Protect Yourself Against the Coming Dementia Crisis

How Do I Protect Myself — and My Family — Against the Projected Alzheimer’s ‘Crisis’?

Introduction

A recent Washington Post article startlingly declared: “Today, the crisis in health care is how to care for the estimated 5.7 million Americans with Alzheimer’s. …The crisis for tomorrow is how to take care of the projected 14 million Americans older than 65 who will develop the disease by 2050.”[1] The article goes on to lament how underprepared (or outright unprepared) are institutions – like our healthcare system – for this looming disaster. If you or your loved one finds themselves afflicted, then, as so often happens, you may be faced with the prospect of dealing with the catastrophe alone.

There are some things that you can do to safeguard your health, improve your chances of avoiding the dread disease, and – failing that – at least make some provision for your future care. This will involve such things as making changes to your diet and home environment, trying to “detoxify” your life (both literally and metaphorically), and attending to your finances. But the hard reality is that you have to start planning (and implementing that plan) now for it to benefit you when and if the time comes. 

Let’s get going.

Protect Your Physical Health

Insofar as Alzheimer’s is a brain-degenerating disease, it is reasonable to think that overall bodily health can affect a person’s susceptibility to some degree.

I’m not saying that poor general health will necessarily issue in a cognitive disorder. Nor am I promising that good general health is a surefire protection. But it stands to reason that your odds of slowing down mental deterioration – or avoiding it altogether – are going to be better the healthier you are.

So, you really ought to make some provisions to protect your physical wellbeing. Here are a few tips to help ensure that you’re on the right path.

Diet

I’m not a medical professional, but it is reasonable to think that the cornerstone of health is diet. Years ago, I was both enlightened and gratified by a sports-nutrition company’s forthright admission that basic diet superseded both exercise and their own “supplements” in importance.

Take a moment and think about the implications of this.

One glaring ramification is that you can’t “fix” an unhealthy lifestyle by swallowing some supplement. There are no magic pills.

If your body has sustained physical damage over years of abuse of neglect, then the only way to roll back that damage is to change your habits. And that will take time.

But, fear not, that is why I’m discussing it.

MIND Your Food

There is a diet that purports both to lower a person’s risk of developing Alzheimer’s as well slowing the mental degeneration of people (such as stroke victims) who are statistically likely to manifest dementia. It’s a takeoff from the National Heart Institute’s “DASH” program – where the former word stands for Dietary Approaches to Stop Hypertension. The newest diet is memorably designated “MIND,” which means Mediterranean and DASH Intervention for Neurodegenerative Delay.

This Alzheimer’s-focused regimen has two prongs. On the one hand, MIND nutritionists recommend that interested dieters add certain things into their diets.

This includes probably predictable things like the following.

Green vegetables (especially cruciferous ones) seem to show up on many health lists these days. And this list is no different. Green veggies – especially the leafy varieties – are nutrient rich, and often include such beneficial minerals and vitamins as beta-carotene, calcium, magnesium, potassium, and vitamins B, C, and K as well as trace elements like copper and manganese. They also tend to contain plenty of antioxidants, fiber, and phytonutrients.

The MIND Diet also prescribes generous helpings of quality beans, berries, nuts, and wholegrains.

For a more comprehensive breakdown of what is – and isn’t – included in the MIND diet, see HERE. Suffice it to say that the recommendations are geared toward guiding against brain and nervous-system degeneration as well as cognitive decline.

One extra benefit of all this healthy eating is that these same food items are capable of conferring ancillary protections against cardiovascular and heart disease, diabetes, and high blood pressure.

Another noteworthy addition, borrowed from the DASH heart-diet recommendations, is a single glass of red wine each day. Red wine, and its active ingredient resveratrol, is supposed to bestow numerous advantages, including a more favorable balance of “bad” and “good” cholesterol in your body. So, salut! (Just don’t drink too much. For more on alcohol and Alzheimer’s, read my article “Is There a Link Between Drinking and Dementia?”)

The MIND diet also calls for the use of olive oil as a substitute for cooking sprays and margarine.

But arguably one of its main thrusts lies in its recommendations concerning meat. There is an overall emphasis on eating less meat, period. The suggestions that I read indicate seven (7) to fourteen (14) portions per week at most. But, there is a decidedly slant towards white meats (mainly chicken, fish, and turkey; but possibly also pork and a few others) over red meats (such as beef and ham).

And this leads to the second, more negative, prong – the subtractions. Dieticians suggest that you cut out red meats almost entirely – regardless of their quality. Dieters are also encouraged to steer clear of all “junk” and processed foods and sugar-based snacks.

Do Eat More of These:

• Beans
• Berries
• Nuts
• Olive Oil
• Vegetables (especially green, leafy ones)
• Wholegrains
• Wine (especially quality reds)

Don’t Eat as Much of These:

• Junk Food
• Processed Food
• Sugar

Again, for a much more detailed list of “dos” and “don’ts,” including specific foods, see my companion article “The Alzheimer’s Dementia ‘MIND’ Diet: What Should You Eat?”

Supplement if Necessary (or Desired)

There is little question but that eating quality foods has got to be the base of your Alzheimer’s-prevention diet. But a case can also be made for boosting the “bioavailability” of certain nutrients and other substances through selective supplementation.

There are many reasons why such supplementation may be necessary. A lot of our food – even when it is organic – is grown in nutrient-depleted soil. This may mean that even a diet that looks great on paper may not actually deliver on all its nutritional promises.

Additionally, we are all subjected – sometimes daily – to various environmental (and other) toxins that tax our bodies’ defense systems and sap our vitality. (For more information, see my article HERE.) The diminution of our nutrients is both a byproduct and a contributing cause of these difficulties. (See HERE.)

What to do?

In order to keep your body within optimal ranges, nutritionally speaking, you may find it advantageous to give your diet a little assist through supplementation.

Moreover, as it turns out, good cases can be made that the availability of certain substances in the body may improve your odds of avoiding Alzheimer’s – or at least slowing down its progression.

Supplements can be grouped under various subheadings. But “herbs” and “vitamins” are two commonly used – even if general – groupings.

Under the category of herbal supplements, you might find recommendations like the following:

• Ginkgo
• Magnolia
• Rosemary
• Saffron
• Turmeric

While, vitamins (and other helpful minerals and nutrients) tend to include things such as:

• Carnitine
• Folic Acid
• Vitamin B12
• Vitamin D3
• Zinc

Elsewhere, I have put together much more detailed expositions of these two subcategories of supplements. If you would like further information, see my articles: HERE, HERE, and HERE.

Drink Clean Water

Water is another fundamental building block of a good diet. Even though water may not spring to mind (no pun intended) immediately when hearing the word “diet,” my contention would be that H₂O is in many ways arguably even more important than some of the other things previously surveyed.

To begin with, a high percentage of our bodies is made up of the stuff. It appears to be essential for human life at every biological level – from our cells and tissues to our organs and organ systems. And it’s equally vital physiologically.

Beyond the vague “hydration,” water plays an important role in many body processes – including cushioning organs, digesting minerals and nutrients, dissolving foreign deposits, excreting waste, lubricating body parts (like eyes, mouths, and other places), maintaining homeostasis (which involves maintaining temperature), and on and on.

You literally can’t live without it. According to one website: “A human can go without food for about three weeks but would typically only last three to four days without water.”[2]

So, it’s clear that we need constant access to fresh water.

And the stuff that we do drink needs continual replenishment because we lose it via digestion, excretion, perspiration, respiration, urination, etc.

But the sad fact is that many people rely on municipal water supplies that have lackluster results when it comes to purification. Practically speaking, this means that a lot of us drink water that is laced with crud.

The nasty stuff in water includes, but is not limited to:

• Heavy Metals
• Herbicides
• Industrial Byproducts and Waste
• Parasites
• Pathogens (including Bacteria, Fungi and Viruses)
• Pesticides
• Pharmaceuticals
• Pollutants
• Radioactive Compounds
• Toxins

This is a shocking list of contaminants for something that is as crucial to life as is water. (If you can stomach it, I have gone into much greater detail on these contaminants, HERE.)

While there may not be any knock-down “proof” that infected or tainted water directly causes Alzheimer’s or other dementias, it is reasonable to believe that imbibing eight (8) or so eight-ounce glasses of filth every day – for years; for decades – is at best placing additional stress upon our immune (and other bodily) systems.

On the other hand, as I mention HERE, some observers actually believe that there are subtypes of Alzheimer’s – one of which, so investigators suggest, may be caused by exposure to toxins or to other nasty stuff. So, at worst, some of the contamination might actually be harming us directly.

But the situation isn’t hopeless. In fact, the fix is straightforward: drink properly purified water! If none is close at hand, then purify your drinking water yourself. There are several methods for this. I’ll list three (3) of the main water-purification options.

1. Boiling – It’s free; theoretically, it’s also straightforward. But it does take time to do. And drinking water must be given additional time to cool. Plus, it may not be “easy” to do when you are trying to monitor a person with dementia.
2. Chemical Disinfection – There are two main varieties of this. Disinfection with chlorine, which is used by many municipal water facilities, and disinfection with iodine, which is used by many campers and outdoorspeople.
3. Filtration – This is going to be the primary method for at-home water purification. There are several types of water filter. Some screw onto the faucet; others go under the sink. Still other filters operate by gravity in stand-alone canisters. Activated charcoal has a great ability to absorb contaminants and is often used as the main filter medium.

Arguably, each of these methods has its place. I go into the three methods at greater length – and offer my own product recommendations – HERE. And, again, my main water-related article can be read HERE.

Presently, my bottom line is merely informational. You should start thinking about these issues and selecting (and implementing) solutions (okay… maybe this pun was intended) for yourself.

Protect Your Home

As I have discussed more extensively HERE, it is probably a good idea to begin making changes to the home environment prior to the onset of any sort of dementia. There are several reasons for this. I will list a couple.

The first reason is that if you make changes early, you yourself will have plenty of time to get used to them before that unhappy time at which you manifest some sort of cognitive impairment. This is important because cognitive impairments – such as Alzheimer’s – often destroy recent and short-term memories. The longer you have had your home’s Alzheimer’s-proofing in place, the more likely those changes are to have found a place in your long-term memory.

The second reason is that changes made in anticipation of a problem will be ready to deal with the problem if it ever materializes. It’s kind of like the old adage that those who prepare for war when there is peace are able to jump into battle without delay when the time comes.

Prepare Your Home Environment for the Worst-Case Scenario

Along these lines, it might be sensible to change your living environment in ways that would make living with Alzheimer’s more manageable.

Whether this actually makes sense for you or not will depend on the resources available and on your specific situation. I recommend having a sort of “advisory committee” to assist you with these kinds of decisions. (This recommendation will be fleshed out in a forthcoming article.)

Basically, I think of things in two related, but slightly different, ways.

In the first place, there will be changes that you will want to make (in some cases) that may be useful when dealing with dementia, but that do not make a lot of sense to make too far in advance.

A prime example of this would be an entrance ramp. You’ll want to have an access ramp in the event that you (or a loved one) is wheelchair bound. But, apart from that, having a ramp on your front door would be a blasted nuisance.

Other examples might be door-knob covers, drawer locks, gates, and other odds and ends that serve to frustrate an impaired person’s attempts to access areas or items that might be unsafe. While everyone in the household is able bodied, these devices will probably only be frustrating.

In the second place, however, will be those changes that can be put in place far in advance, without any negative interruption into your daily life.

Perhaps the foremost illustration of this would be ensuring that your living space has adequate lighting. Making certain that you have a well-lit dwelling will not generally disrupt the lives of anyone in the household. In fact, it will probably make everyone generally safer, since even people with normal mental function can sometimes trip and hurt themselves in dimly lit spaces. Because lighting can also serve as a theft deterrent, investing in it early on is highly advisable.

This category might also include more impairment-specific modifications like having a walk-in bathtub. Although a totally able-bodied person could utilize a walk-in bathtub without any difficulties, such a thing is plainly intended for someone who is physically disabled. The main issue, here, would be the expense. If you’re building a new house and can select any sort of bathtub you wish, then you might consider making it a walk-in. But if you already occupy a finished house, and neither you nor any loved one is physically impaired, then you may much prefer to simply skip the (presently needless) expense of switching the tub out.

Items in this subcategory will also include some simpler gadgetry – like gun locks – that are good ideas to have anyway, regardless of whether there is a cognitively impaired person on the premises or not.

Common Modifications:

• Control Access to Attics, Basements, Garages and Kitchens
• Improve Lighting
• Install Mobility Aids (e.g., Handrails and Grab Bars)
• Lock Cabinets and Drawers
• Secure Firearms, Pharmaceuticals, Thermostats, etc.

For a more complete list of possible home modifications, see my “Ultimate Guide to Alzheimer’s-Proofing A Home: Master List.” Every situation is subtly different. My resource is basically designed to get you brainstorming about changes that may have to be made in your own home.

Are you wondering when to begin making changes? I talk a bit more about that HERE.

Unsure what to buy? I recommend select products HERE.

Protect Your Finances

Among the predictable outcomes of Alzheimer’s Disease is the damage that it – or, more accurately, its (expensive![3]) required care – does to personal finances. With a condition like Alzheimer’s (or another sort of dementia), when a person advances far enough he or she will need around-the-clock care. This kind of care is called “custodial” or “long-term” care. And the kicker? It’s not covered by health insurance or by Medicare.

Be aware that if you or your spouse (or loved one) requires long-term care, the cost can be astronomical (by many people’s standards, anyway). In today’s dollars, nursing homes can cost upwards of $75,000 to $100,000 per year. Depending on the amenities and services provided, many can cost even more. The average nursing-home stay is between two (2) and three (3) years.[4]

Together, these basic facts allow us to predict that anyone who has to enter into a nursing home will be looking at someone in the neighborhood of $150,000-$300,000 just for their custodial care. For a married couple, these baseline figures would have to be multiplied by a factor of two (2), yielding $300,000 to $600,000. And these estimates are somewhat conservative.

Seniors may need other healthcare or services that are not included in the cost of a nursing home.

It’s expensive to grow old. And it’s expensive to receive care for a cognitive (or other) impairment.

This kind of care is usually referred to custodial or long-term care. And, as I have discussed at greater length elsewhere (see HERE), there are really only three (3) main options for paying for it.

1. Private Pay. This simply means that you pay for your (or your loved one’s) care from money that comes out of your own assets or income stream.There are many different income streams that are theoretically possible. If someone is still working, whether full or part time, then he or she will have earned income. Retired persons may have pensions or Social Security benefits. People can have money coming in from alimony or spousal “maintenance.”Other sources sometimes of income may also come into the picture. These can be extremely varied and probably resist exhaustive summary. But common ones include the following: dividends from insurance policies or stocks,[5] income from rental properties, interest from interest-bearing accounts, payments from (private) annuities,[6] renewals from commission sales, residuals or royalties from copyrighted works, and settlements of life-insurance proceeds or trust funds.Assets can be equally varied. But most people will have assets spread across a range of common categories, including banking instruments like certificates of deposit (CDs), checking and savings accounts, money markets, and so on; cash on hand; collectibles (e.g., antiques, precious metals, etc.); houses, land, vehicles, and other owned physical properties (in the form of equity); intellectual properties (copyrights, patents, trademarks); investments (whether bonds, stocks, or something else); life-insurance policies (in the form of cash value); pre-paid funeral expenses or other services; and retirement accounts such as 401(k)s, IRAs, Roth IRAs, SEP IRAs, etc.
2. Medicaid. If you have insufficient assets or income to afford your required care, then one option is to apply for government assistance. In this case, the relevant program is part of Medicaid. However, qualifying for Medicaid first requires that your own assets be more or less fully exhausted. There is a systematic “spend down” that is strictly enforced, leaving the would-be recipient with virtually nothing.Although I cannot advise you of the precise action steps that you’d need to take for yourself or your loved one, I can relate (my memory of) my parents’ experience. When my dad’s retirement account had been exhausted – and his brokerage account value plummeted – Medicaid became the only game in town for them.My dad had to cash out his life-insurance policies, liquidate the remaining money held by his financial adviser, sell his car, and so on. My mom, a longtime schoolteacher, had to spend her own 403(b) down (to around $30,000, if I recall correctly). But she was allowed to keep her residence and her own vehicle.Besides having to be more or less impoverished in order to qualify for it, one downside of Medicaid is that it limits families in terms of where their loved one can receive care. You may not be able to get your loved one into your first-choice nursing home. You will have to find one that has an available “Medicaid bed.” It may not be the closest or best facility for your family’s overall needs. And if a husband and wife both eventually require long-term care, then they may be separated from each other if they are solely dependent on Medicaid.
3. Long-Term-Care Insurance. Alternatively, you can arrange to protect your assets and income with an insurance contract. Long-term-care policies pay out when a person is certified by a medical professional to lack two out of six Activities of Daily Living[7] (ADLs) or to have severe cognitive impairments. However, like the Medicaid Trust (see further down), this option requires a fair bit of foresight. After all, you cannot hope to pass the requisite underwriting process if you’re already demonstrably debilitated.
4. Medicaid Trust. Sometimes, people speak of a fourth option. But this is, in a sense, a variation on the private-pay and Medicaid options. Called a “Medicaid Trust” – when set up correctly by a competent attorney – this instrument allows a person (or couple) to divest themselves of ownership of many of their assets. The idea is that if a person has distanced him- or herself from various assets, then those assets will not be counted when the person is seeking qualification for Medicaid.As with other trusts, the trustees are constrained to use the granted assets for the care of the relevant beneficiary. However, you’ll need a lawyer to draft and file the necessary documents.This option may be a good fit for some families. But the relevant assets must be retitled at least five (5) years prior to going into a long-term-care facility or filing for long-term-care assistance. Additionally, the assets must be granted irrevocably. Finally, if the result is to qualify a person for Medicaid, then all the negatives of Medicaid apply to this option as well.

These are complex topics. In order to become prepared for the future, and to be in a position to make an educated decision when and if the time comes, you should consider speaking with financial, insurance, and legal professionals in your area.

The moral of this brief story is that you need to begin your financial planning before disaster strikes. So, start thinking through the issues today.

Notes:

[1] Ann Norwich, “We’re Not Prepared for the Coming Dementia Crisis,” Washington Post, Oct. 26, 2018, <https://www.washingtonpost.com/opinions/were-not-prepared-for-the-coming-dementia-crisis/2018/10/26/b4484cfc-d914-11e8-9559-712cbf726d1c_story.html>.

[2] Dina Spector, “Here’s How Many Days a Person Can Survive Without Water,” Business Insider, Mar. 8, 2018, <https://www.businessinsider.com/how-many-days-can-you-survive-without-water-2014-5>.

[3] I sketch some of these expenses HERE.

[4] The current number seems to bounce around somewhere in the vicinity of 2.3-2.4 years.

[5] Or income from other equities, securities, and other variable instruments.

[6] On at least a few common definitions, pensions and Social Security would both count as annuities. But here the contrast would be between annuities that an individual buys for him- or herself through a finance or insurance company, as opposed to employer-sponsored or government-subsidized benefit plans.

[7] These including being able to bathe, dress, and feed yourself as well as being able to “transfer” in and out of bed and toilet by yourself and to have control over your bodily functions (continence).