Cognitive Aging Progress in Understanding and Opportunities for Action (2015) / Chapter Skim
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6 Community Action: Health, Financial Management, Driving, Technology, and Consumer Decisions
6 Community Action: Health, Financial Management, Driving, Technology, and Consumer Decisions
Pages 227-256
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From page 227... ...
SUPPORTING AND MAINTAINING THE PUBLIC'S COGNITIVE HEALTH As discussed in Chapter 4C and detailed in Recommendation 3, there is evidence that individuals and their families can make changes to reduce cognitive decline and promote healthy cognitive aging. Individuals vary widely in their cognitive capacity and in the extent to which these actions will affect their cognitive function.
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. The three health- and behavior-related actions identified by the committee with the strongest evidence for effectiveness in positively affecting cognitive aging are • engaging in physical activity, • reducing cardiovascular disease risk factors, and • managing medications effectively.
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. Reduce Cardiovascular Disease Risk Factors The management of cardiovascular disease risk factors encompasses physical activity, healthy eating, healthy weight management, and smoking cessation.
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Based on the data presented in Chapter 4B of this report, working toward these goals may help improve cognitive health. Many community resources, programs, and opportunities are aimed at reducing cardiovascular disease risk factors.
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Potential adverse effects of medications are frequent topics of discussion at senior BOX 6-1 Online Resources for Safe Medication Use in Older Adults • merican Geriatrics Society Beers Criteria (including public education re A sources)
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This section provides a brief discussion of ways to sustain changes in physical activity. Reducing cardiovascular risk factors and many other relevant lifestyle and health behaviors has been and continues to be the focus of efforts to sustain behavior change (see Chapters 4A and 4B)
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A systematic review of programs that promote physical activity for all age groups found that creating community rail-trails was very cost-effective (Laine et al., 2014) , although costs for changes to the built environment may vary from community to community, based on the existing infrastructure.
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. The Financial Fraud Enforcement Task Force, established in 2009, defines elder fraud as "an act targeting older adults in which attempts are made to deceive with promises of goods, services, or financial benefits that do not exist, were never intended to be provided, or were misrepresented" (Financial Fraud Enforcement Task Force, 2014)
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These include giving institutions the authority to place a short-term hold on a suspicious or unsuitable transaction to allow time for investigation and intervention, clarifying privacy laws to allow this reporting, creating a national database of those who commit financial abuse and exploitation of elders, and revising databases that record consumer complaints so that the reporting of suspected fraud or exploitation does not appear among complaints about a financial advisor or institution. In 2010, Washington State enacted a law allowing a 10-day hold on any suspicious transaction involving a vulnerable adult to allow time for investigation and possible intervention.1 The law also includes requirements for the training of financial institution employees about the financial exploitation of vulnerable adults.2 Furthermore, standards are needed for how to present financial information requiring a decision so that it can be understood by someone who has cognitive changes seen with aging and to verify that the consumer has made a decision that meets his or her financial means and objectives.
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The projects are funded by ACL, and together they served more than 1 million people in 2013. Next Steps: Financial Decision Making Credible consumer financial education programs are offered through community and civic groups; retirement housing communities; faith communities; and state, regional, and county aging networks.
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F • inancial Fraud Enforcement Task Force: Protect Yourself: Elder Fraud and F Financial Exploitation (Financial Fraud Enforcement Task Force, 2014) • ational Council on Aging: Top 10 Scams Targeting Seniors (NCOA, 2014)
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Strategies to consider include giving financial institutions the authority to place a short-term hold on a suspicious or unsuitable transaction to allow time for investigation and intervention, enacting clear privacy laws to allow this type of reporting, creating a national database of those who commit elder abuse and financial exploitation, and revising databases that record consumer complaints so that a financial advisor's or institution's reporting of suspected fraud or exploitation does not appear as a complaint about the advisor or institution. DRIVING Driving an automobile safely relies on several elements of cognition, such as processing speed, decision making, and multitasking.
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For example, the California Department of Motor Vehicles provides a 15-question online self-assessment (California DMV, 2014)
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ermont Department of Motor Vehicles: Mature Drivers (Vermont DMV, V 2014) irginia Grand Driver: Driver Safety Tips (Virginia Grand Driver, 2014)
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Furthermore, because many of these products are not free, the need to make informed choices becomes even more important as many older adults have fixed incomes and may not be able to afford spending their limited financial resources on products with potentially false claims of improving cognitive function. Many groups need independent and evidence-based information: individuals and their families; professionals in the health care, public health, and long-term care areas; and senior centers, exercise facilities, and numerous other locations.
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from the research findings? • Comparative effectiveness: Have the benefits of the product been compared to the benefits of other products or lifestyle choices, such as physical activity, intellectual engagement, social interaction, or diet, that may impact cognitive health?
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Information gateways have been set up as resource tools for a variety of public health concerns. For example, the Child Welfare Information Gateway is a joint effort of the Department of Health and Human Services' Children's Bureau and the Administration for Children and Families that offers an extensive website of resources, information, and a toll-free information phone line to help protect children (HHS, 2014a)
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Because technology is such a broad topic with so many applications, this report highlights just a few examples where technology may be useful to or adapted for older individuals who are experiencing cognitive changes. Smart Homes Environmental adaptations and "smart homes" have been developed as a way to keep older adults safer at home, maintain or enhance their independence, improve early recognition of signs of illness, and improve quality of life.
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OATS is expanding to rural areas and adding online courses in Internet essentials as well as pilot courses on health and financial information. There are also guidelines available for design training and instructional programs for older adult learners (e.g., Czaja et al., 2013)
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Positive outcomes can be reached via many mechanisms and with innovation from organizations big and small, public and private. RECOMMENDATIONS Recommendation 8: Develop Consumer Product Evaluation Criteria and an Independent Information Gateway The Centers for Disease Control and Prevention, National Institutes of Health, and the Administration for Community Living, in conjunc tion with other health and consumer protection agencies, nonprofit organizations, and professional associations, should develop, test, and implement cognitive aging information resources and tools that can
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, professional associations, and relevant private-sector companies and consumer organizations should develop, expand, implement, and evalu ate programs and services used by older adults relevant to cognitive aging with the goal of helping older adults avoid exploitation, optimize their independence, improve their function in daily life, and aid their decision making. Specifically, • Financial decision making: The banking and financial services industries and state and federal banking and financial regulators should develop and disseminate banking and financial policies, services, and information materials that assist older adults and their families in making decisions that meet their financial means and objectives, that reduce the op portunities for unsuitable decisions, and that mitigate the harms of such decisions.
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Laws and regulations should be revised to mitigate civil liability and professional harms resulting from such protective actions. • Driving and transportation: NHTSA, states' departments of motor vehicles, and rel evant professional and consumer organizations such as the American Automobile Association should expand, validate, and disseminate tools and informational mate rials to assist older adults in maintaining and assessing their driving skills and to assist older adults and their families in making decisions about safe driving.
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2012. American Geriatrics Society updated Beers criteria for potentially inappropriate medication use in older adults.
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http://www.cdc.gov/physical activity/everyone/guidelines/olderadults.html (accessed December 15, 2014)
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http://www.fda.gov/Drugs/ResourcesForYou/ucm163959.htm (accessed December 15, 2014)
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Interna tional Journal of Behavioral Nutrition and Physical Activity 8:125. MetLife Mature Market Institute, National Committee for the Prevention of Elder Abuse, and Virginia Tech.
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http://seniortransportation.net (accessed December 15, 2014)
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International Journal of Behavioral Nutrition and Physical Activity 8:105. van Stralen, M
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http://www.dol. wa.gov/driverslicense/seniors.html (accessed December 15, 2014)
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