The most comprehensive analysis to date of research on the effect of negative stereotypes on older people's abilities has concluded that these stereotypes create a significant problem for that demographic.
31 jan 2015--A research team at the University of Kent's School of Psychology carried out a review and meta-analysis of Aged-Based Stereotype Threat (ABST).
They statistically analysed international evidence from 37 research studies, both published and unpublished. They concluded that older adults' memory and cognitive performance is negatively affected in situations that signal or remind them of negative age stereotypes. These effects affect both men and women.
The research, funded by the Economic and Social Research council (ESRC), was carried out by Ruth Lamont, working with Dr Hannah Swift and Professor Dominic Abrams. It further found that older people's cognitive performance suffers more when the threat is induced by stereotypes rather than by facts.
The meta-analysis showed that even a hint that performance was being pre-judged because of age criteria was enough to affect older people's performance.
Ruth Lamont said that the study evidence highlighted that even 'subtle differences' in the way people behave toward older people - such as being patronising or speaking slowly - could be enough to make them underperform when others are testing their abilities, either formally or informally.
Researchers have previously concluded that stereotype threat affects the major social categories of gender and ethnicity, but this new meta-analysis, which looked at evidence from over a decade of research, highlights the need to be just as concerned about age stereotypes, Ruth Lamont suggested.
The research team further conclude that the vulnerability of some older adults to ABST when they perform memory, cognitive or physical tasks has important social, economic and clinical implications which will become more relevant given an increasingly aging population and workforce.
More information: The paper, titled A Review and Meta-Analysis of Age-Based Stereotype Threat: Negative Stereotypes, Not Facts, Do the Damage, is published in the American Psychological Association's journal Psychology and Ageing. See: psycnet.apa.org/?&fa=main.doiL… doi=10.1037/a0038586
Provided by University of Kent
Wednesday, January 28, 2015
New study reveals active sex lives of the over 70s
Older people are continuing to enjoy active sex lives well into their seventies and eighties, according to new research from The University of Manchester and NatCen Social Research.
28 jan 2015--More than half (54%) of men and almost a third (31%) of women over the age of 70 reported they were still sexually active, with a third of these men and women having frequent sex – meaning at least twice a month – according to data from the latest wave of the English Longitudinal Study of Ageing (ELSA).
The paper, lead authored by Dr. David Lee, an Age UK Research Fellow at The University of Manchester's School of Social Sciences and entitled "Sexual health and wellbeing among older men and women in England," is published in the American academic journal Archives of Sexual Behavior.
It is the first study on sexual health of its kind to include people over the age of 80 and uncovers a detailed picture of the sex lives of older men and women in England, finding that a sizeable minority remain sexually active in their old age.
Contrary to popular misconceptions, it finds that overall health and conflicting partnership factors were more closely linked to decreasing sexual activity and functioning, rather than simply increasing age.
Of the more than 7000 people who responded to the questionnaire, very few (less than 3%) declined to answer direct questions about their sexual activities and problems.
Dr Lee said: "This is the first nationally-representative study to include people over the age of 80 when asking older men and women in England about their sexual health.
"We hope our findings improve public health by countering stereotypes and misconceptions about late-life sexuality, and offer older people a reference against which they may relate their own experiences and expectations.
"Our ongoing research is also highlighting the diversity of late-life sexualities, and trying to impose youthful norms of sexual health on older people would be over-simplistic and even unhelpful.
"It is however important that health professionals act on this and are more open about discussing sexual health with older people – it can't simply be assumed to be an irrelevance."
Problems most frequently reported by sexually active women related to becoming sexually aroused (32%) and achieving orgasm (27%), while for men it was erectile difficulties (39%). Chronic health conditions and poor self-rated health seemed to have more obvious negative impacts on the sexual health of men compared to women.
Men were more concerned about their sexual activities and function than women and, with increasing age, these concerns tended to become more common. Sexually active women were less dissatisfied with their overall sex lives than men, and also reported decreasing levels of dissatisfaction with increasing age.
The study also found that many septuagenarians and octogenarians were still affectionate towards their partners, with 31% of men and 20% of women reporting frequent kissing or petting. Among those who reported any sexual activity in the past three months, 1% of men and 10% of women reported they felt obligated to have sex.
Caroline Abrahams, Charity Director at Age UK, said: "The fact this is the first time that people over 80 years old have been included in this kind of research highlights how often the public health needs of older people, including sexual health, are ignored or overlooked.
"With an ageing population it is important that providers of sexual health services understand the needs of older people in both clinical settings and when developing information and advice. These recent findings now need to be used to improve sexual health advice and information for older people."
Provided by University of Manchester
Tuesday, January 27, 2015
Higher dementia risk linked to more use of common drugs
Diagram of the brain of a person with Alzheimer's Disease. Credit: Wikipedia/public domain.
27 jan 2015--A large study links a significantly increased risk for developing dementia, including Alzheimer's disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine (Benadryl). JAMA Internal Medicine published the report, called "Cumulative Use of Strong Anticholinergic Medications and Incident Dementia."
The study used more rigorous methods, longer follow-up (more than seven years), and better assessment of medication use via pharmacy records (including substantial nonprescription use) to confirm this previously reported link. It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist—and may not be reversible even years after people stop taking these drugs.
"Older adults should be aware that many medications—including some available without a prescription, such as over-the-counter sleep aids—have strong anticholinergic effects," said Shelly Gray, PharmD, MS, the first author of the report, which tracks nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought (ACT), a joint Group Health-University of Washington (UW) study funded by the National Institute on Aging. "And they should tell theirhealth care providers about all their over-the-counter use," she added.
"But of course, no one should stop taking any therapy without consulting their health care provider," said Dr. Gray, who is a professor, the vice chair of curriculum and instruction, and director of the geriatric pharmacy program at the UW School of Pharmacy. "Health care providers should regularly review their older patients' drug regimens—including over-the-counter medications—to look for chances to use fewer anticholinergic medications at lower doses."
For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg/day of doxepin, 4 mg/day of diphenhydramine, or 5 mg/day of oxybutynin for more than three years would be at greater risk for developing dementia. Dr. Gray said substitutes are available for the first two: a selective serotonin re-uptake inhibitor (SSRI) like citalopram (Celexa) or fluoxitene (Prozac) for depression and a second-generation antihistamine like loratadine (Claritin) for allergies. It's harder to find alternative medications for urinary incontinence, but some behavioral changes can reduce this problem.
"If providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient," Dr. Gray said, "they should use the lowest effective dose, monitor the therapy regularly to ensure it's working, and stop the therapy if it's ineffective." Anticholinergic effects happen because some medications block the neurotransmitter called acetylcholine in the brain and body, she explained. That can cause many side effects, including drowsiness, sore throat, retaining urine, and dry mouth and eyes.
"With detailed information on thousands of patients for many years, the ACT study is a living laboratory for exploring risk factors for conditions like dementia," said Dr. Gray's coauthor Eric B. Larson, MD, MPH. "This latest study is a prime example of that work and has important implications for people taking medications—and for those prescribing medications for older patients." Dr. Larson is the ACT principal investigator, vice president for research at Group Health, and executive director of Group Health Research Institute (GHRI). He is also a clinical professor of medicine at the UW School of Medicine and of health services at the UW School of Public Health.
Some ACT participants agree to have their brains autopsied after they die. That will make it possible to follow up this research by examining whether participants who took anticholinergic medications have more Alzheimer's-related pathology in their brains compared to nonusers.
More information: Cumulative Use of Strong Anticholinergic Medications and Incident Dementia, JAMA Internal Medicine, 2015.
Provided by Group Health Research Institute
Saturday, January 24, 2015
Four factors impact QoL from perspective of dementia sufferers
24 jan 2015—Four factors have been identified that affect quality of life from the perspective of people with dementia. The findings were published in the January issue of the Journal of the American Geriatrics Society.
Hannah M. O'Rourke, B.Sc.N., from the University of Alberta in Edmonton, Canada, and colleagues conducted a systematic review and meta-synthesis of primary qualitative studies to identify factors that influence quality of life from the perspective of individuals with dementia. Eleven qualitative studies were identified, which included a combined sample of 345 people with mild, moderate, and severe dementia. The techniques of taxonomic analysis, constant comparison, and importing concepts were used to synthesize findings from primary studies.
The researchers found that, according to people with dementia, four factors and the experience of connectedness versus disconnectedness within each factor influenced quality of life. These factors were relationships (together versus alone), agency in life today (purposeful versus aimless), wellness perspective (well versus ill), and sense of place (located versus unsettled). The key outcomes of good and poor quality of life were happiness and sadness, respectively.
"The four factors identified potentially modifiable areas to improve quality of life for people with dementia, even in the context of worsening cognitive function," the authors write.
Hospitalized for pneumonia? Your risk of cardiovascular disease is higher
Your chance of having a heart attack or stroke increases significantly if you have been hospitalized for pneumonia, according to a paper published today in the influential JAMA (Journal of the American Medical Association).
21 jan 2015--"The main conclusion from our study is that someone hospitalized for pneumonia should be considered at greater risk of developing cardiovascular disease," said lead author Dr. Vicente Corrales-Medina, an infectious diseases physician and researcher at The Ottawa Hospital, and assistant professor with the University of Ottawa's Faculty of Medicine.
"This means two things. First, it provides yet another reason to do everything we can to prevent pneumonia from occurring in the community, through vaccination and basic hand hygiene, for example," he continued. "This is especially important for the elderly and those with other risk factors for cardiovascular disease, such as diabetes, smoking and high cholesterol."
"Second, once pneumonia has occurred, physicians should develop a care plan understanding that these patients are more likely to develop cardiovascular disease in the weeks, months and years following their recovery from this infection," added Dr. Corrales-Medina. "Such measures could include screening and primary prevention strategies for cardiovascular disease."
While other studies have made the connection between pneumonia hospitalization and cardiovascular disease, this is the first to only look at pneumonia patients with no previous history of cardiovascular disease while also taking into account the effect of other established cardiovascular risk factors. By doing so, their results strongly indicate that hospitalization for pneumonia should be considered its own risk factor for future cardiovascular disease.
The JAMA paper used records of 3,813 people from two community health studies, both based in the United States. One enrolled participants aged 65 and older and the other enrolled participants aged 45 to 64. The JAMA study analysed health data of 1,271 pneumonia patients against 2,542 control patients (matched by age) over a period of 10 years.
Results showed that these pneumonia patients had a raised level of risk for cardiovascular disease over the entire 10 years, with the highest risk experienced in the first year. For example, in the group aged 65 and older, a pneumonia patient was four times more likely to develop cardiovascular disease in the first 30 days following the infection. In the tenth year, they were a little less than twice as likely to develop cardiovascular disease.
Another way of looking at it: The 10-year risk of developing cardiovascular disease for a 72-year-old woman with two cardiovascular risk factors (hypertension and smoking) increases from 31% to 90% if she is hospitalized for pneumonia.
Results from the group aged 45 to 64 showed that the risk was higher in the first two years, but not significantly raised after that. In this younger group, a pneumonia patient was 2.4 times more likely to develop cardiovascular disease in the first 90 days after the infection.
Dr. Corrales-Medina's current research is focused on trying to determine what biological mechanisms are responsible for this raised risk of cardiovascular disease after pneumonia, in order to develop therapies to prevent the subsequent onset of cardiovascular disease.
More information: "Association Between Hospitalization for Pneumonia and Subsequent Risk of Cardiovascular Disease" JAMA, 2015. doi:10.1001/jama.2014.18229
Provided by Ottawa Hospital Research Institute
Tuesday, January 20, 2015
Drinking moderate amounts of alcohol is linked to reduced risk of heart failure
Evidence already exists for the beneficial effects of drinking moderate amounts of alcohol on the risk of developing a number of heart conditions; however, the role it plays in the risk of developing heart failure has been under-researched with conflicting results.
20 jan 2015--Now, a large study of nearly 15,000 men and women, published online today (Tuesday) in the European Heart Journal, shows that drinking up to seven drinks a week in early to middle age is associated with a 20% lower risk of men developing heart failure in the future when compared to people who did not drink at all, and a more modest 16% reduced risk for women.
Heart failure is a condition in which the heart can no longer pump blood around the body as well as it used to. The most common reason is that the heart muscle has been damaged, for instance by a heart attack. High blood pressure, heart muscle disease (cardiomyopathy), heart valve problems, an irregular heart beat (arrhythmia), viral infections, drinking excessive amounts of alcohol, consuming recreational drugs and the side-effects of radiotherapy treatment for cancer can all contribute to heart failure developing. Heart failure is a major public health problem with over 23 million people living with it worldwide.
Dr Scott Solomon, Professor of Medicine at Harvard Medical School and Senior Physician at Brigham and Women's Hospital, Boston, USA, Dr Alexandra Gonçalves, a research fellow at Brigham and Women's Hospital, and colleagues analysed data from 14,629 people aged between 45-64 years who had been recruited to the Atherosclerosis Risk in Communities Study between 1987 and 1989 in four communities in the USA. They followed the participants for 24-25 years to the end of 2011, and they questioned them about their alcohol consumption at the start and at each of the three subsequent visits made at three-yearly intervals.
They defined a drink as one that contains 14g of alcohol, equivalent to approximately one small (125ml) glass of wine, just over half a pint or a third of a litre of beer, and less than one shot of liquor such as whisky or vodka. The study participants were divided into six categories: abstainers (people who recorded having drunk no alcohol at every visit by the researchers), former drinkers, people who drank up to seven drinks a week, or between 7-14 drinks, 14-21 drinks, or 21 or more drinks a week.
During the follow-up period 1271 men and 1237 women developed heart failure. The lowest rate of heart failures occurred in those drinking up to 7 drinks per week and the highest rate was seen among former drinkers.
After taking account of various factors that could affect the results such as age, diabetes, high blood pressure, heart disease or heart attacks, body mass index, cholesterol levels, physical activity, education and smoking, men who consumed up to seven drinks a week had a 20% reduced risk of developing heart failure compared to abstainers, while the risk was reduced by 16% in women consuming the same amount. Former drinkers had the highest risk of developing heart failure - a 19% and 17% increased risk among men and women respectively compared to abstainers. Interestingly, among both men and women consuming the most amount of alcohol (14 or more drinks a week), the risk of heart failure was not significantly different compared to the risk for abstainers. Drinking excessive amounts of alcohol over a long period of time is known to increase the risk of cardiomyopathy. However, the number of very heavy drinkers in the study was small, which could have limited its power to detect such an association.
However, when the researchers looked at death from any cause, there was an increased risk of death of 47% for men and 89% of women who reported consuming 21 or more drinks a week at the start of the study.
Professor Solomon said: "These findings suggest that drinking alcohol in moderation does not contribute to an increased risk of heart failure and may even be protective. No level of alcohol intake was associated with a higher risk of heart failure. However, heavy alcohol use is certainly a risk factor for deaths from any cause.
"The people who were classified as former drinkers at the start of the study had a higher risk of developing heart failure and of death from any cause when compared with abstainers. This could be related to the reasons why they had stopped drinking in the first place, for instance because they had already developed health problems that might have made them more likely to go on to develop heart failure."
The protective effect of moderate drinking were more marginal in women than in men and the authors think this may be due to the fact that women metabolise alcohol in a different way to men and it can affect them differently.
Overall, most participants were abstainers (42%) or former drinkers (19%), with 25% reporting up to seven drinks a week, eight percent reporting seven to 14 drinks a week, and three percent reporting drinking 14-21 and 21 or more drinks a week respectively. Most drinkers also drank more than one type of drink. This meant that the researchers were unable to assess the role of binge drinking or any differences between types of drink.
"It is important to bear in mind that our study shows there is an association between drinking moderate amounts of alcohol and a lower risk of heart failure but this does not necessarily mean that moderate alcohol consumption causes the lowered risk, although we did adjust our results to take account, as far as possible, for a variety of other lifestyle factors that could affect a person's risk," concluded Professor Solomon.
More information: "Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study", by Alexandra Gonçalves et al. European Heart Journal. DOI: 10.1093/eurheartj/ehu514
Provided by European Society of Cardiology
Monday, January 19, 2015
100 million Americans live with chronic pain, but treatment research is insufficient
An estimated 100 million Americans live with chronic pain. A new report by an independent panel convened by the National Institutes of Health has found a need for evidence-based, multidisciplinary approaches to pain treatment that incorporate patients' perspectives and desired outcomes while also avoiding potential harms.
19 jan 2015--"We learned that sufficient clinical research doesn't exist to show physicians how best to treat chronic pain in adults, many of whom suffer from multiple health problems," said the founding director of the Indiana University Center for Aging Research and Regenstrief Institute investigator Christopher Callahan, M.D., who served on the seven-member panel.
While opioids are frequently prescribed for chronic pain, the panel noted the absence of pain assessment and treatment guidelines. The panel also reviewed reports that suggest insufficient data exists on drug characteristics, dosing strategies and tapering options.
"Are opioids the appropriate treatment? And, if so, at what dose and for how long? Could other, less dangerous treatments work for some people? The panel found that, in spite of what many clinicians believe, there is no evidence that pain narcotics—with their risks of dependency, addiction and death—are an effective long-term pain treatment. More research is needed to guide effective care for chronic, often debilitating, pain," Dr. Callahan said.
The panel identified barriers to implementing evidence-based, patient-centered care, including what Dr. Callahan described as the important emotional aspects of pain, including the perceptions of suffering endured by people with chronic pain.
"Ten years ago, the medical community spoke of pain as the fifth vital sign," Dr. Callahan said. "Even though we know that treatment should be tailored to individual patients, there is no existing algorithm that helps researchers or clinicians determine which patients with which type of pain should be treated with which available approach.
"We heard information presented that there has been a dramatic increase in opioid overdoses by individuals who illegally obtain and abuse these prescription drugs—often family members or family friends who take the medications from the patient," Dr. Callahan said.
"The panel did hear suggestions of what providers might do in the face of the limited available evidence. For example, physicians might prescribe smaller quantities of opioids. This could potentially require individuals in pain to travel more frequently for prescription refills, but it would also decrease the amount of drugs potentially available to abusers.
"In educating their patients, providers might also tip the balance of their cautions about these drugs to highlight that they are important drugs with important dangers to both the patient and those who might obtain them accidentally or illegally. At the same time, the panel heard testimony that patients who responsibly use these medications should not be treated like criminals."
Dr. Callahan, who is the Cornelius and Yvonne Pettinga Professor of Medicine at the IU School of Medicine, calls for funding for clinical trials designed with input from both patients and those who treat pain. An internist and geriatrician who is an expert in health services research, health care systems and policy, Dr. Callahan has conducted several studies that have found the multidisciplinary team approach recommended by the panel has been effective in the care of older adults, who, like many chronic pain patients, often have multiple health problems and needs.
More information: The panel's report, "National Institutes of Health Pathways to Prevention Workshop: The Role of Opioids in the Treatment of Chronic Pain," published online first at www.annals.org by the Annals of Internal Medicine,
Provided by Indiana University
Friday, January 16, 2015
Scientists look to heart disease and strokes for clues to treating Alzheimer's
A growing body of research suggests that the most common cause of dementia in older people is a mix of vascular and Alzheimer's-related brain abnormalities, and that approximately half of people who die with Alzheimer's also have evidence of strokes in their brains. Furthermore, when strokes and hallmark Alzheimer's plaques and tangles are combined, it increases a person's likelihood of experiencing dementia. Stroke, or as it is known more generally as cerebrovascular disease, occurs with aging and is made worse by conditions like smoking, hypertension or diabetes.
16 jan 2015--Recommendations by a group of scientists to bolster research on how Alzheimer's and vascular conditions progress together and influence each other are available online today, in advance of publication, by Alzheimer's & Dementia: The Journal of the Alzheimer's Association. The authors hope this research agenda, if executed, will uncover new clues for effectively treating or preventing dementia.
"We are encouraged by the potential for new treatment strategies for dementia to arise from studying the crossover of vascular factors with the progression of Alzheimer's," says Heather M. Snyder, Ph.D., director of medical and scientific operations for the Alzheimer's Association, and first author of the new article. "In terms of next steps, we need to develop the research tools and collaborations necessary to further scientific investigation in this promising area of study."
Cerebrovascular disease can be prevented with a variety of drug and lifestyle interventions; however, this has not yet been established for dementia. Snyder says, "Whether improved control of vascular risk factors can be translated to decreased dementia risk is not known, but results from a number of studies suggest that it is possible, and this untapped potential definitely deserves greater research attention."
In December 2013, the Alzheimer's Association, with scientific input from the National Institutes of Health's National Institute of Neurological Disorders and Stroke (NINDS) and National Heart, Lung and Blood Institute (NHLBI), convened a group of scientific experts to discuss the scientific findings to date and gaps in research on vascular contributions in Alzheimer's and related forms of dementia. The newly-published article summarizes the meeting and discussions, including an outline of next steps.
"Blood vessels that deliver nutrients to the brain and carry away waste are vital for normal cognitive function," says co-author Roderick Corriveau, Ph.D., the NINDS program director who oversees dementia research. "Understanding vascular contributions to cognitive impairment and dementia, including changes due to stroke, heart disease and diabetes, are critically important to guide the development of preventions and treatments for dementia."
"Inadequate blood flow can damage and eventually kill cells anywhere in the body," says Donna M. Wilcock, Ph.D., a neurovascular researcher who is an assistant professor in the Department of Physiology at the University of Kentucky College of Medicine in Lexington and a co-author of the paper. "Since the brain has one of the body's richest networks of blood vessels, it is especially vulnerable. Considering this and demonstrated success in reducing risk for heart disease, stroke and other vascular-related diseases through healthy lifestyle modifications and use of medications, it only makes sense to increase our understanding of the role vascular factors play in Alzheimer's and dementia."
The authors of the article recommend filling gaps in several key areas of research, including:
The relationship between diabetes and insulin resistance and risk of vascular disease, Alzheimer's and related dementia.
Genetic factors that may influence vascular processes and other changes in the brain.
Impact of immune system response on blood flow in the brain in the progression of Alzheimer's disease.
The role of fat breakdown in the brain in the removal of amyloid build-up that leads to the hallmark brain plaques in Alzheimer's disease.
Controlling the impact of vascular risk factors on memory and thinking abilities.
The authors also conclude that biological markers, which are used to detect and measure disease progression, of key vascular processes related to impairment of brain function, memory and thinking abilities are needed to move this research further and faster.
"Having the methods to detect early signs of vascular-related brain injury or disease with the greatest impact on Alzheimer's and dementia would greatly enhance our efforts to develop effective therapies," says David Knopman, M.D., professor of neurology at the Mayo Clinic College of Medicine in Rochester, MN, and a co-author of the paper. "Especially needed are tools that are highly accurate and do not require invasive procedures to collect and measure." Dr. Knopman is vice chair of the Alzheimer's Association Medical and Scientific Advisory Council.
Among the biological markers the authors say are necessary are:
Ability to detect amyloid in blood vessels in the brain.
Imaging technology that can detect changes from dying brain tissue.
Indicators of risk for Alzheimer's in pre-diabetic individuals.
Improved methods for measuring the impact of blood flow in the brain on memory and thinking abilities.
"Future investment for these areas of scientific discovery will be essential to galvanize the scientific community and provide forums of communication between the dementia and vascular fields," the authors state in the paper.
As a further next step, research sessions and scientific presentations focusing on the relationship between vascular factors, Alzheimer's disease and related dementias are being planned for upcoming major scientific and medical conferences—including meetings hosted or sponsored by the Alzheimer's Association, the American Heart Association, and the National Institutes of Health.
Provided by Alzheimer's Association
Thursday, January 15, 2015
Experts recommend weight loss drugs, surgery as supplement to lifestyle interventions
The Endocrine Society today issued a Clinical Practice Guideline (CPG) on strategies for prescribing drugs to manage obesity and promote weight loss.
15 jan 2015--The CPG, entitled "Pharmacological Management of Obesity: An Endocrine Society Clinical Practice Guideline," was published online and will appear in the February 2015 print issue of the Journal of Clinical Endocrinology and Metabolism (JCEM), a publication of the Endocrine Society.
Obesity is a worsening public health problem. According to the 2012 National Health and Nutrition Examination Survey, about 33.9 percent of adults ages 19-79 were overweight, 13.4 percent were obese and 6.4 were extremely obese.
The Food and Drug Administration has approved four new anti-obesity drugs - lorcaserin, phentermine/topiramate, naltrexone/bupropion and liraglutide - in the past two years. Medications like these can be used in combination with diet and exercise to help people lose weight.
"Lifestyle changes should always be a central part of any weight loss strategy," said Caroline M. Apovian, MD, of Boston University School of Medicine and Boston Medical Center, and chair of the task force that authored the guideline. "Medications do not work by themselves, but they can help people maintain a healthy diet by reducing the appetite. Adding a medication to a lifestyle modification program is likely to result in greater weight loss."
In the CPG, the Endocrine Society recommends that diet, exercise and behavioral modifications be part of all obesity management approaches. Other tools such as weight loss medications and bariatric surgery can be combined with behavioral changes to reduce food intake and increase physical activity. Patients who have been unable to successfully lose weight and maintain a goal weight may be candidates for prescription medication if they meet the criteria on the drug's label.
Other recommendations from the CPG include:
If a patient responds well to a weight loss medication and loses 5 percent or more of their body weight after three months, the medication should be continued. If the medication is ineffective or the patient experiences side effects, the prescription should be stopped and an alternative medication or approach considered.
Since some diabetes medications are associated with weight gain, people with diabetes who are obese or overweight should be given medications that promote weight loss or have no effect on weight as first- and second-line treatments. Doctors should discuss medications' potential effects on weight with patients.
Certain types of medication - angiotensin converting enzyme inhibitors, angiotensin receptor blockers and calcium channel blockers - should be used as a first-line treatment for high blood pressure in obese people with Type 2 diabetes. These are effective blood pressure treatments that are less likely to contribute to weight gain than the alternative medication, beta-adrenergic blockers.
When patients need medications that can have an impact on weight such as antidepressants, antipsychotic drugs and medications for treating epilepsy, they should be fully informed and provided with estimates of each option's anticipated effect on weight. Doctors and patients should engage in a shared-decision making process to evaluate the options.
In patients with uncontrolled high blood pressure or a history of heart disease, the medications phentermine and diethylpropion should not be used.
MRI could predict Alzheimer's disease, improving treatment
UQ scientists have found MRI’s could be used to predict Alzheimer’s disease. Credit: Tane Sinclair-Taylor
14 jan2015--Scientists at the University of Queensland have discovered that magnetic resonance imaging (MRI) could be used to predict the risk of Alzheimer's disease.
The discovery could greatly improve outcomes for Alzheimer's patients, as early diagnosis could increase the effectiveness of drug treatments.
The study, led by Associate Professor Elizabeth Coulson of UQ's Queensland Brain Institute, found that people with a shrinking basal forebrain were seven-times more likely to have worsened cognitive function within 18 months.
"Existing Alzheimer's disease drugs try to enhance the function of the degenerating basal forebrain, but often too much damage is already done by the time drugs are administered," Associate Professor Coulson said.
"Early diagnosis is important for being able to treat people with Alzheimer's disease earlier, and work out a personal treatment course for them.
"If we can give the existing drugs to people earlier, when they first display evidence of a decline in their basal forebrain, even perhaps before they are diagnosed with Alzheimer's disease, then hopefully those drugs will be more effective."
More than 330,000 Australians suffer from Alzheimer's disease and are primarily treated with cholinergic drugs that target the basal forebrain, which degenerates with the condition.
Lead author and QBI PhD student Georg Kerbler said the study used data from the CSIRO's Australian Imaging, Biomarkers and Lifestyle Flagship Study of Ageing.
They analysed data involving more than 220 elderly people, including 145 healthy people, 40 showing mild cognitive impairment, and 38 with Alzheimer's disease.
"We're now working on validating these findings so a method to assess basal forebrain dysfunction can be rolled out into hospitals in the future," Mr Kerbler said.
"Our MRI method is currently a specialised research tool, and routine diagnosis needs to be performed in hospital MRI departments."
Large clinical trials have found that the effects of cholinergic drugs used to treat Alzheimer's disease are often transient and mild; but some patients appear to benefit from them for many years.
Geriatrician and Prince Charles Hospital Internal Medicine Services Head of Research Dr Eamonn Eeles, said the outcomes of using such drugs could be improved if they were given to patients earlier.
More information: Georg M Kerbler, Jürgen Fripp, Christopher C Rowe, Victor L Villemagne, Olivier Salvado, Stephen Rose, Elizabeth J Coulson, Alzheimer's Disease Neuroimaging Initiative, "Basal forebrain atrophy correlates with amyloid β burden in Alzheimer's disease," NeuroImage: Clinical, Volume 7, 2015, Pages 105-113, ISSN 2213-1582, dx.doi.org/10.1016/j.nicl.2014.11.015.
Provided by University of Queensland
Tuesday, January 13, 2015
A virtual reality brain training game can detect mild cognitive impairment
A virtual reality brain training game can detect mild cognitive impairment (MCI). Credit: Journal of Alzheimer's Disease
13 jan 2015--Greek researchers demonstrated the potential of a virtual supermarket cognitive training game as a screening tool for patients with mild cognitive impairment (MCI) among a sample of older adults. MCI is a condition that often predates Alzheimer's disease (AD) and is characterized by memory loss and inability to execute complex activities such as financial planning.
So far virtual reality game-based applications and especially virtual supermarkets have been used as cognitive training applications and as measures of cognitive functions, although it has been shown that they can detect MCI only when used in combination with standardized neuropsychological tests. However scientists from the Aristotle University of Thessaloniki (AUTH), the Greek Association of Alzheimer's Disease and Related Disorders (GAADRD) and the Centre for Research and Technology Hellas/Information Technologies Institute (CERTH/ITI) have succeeded in making the shift to MCI screening via robust virtual reality game applications that can be used on their own for accurate MCI detection.
In an article published in the Journal of Alzheimer's Disease, the researchers have indicated that the virtual supermarket (VSM) application displayed a correct classification rate (CCR) of 87.30%, achieving a level of diagnostic accuracy similar to standardized neuropsychological tests, which are the gold standard for MCI screening. Patients with MCI can live independently and not all such patients progress to AD. Therefore the global effort against cognitive disorders is focused on early detection at the MCI stage.
A large number of older adults use computerized cognitive training exercises/games as an easy and enjoyable means of exercising their brain. If these games and exercises can also detect cognitive disorders, the whole cognitive screening process could become more pleasurable, thus motivating more people to be evaluated. With the majority of older adults examining their cognitive health regularly through such games, possible cognitive impairment will be detected at the MCI stage thus allowing patients to enjoy a better quality of life and remain independent for a longer time.
A virtual reality brain training game can detect mild cognitive impairment (MCI). This is a VSM payment screen. Credit: Journal of Alzheimer's Disease
The use of the VSM as a robust screening test could have profound implications for the diagnosis and treatment of MCI, the most important of which is the possibility for automated remote MCI screening. The performance of older adults playing such a game at home could be monitored and an algorithm embedded in the game could inform them when their performance suggests possible cognitive impairment due to MCI, prompting them to visit an appropriate health service. Such a system would have the ability to screen the majority of older adults effectively, while at the same time minimizing examination costs. As computer applications increasingly become embedded in our work and social life, they could also become part of our preventive healthcare. Research on the use of the VSM for remote assessment is already underway and the results of that study will be published soon.
The VSM has been developed as part of the "Εν-ΝΟΗΣΗΣ" project for the use of new technologies in the screening, diagnosis, treatment and support of patients with MCI. Its development, testing and research application have been undertaken by research organizations that have been heavily involved in the transfer and dissemination of high-quality research knowledge, advanced solution development and leading-edge technologies. The same organizations are currently involved in the development and trialing of other novel technological instruments that respond to a number of clinical and organizational needs in the effort against cognitive disorders.
More information: "Can a Virtual Reality Cognitive Training Application Fulfill a Dual Role? Using the Virtual Supermarket Cognitive Training Application as a Screening Tool for Mild Cognitive Impairment," by Stelios Zygouris, Dimitrios Giakoumis, Konstantinos Votis, Stefanos Doumpoulakis, Konstantinos Ntovas, Sofia Segkouli, Charalampos Karagiannidis, Dimitrios Tzovaras, and Magda Tsolaki,, DOI: 10.3233/JAD-141260, Journal of Alzheimer's Disease, published online in advance of Volume 44, Issue 4.
Provided by IOS Press
Monday, January 12, 2015
Physical activity intervention for the elderly
Aerobic, strength, balance, and flexibility training can improve overall physical function—even among people who already have lost muscle mass due simply to aging—a condition called “sarcopenia.” Credit: Stephen Ausmus
12 jan 2015--Bone loss is not the only nemesis of the elderly. As the percentage of people aged 85 and older grows, the stakes are high for healthy individuals living independently who do not maintain their muscle mass and strength. Age-related muscle loss—which excludes disease-related muscle loss—is called "sarcopenia." This condition can lead to costly surgeries and hospital stays due to fractures after falls that occurred from weak muscles, says physiologist Roger Fielding.
In 2012 alone, 2.4 million nonfatal falls among older adults were treated in emergency departments, according to the Centers for Disease Control and Prevention's (CDC) National Center for Injury Prevention and Control. In addition, death rates from falls among older people have risen sharply during the past decade, CDC reports.
Fielding is with the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston, Massachusetts. He is director of the center's Nutrition, Exercise, Physiology, and Sarcopenia Laboratory. The HNRCA is funded in part by the USDA Agricultural Research Service.
HNRCA and international scientists have now arrived at a consensus on sarcopenia's clinical definition. The team developed simple tests to help local healthcare practitioners make diagnoses and treatment plans. The tests include assessing whether a person can walk 13 feet in 4 seconds or less.
"The gait speed cut point we found is 1 meter—or 3.25 feet—per second," says Fielding. "Below that, the risk of mortality and institutionalization increases dramatically." Fielding wants clinicians to think of these tests as an important vital sign for elders, similar in importance to blood pressure readings.
By age 80, an estimated 40 percent of the muscle mass that was present at age 20 is lost, HNRCA researchers say. But a subpopulation of older adults has muscle loss that is even greater than that of others in their age group. This extrememuscle loss has been associated with physical performance limitations and disability.
A study headed by HNRCA's geriatrician Christine Liu and coauthored by Fielding and others looked at data collected on a group of 177 elders aged 70 to 89 years who were functionally limited and at risk of becoming disabled due to lack of mobility. The data was collected during the "Lifestyle Interventions and Independence for Elders" study. The volunteers' body composition, including lean muscle and body fat, was measured both before and after the intervention.
One group of volunteers participated in a physical activity intervention that included aerobic, strength, balance, and flexibility training. The results demonstrated that elders with sarcopenia are capable of improving their overall physical function, including balance, walking, and strength, in response to physical activity.
"Sarcopenia should not deter clinicians from encouraging physical activity in older clients," says Liu. "Even with relatively little muscle mass, these individuals benefited from preventive exercise."
Provided by Agricultural Research Service
Sunday, January 11, 2015
What can beagles teach us about Alzheimer's disease?
Keep your brain active. Credit: Soloviova Liudmyla/Shutterstock
11 jan 2015--Every 67 seconds someone in the United States is diagnosed with Alzheimer's disease and new estimates suggest that it may be the third leading cause of death of older people.
Alzheimer's disease is associated with losses in memory in older people that become severe enough over time to interfere with normal daily functions. Other signs of Alzheimer's include changes in the ability to communicate, losses in language, decreased ability to focus and to pay attention, impairments in judgment and other behavioral changes.
People with Alzheimer's disease experience changes in their brains (which we can see in autopsies). Over the course of the disease, clumps of protein (called senile plaques) and tangles in neurons (called neurofibrillary tangles) accumulate. These plaques and tangles interfere with how the brain works and disrupt connections that are important for intact learning and memory ability.
The majority of studies to develop treatments for Alzheimer's disease use mice that are genetically modified to produce human proteins with mutations. But these mutations are usually present in less than 5% of people with Alzheimer's disease. This limitation can make it difficult to translate benefits of a treatment tested in mouse studies to people. However, there are several animals that naturally develop human-like brain changes that look much like Alzheimer's disease, including dogs.
Old dogs, new research tricks
Old dogs may teach us a great deal about aging. As dogs get older, some develop learning and memory problems, much like we do. And like people, not all old dogs become impaired. Indeed, some old dogs remain bright and able to learn just as well as younger dogs, although they may be a little slower in reaching high levels of performance.
When an older dog has cognitive problems, we may see them as changes in behavior that can be disruptive to the relationship between owners and pets. For example, an old dog with cognitive problems may forget to signal to go outside, may be up at night and sleep all day, or have trouble recognizing people or other pets in the family. This is similar to a person with Alzheimer's disease who may have difficulty communicating, disrupted sleep/wake cycles and trouble remembering family and friends.
When aged dogs show cognitive changes not caused by other systemic illnesses, they are related to brain changes that are strikingly similar to people. For example, old dogs develop senile plaques in their brains that are made of a protein that is identical to one that humans produce. This protein, called beta-amyloid, is toxic to cells in the brain.
Staying sharp.
Unlike mice and rats, old dogs naturally develop significant brain pathology like we see in people. In this way, aging dogs may resemble aging humans in a more natural or realistic way than mice with genetic mutations.
There are many other changes in the brains of people with Alzheimer's disease that are similar in aging dogs. These include changes in the blood vessels of the brain, the accumulation of damaged proteins and losses in cells, and chemicals that support cells in the brain. These changes may be modified by lifestyle factors.
Healthy living, healthy aging
There are many reports of how our lifestyle can be good or bad for aging. The food we eat can be a potent contributor to how our brains age. For example, several studies in people show that antioxidant-enriched diets (including lots of fruits and vegetables) and the Mediterranean diet are associated with healthier brain aging.
Physical exercise and good cardiovascular health also appear to be associated with a lower risk of developing Alzheimer's disease and cerebrovascular disease, which is a cause of dementia. Keeping your brain active and challenged with puzzles, brain games and an engaging social life, are all linked to better memory and less risk of disease and studies are ongoing in people to measure the effects systematically.
Beagles and the brain
Dogs may be very well suited to help us understand how these lifestyle factors help our brains as we get older. Our lab initially began studying beagles in the early 1990s as there was interest in developing a drug to treat "dog dementia" based on pet owners observations of changes in behavior in their older dogs. At that time, little was known about learning and memory changes in aging dogs (beagles over eight years of age) and our earliest research was designed to find ways to systematically measure these changes.
Eat well. Credit: Nicki Mannix, CC BY
The first step in doing this was to teach dogs to look at different objects (for example a Lego block or a toy truck) and learn that one of the two always hid a food reward. When we switched the food reward to the object that was previously not rewarded, older dogs kept choosing the wrong object. Young dogs very quickly switched over to the new object.
When we counted the number of errors dogs make to learn the problem, old dogs made many more errors overall. Interestingly, not all old dogs were impaired. Another subset of old dogs showed significant losses in their ability to remember information and some showed changes in their ability to be "flexible" in changing behaviors.
This is very similar to people. Not everyone ages in the same way – some people remain sharp as tacks well into their older years. After measuring learning and memory changes in dogs, we next studied the brain changes that were most strongly linked to these cognitive losses. We found that senile plaques in the brains of old dogs were more frequent in the animals that had learning and memory problems. In our more recent studies, we have been seeking ways to improve brain health in old dogs with the hope that these approaches can translate to healthy aging in people.
For instance, in several studies of aging in beagles, we have found that a diet rich in antioxidants that includes vitamins E and C, and importantly, fruits and vegetables, can lead to wonderful benefits in learning and memory ability that can be maintained for years.
Keep running. Credit: Marco Bellucci, CC BY
For example, dogs that had trouble remembering where they had seen a food reward (this is an example of spatial memory) showed significant improvements in their memory over time. Also, old dogs showed rapid improvements in their ability to modify their behaviors when the rules had changed in the task they were learning (an example of enhanced executive function).
In addition, providing dogs with physical exercise, social enrichment and "brain games" (like the food reward game) can also significantly improve cognition as they get older.
If we take these factors into account, we may be able to engage in strategies and lifestyle changes that will be good for both species. Exercise, social interaction, learning new tricks – participating in the same activities with our aged companion animals, the benefits will be twofold: for them and for us.
Source: The Conversation
Saturday, January 10, 2015
A healthy lifestyle may prevent heart disease in nearly three out of four women
Credit: Journal of the American College of Cardiology
10 jan 2015--A new study that followed nearly 70,000 women for two decades concluded that three-quarters of heart attacks in young women could be prevented if women closely followed six healthy lifestyle practices.
The study, published today in the Journal of the American College of Cardiology, followed participants in a study of nurses established in 1989, which surveyed more than 116,000 participants about their diets and other health habits every two years. Researchers from Indiana University, the Harvard School of Public Health, and Brigham and Women's Hospital analyzed data on 69,247 of the participants who met the requirements for their study.
"Although mortality rates from heart disease in the U.S. have been in steady decline for the last four decades, women aged 35-44 have not experienced the same reduction," said Andrea K. Chomistek, ScD, a researcher from the Indiana University School of Public Health-Bloomington and lead author of the paper. "This disparity may be explained by unhealthy lifestyle choices. We wanted to find out what proportion of heart disease cases could be attributed to unhealthy habits."
Healthy habits were defined as not smoking, a normal body mass index, physical activity of at least 2.5 hours per week, watching seven or fewer hours of television a week, consumption of a maximum of one alcoholic drink per day on average, and a diet in the top 40 percent of a measure of diet quality based on the Harvard School of Public Health healthy eating plate.
During 20 years of follow-up, 456 women had heart attacks and 31,691 women were diagnosed with one or more cardiovascular disease risk factors, including type 2 diabetes, high blood pressure or high levels of blood cholesterol. The average age of women in the study was 37.1 years at the outset; the average age of a heart disease diagnosis was 50.3, and the average age for diagnosis with a risk factor for heart disease was 46.8.
Researchers found that women who adhered to all six healthy lifestyle practices had a 92 percent lower risk of heart attack and a 66 percent lower risk of developing a risk factor for heart disease. This lower risk would mean three quarters of heart attacks and nearly half of all risk factors in younger women may have been prevented if all of the women had adhered to all six healthy lifestyle factors, the authors said.
For women who were diagnosed with a risk factor, adherence to at least four of the healthy lifestyle factors was associated with a significantly lower risk of going on to develop heart disease when compared to those who did not follow any of the healthy lifestyle practices.
Independently, not smoking, adequate physical activity, better diet, and lower BMI were each associated with a lower risk for heart disease. Women who consumed moderate amounts of alcohol—approximately one drink per day on average—saw the lowest risk compared to those who did not drink at all and those who drank more.
"This is an important public health message," said Chomistek. "Women should begin following these lifestyle practices early in life, especially if they are already taking medication for a risk factor such as hypertension or high cholesterol. It's an easy way to prevent future heart trouble."
Provided by American College of Cardiology
Friday, January 09, 2015
Was Beethoven's music literally heartfelt? Could cardiac arrhythmia have influenced famous works?
Could it be that when Ludwig van Beethoven composed some of the greatest masterpieces of all time that he was quite literally following his heart?
09 jan 2015--The striking rhythms found in some of Beethoven's most famous works may have been inspired by his own heartbeat, says a team of researchers from the University of Michigan and University of Washington that includes a cardiologist, medical historian, and musicologist.
Authors of a new essay that appears in Perspectives in Biology and Medicine analyzed several of Beethoven's compositions for clues of a heart condition some have speculated he had. The rhythms of certain parts of renowned works, researchers say, may in fact reflect the irregular rhythms of Beethoven's own heart caused by cardiac arrhythmia.
"His music may have been both figuratively and physically heartfelt," says co-author Joel Howell, M.D., Ph.D, a professor of Internal Medicine at the University of Michigan Medical School and member of the U-M Institute for Healthcare Policy and Innovation. "When your heart beats irregularly from heart disease, it does so in some predictable patterns. We think we hear some of those same patterns in his music."
"The synergy between our minds and our bodies shapes how we experience the world. This is especially apparent in the world of arts and music, which reflects so much of people's innermost experiences," Howell adds.
The essay's lead author is Zachary D. Goldberger, M.D., M.S., a cardiologist at Harborview Medical Center, University of Washington School of Medicine and a former cardiology fellow and Robert Wood Johnson Clinical Scholar at U-M. Steven Whiting, Ph.D, a musicologist and Beethoven expert from the U-M School of Music, Theatre and Dance, is the other author.
Ludwig van Beethoven
The team studied the rhythmic patterns of several compositions that may reflect Beethoven's experience of an arrhythmia, a condition that causes the heart to beat too fast, too slow, or with an irregular rhythm. Sudden, unexpected changes in pace and keys in Beethoven's music appear to match such asymmetrical patterns.
Take for example the final movement "Cavatina" in Beethoven's String Quartet in B-flat Major, Opus 130, an emotionally-charged piece that Beethoven said always made him weep. In the middle of the quartet, the key suddenly changes to C-flat major, involving an unbalanced rhythm that evokes dark emotion, disorientation and what has even been described as a "shortness of breath."
In the composer's directions to musicians playing the piece, the section is marked beklemmt, a German word that translates to "heavy of heart."
Authors note that "heavy of heart" could mean sadness but may also describe the sensation of pressure, a feeling that is associated with cardiac disease. "The arrhythmic quality of this section is unquestionable," they write.
Researchers identified arrhythmic patterns in other pieces as well. They studied the Piano Sonata in A-flat major, Opus 110 - the central sonata in a group of three that comprise Beethoven's final contributions to the genre - and the opening of the "Les Adieux" Sonata (sonata opus 81a, in E-flat major) written during the French attack on Vienna in 1809.
Beethoven has been linked with a litany of mysterious health problems including inflammatory bowel disease, Paget's disease (abnormal bone destruction), liver disease, alcohol abuse, and kidney disease. His most often described ailment was deafness, which the authors say could have heightened his other senses and made him even more aware of his heartbeat.
"We can't prove or disprove that Beethoven had many of the diseases he's been supposedly afflicted with because almost all of today's diagnostic medical tests didn't exist in the 18th century, and we are interpreting centuries-old medical descriptions into the context of what we know now," says Goldberger.
"However, the symptoms and common association of an abnormal heartbeat with so many diseases makes it a reasonable assumption that Beethoven experienced arrhythmia - and the works we describe may be 'musical electrocardiograms,' the readout of modern heart rhythm testing equipment.
"While these musical arrhythmias may simply manifest Beethoven's genius, there is a possibility that in certain pieces his beating heart could literally be at the heart of some of the greatest masterpieces of all time."
Provided by University of Michigan Health System
Thursday, January 08, 2015
Resolutions linked to 'ideal self' most effective, Stanford psychologist says
New Year's resolutions can be an action plan or just an expression of hope for the future, says Kelly McGonigal, a lecturer in Stanford's Graduate School of Business and senior teacher at the university's Center for Compassion and Altruism Research. Credit: Sondem/Shutterstock
08 jan 2015--New Year's resolutions present opportunities to connect to one's ideal self, a Stanford expert says.
Psychologist Kelly McGonigal says that research shows that when people resolve to change, they may immediately feel more confident, in control and hopeful.
A lecturer in Stanford's Graduate School of Business and senior teacher at the university's Center for Compassion and Altruism Research, McGonigal is an instructor for a Stanford Continuing Studies course on willpower and change and the author of the book, The Willpower Instinct.
She talked about New Year's resolutions in a recent conversation with Stanford News Service.
Are New Year's resolutions an effective approach for personal growth?
It depends what kind of resolutions you set. For many people, New Year's Resolutions are an expression of hope, not an action plan for the future. Research shows that when people resolve to change, they immediately feel more confident, in control and hopeful. They even feel stronger and taller, which is kind of ridiculous, but this just shows how uplifting resolving to change can be. If people want to make resolutions as a way to connect to a growth mindset – the belief that through effort and support, you can change and grow in meaningful ways – that's fine. It's not necessarily a tragedy if you fall short.
The problem comes when people fall prey to "false hope syndrome," a term psychologists use to describe the cycle of 1) vowing to change, 2) being surprised by how difficult it is, and 3) giving up, all because the actual process of change doesn't provide the same emotional boost as the initial resolution. Then you get into the territory of people making the same resolution five years in a row, without ever making progress – and you may eventually "learn" from this experience that there's no point in trying to change.
If you're going to make a resolution, I say, either use it as an opportunity to connect to your ideal self, but don't turn it into a reason to beat yourself up when you aren't totally transformed on Jan. 2 – or really reflect on what you want and who you want to be, and invest in yourself from that perspective.
The worst thing to do is make a promise to yourself that you don't really care about and don't really plan to see through.
Are concrete resolutions easier to achieve than more abstract ones?
I can't imagine having one without the other. People who set exceptionally specific goals often succeed, but the small habit doesn't inspire greater change. If you want to create health, setting a small goal – like eating one more serving of vegetables a day – is great. But without remembering the big "why," eating the vegetable can become a kind of game that you feel good about winning – it feels good to mentally check it off your to-do list for the day. But succeeding at this small goal won't necessarily make you identify as someone who cares about your health, and wants to make healthier choices across the board.
The best kind of resolution is one that has a "big why" – to create health, to reconnect with a personal passion, to strengthen an important relationship, to change your financial situation, to develop yourself in some way, or to contribute to others in some way. And then you pick a small action or change that reflects this big goal, to remind yourself of it and to help you take steps toward it.
These can be very small if the "why" is clear, and still lead to big change in the long-term. One of my favorite examples of a small "what" that's been shown to have a major impact is delaying the first cigarette of the day by 10 minutes. That's doable.
I encourage people to think of a New Year's resolution that small after they've gotten clear on the big "why."
What types of "inner questions" should people ask themselves in developing their goals?
All too often people skip the "why" and go straight for a "what" that they think they can nail. But why vow to change something that isn't connected to the vision you have for your life? It may be a little more intimidating to think about the biggest "why's," but you have a much better chance of making a meaningful resolution.
I like to go big. For example:
What do I want to experience more of in my life, and what could I do to invite that/create that?
How do I want to be in the most important relationships or roles in my life? What would that look like, in practice?
What do I want to offer the world? Where can I begin?
How do I want to grow in the next year?
Your mindset when you contemplate these questions matters. If people want to seriously engage in the process of change, it takes more than five seconds of reflection.
I have a few favorite "pre-resolution" suggestions:
List your favorite memories and triumphs of 2014, including the challenges you faced, even if things didn't turn out the way you hoped. This can help you take a big-picture perspective on how you want to grow.
Make a list of what you are grateful for in your life. If you make a "gratitude list" first, you might be surprised how it shapes your wish list for 2015.
Write yourself a letter from your future self, dated 1/1/2016. Imagine looking back at 2015. In your letter, thank your present self for all you did to achieve your goals – and be specific. Or give yourself some compassionate advice from your wiser, 2016 self. This can lead to a reflection on what you might like to resolve for the coming year.
How can people hold themselves accountable to their resolutions?
Find a partner. It doesn't have to be someone who shares the same goal – just see if there's someone in your life who is interested in being a support buddy. Studies show that something as simple as texting a buddy when you take an action toward your goal triples the rate of success.
Another way to hold yourself accountable is to check in with whether the goal feels meaningful, and is serving you well. True self-accountability means paying attention to whether your choices are creating what you want in your life.
Or, is trying to stick to the goal creating more self-criticism or resentment than positive change? Have there been any negative consequences?
For example, you could set the goal to get up one hour earlier to exercise, and find that the sleep deprivation is making you enjoy being a parent less. That would be an excellent reason to hold yourself accountable to changing the "how" of exercising more to something else, like dancing in your kitchen for two songs after you do the dishes.
How can people cope with failure when they regress on their resolutions?
If you've connected to a big "why," and you have recruited a buddy, you're going to have a much better chance recovering from these setbacks. The other real resource is mindset.
Change involves setbacks – research shows that people who ultimately succeed have no fewer setbacks early on than people who eventually give up. So, the first thing is to expect to fail at some point, and not take it as evidence that change is futile.
One mindset trick I like to use is to imagine that I already know the ending of this story: I have made the change or reached the goal that I set. And so I ask, from that point of view, what did I do that led to the outcome of long-term success?
People give up after setbacks when they don't know the ending –and they suspect it will be "I failed." But you can choose the ending and make it a self-fulfilling prophecy.
This perspective – psychologists sometimes call it encoding prospective memories, or making a future memory – can trick your brain into making what you need to do feel very possible and real, as if you've already done it.
