based around the trio of core tenants Dr. Attia feels are critical to performance: stability, strength, and stamina.  The latter category is broken into aerobic and anaerobic training, equating to long steady versus short aggressive efforts.  Cardiovascular health is critical to maintaining both the respiratory and circular systems, by engaging the lungs and heart respectively.  [REF]

 

1. Hike 1.5 miles on a hilly trail.

2. Get up off the floor with minimal support.

3. Pick up a young child from the ground.

4. Carry a pair of 5-pound grocery bags for 5 blocks.

5. Lift a 20-pound suitcase into an overhead compartment.

6. Balance on one leg for 30 seconds.

7. Have sex.

8. Climb up 4 flights of stairs in 3 minutes.

9. Open a jar.

10. Do 30 consecutive jump-rope skips.

 

What’s nice about this battery of tests is how closely it mimics the activities required to function in normal society.  Thus, these skills can be practiced and reinforced throughout the course of daily life. 

 

This selection can also be curated to incorporate specific capabilities important to certain retirement plans, like maintaining the flexibility required to swing a golf club, the strength to lift and strain a stockpot of pasta, the mobility to pull weeds from the flower garden, or the energy to stay up and watch your favorite evening TV show live. 

 

Often, it’s not just the task itself, but how achy the body feels the next day after a strenuous effort.  Also, make sure to mix up workouts, to engage different muscles, and avoid repetitive boredom.  Exercising should and can be fun.  Just try to complete a few daily activities of interest, be it singing aloud while showering, standing up at the counter while cooking, or walking around the mall while shopping, to promote natural bodily movement.

 

Science shows that the human physique weakens substantially as it devolves in the advanced years.  Most notably in terms of depletion are bone density and muscle mass, which can degrade by upwards of 1% per year in the later stages of physical existence.

 

There’s no doubt life gets slower, and harder, with age.  Despite noticeable decline in corporal function, old folks can continue to participate in sports of their choice, just at a lower level, and leisurely pace.

 

Later in the progression, basic tasks that used to be commonplace become difficult.  These fundamental daily movements also get more tedious, and dangerous, over time.  The ability to function on one’s own at home is a key element of the independent lifestyle elders crave.  Confidence is key.

 

Actively testing and assessing mobility is a great way to monitor bodily changes over time as a result of aging.  It’s better to evaluate physical faculties in a controlled setting, rather than pushing feeble bones to the brink in a stressful time of need. 

 

For simplicity, it helps to focus of tests that are dynamic, but safe, with quantifiable measurements, which don’t require any ancillary equipment.  This allows progress to be tracked over time, and doesn’t risk injury as bodily deterioration occurs.  Each individual is different, and measurement metrics can change, for better or worse, rapidly in the later stages of life.  Make sure to document the journey, and record deviations in performance.

 

Based on reviewing medical science, below is a trio of simple test protocols that can be used to monitor bodily function of the elderly.  [REF]

 

The Sit-and-Reach Test doesn’t require much additional information beyond the descriptive name.  Simply sit on the floor with your legs fully extended in front of you, feet pressed against a wall.  Slowly reach forward with both hands as far as possible, without bending or raising your knees.  Then, have someone measure the minimum distance from your fingertips and your toes.  Average flexibility for a 65-year-old senior is a 7-to-11-inch gap, depending on body height.

 

The 6-Minute Walk Test is also self-explanatory, but does rely on finding a long, flat surface like an empty parking lot or high school track.  Start the timer, then set out at the fastest pace you can maintain for 6 minutes, recording the total distance traveled.  A fit 65-year-old should be able to cover a minimum of 400 meters, or one full lap around a standard oval, with 600 meters or more being desirable.

 

The 4-Stage Balance Test may take a little practice to execute at first, but is a useful and safe way to quantify bodily equilibrium.  Beginning with your feet side by side, slide one foot back until toes are even with the heel, pause for 10 seconds, then, if comfortable, shift the rear foot directly behind the front one.  If you can hold this aligned stance for an additional 10 seconds, the last step is to fully raise the rear leg, putting all your weight on the front appendage.  Any 65-year-old who can work through this entire progression is deemed to have excellent balance, but achieving each prior stage is still valuable, and can be improved with practice.

 

Sensory

If the prior balance test sequence sounds similar to a driving under the influence protocol, that’s because it is.  Which shows how much mental and physical faculties can degrade in old age.  And is a strong justification for tactfully taking away an impaired grandparent’s vehicle, getting them out from behind the wheel, while finding other ways to enable transportation mobility.

 

Analyzing bodily function via field sobriety tests combines evaluating linked sensory faculties, which allow the mind and body to communicate in its normally elegant dance.  Until alcohol inhibits these pathways.  Administered by law enforcement as part of a DUI check, these tests are designed to assess balance, coordination, and multitasking.  The same basic motor skills that often degrade with age. 

 

There are 3 commonly used evaluations as described to follow.  [REF]

 

The One-Leg Stand (OLS) method is the simplest.  The subject is asked to raise one foot 6 inches off the ground, then count up by one sequentially starting at 1,000.  Various balance behaviors are monitored during this time, including dipping, hopping, and swaying.  This scheme is only 65% reliable in assessing inebriation.

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The Walk-And-Turn (WAT) procedure is basic and physical.  The cop instructs the patient to walk in a straight line, heel to toe, for 9 steps, then rotate on one foot, and make the return journey.  This check is often done on the painted edge or center line of the road.  Signs of impairment include: not following directions, lack of balance, frequent pausing, poor walking execution, and simply taking the wrong # of steps.  This analysis is 68% effective.

 

The Horizontal Gaze Nystagmus (HGN) test reviews involuntary jerking of the eyeball.  Using a flashlight or pen, the officer has the subject track the illuminated object, then assesses eye movement.  Lack of following, jerking at 45 degrees off the vertical or less, or substantial twitching at max deviation, are all signs of drunkenness.  This protocol is 77% accurate if administered appropriately.

 

Failing any portion of the Standard Field Sobriety Test (SFST) battery allows the police to administer a breathalyzer or chemical blood analysis.  If executed correctly, this hybrid approach is 90% reliable for assessing legal intoxication, and admissible in court proceedings. 

 

Outside the law enforcement drunkard space, similar sensory checks can be just as relevant in determining bodily function for debilitated seniors. 

 

The latter HGN check simply relies of measuring basic function of the human sensory system, as the brain is the integral processing center that enables sight and reaction time, both key faculties for safe driving.  Fortunately, eyesight functionality can be evaluated without needing to be pulled over by the cops while inebriated.

 

There are all sorts of vision tests available online, which can be executed with natural eyes, potentially supplemented by whatever glasses or contacts the user may have at their disposal.  Ocular acuity tends to decline with age, but there are various ways to mitigate and correct this deterioration.

 

In lieu of a formal eye evaluation, vision can be assessed through ancillary test means like reading written instructions or identifying images in pictures.  Additionally, sight skills can be analyzed in dynamic scenarios, such as catching a ball, watching television, or even, liking back to the prior conversation, driving a car.  This latter activity offers a much wider range of stimulation, so must be attempted with discretion.

 

Smell and taste are also senses which can evolve over time.  In contrast to other bodily traits that diminish, these faculties usually become heightened and refined through age and experience.  Granted, this experiential evolution can lead to preference changes in ice cream flavor and candle scents.  Don’t be afraid to branch out into new food cuisines to broaden and reinforce the palate as an adult. 

 

There’s no need for formal testing of these mouth and nose systems, aside from if complete lack of functionality is experienced.  Such an occurrence, while not fatal, may be emblematic of broader mental acuity issues.  At the very least, experiential eating can be disconcerting, as many know from COVID-19 symptoms.

 

Then, there’s the sensory system most commonly known to degrade over time.  Hearing.  This is a throughline in countless comedy movies, most notably and seasonally relevant, Aunt Bethany from National Lampoon Christmas Vacation.

 

Any old person who’s hearing starts to go, often without their knowledge, incurs reduced perception of their surroundings.

 

In this modern era, ear functionality is monitored by doctors essentially from birth, using bulky headphones and tonal pings, usually in a controlled office environment.  But hearing success in the real world is much more dynamic, requiring the ability to attenuate varying decibel levels, and monitor multiple noise input streams, simultaneously.

 

As with many other elements of bodily change, seniors are often hesitant to acknowledge or evaluate their diminished faculties to others.  Fortunately, there’s all manner of at-home means for checking auditory acuity.

 

Surveys inquiring about difficult sound surroundings.  Listening to recorded outputs that simulate hearing loss.  Exposure to unpredictable sound stimuli like fireworks.  Tone definition using composed music or individual instruments.  White noise background level exposure.  Even the basic whisper protocol, perfected in elementary school for covert communication, but still quite relevant in old age.  [REF]

 

Obviously, a professionally-administered medical hearing exam is more conclusive, but these preliminary checks can help ascertain if further clinical guidance is warranted.

 

Cognition

When the world goes grey, bland, and silent, it obviously becomes more boring.  That’s why maintaining mental acuity is just as important as physical operation as an individual ages.

 

Dementia, while not ranking very high on the previously presented cause of death list, can substantially hinder quality of life.  Fortunately, there’s specific evaluations for this ailment, which can be used by both family and caregivers to assess cognitive function.

 

It’s important to execute such testing on a regular basis, as brain function can degrade rapidly.  Also, try to keep the format, setting, timing, and administrator constant to establish a consistent baseline, then highlight deviations from this benchmark.  Another approach is to get the subject out of their comfort zone, to interpret dynamic reaction time and decision making.

 

Aside from dementia, Alzheimer’s disease being the harshest form of mental impairment, there are other reasons why a person’s brain may not be working perfectly.  External factors, that can hopefully be remedied with lifestyle changes, including fatigue, stress, frustration, malnourishment, and depression. 

 

Calling someone out for not remembering facts isn’t the right approach.  It’s important to frame up the reasons, and motivations, for directing any sort of test on an elderly person.  There’s a substantial difference between a brief bout of forgetfulness and true deep memory issues.  This subject can be very sensitive, since loss of function means loss of freedom.

 

There’s now all manner of free analysis resources online, easy to execute in the privacy of one’s own residence.  These apps can even be used as a training tool to sharpen and improve cognitive capability.  Still, always consult a doctor before making any drastic lifestyle changes or decisions.  [REF]

 

It’s very important to document key decisions, like preferred end-of-life care and monetary asset beneficiaries, when all parties are still mentally capable, then reinforce and remind the suspect regarding these decisions as needed.  Having financial and physical houses in order can provide substantial piece of mind, not just for the aging grandparents, but for their entire lineage of offspring.

 

Cognitive examination is a quick way to assess mental function.  While the results aren’t sufficient to diagnose specifical aliments, poor performance provides guidance for further medical evaluation.

 

Perception testing checks the brain’s ability to process basic and engrained information, with no research or studying required.  This mental review can determine functionality in a variety of fields: acknowledgement, comprehension, decisiveness, judgement, language, memory, and reasoning.

 

Cognitive impairment, at its core, can be identified by failure in everyday tasks, including scheduling, strategy, and even speech.

 

Typically tests last about 15 minutes, and cover a range of topics.  These can be informally taken at home, or administered in a doctor’s office under more curated conditions.  One of the first checks of functionality is to make sure the patient is currently grounded in reality, in terms of their setting and circumstances, like date, location, etc.

 

Next, a battery of simple tasks are executed: memorizing words, identifying pictures, counting numbers, recalling facts, drawing shapes.  All these activities involve basic and common elements.  Essentially, this work is akin to revisiting fundamental skills learned in elementary school, reading and writing, math and memory.  This analysis is best done in person with physical items so the practitioner can see the patient’s reactions.

 

Memory, of both short and long term, is a very important element of brain function.  Checking this element of cranial capacity can be done at any time, using either new or repeat questions.  Feel free to leverage the classic “5 Whys”.

 

What did you eat for breakfast?  Where did you spend your last birthday?  Why did you change jobs during your career?  Who was your favorite primary school teacher?  When were you born?

 

Alternatively, scenario roleplay can be used to judge decision-making in real time.  What would you do if you get a flat tire on the highway?  How do you arrange items for self-checkout at the grocery store?  Do you load the dishwasher the same way every time?   

 

Don’t keep these questions so predictable that they get engrained, but maintain a few common ones, to see if any changes in response occur, even with fundamental material seared in the memory banks.

 

Another option is to covertly build the assessment into daily conversation.  Check basic memory skills by calling out 3 physical items in the room, then ask your friend or partner to repeat them back.  For the final object, make some small talk related to a family heirloom history, garage sale acquisition cost, need for cleaning, or other random relevant discussion for a few minutes. 

 

Then, out of the blue, have the subject try to recall the trio of elements in the space previously identified.  This off-the-cuff conversation can be both frustrating and enlightening regarding the ability of an aging mark to balance multiple concepts in their mind.

 

Often, cognitive testing can be done discreetly, in conjunction with other routine activities.  Games and puzzles are a great way to both reinforce and monitor mental function.  Jigsaw.  Cards.  Dice.  Dominos. Crossword.  Sudoku.  Even shared horoscope reading can be a valuable daily pursuit to promote repetitive brain engagement.  [REF]

 

On the clinical side, one of the most widely accepted means of testing mind function is the SAGE, short for Self-Administered Gerocognative Exam. This digital evaluation was developed by researchers at Ohio State University in 2010. 

 

This annual check-in includes a top section, where personal health information is provided from memory, then a list of 12 curated brain teaser questions which should only take 15 minutes to answer.   There are 5 different versions, eliminating the potential for old folks to memorize answers.

 

When administered in physical paper form, additional assessment of reading, comprehension, and writing functionality can be gleaned.  A success rate of 50% is considered the minimum bar to not necessitate seeking further medical examination.  [REF]

 

A commonly referenced example question from SAGE is being able to draw a standard clock displaying a specific time, with the long and short hands correctly labelled, and pointing to the right numerals.  Analysis of circle drawing, number writing, and general proportionality can also be gleaned using the composite image.

 

There are some downsides to this continual monitoring of any individual, especially an old and ornery one.  Taking tests can be just as nerve-racking in old age as they are in high school, and potentially more so, if the reason for the torture isn’t explained.  Excess stress can lead to a false negative with regards to performance, both physically and mentally.  The best approach is to review elder functionality in a comfortable and casual environ.

 

For those interested in evaluating their own relative’s acuity, be it physical, sensory, or cognitive, below are some online links of interest.  If motivated, try to go through this list once per year with aging family members to build a habit.  Modifying the cadence, and varying the exact test protocols, make the check-in dynamic, but familiar enough to not confuse.

 

The other option is to end up strapped to a lie detector machine in the bowels of a motorcoach, being interrogated by former CIA agent Jack Byrnes, a.k.a. Robert De Niro.  That’s a tough introduction to the Focker family.

 

Assessment

• Skill – Description: Tips (Time) [Link]

• Strength – Metrics for an incredibly simple sit-and-stand chair protocol: Focus on safe form up and down, as opposed to pure speed. (30 seconds) [REF]

• Balance – Basic description of 4-stage balance test: Try using the non-dominant leg, and have a spotter available. (1 minute) [REF]

• Memory – Image recall in simple format: Act quickly and accurately. (2 minutes) [REF]

• Reaction – Computer screen tracking to evaluate reaction time: Metrics for all ages, make sure your mouse ball works. (3 minutes) [REF]

• Hearing – At-home online auditory test: Very scientific, detailed, and accurate if speakers are calibrated. (3 minutes) [REF]

• Vision – Interactive online screening for all manner of potential vision ailments: Make sure the display lighting and distance are set as directed. (5 minutes) [REF]

• Cognition – Direct link to Self-Administered Gerocognative Exam, or SAGE. (10 minutes) [REF]

• Physical – 5 AARP recommended tests for checking bodily function. (Varies) [REF]

• Sensory – 3 methods for monitoring the spatial skills of seniors. (Varies) [REF]  

• Cognition – 7 quick online protocols to check for early Alzheimer’s disease. (Varies) [REF]

 

Disclaimer

The author of this post is not a trained health professional, and the topics discussed are a compendium of his personal analysis, ideas, and thoughts.  While information has been compiled from clinicians, scientists, and other research practitioners, through the powers of the internet, each individual’s health circumstances are different, and official medical consultation should be enlisted before undertaking any major life changes.  Please consult a doctor, preferably an honest one, if any of the content provided resonates too deeply.