Grief can be like that. It also can manifest as deep sorrow, hostility, guilt, confusion, and fatigue. It’s a process that waxes and wanes and an experience that varies from person to person. There’s no absolute timeline or way to grieve, but most people start to return to a sense of normalcy in about six to 12 months.

Grief occurs not only when a loved one passes but also can happen with a terminal diagnosis, such as cancer or Alzheimer’s disease. Known as “anticipatory” grief, it affects both the diagnosed person and loved ones.

Grief’s Impact on Health

The grieving process can lead to everything from bodily pain and a weakened immune system to stomach upset and insomnia. According to George Slavich, PhD, director of the Laboratory for Stress Assessment and Research at the Semel Institute for Neuroscience and Human Behavior at UCLA, the root of these symptoms can be traced back to our evolutionary response to the loss of a social connection.

“As humans, we are strongly motivated to seek out social bonds that are warm, dependable, friendly and supportive,” says Slavich. “Losing someone close to us terminates that bond and the social and physical protection they provided, which historically could have put the body at an increased risk of physical danger.”

When you lose someone that you’ve been with for a long time, the body and brain go on high alert to protect you from potential dangers. Your immune system ramps up and sends immune cells throughout the body to deal with possible physical wounds that might occur. At the same time, however, your immune system lowers its antiviral defense system, making your body more vulnerable to viral infections. “If you’ve ever come down with a cold after a stressful time, you may have experienced this response,” says Slavich.

The grieving process can cause prolonged inflammation and lead to psychological and behavioral symptoms such as fatigue, loss of pleasure, and social withdrawal. If these symptoms persist beyond six months, it may indicate prolonged grief, which can have serious health implications.

Prolonged Grief

This type of grief is marked by persistent and pervasive feelings of longing, sadness, and preoccupation with the deceased. It can significantly interfere with a person’s daily functioning and quality of life. Common symptoms include an inability to accept the loss, numbness, bitterness, difficulty engaging in life, and a feeling that life is meaningless without the deceased.

Prolonged grief is associated with increased cancer risk, cardiovascular problems, and early mortality. It may lead to heart attacks, especially in people who already have a higher risk of heart disease.

Takotsubo cardiomyopathy, also known as broken heart syndrome or stress cardiomyopathy, can be triggered by intense grief. This condition temporarily weakens the heart’s left ventricle and can mimic a heart attack, even in those who do not have cardiovascular disease. It tends to affect postmenopausal women much more than men. Recovery from this transient condition can take days or weeks. However, this doesn’t mean the condition should be ignored or untreated, because there can be long-term consequences.

Anticipatory Grief

Anticipatory grief is the emotional response experienced when a loss is expected but has not yet occurred, such as with a terminal illness diagnosis. Key characteristics of anticipatory grief include feelings of sadness, anxiety, anger, and helplessness. It affects both the diagnosed and loved ones. For example, loved ones can become consumed with imagining life after the loss and worrying about how to cope. It may change how an individual interacts with the dying person, such as increased closeness or emotional distancing as a protective measure.

Stress and anxiety can lead to physical symptoms like fatigue, changes in appetite, and sleep disturbances. Feelings of relief or guilt also can be part of anticipatory grief, especially if the loved one has been suffering. Understanding and acknowledging anticipatory grief can help in the processing of emotions and better prepare for the eventual loss.

Patience, Acceptance, and Self-Care

It’s important to accept that it is normal to grieve and give yourself permission to experience the full range of emotions. Surrounding yourself with supportive friends and family with whom you can share your feelings can provide comfort and validation. Support groups, both in-person and online, can also offer a sense of community and understanding. Sometimes, the intensity of grief requires professional intervention. Therapists or counselors specializing in grief can provide strategies and support to navigate the emotional turmoil.

After losing a loved one, thoughts can constantly drift between the past and the future. Practicing mindfulness meditation is one way of becoming aware of your thoughts, grounding your awareness in the present, and reducing overall psychological stress.

Sleep may become challenging. It may be difficult to fall and stay asleep. And a sense of purposelessness can make it hard to get out of bed up in the morning. However, “sleep is one of the strongest drivers of immune activity,” Slavich says, and “having a standard sleep schedule is really important for properly regulating your immune system.”

Along with quality sleep, a healthy diet and regular exercise are recommended for self-care. Choose nutritious foods daily. Include lean proteins, fruits, vegetables, healthy oils and leafy greens. These choices help reduce inflammation. Likewise, moving your body regularly supports brain and immune health. Breaking a sweat helps decrease feelings of stress and anxiety. Exercise triggers the release of dopamine and serotonin; two brain neurotransmitters that play a pivotal role in maintaining positive mood. Exercise also slows the release of cortisol, the hormone that can wreak havoc when it flows unabated under chronic stress.

“Each of these strategies can help promote resilience following interpersonal loss,” Slavich says, “but the most important thing is to begin with the strategy that you know you’ll actually follow through with.” He also recommends telling your healthcare provider about your loss. This will enable your provider to take your personal situation into consideration and to understand how your grief may be involved in any symptoms you may be experiencing.

Coming up with the best strategy for dealing with grief needs to be a team effort between you and your healthcare provider, Slavich says, but “if they don’t know what’s going on in your life, they won’t be able to help.”

Creating a memorial or engaging in rituals to honor the person you’ve lost can help with healing and acceptance. This could be through a dedicated space in your home, a scrapbook, or participating in activities that the deceased loved. It helps keep their memory alive and allows you to celebrate their life.

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© Maskot | Getty Images
Keep your private information private. If you are unsure how to manage privacy settings on social sites, ask for help from friends or family.

The key words are “used appropriately.” Here we explore the positive and negative aspects of social media, pitfalls to be aware of, and how to use social media platforms in healthy and beneficial ways.

Down the Rabbit Hole

It’s all too easy to scroll mindlessly through social media content and emerge from online wanderings wondering where the time went. A survey by Morning Consult found that 54% of Gen Zers (born 1997–2012) reportedly spend at least four hours daily on social media. About 48% of Baby Boomers (born 1946-1964) spend between 10 minutes and one hour on social media per day, according to a study by McKinsey & Co. While the trends segmented by age unsurprisingly report younger people spend more time on social media compared with older adults, individual use varies widely.

“People of all ages can spend great amounts of time on social media,” says ­Castel. “That takes time away from exercising and in-person socializing, both of which can help with mood, memory, and cognitive functioning.”

Addictive By Design

Studies have shown that social media use activates the brain’s reward center by releasing dopamine, a brain chemical associated with reward, pleasure, motivation, and addiction. Repetitive floods of dopamine can potentially lead to anxiety, depression, and irritability in some people. Tripping the dopamine pleasure switch is a deliberate design feature of social media platforms. For example, have you ever repeatedly checked your Facebook posts to see how many likes you received and who liked it? The unpredictable nature of social media, such as not knowing how many likes a post will receive and when, is a deliberate design feature because it keeps users engaged and coming back for more. It’s like a slot machine, which includes the anticipation of reward with each pull, bringing you closer and closer to a potential win. And when you do get a win (or a like) dopamine levels rise.

In fact, social media companies hire people called “attention engineers,” some culled from Las Vegas gaming corporations, to develop features to capture and keep people on their sites.

The Consequences of Manipulation

Ok, so social media is manipulative. Not a huge surprise. But there are valid reasons why curbing social media use for young people has escalated to legislative levels. It can be harmful to health, especially mental health. Constant comparisons to other people can be emotionally depleting. Scrolling through images of people on exotic vacations, eating at expensive restaurants, and endlessly having fun while looking fantastic can create feelings of unworthiness, depression, and also anxiety.

Obviously, there are a lot of unrealistic portrayals, misinformation, and deception online. But it’s not always obvious. Artificial intelligence will and already has made reality harder to discern. It can be quite easy to do. With the use of simple filters, anyone can look younger with flawless skin and a thin physique. And that’s not without consequence or significance. In recent years, plastic surgeons report requests from people who want to look like their filtered Snapchat and Instagram photos. And people in their 20s are getting “preventive” Botox in record numbers.

Fortunately, there has been some pushback, including from celebrities such as Jamie Lee Curtis who has often been a defender of realistic aging, bravely posting untouched photos of her face and body. At the Radically Reframing Aging Summit last year, Curtis (now 65) said she is pro-aging and spoke about how we needed to look positively at aging, rather than be obsessed with looking young. “This word ‘anti-aging’ must be struck,” she said. “I am pro-aging. I want to age with intelligence, and grace, and dignity, verve, and energy.”

The Upside of Social Media

Social media platforms unite us like never before and expand our social reach. For example, through sites like ancestry.com people have contacted relatives they didn’t even know they had. Video chats and photo sharing bring them together to create new memories and offer an easy way to make plans for in-person visits.

A recent Chinese study published in Healthcare, an international, scientific, peer-reviewed journal, reported that: “Social media satisfied older adults’ emotional needs, and maintained and expanded the social networks of older adults. …A good social network can enhance subjective well-being and life satisfaction.”

Researchers also report that social media can provide opportunities to enhance the mental health of users by facilitating social connections and peer support. Online communities can provide a space for discussions regarding health conditions, adverse life events, or everyday challenges, which may decrease the sense of stigmatization and increase belongingness and perceived emotional support. Mutual friendships, rewarding social interactions, and humor on social media can reduce stress and enhance wellbeing.

Many people use Facebook to stay connected with loved ones. It enables frequent conversations, helps bridge the generation gap, and allows older adults to see their grandchildren grow through shared photos and videos. For families living apart, social media can alleviate stress and anxiety by allowing easy check-ins with loved ones. This is especially crucial for older adults with serious health issues who are living alone.

Enjoy Wisely

There are social media groups for everything from Argentine tango to pickleball, birdwatching to philosophy, and there are many groups for health conditions. Because misinformation also runs rampant, be sure to consult with your physician before acting on any health recommendations from social sites.

A heavy dose of skepticism is also warranted when making new friends, especially when romance is on the line. “Romance scams can start with what feels like very innocent behavior, but can escalate,” warns Castel. “Don’t be afraid to cut off communication, and don’t feel rushed or pressured into making any decisions, especially those that involve financial aspects and requests.”

Facebook friend scams are notorious. For example, a handsome man or woman claims to like your wonderful posts and wants to be friends. If it looks too good to be true, it’s likely a scam. Castel recommends talking with friends in person about how they connect online, and to ask about some of the dangers that others have experienced. “Scams and fraud can be rampant, and you need to be careful with what you share, even if you think it is a trusted source,” he says. In some cases that “trusted source” may have been hacked. Don’t be too quick to click on a link.

It’s wise to keep your data as private as possible. A smart policy to adopt is to never give out private information such as phone numbers or addresses to anyone on social media sites. Know that you can set privacy settings that allow only people you know onto your platform.

Smart Shopping

Ads on social media platforms can be especially enticing. But before you click that buy button, be on guard for potential scams. Check to see if the company is real. Look for a physical address and phone number (often at the very bottom of their webpage). Look for spelling errors and odd disclaimers and especially be on the lookout for those that want you to enroll or subscribe for regular shipments. Make sure retailers allow returns and enough time (at least 30 days) to make a return. Research online by entering the company’s name and the words “fraud alert” after the name to see if there have been complaints. Use a credit card to dispute charges if the item never arrives.

Used wisely, social media can open up a whole new world of connectivity with friends and family near and far. It’s not a replacement for in-person socialization, but it is an excellent tool for exploring new interests and for making new friends to potentially meet with in the real world.

The post The Pros and Cons of Social Media Use appeared first on University Health News.

These habits involve medical care, lifestyle choices, stress management, and other concerns, says Dana Kelly, PhD, a clinical neuropsychologist with the Massachusetts General Hospital Psychology Assessment Center.

“One of the biggest sabotages of good brain health that I see are people who neglect their health,” Dr. Kelly says. “It could be not taking their prescribed medications, not using their prescribed hearing aids, not using their prescribed CPAP machines, etc. I certainly appreciate that there are a lot of often legitimate reasons why people are not fully adherent to their doctors’ recommendations. But I always encourage patients to have very open and honest conversations with their physicians about their concerns, so that a solution or compromise can be found.”

Healthy Body, Healthy Mind Attending doctors’ appointments routinely, like with your primary care provider, is essential to keep tabs on your health, which has direct consequence for your brain health, Dr. Kelly says. “Go to your annual eye doctor appointment. Go to your dentist appointment. All of these things have downstream implications for brain health.”

She adds that many people contribute to their own cognitive problems by not wearing their hearing aids, or only wearing their hearing aids when they leave the house. “Our brains need that stimulation,” Dr. Kelly says. “If we don’t wear our hearing aids routinely, then the amount of input that comes into the brain is reduced. We want to keep the brain stimulated and active.”

She also notes that medication adherence, regardless of what condition is being treated, can play a huge role in brain function. “People might have side-effect concerns about their medications, which are certainly legitimate, but it can be dangerous to your health to stop taking medication or take them differently than your doctors prescribe,” Dr. Kelly says. “So please always have a discussion with the prescribing provider before you make any changes.”

Don’t Skip Your Workout

A rainy day can make it easy to avoid your morning walk around the block. Or when a friend can’t make it to the gym with you, it can be easy to skip a workout altogether. Or you may just not feel like breaking a sweat today.

Once in a while, it’s OK to have a little more sedentary time. But don’t fall into the habit of going day after day without some physical activity.

“The research is clear that exercise is very important with aging, as it affects our physical health, emotional health, and cognitive health,” Dr. Kelly says. “All forms of exercise are good for our brain. Aerobic exercise can be beneficial from a sense of keeping good cardiovascular fitness, which has direct benefits for our cerebrovascular health. Strength­based exercises can also be excellent for a variety of reasons, including that they keep our muscles strong and help prevent falls. Any time we have a fall and hit our head, that could potentially be problematic for the brain.”

She adds that strength-base exercises can also be very helpful from a mindfulness perspective. “When I say mindful, I mean the act of being present, which has been shown to be wonderful for the brain in increasing attention span and reducing stress and anxiety, thereby improving our overall brain health and memory,” Dr. Kelly says. “Often when we’re doing strength exercises, we are in a mindful state. For example, during yoga, tai chi, and weightlifting, we tend to focus on the movements and what we’re actively doing, as opposed to the mind wandering and being distracted by things in the past and in the future.”

Exercises that promote improved flexibility and balance are also important as you get older. Remember that exercise is a simple, but effective, way to help manage stress. So are meditation, breathing exercises, and journaling. “I would emphasize that stress can be just as bad for brain health as some of these more physical or tangible problems like not exercising,” Dr. Kelly says.

You probably know most of the behaviors you should and shouldn’tbe engaging in to support better memory. But if you’re concerned you’ve developed some unhealthy habits—even minor ones—take stock of your routines and look for ways you can make some positive changes and get back on a healthier track.

The post The Brain-Healthy Habits That Are Easy to Skip, but Should Be Part of Your Normal Routine appeared first on University Health News.

A:For some people, a cluttered or messy home environment can trigger anxiety, the same way that being in a crowd or giving a speech might heighten stress and anxiety in other people. Your wife may have anxiety that is managed by keeping your home orderly and free of clutter. She may take steps to control other anxiety triggers in her life without you realizing it. Seeing things out of place and not feeling she can help restore order may be a major anxiety trigger. Sometimes a cluttered environment sends the brain a signal that there is still work to be done in a given situation, which can be anxiety-inducing for many peo­ple. If it is appropriate, you and your wife may offer to help straighten things up. This could be a win-win solution as it would help your daughter but also reduce the clutter that seems to be bothering your wife. For many people who are especially bothered by clutter or disor­ganization, the simple act of addressing the sit­uation can be enough to bring down the stress and anxiety. If getting directly involved is not an option, your wife may benefit from talking with a mental health professional about finding other coping strategies.

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Depression and Anxiety

Research shows that anywhere from 30 percent to 50 percent of people with chronic pain struggle with depression and anxiety. Other common emotional responses to pain include sadness, frustration, anger, or feeling misunderstood. There are numerous reasons for emotional responses to chronic pain, including that people who suffer from conditions associated with ongoing pain may isolate from others and, in many instances, may lack the mobility they once enjoyed.

What’s more, chronic pain-related stress and anxiety can actually make the pain worse. “In studies of patients with chronic pain, my colleagues and I consistently found that negative thoughts, such as self-blame and negative self-statements such as, “I am useless,” were associated with increased pain intensity, interference in everyday life, and distress,” says Susan Evans, PhD, Director of Education in Psychology, Weill Cornell Medicine, Department of Psychiatry.

Despite chronic pain’s association with sadness and negativity, Evans points out that pain and suffering are not necessarily synonymous. “For example, someone may report moderate pain intensity but experience relatively low levels of distress. This observation suggests that while we may not have control over the cause or the intensity of pain, we can employ helpful ways to cope with pain,” says Evans.

Coping Strategies

If you are dealing with the emotional side of chronic pain, Evans recommends seeking support from mental health professionals, such as psychologists or therapists, who specialize in chronic pain management. They can help you explore tools to manage your emotions, such as cognitive behavioral therapy (CBT), mindfulness meditation, and stress reduction.

CBT is a therapeutic approach that addresses the connection between thoughts, feelings, and behaviors. It can help individuals identify and change negative thought patterns contributing to anxiety and pain. “Cognitive skills for pain may include observing the relationship between one’s thoughts, emotions, and behaviors, and challenging and reappraising thoughts and beliefs,” says Evans. For example, she explains, someone may think, “This pain is the end of me,” but after further consideration, they may conclude, “I can still live a good life, despite the pain.”

Behavioral Strategies

Behavioral strategies that can help you deal with the emotional side of pain include progressive muscle relaxation, breathing techniques, and guided imagery.

Progressive muscle relaxation (PMR). This involves tensing and then relaxing different muscle groups. By doing so, a person can become more aware of muscle tension and learn to release it, promoting overall relaxation.

Deep breathing exercises. Controlled breathing can help reduce anxiety and promote relaxation. Techniques like “diaphragmatic breathing” involve deep and slow inhalation through the nose, holding your breath briefly, and then exhaling slowly through your mouth.

Guided imagery. Visualization or guided imagery involves creating calming mental images to counteract negative thoughts and emotions. This technique can help redirect focus away from pain and stress.

Mindfulness Meditation

Meditation practices, such as mindfulness-based stress reduction (MBSR), can be effective in managing anxiety associated with chronic pain. “A skill that is acquired in mindfulness is the ability to cultivate detached observation,” says Evans. This skill fosters “distancing” and “diffusion,” which are two techniques that can help with pain reduction.

Distancing: This involves mentally stepping back from your thoughts or emotions to create a sense of space between yourself and what you’re experiencing. When a challenging thought or emotion arises, instead of getting completely absorbed in it, you observe it from a more detached perspective. It’s like taking a step back to see the thought without becoming overwhelmed by it.

Diffusion: This involves loosening the grip of thoughts or emotions by changing how you relate to them. For instance, rather than taking thoughts and emotions too seriously or letting them control you, diffusion involves seeing them as passing events in the mind. You might imagine thoughts as clouds drifting by or use language that emphasizes their transient nature, such as: This, too, shall pass.

Effective Ways to Control Emotions

Acceptance of the pain can help in coping with the emotional burden. “Acceptance does not mean giving up. In the context of pain, acceptance means acknowledging the presence of pain and at the same time employing coping strategies that increase a sense of control and self-efficacy,” says Evans. Control is about feeling like you can have an impact on your circumstances, while self-efficacy means believing in your own ability to handle different aspects of life effectively. Both concepts are crucial for a positive mindset.

Chronic pain can lead to stress, anxiety, depression, and a wide range of emotional challenges, but chronic pain does not have to be synonymous with suffering. If negative emotions are consistently affecting your mood or ability to function, talk with your doctor. It may also be useful to seek help from a mental health professional.

The post Take Steps to Improve Quality of Life by Managing the Emotional Side of Pain appeared first on University Health News.

Occasional heartburn usually responds to over-the-counter antacids, which neutralize stomach acid (e.g., Tums, Rolaids, and Maalox). Frequent heartburn sufferers may need drugs such as H2 blockers or proton pump inhibitors (PPIs), which reduce how much acid your stomach makes. Although PPIs are generally considered safe, researchers have identified potential risks associated with them, especially when using them longterm.

There are, however, some natural solutions that can work quite quickly, cost little to nothing to try and have been found to be effective in many people.

The Benefits of Slow Deep Breaths

Suzanne Smith is an integrative nurse practitioner in the UCLA Integrative Digestive Health and Wellness program. She teaches her patients how to tap into the benefits of deep breathing. The calming effect is virtually instantaneous, which is why she finds diaphragmatic breathing such a valuable tool for people who have gastroesophageal reflux disease (GERD), or abdominal bloating and distention.

“When we take deep diaphragmatic breaths, it calms the body and the diaphragmatic movement also creates a kind of anti-reflux action that can help relieve GERD symptoms, which can be especially helpful to people who are not responding to PPIs.”

The technique isn’t necessarily a replacement for medications, though in some cases it might be. When used skillfully, the breathing practice can do more than just relieve GI distress; it may prevent it in some people. For example, Smith recommends taking a few deep slow breaths before and after meals to aid digestion.

Adjust Eating Habits

It can be easy to overeat, especially if you fill up large dinner plates and have tempting platters of food on the table during meals. Large meals can increase stomach pressure, leading to heartburn. Use smaller food plates and keep serving platters away from the dinner table. You can also try eating smaller, more frequent meals to reduce the risk of overloading your belly at one sitting.

Understanding your trigger foods and avoiding them can stop heartburn before it even starts. Common triggers include spicy foods, tomatoes, citrus fruits, garlic, onions, chocolate, coffee, caffeine, alcoholic beverages, and fatty or fried foods. Also know that smoking and alcohol both can irritate the lining of the esophagus and can exacerbate heartburn symptoms. It’s best to quit smoking and limit alcohol consumption to ease heartburn.

Most people realize that eating before bed is not wise for the waistline, but it’s also a heartburn trigger. Avoid lying down after eating, and try to eat your last meal at least two to three hours before going to bed.

Lifestyle Modifications

Excess weight can put pressure on your abdomen, pushing up your stomach and causing acid to reflux into your esophagus. Maintaining a healthy weight, therefore, can reduce that from happening. Tight belts and other snug clothing can similarly squeeze your stomach and push acid up into your esophagus.

When you eat, take your time. Eating slowly and chewing thoroughly can help prevent overeating and reduce heartburn symptoms. Stress and anxiety also can worsen heartburn symptoms.

“Sometimes people don’t have a positive relationship with food, and they may have some anxiety that’s not always conscious,” Smith adds. “In such cases, the body might see food as a threat instead of a positive element. This can trigger the stress response and GI upset.” Practices like tai chi, yoga, and deep breathing can help manage stress.

Exercise in general can be helpful. A study published in JAMA Internal Medicine reported that getting at least 30 minutes per day of moderate-to-vigorous exercise can be particularly effective in reducing acid reflux. Exercise boosts activity in the digestive tract, so it may help clear stomach acid that causes heartburn symptoms.

When to See Your Doctor

If you frequently experience heartburn (twice a week or more) or if your symptoms are severe, it’s important to consult with a healthcare professional. Chronic heartburn can be a symptom of GERD, which can lead to more serious problems, including inflammation of the esophagus, esophageal ulcers, or Barrett’s esophagus, which can increase the risk of esophageal cancer.

The post Natural Ways to Ease Heartburn appeared first on University Health News.

Historically, kava has been used for thousands of years in religious rituals and ceremonial practices and for its medicinal effects as such as pain reliever, muscle relaxant, and as a remedy for anxiety, nervousness, and insomnia.

A set of compounds known as lactones are present in abundance, almost exclusively in kava, and are names kavalactones. These compounds are thought to be responsible for the health benefits reported in traditional kava preparations, though it is important to note that there are potential risks associated with its use.

Special Functions. Reported benefits of kava include neurological support, particularly for stress and anxiety, and for anti-inflammatory actions, as well as for anti-cancer potential. Howevevr, kava is best known for potential benefits against generalized anxiety disorder (GAD) with a number of clinical studies indicating positive benefits with kava use compared with placebo control. The mechanisms of action for the proposed benefits of kava are not well understood and require additional research and study.

Side Effects, Toxicity, and Interactions. Kava use is not free from side effects, including fatigue, headaches, tremors, and restlessness and its incorporation into a daily regimen should be treated with caution. Long-term use of kava may contribute to kava dermopathy, a condition involving dry, flaky skin with a yellow discoloration.

Additionally, liver toxicity has been reported with kava use—between the late 1990s and early 2000s, over 100 cases of liver toxicity were reported with kava exposure. However, due to dissimilarities among kava products and inadequacies in reporting, there is limited information to support a causal relationship between kava and liver damage.

Intake of kava may result in adverse drug interactions and it should not be taken with alcohol, certain anxiety medications (such as benzodiazepines and barbiturates), or with medications commonly used for patients with Parkinson’s disease. Kava may interact with other substances as well so be sure to talk with your healthcare provider about any other medications or supplements you use before incorporating kava supplements into your daily regimen.

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First-Line Tests

In the poll, which included 1,242 adults ages 65 to 80, 80 percent of respondents said they saw the benefit of tests that can provide an early warning that a person’s memory and thinking abilities have started to decline, and 60 percent said that health-care providers should offer annual memory tests to all older adults. Some primary-care doctors do just that at your annual wellness check, using simple tests that typically take five minutes or less. With your permission, your doctor can have you complete the General Practitioner Assessment of Cognition, the Memory Impairment Screen, or the Mini- Cog. The tests vary slightly, but all involve recalling certain facts, such as a short list of words you are shown at the beginning of the test—you also may be asked to draw a clock face with the hands pointing to the current time, count backward from a high number, and/or spell a word backward.

Despite the ease with which these tests can be taken, 80 percent of poll respondents said they had not undergone any cognitive testing in the past year, and 59 percent reported never having been screened. “It is possible they were not offered testing because they were not having memory issues,” Dr. Bloom says. That fits with advice from the U.S. Preventive Services Task Force, an independent panel of health experts that makes evidencebased recommendations for preventive medicine, including screening. In 2020, the panel concluded that the current evidence is insufficient to assess the balance of benefits and harms of screening for cognitive impairment in asymptomatic older adults.

Don’t Panic

Keep in mind that some memory changes in older age are normal— for example, you may find it a little harder to multitask, occasionally misplace your car keys, or draw a blank when it comes to remembering the name of someone you only just met. But routinely finding that you’ve left something in the wrong place (for example, putting the TV remote control in the cutlery drawer), becoming disoriented when it comes to remembering time and place, or getting lost while walking or driving along familiar roads may be a cause for concern. “If the simple tests carried out at your doctor’s office point to a potential problem, you will be referred for a more thorough evaluation,” Dr. Bloom notes.

Spur to Action

Most of the poll respondents (96 percent) said that if a cognitive screening test indicated a degree of impairment, they would take action to protect their brain health. Some studies have suggested that engaging in physical activity and consuming a healthy diet rich in fruits, vegetables, whole grains, and healthy fats may help delay cognitive decline. “There also is evidence that mental stimulation in the form of crosswords and other brain games may help, along with maintaining an active social life and addressing vision and hearing impairment,” Dr. Bloom adds. (See next month’s issue for tips on choosing hearing aids.)

If more advanced cognitive testing suggests that you are at risk of dementia, you may want to try taking medications that can delay dementia progression in some people. While older drugs have not been as successful as clinicians have hoped, a new option called lecanemab (Leqembi®) shows more promise for people with mild cognitive impairment (noticeable memory issues that can be a precursor for Alzheimer’s disease) and early dementia. “However, further study is needed to clarify the drug’s efficacy and safety,” Dr. Bloom cautions. See our May 2023 issue for more on lecanemab and other drug options.

Advance Care Planning

Threequarters of the poll respondents said they would adjust their financial and health-care planning in response to worrying test results. “All older adults should think about setting up an advance care plan,” Dr. Bloom says. “Such plans enable you to communicate your preferences for medical treatment if you should ever become unable to make your own healthcare decisions.” You don’t need a lawyer to set up a plan—your local health department can provide state-approved forms. For further guidance, visit Prepare for Your Care online (see Resources).

Resources

Prepare for Your Care

https://tinyurl.com/PrepFC

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The use of nonpharmaceutical healing methods is popular among people who want to avoid the potential side effects of pain medications and instead manage pain with natural treatments that rely on the mind-body connection. Mindbody therapies are treatments that harness the mind’s ability to impact the functions and symptoms of the body.

“Two people can have the same injury or trauma, but how they experience pain and cope with it is often different,” says Chiti Parikh, MD, Integrative Health and Wellbeing specialist, Weill Cornell Medicine. “How the body experiences pain is very much determined by how the mind processes these signals. This is why an integrative approach to pain focuses not just on the physical aspect of the pain but also prioritizes optimizing the mind-body connection,” she explains.

Examples of mind-body therapies include acupuncture, massage, meditation, relaxation techniques, tai chi, and yoga. “Countless studies demonstrate the effectiveness of these integrative mind-body techniques. They often confer their health benefit by optimizing the mind-body connection, which is central to how someone experiences and heals from pain,” says Dr. Parikh.

“Now prior to using any medications such as nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, and naproxen, antidepressants, or opioids, some of the nondrug therapies that American College of Physicians (ACP) recommends include acupuncture, exercise, mindfulness-based stress reduction, tai chi, yoga, and progressive relaxation, among other things,” she explains.

For people interested in holistic pain management, whether alone or in combination with traditional medicine, some options to consider are described here.

Acupuncture

Traditional Chinese medicine practitioners believe acupuncture balances the flow of energy known as qi or chi. Western medical practitioners see it as a way to stimulate nerves and muscles in a way that promotes pain relief and healing. In acupuncture, disposable, stainless steel needles are used to stimulate the body’s 14 major meridians, or energycarrying channels, to resist or overcome pain or illness by correcting imbalances. Acupuncture is also thought to decrease pain by increasing the release of endorphins—chemicals that block the message of pain from being delivered up to the brain. Types of pain treated with acupuncture include joint pain, muscle pain, headaches, and low back pain. “There is ample evidence that acupuncture can be beneficial in addressing chronic low back pain,” says Dr. Parikh. “That is why the ACP updated its evidence-based guidelines on managing chronic low back pain to include acupuncture.”

Exercise

Exercise is one of the most important ways you can manage pain, while improving your overall health. Some good examples of exercise for those with chronic pain include walking, swimming, tai chi, yoga, and strength training. If you have limited mobility, consider finding small exercises you can do while seated or lying down. Talk to your doctor or a physical therapist about which exercise best fits your pain management needs and physical capabilities.

Massage

In addition to relieving pain by relaxing painful muscles, tendons, and joints, massage can help decrease stress and anxiety, which can increase pain. There are a wide range of massage styles, including deep tissue, shiatsu, trigger point, and reflexology.

Mindfulness Based Stress‑Reduction

Mindfulness and meditation help quiet the nervous system and lower stress, which decreases muscle tension and can lead to lower pain levels. There are many styles of meditation and mindfulness training, such as techniques that focus on breathing, progressive relaxation, or engaging in guided imagery.

Talk to Your Doctor About Integrative Care

Although things like acupuncture, meditation, and massage have good safety records for their use in the treatment of pain, that doesn’t mean that they’re risk-free for everyone, according to the National Center for Complementary and Integrative Health, which is part of the U.S. Department of Health and Human Services. So if you’re considering a holistic approach to pain management—such as herbs, which sometimes accompany acupuncture– remember that natural doesn’t always mean safe and that some dietary supplements may have side effects or interact with medications. Always talk to your doctor before trying an alternative health-care approach, and tell all your doctors about any integrative therapy you are using so your medical records will be up to date and accurate for everyone on your health-care team.

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A:  A migraine headache is a neurological condition (i.e., it’s a disease of the nervous system) and unlike other kinds of headaches, a migraine has other symptoms, such as nausea, vomiting, and dizziness. The pain is intense and can last four to 72 hours, it can affect one or both sides of your head, and the pain usually gets worse with activity. Other symptoms include being sensitive to light, sounds, and smells, and feeling weak. Some people with migraines have different triggers, such as stress and anxiety, certain foods/beverages, changes in hormone levels, inadequate sleep, sudden weather changes, and medication overuse, which can happen from long-term use of some prescription and over-the-counter medications. To help your physician diagnose yoru headache, keep track of what might be triggering your symptoms, when they started, what the pain feels like, how long it lasted and anything that might have helped relieve it. Try to recall any subtle changes prior to the commencement of the pain (e.g., mood changes, food cravings, frequent yawning, increased urination, or fluid retention). After the pain passes, some people feel drained, while others might feel elated. There are some prescription medications that can help prevent migraine symptoms as well as nonpharmaceutical remedies that may be helpful. Digestive conditions such as irritable bowel syndrome and celiac disease might be linked to migraines. Treating these conditions may help reduce or eliminate migraine occurrence.

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