Monday, November 11, 2019

Extraordinary Aging


John le Carré has a new book, Agent in the Field.  It is his 25th book in a writing career that began in 1961.  What’s notable about the book is that le Carré just turned 88 and Agent in the Field is a terrific book, one of his best.  Age can be a limiting factor on creativity, but here is an example of someone who like many of the characters in his books has beaten the odds.

If you are not familiar with le Carré, which is the pen name for David Cornwall, he is the master of spy novels.  He rescued the genre from the James Bond comic book portrayals of spies.  His novels are serious and thoughtful.  They address enduring human qualities—trust, deception, betrayal, and the search for truth.  His best-known novels include The Spy Who Came in from the Cold and Tinker, Taylor, Soldier, Spy and the other Cold War books that feature George Smiley.  As the Cold War wound down, le Carré, began writing about other conflicts, among them Russia’s involvement in Chechnya (The Russia House), Israeli-Arab struggles (The Little Drummer Girl), and the corruption of international drug makers (The Constant Gardener).  Like the earlier Smiley books, these novels are engaging, tense, and interested in character as much as plot.  

In 2017, Le Carré published A Legacy of Spies.  The book was set in the present, but it revisited characters and events from The Spy Who Came in from the Cold and Tinker Taylor.  The book seemed to be a summing up, a capstone for a long odyssey.  By tying up loose ends from the early books, it seemed almost like a retirement announcement.

Yet here is le Carré with a new book.  Agent in the Field has a contemporary feel, not just because it is set in the present, but in the characters and the issues they confront.  Events are colored by Brexit, the disintegration of American foreign policy, and the power of outrageously rich people.  The book has a compelling plot, and like all le Carré’s books, you experience the dilemmas and anguish of the main characters.  The denouement is shocking.  I won’t give any clues, but It took my breath away, and perhaps most upsetting, the ending is quite plausible.  

How has le Carré persisted over his long life as a writer and commentator on contemporary society through his novels?  I really don’t know much about him.  Does he eat a healthy diet and exercise, or like some of his characters in the novels drink a whiskey or two every evening?  In the end, we don’t know much about what makes for successful aging, but le Carré demonstrates what can sometimes be achieved in a long life.

A few additional notes:  

·      If you haven’t read any of le Carré’s books, I’d suggest starting with the classic Tinker, Taylor, Soldier, Spy.  In addition to the book, there is a 2011 movie that was quite good, though it would help to read the book first to be able to keep the characters straight.  There is an even better BBC series based on the book with Alec Guinness playing George Smiley.  It may still be available on Netflix or some other source.   I also just read there is another Guinness series based on the book Smiley’s People.  

·      Other movie versions of le Carré’ books are good.  I particularly liked The Constant Gardener, both the book and the 2005 movie.  

·      And finally—the old writer of the East-West cold war struggles has some choice words in Agent in the Field, about Putin and Trump.


            

Thursday, November 7, 2019

Karen's Students questions

Steve saw this restaurant in Sweden recently

Our friend Karen Fingerman has again asked students in her class on adult development and aging at the University of Texas—Austin to look at our blog, and ask us questions that they would like us to answer.  Karen and her teaching assistant selected 7 questions and sent them to us.  The students once again raised excellent questions. Here are the questions and our answers. 

 1.     How does the death of a partner in old age affect the aging process of the surviving spouse? 
– answered by Judy


This is one of those answers that must embrace individual differences, as we have seen a wide variety of responses to loss of a partner over the years.  Loss of a long-time life partner is always painful, as over time the two people usually have developed a symbiotic sort of relationship.  Whether the loss comes suddenly or after a period of decline, the finality of death forces the survivor to live in an altered reality not of their choosing.  They must make all of the decisions for themselves, after a life of shared decision-making (usually).  


As we think of the many people we have seen, there are probably two or three main patterns. One is for the surviving spouse to want to re-couple as quickly as possible.  We used to think it was mainly men who did this, responding to the casserole-toting widows and divorcees who seek them out, and wanting to find someone to take care of the details of everyday life.  But I have seen quite a few women who also want to remarry quickly, mainly because they cannot fathom not being part of a couple, and they want to resume that "couples" social life.  Once they have re-partnered, they imagine that they will return to their previous status quo.  Sometimes that is the case, sometimes not, depending on how the relationship works out.  For these people, the trajectory of their aging is largely not impacted.


A second group of people are those who have no desire to ever be in another relationship. They may believe that their partner was their lifelong love, and thus, irreplaceable.  Or, if there was an extended period of caregiving, they may not want to take that on again.  Some of these individuals go through an extended period of mourning, which validates the importance of their relationship, and comes to define them to the world. Eventually they may seek out same sex activities or resume previous friendships that do not challenge their decision to remain single. This allows them to develop a social support network that is likely beneficial to their mental and physical well-being.  Other people, however, isolate themselves in their grief, or they may have under-developed social skills that prevent them from joining in activities with others. These individuals are more vulnerable to premature aging, or to poor self-care that may lead to declines in health.


There's a third group we have seen, those who have large extended families, which serve the function of cushioning the isolation that might otherwise occur following the death of a spouse. If there are multiple generations in the family, they may find a helping role, such as caring for grandchildren or preparing holiday meals, that provides meaning and motivation to remain active and engaged in life.


In summary, there are multiple possible ways that loss of a spouse can affect individuals, and the mediating factor in how they navigate the aging process is probably social support.


2.  How does one come to terms with death?  What is the correct time to have a discussion about it? 
– answered by Judy


Having spend thirty years in practice and doing research with aging populations, we have a particular bias about this.  Death is a very natural part of life.  All living things die.  When our four-year-old or seven-year-old grandchild asks about death, we explain it to them in words they can understand.  They lost one of their grandparents about two years ago, when they were two and five.  They lost a great-grandmother six months before that.  They will inevitably lose other people.  Because none of our family has hesitated to respond to their questions, they have a basic understanding that will make it much easier as they go through life.  At times they are sad about it, but they are also accepting of it.  


Unfortunately, many people simply do not want to talk about death.  My father certainly could not.  But my mother, who was his caregiver, was eager to speak up about her wishes at the end.  In the past twenty years, Advanced Directives have become part of estate planning, which present people with the opportunity to designate which life-saving procedures they do or do not want in the event of a fatal situation.  These decisions should be made by the individual unless they are not competent to do so.  Ideally, Advanced Directives are made when the person is perfectly healthy so they can think about them objectively.  What is sometimes not done, however, is to explain exactly what those "life-saving" procedures are and what the consequences may be.  I actually spent a fair amount of time in my practice explaining those things, particularly to my clients who were in assisted living or skilled nursing.  


One way to initiate conversations about death and dying, and particularly end of life decisions, is to do so indirectly.  For example, when an acquaintance or friend of the family member dies, you can have a conversation about what happened and what they might want to have happen differently for them when the time comes.  By the time my mother died at nearly 92, she had seen many, many people die, and it helped her decide what she did and did not want at the end. Every time someone died, we would talk about it, and re-affirm her decisions.



3.  What should you do when differences of opinions arise in a family for end-of-life care? –answered by Judy
 This is related to the previous question.  The ideal situation is for the person who is dying to have already made those choices.  The next best choice is for the dying individual to have indicated who they wanted to make those choices for them.  My mother chose to move to be near me because she knew that not only did I know what she wanted, but that I wouldn't be afraid to follow through on her choices in the face of criticism from other family members.  As it turned out, by the time she died, the entire family was supportive of her decisions, which made our life simpler.  However, there are times when family members come forward with their own ideas that are different from either the dying person or their spouse, and that can cause needless emotional distress for the caregiver.


When decisions have not been made ahead of time, health care providers will sometimes be helpful in explaining exactly what the options are, but not always.  Sometimes they simply don't take the time, and sometimes their explanations are hopelessly medicalized so no one really understands them.  Some health care workers are uncomfortable talking about death and dying, too, and it causes them to either hold out false hope or to fail to respond realistically to family's questions.  In that case, if there is a social worker or psychologist available with expertise in end of life care, having a disinterested third party can help everyone come to a compromise agreement.

4.  In class, I have learned that stress does seem to age you faster as opposed to being carefree. As a 20 year old worried about her aging parents, how can I convince them to take advantage of vacation days without making them more stressed about missing out on work days? 
–answered by Steve and Judy

You ask a good question about the association of stress and aging, and it sounds like you want to have a positive influence on your parents.  It sounds like you already know that they do not readily take advice when it comes from their child.  That is very common in parent-child relationships.  One reason for this resistance is that parents still see themselves in the parenting role, no matter how old their children might be.  Their adult children give advice, but their parents don’t necessarily take it.  They also may resist changes, because they want to stay in control of their lives.  So when a child tells them what to do, they often resist, even if what the child proposes is a reasonable thing to do.

Instead of suggesting ways your parents might manage the stress in their lives, you might take a more indirect approach. When someone they know takes a vacation, you may show an interest in how those people have lowered their stress by using their vacation days effectively. Similarly, if you find an article (and there are lots of articles about stress and how to lower it), you might send that on to them. Lowering stress is about making conscious choices about how you use your time, and includes things like diet, exercise and self-care, so you can perhaps try to do some of those things yourself, and share your experiences about how it lowers your own stress.  When you bring up the subject by talking about what other people do, it is less challenging than giving advice, and less likely to be perceived as a criticism.

5.  Both of my mother’s parents had Alzheimer’s before they died. My mother has lived the majority of her adult life with the thought that she will most definitely get Alzheimer’s one day. How can I change my Mother’s mindset regarding her future with Alzheimer’s?
 –answered by Steve and Judy

All the publicity about Alzheimer’s disease and other degenerative brain diseases has been helpful in raising awareness and research funds, but the downside is that this attention also raises people’s fears.  For most people the risk of dementia is fairly low, at least until advanced ages (over 85), but that does not stop some people from worrying over each lapse of memory.  For someone whose parents both had Alzheimer’s disease, the risk is greater, and worrying about what may happen is understandable.

When people potentially have genetically-influenced disorders such as Alzheimer’s, the challenge is to live a full life as long as they are able.  In a way, we all face that challenge as we grow older, that is, we know something bad will eventually happen, but we don’t know when.  As we wrote in the previous example, you will have more success approaching your mother indirectly, rather than giving her advice.  There are a lot of articles about possible strategies for lowering risk of dementia.  You can pick out articles now and then and show it to your mother.  Or you might try one of the strategies yourself, like exercise or diet, which are good generally for health.  As we suggested above, your conversation with your mother can be about what other people have done, or your own experience, rather what she should do.  

When we started working in this field, over forty years ago, there was far less information about Alzheimer's disease and dementia.  The common view was that if you lived to a very old age, you might become senile, and that was to be expected.  As a consequence, not many people worried about it, perhaps because they correctly assumed they might die of something else before that time came.  As the dementias became better known, and the possibility of a genetic component became publicized, anxiety about the future began to increase in our client populations.  

Now fear of Alzheimer's is a standard feature of conversations among older people.  So while the actual numbers of people who get it have probably not changed, the number of people who are afraid they will has increased exponentially.  Trying to get people not to worry about what might not happen can be an exercise in futility, particularly in the face of the constant barrage of news articles about it.  We have seen the ravages of dementia up close, and neither of us would want that to happen to us.  But, of course, it could.  The odds are better that it won't though.  So the challenge is to find a way to think about it to ease the anxiety.  

Anxiety is a generalized worry about what might happen in the future.  One way to deal with it is to find aspects of the problem that you do have control over.  That includes making decisions about the future, should your mother become incapacitated. Now, while she is fine, is exactly the right time to do it.  Who would she want to make decisions for her if she was unable?  What kind of living situation would she prefer? Once these decisions have been made, she might be able to let go of worrying about it on a daily basis, knowing that she has done everything she can to plan for the future.  The best outcome would be if she decided to postpone worrying about it so that she can enjoy the present time with you.



6.  My biggest fear is to live a life full of regrets, only to realize those regrets didn’t matter in the end.What regrets do you wish you let go of as you’ve aged? 
–answered by Steve

This is wonderful question that gets at an issue, regret, which is widely discussed in literature, but not in adult development.  Regret highlights a major challenge that young adults face, how to know that the decisions you are making will lead you down the right path, or leave you feeling disappointed with your life.

We have had ups and downs in our lives, and we certainly have some regrets, but on the whole we feel good about what we have done and the choices we made. One reason is we were open to opportunities that arose.  For example, we moved across country when our children were still young to take new and better jobs and to live in a better environment.  Although we had time-consuming jobs, we found time to do the things we enjoy, such as traveling.  Judy says she has heard older clients say they regretted not having taken trips, but no one ever told her they regretted taking trips.

One thing we have always been able to do is make decisions quickly.  Once we get a sense of what we think is the best choice, we move ahead.  I probably do a little more mulling on decisions than Judy, but we almost never have gotten stuck.  Some choices have not worked out as well as we hoped, but we don’t find ourselves dwelling on regrets.  Instead, we are able to enjoy the good things in our lives.  

In the next few years, you are likely to face a lot of decisions that will affect the course of your life.  If you tend to get stuck trying to make decisions, there is a strategy that will help.  Divide a piece of paper into two columns and write down the pros and cons of the choice you have.  Doing pros and cons can help you organize your thoughts, and weigh more carefully whether to proceed or not.  You can also see if you need more information before you make your decision. 

You can also use pros and cons if you tend to be impulsive and find yourself regretting hasty decisions? Do you rush into relationships or purchases or other things?  You might want to make a rule that you won’t make big decisions without taking some time to think things through.  Doing pros and cons will give you time to sort out your thoughts and look at the possible risks and gains.  


7.  How do you prevent social, emotional, and physical isolation in old age? 
answered by Steve

This question focused particularly on the isolation that can occur following placement in a nursing home.  People who are moved into nursing homes are cut off from family and friends, and are likely to experience feelings of loneliness and isolation.  Many nursing homes welcome visitors, but some do not or do not provide places where the resident and friends can comfortably visit.  For many people, visiting a friend or relative in a nursing home is upsetting.  They do not want to be around people who are old and sick, or have trouble figuring out what to say or do with their friend or relative. And no matter how skilled and caring the staff may be, the social activities they organize in a nursing home will not replace a resident’s long-standing relationships or the comfort of one’s own home.

Nursing homes can take some practical steps to help foster visits from family and friends.  At the time of placement, a staff member can give family members an orientation to the facility, talking about the importance of visiting and helping families think about what they might do or say during the visit.  Family may feel guilty for placing a parent or spouse, and being able to talk about that can help them get past feelings of awkwardness about visiting.  Staff can also be supportive of visits, making sure the visitors feel welcomed and getting to know the visitors. Better facilities have support groups for family members, often led by a member of the social services staff.

An unfortunate aspect of most US nursing homes is that residents live in small rooms with one or sometimes multiple roommates.  The lack of privacy leads people to withdraw within themselves, and makes visitors uncomfortable.  Although it is not likely that facilities will suddenly change to single rooms, they should be able to provide an attractive place for visits, including private areas away from other residents and blaring televisions.  Single rooms are the norm in most economically-advanced countries, but that is another discussion.

Of course, the biggest obstacle to these strategies for reducing isolation is cost.  The argument will be that staff are too busy or that space is simply not available or that family simply do not want to visit.  But we have been in facilities that provide care in a welcoming, attractive, and homelike setting, and where staff emphasize their interactions with residents and their families.  When you find a special facility like that, talk it up or write a letter to your local newspaper or on a social website.  


Wednesday, October 16, 2019

Some Sound Advice for a Healthy Old Age

Duck Confit at Chez Panisse

It’s rare to find a sensible article about healthy aging these days.  A recent article in the Washington Post is a rare exception.  The article is entitled, “The longevity files: A strong grip? Push-ups? What actually can help you live to a ripe old age.”  The author, Christie Aschwanden, sifts through the various claims, and explains why so many of the assertions about diet, exercise or other life style factors are likely to be exaggerated.  For example, why do people who do 40 pushups have a lower risk of cardiovascular disease?  The answer—people who can do 40 pushups are healthy enough to do them in the first place.

The message of the article, which we strongly agree with, is that there is no magic bullet, no specific exercise or diet or other lifestyle that will help us live longer and healthier.  But the article makes a strong case that there are some fundamental approaches that do help.  

First and foremost is exercise.  The benefits of regular moderate exercise are well-established for reducing the risk of illness.  Intensive exercise does not add any additional health benefits, but is more likely than moderate activities to lead to injuries.  Staying fit also means we can do more of the things we want and have better recoveries from illness or surgeries. 

Likewise, with diet, moderation is the key.  The claims of benefits of anti-aging diets and anti-aging foods are exaggerated.  The Mediterranean diet has gotten considerable attention for lowering cardiovascular disease, but the article and our own reading of the evidence suggests the effects are modest.   Maintaining a good weight (not too high, but also not too low) is also important for health

Other strategies mentioned in the article for sustaining health were being engaged in activities and
with other people, getting enough sleep, and lowering stress.  The claims about health benefits of red wine and other alcohol, however, were probably exaggerated.  People who had health problems were probably less likely to drink in the first place.  

The barrage of health claims in the media and on the web is likely to continue, along with articles that counter these claims.  Stories this past month reported on research that suggested that beef and pork and even cured meats are not actually bad for us.  The article has produced a firestorm of response in the public health field.  Scientists at Harvard are quoted as saying that the conclusions of the article “harm the credibility of nutrition science and erode public trust in scientific research.”  But the real conclusion is that weak research that makes sweeping claims about health benefits of a particular diet or exercise or life style erodes public trust, and really just confuses us all.  

That’s the conclusion that Aaron Carroll also makes.  Carroll, who is a researcher at Indiana University of Medicine, is our favorite writer on health issues.  Most writers report on findings that reinforce their beliefs, and most of us pay attention only to the headlines consistent with what we want to believe about healthy living.  Carroll is different.  He understands research and weighs the evidence carefully.  He provides balanced and thoughtful articles on health issues.  We have provided a link to his column on the red meat controversy and a couple other articles on the topic.

For Aaron: Carroll’s article on red meat:



 https://www.nytimes.com/2019/10/14/upshot/diet-soda-health-myths.html

Wednesday, September 18, 2019

Celebrating Our 39th Anniversary in Paris

Here we are with Notre Dame behind us

We have just come back from Europe, where we celebrated our 39thwedding anniversary.   The trip came about because Steve had been invited to speak at a conference, the International Psychogeriatric Association, which was held in Santiago de Compostela in Spain.  Santiago de Compostela turned out to be a lovely town.  For over a thousand years, the town has been the destination of a great pilgrimage to visit relics of one of the apostles, St. James.  The relics are housed in a magnificent cathedral.  Pilgrims from all over Europe walk to Santiago de Compostela to visit the relics.

The conference was quite interesting.  Of particular note was the importance several speakers placed on providing high quality medical and social care for persons with dementia.  That sounds obvious, yet often the obvious medical problems get overlooked, partly because persons with dementia sometimes can’t report problems and partly because medical personnel are not trained to look for problems.  As a result, undiagnosed health problems and untreated pain diminish the person’s quality of life and may compromise further the person’s cognitive ability.  Speakers also discussed how social care and the quality of the environment can likewise make a difference for people with dementia.

Since we were going to be in Europe, we decided to stay longer and celebrate our anniversary in Paris. We have been to Paris many times, but we still enjoy going there.   We have seen the major tourist sites, and so we don’t feel pressure to cram in visits to the Louvre or to ride up to the top of the Eiffel Town.  Instead, we have a leisurely pace.  We may seek out a small museum we have not been to before, or just walk through an interesting neighborhood.  Judy keeps a list of restaurants in Paris that she reads about, and we visit new places as well as old favorites.  

We have found a hotel that we like that is down the block from our favorite bakery, Gontran Cherrier, where we buy breakfast pastries and a half baguette for later in the day.  The hotel is in a neighborhood that is off the main tourist route and it looks like a movie set of Paris 75 or 100 years ago. The narrow streets are filled with cafes and shops.  In the morning, we see shopkeepers opening up. The fish monger has a prominent location at a street corner, and each morning except Monday starts setting out fish on ice in front of the store.  The same routine is going on at other stores.  You can get almost anything you might need.  Beginning around 4 pm, the cafes begin to fill up with local people, having a drink and sometimes staying for dinner.  People are out walking as well, and children can ride on a merry-go-round in the middle of the neighborhood.

You might ask, why make a big deal on a 39thanniversary?  Why not wait a year to the 40thanniversary and do a big trip then?  First, of course, was the opportunity.  We were in Europe anyway.  But more importantly, what we have learned about aging is to take advantage of opportunities now, because you never know what might happen in the next year.  This is not a morbid thought.  Rather, we are being practical and know that at some point we won’t be able to make this kind of trip.  We have known a lot of older people who say they regret not having traveled to some place special when they still could, but we have never met anyone who said they regretted having made a trip or pursued some other opportunity to do something they always wanted to do. 

While we were in Paris, we had time to talk about the places we love to visit and things we like to do, and we hit on an idea that is perfect for our 40th.  Tune in next year to find out what it is.

Tuesday, September 17, 2019

The Liberation Museum in Paris

The bunker

We grew up in the shadow of World War II. When we first came to Paris many years ago, the scars of the war including the ruins of bombed out buildings, were still present. We've read many books and seen lots of movies about the war. Some of those stories were about the heroic efforts of the French resistance.  So we had an idea what it was like during the war in France and in Paris.

On our recent visit to Paris, we went to the Musee de la Liberation de Paris (The Liberation Museum of Paris), which had recently moved to a new building.  The way this museum was designed, we felt that we were stepping back in time as we followed a timeline from World War I onward.  The losses in the first World War were devastating to France, which we had seen evidenced in the memorials in every little town listing the fallen in both wars.  Whole families were erased in that first war, and the French had little appetite for another war so soon.  They slid into denial when Hitler first started his advances, and they thought it would be possible to reach an accommodation that would avoid a war.  As a result, France was late to rearm and prepare for war. After the Germans occupied France, some people actively supported Nazi ideas and worked with the occupying forces.  Other people remained passive, hoping just to get by.  Many others, however, realized how horrible the situation was and became part of the resistance. 

The museum told the story of the war, occupation, and liberation through the lives of two individuals, Jean Moulin and Philippe de Hauteclocque, who used the alias “Leclerc.”  By focusing on two minor figures not everyone knows, the museum brought the story down to a personal level. Although they came from very different backgrounds and held different political beliefs, both Moulin and Leclerc made the decision not to go along with the occupation, but to resist. Moulin had been mayor of a Paris suburb when France fell to the Germans in 1940. He quickly became active in the resistance and was captured and killed by German forces in 1943.  Leclerc was an officer in the army who fled the country after the occupation, and joined the Free French forces in Africa. In 1944, he led the French troops that liberated Paris. 

The museum also highlighted stories of ordinary people and what they did during that time. 
When you read histories or historical novels of that era, it's tempting to imagine that you would do something heroic, out of a sense of commitment and honor.  While we were struck by the heroism of these individuals, it was also apparent that their lives were threatened on a daily basis, so in a sense they had nothing to lose to take a risk. They could die anyway, even if they did nothing to oppose the occupation. You’d like to imagine you’d be the one who would be the hero, but if you’re not tested you never know. 

The museum had photographs, letters, newspapers and even some films clips.  One film showed a woman during the fight to liberate Paris.  She was young, perhaps 21 or 22 years old, and was fearless. During a firefight, she saw a German soldier go down in the street.  She rushed out and wrestled his rifle and other weapons away from him. We don’t know what happened to her or whether she even survived the war. But Judy, especially, was drawn to her because she epitomized the fearlessness that she hoped she might have had in that situation.

The new museum building has been constructed over a bunker that had served as the hub of resistance activities in the days leading up to the liberation. The Nazis knew there was an air raid shelter there. They didn’t know the resistance had dug out a bunker underneath it  and made it a control center for resistance activities across Paris.  As we stood In the bunker, it was possible to imagine the activities that took place there, and the incredible tension they lived under as they fought for their lives and the freedom of their country.  We came away awed and inspired by the courage they showed in what had to have seemed like a hopeless situation. 

Sunday, August 4, 2019

Would You Want to Know If You Will Develop Alzheimer’s Disease?



            Identifying early markers of Alzheimer’s disease has long been a goal of research.  Some new developments suggest that it may be possible soon to identify whether someone who is not currently symptomatic is beginning to accumulate clumps of amyloid in the brain.  Would you want to know?
            Paula Span, one of the best writers about aging issues, has an excellent column this week about this issue.  PET scans can identify with some accuracy accumulations of amyloid in the brain.  These scans are expensive, $5000 to $7000 each according to Span, and are not covered by insurance, including Medicare. The Alzheimer’s Association has long advocated that Medicare cover PET scans, but Medicare will not pay for tests that do not lead to therapeutic interventions.  Besides PET scans, a recent article reported that a blood test that examined the ratio of two types of amyloid could fairly accurately predict amyloid in the brain.  It has been possible for a while to test for the genetic marker for at least some cases of late onset Alzheimer’s, the APO E4 allele.  
            But would you want to know?  And what difference would it make for you?
            Of course, if there were a treatment that would slow or entirely prevent Alzheimer’s, it would make sense to know.  But there is no treatment.  
            Would you change your lifestyle, exercising more and eating a healthier diet?  This is something we should all do anyway, because it will help us maintain health and better functioning longer.  Would knowing you were going to get Alzheimer’s disease make a difference?  A recent study suggests that lifestyle offers some protection for people with genetic risk (Lourida et al., 2019).  The difference is small, but encouraging. But maybe some people would go the other direction—if you are going to get Alzheimer’s, you might as well enjoy life to the max now.  To hell with diet and exercise.  
            Span discusses whether knowing one’s risk might lead to developing an advanced care plan, including advance directives and someone you trust to manage your estate if you are no longer capable.  Again, this is something we all should do anyway. 
            Would knowing your risk lead you to make different life decisions?  Would you stop putting off traveling to places you have always wanted to visit or doing things you have always wanted to do?  Again, it would be a good thing to start doing those things anyway.  Judy and I have gotten good at seizing opportunities.  We both feel good now, but we don’t know how long that will be the case.  We have also gotten past the bucket list approach.  We don’t want to go to every exotic place, but instead, we travel to places that call to us in one way or another.  Frankly, the call often is from the food, or to visit with friends.  Would you rather worry about amyloid or search Paris for the best croissant?
            There is one other issue about wanting to know.  Not everyone with accumulations of amyloid develops dementia, and some types of dementia may not involve amyloid at all.    So these tests may indicate increased risk, but not everyone will get the disease.  
            We think it’s important to have a plan.  Rather than worrying about what might happen—something bad will eventually happen—we try to use the opportunity we have to do things that we value and enjoy.  

For Paul Span’s article…

Lourida, I. et al. (2019). Association of lifestyle and genetic risk with incidence of dementia.  JAMA.  doi: 10.1001/jama.2019.9879.