Unless something changes, the total number of people in the United States who have dementia will skyrocket over the next few decades. The Alzheimer’s Association reports that one in three Americans age 65 or older currently have some type of dementia. Our population is also aging.
It is already becoming harder to qualify for needs-based assistance programs. The Veterans Administration changed its qualification rules last year. We will need more care providers, more assisted living facilities, more skilled nursing homes, and billions of dollars to pay for all of these things. Or people could stop getting dementia.
When I ask clients about cognitive decline they always tell me who in their family had dementia. Many believe that they are genetically predestined to fall into the same patterns as their parents and grandparents. But it may not be your mother and father’s genes that harm you. It may be their bad habits.
Only about 1% of people inherit a gene mutation that causes early onset Alzheimer’s. Another gene called APOE can influence your risk for the more common late-onset type of Alzheimer’s. Everyone has two copies of the APOE gene. It comes in three types – APOE2, APOE3, and APOE4. I don’t pretend to understand the mechanics of this. But I do know that I have two APOE3 genes. It is the most common, and it does not appear to influence the development of Alzheimer’s. Research by D.M. Michaelson found that having one copy of APOE 4 can increase your risk by 2 to 3 times while two copies can increase the risk by 12 times. But even if you do have an APOE4 gene, there is a great deal that you can do about those risks.
Dale Bredesen is a California neurologist who has studied Alzheimer’s for more than 30 years. He says that Alzheimer’s can be prevented and in many cases cognitive decline can be reversed. He is careful never to say “cured.” There appears to be no silver bullet. But Dr. Bredesen has identified about three dozen drivers of the disease, which he calls “neuro-terrorists.” They include such things as insulin resistance, chronic stress, leaky gut, lack of exercise, smoking, exposure to toxins, trans fats, and refined carbohydrates. Now you can add cognitive decline to the long list of reasons to avoid these things.
I help people develop the best legal strategies to put in place as they age. We always plan for the possibility of incapacity. But the best way to grow older is to stay healthy. Obviously, we don’t always control that. But we can control most of those neuro-terrorists. Saying you don’t plan to go to a nursing home is very different from not doing things that might send you there. The effects of a decades-long assault on your brain of poor eating, poor movement, poor stress management and poor sleeping habits can eventually produce symptoms of cognitive decline. Life is better when your brain works properly.
Unfortunately, we don’t respond well to problems that have incremental impact. The revelation that smoking will slowly kill you wasn’t good enough to change the culture. It took a century and the financial impact of higher taxes and insurance rates to make most people quit smoking. I have no financial incentives to exercise, eat well, sleep enough, or manage stress. But I understand that taking small steps now can have lasting impacts. I also recognize that health care is not restricted to those services that are covered by my insurance.
Having a legal plan in place to deal with the effects of growing older is critical. Planning for long-term care is an important part of that plan. But two important components of your plan should be doing things that help your brain work properly and cultivating relationships with people who will want to help you when you can’t cut your grass anymore. Leaving a legacy is one of the most important parts of life. Your written estate plan is an important part of that legacy. But it’s not the only part.