Carly Belloff: Memory and Aging

Context

Reference to a current Michigan bill or law that relates in some way to your proposal:

In House Bill No. 4866, it states that “THE DEPARTMENT MAY PROVIDE GRANTS TO PUBLIC AND PRIVATE NONPROFIT ENTITIES FOR PROJECTS THAT DEMONSTRATE WAYS TO INTEGRATE MENTAL HEALTH SERVICES FOR OLDER ADULTS INTO PRIMARY HEALTH CARE SETTINGS, SUCH AS FEDERALLY QUALIFIED HEALTH CENTERS, …PRIMARY CARE CLINICS, AND PRIVATE PRACTICE SITES.”

Therefore, this bill shows that Michigan recognizes the need to incorporate mental health services into primary health care settings for older adults, as the government provides grants to entities who have projects that assist with this prominent issue. Although this bill illustrates that Michigan is willing to help older adults who already experience some type of mental deterioration, I assume they would also help fund a mental health project similar to my proposal that focuses on integrating mental health services such as an online memory course to help younger adults prolong the cognitive decline that occurs with age.

Why this proposal will make a difference in the lives of students of all ages across Michigan, or a significant subgroup (by age, background, economic status, and/or region, etc.) of students in Michigan:

Similar to how individuals obtain a discount on their automobile insurance by taking driver safety courses because these courses not only save lives, but also reduce the number of claims that the insurance company will receive, I believe this same policy should occur with memory courses. It is the insurance companies that pay for medical bills, nursing homes, and any other additional medical requirements for those diagnosed with Dementia, so I propose that Michigan insurance companies should provide medical insurance discounts to those who take a memory improvement course. This type of online course will not only save lives, as it will help people keep their minds healthy, but it will also reduce the amount of medical insurance claims that can occur later on in life.

If students participate in these memory courses before their cognitive decline begins, then they will be more likely to maintain their healthy brains. Not only is the financial burden of dementia in Michigan about $5 billion per year, but dementia is also the 6th leading cause of death in Michigan. For example, in Michigan specifically, the number of deaths from Alzheimer’s disease in 2013 was 3,220 and there was a 96% increase in Alzheimer’s deaths since 2000. Similarly, in 2017, it was found that 180,000 Americans living in Michigan who are age 65 and older were diagnosed with Dementia and this number is estimated to increase to 220,000 by 2025 (a 22.2% increase). Therefore, compared to other states, Michigan is the 8th state that is most affected by this disease behind CA, FL, IL, NY, OH, PA, and TX. With that being said, considering its profound impact on caregivers, dementia thus affects at least 400,000 people in the state of Michigan. Therefore, it is clear that dementia directly affects the lives of thousands of individuals living in Michigan, and I believe it is extremely important to prevent people from being a part of this disturbing number at an early age before the brain is too far gone.

These memory courses will make a difference in the lives of students of all ages across Michigan because according to many studies, mental exercises during both grade-school years and late adulthood independently contribute to a slower mental decline in old age. About one-third of cognitive decline in older adults occurs because of physical abnormalities in the brain such as plaques of amyloid beta proteins linked to Alzheimer’s disease, but the amount of cognitive activity throughout a person’s lifetime could explain an additional 10% of their cognitive decline. For example, participants who performed the least amount of brain activity saw 50 percent more cognitive decline whereas those who performed the most amount of brain activity had 33% less cognitive decline. Therefore, these online memory courses can teach students how to incorporate brain activity into their daily lives and as a result will help them prolong the amount of cognitive decline that they experience with aging.

https://www.livescience.com/37958-brain-activities-alzheimers-memory.html

How and where did you learn about the issues underlying your proposal?

Unfortunately, I was able to experience this issue of cognitive decline and dementia first-hand, as these disorders affected the lives of many of my loved ones. Dementia is a very sad disease and affects the lives of not only the people diagnosed, but also the numerous caregivers. After learning that these types of brain malfunctions can occur genetically, I conducted much research to see what could be done to prevent my own brain from declining as well as the thousands of people who are affected. I found much research that illustrates how training your brain and keeping your mind engaged with brain activities can prolong this cognitive decline. I was even able to witness how essential it is to keep your brain stimulated, as my family and I believe my grandpa was diagnosed with dementia at such a late age because he retired at a late stage in his life and always partook in mind activities such as by doing Soduko puzzles. Similarly, after volunteering at Brookdale nursing home, I was able to observe that it is important to start these types of brain activities early on in life before the brain already experienced too much cognitive decline similar to the brains of the residents in Brookdale’s memory care facility.

How has your service activity influenced your thinking about this proposal?

This semester I am volunteering at Brookdale Senior Living, which is a Memory Care community that provides Alzheimer’s and dementia care for seniors. After interacting with these residents, I was able to see the affects that cognitive decline can have on people first-hand. For example, one resident told me how she has had three husbands throughout her life and has pictures that she looks at every morning, but struggles to this day to remember any of their names. Another resident continuously asked me where she was, as she was not able to remember or process this information. After observing the struggles that these residents with dementia experience, it only made me feel stronger about my proposal, as I am determined to help younger adults in Michigan experience the least amount of cognitive decline as possible so they do not end up living in memory care facilities such as Brookdale later on in life. Although Brookdale provides its residents with engaging activities such as puzzles and card games that can help maintain a healthy brain, the resident’s brains at Brookdale are already too far gone, showing how essential it is to start these brain activities at an early age. As a volunteer, I constantly do puzzles with the residents as well as play card games such as Uno, but it is clear that the residents struggle with these activities as a result of their cognitive decline. 

Link to your media artifact(s) giving background on the issue:

My infographic: Issues on Memory and Aging

Consultations

Talk directly with at least 3 real live people who have special knowledge about this topic or the impact your proposal would have, and summarize their comments. These may include people appearing in your media artifact (video, podcast, etc.).

CONSULTATION 1:

I had the pleasure of speaking with Martin Goldstein, a Neurologist at Mount Sinai Hospital in New York. Neurologists diagnose and treat disorders of the brain, spinal cord, peripheral nerves, muscles, and the involuntary nervous system that controls the heart, lungs, and other organs. They treat headaches, strokes, dementia, seizures, epilepsy, multiple sclerosis, sleep disorders, and neuromuscular diseases. I was fortunate enough to speak with Martin Goldstein on the phone regarding the issue of memory and aging and he stated as followed:

“A healthy brain is as important as a healthy heart. Today people are focusing on aerobic exercises in order to maintain a heart, but I think it is just as important for people to focus on maintaining a healthy brain starting at an early age.”

CONSULTATION 2:

I had the pleasure of speaking with my mother, Amie Belloff, who was a caregiver to her father with Dementia. She shared her experiences of caring for her father and explained how sad it was when her father continuously asked what day of the week it was or if he ate or took his medicine yet. After sharing my memory course idea with Amie, she agreed that her father definitely would have benefitted if he conducted brain activities such as memory puzzles at a young age. She shared that her father’s brain lasted as long as it did because of the Soduko puzzles he would do and agreed that if he started these games earlier in life, then maybe he would still be alive today. Amie also shared that her father retired at a late age, and she believes this kept his brain stimulated and therefore prolonged his onset of Dementia. Because Dementia can be hereditary, Amie said that she is very nervous and would definitely partake in these memory games, as she is willing to do anything that will give her a chance to retain her memory for as long as possible.

CONSULTATION 3:

I had the pleasure of speaking with Larrissa Carlton, the program coordinator at Brookdale Senior Living. Below are the questions I asked her as well as her responses:

You’re taking care of residents with a disease where there’s no cure. What in your day is fulfilling to you in dealing with these residents with Dementia? For me it’s very fulfilling to know that this is their last stop. Brookdale is most of these resident’s last home. It’s my job to make them smile and happy. It is extremely rewarding that you can make them smile everyday by doing activities and doing something they enjoy. Fulfilling and easy to go to work to make them smile.

What’s your background and expertise in this field? Recreational therapist and during internship I worked in long term care. Worked in rehab facilities and then studied psychology. Now, work with patients with Dementia, which has psych mixed into it.

What made you choose working at a memory care facility? Passion for field and also in memory care. It’s a special population of folks and to my heart. They can’t do anything their disease and it’s my job to enlighten that moment and bring happiness. Being able to increase their quality of life is what drew me.

From the facilities perspective, have you seen the number of patients with dementia increase or decrease? Increase. Always getting new people. When I started we didn’t have as many but now a lot more.

Do you do any activities to help your residents improve their memory or not further reduce? We do a lot of cognitive training. Activities like hangman where they have to guess the word. A lot of trivia. A lot of reminiscing. If we talk about things they can remember, this will keep it in their memory longer. Games that help their memories. Card games that volunteers such as yourself do with them. All cognitively stimulating activities.

How much time per week is spent? A minimum of 3 times a week. Do it pretty often. Even if it isn’t on their calendar, I still try to do a 15 min memory activity. Even just having someone read out loud is cognitively stimulating. Sometimes I have one of the residents read the daily newspaper out loud to the rest of the residents. Sometimes this is very challenging for them to do, but this is a characteristic that occurs with Dementia.

Do you see any improvements with the patients who take advantage of the activities? Wouldn’t say improvement. Residents who participate maintain their cognitive activity longer than the ones who do not. The residents who do not come out of their room vs the residents who come out and socialize can maintain their cognitive memory longer. The residents who do leave their room will eventually start to decline, but the decline will happen slower.

Do you feel that these memory games are of any help? Yes

Do you feel if people participate in these brain activities to increase their memory at an earlier age then it would have prolonged the onset of dementia? I think it’s a possibility. As far as it being true through research, I think it could be a possibility that It could help because I do believe that stimulating our brains is very big and using our brains as much as we can is very big. So I definitely think it will prolong the onset of Dementia by increasing your cognition.

Research shows that brain activities can help decrease the amount of cognitive decline that people experience if these activities start at an early age. How do you feel if we can prolong this, shouldn’t insurance companies give discounts if they take these courses to help their memory at an early age? I think that is a very good idea. It will be very beneficial because dementia is a very sad disease. It’s like someone is dying while they are living. It’s crazy to watch. And if you can see someone with the disease as it progressives and the fact that you want to help them before they decline is amazing and it can possibly decrease the number of people with dementia. Awesome idea and can truly benefit individuals. I think a lot of people would be more likely to participate in the activities because of these discounts. People won’t do something unless there is incentive and this idea will benefit them in the long run.

Prospectus:

Describe the specific issue or problem, being sure to provide sufficient context so that someone less familiar with the issue has a sense of the bigger picture, but know that your focus here is on a more detailed spelling out of the specific problem or issue that you’ve identified. (250 words minimum)

With the aging of the population, providing care to someone with dementia is becoming inevitable and a normative life experience across all 50 US states. Over 5 million Americans are living with Alzheimer’s Diseases, and as many as 16 million Americans are predicted to have the disease in 2050. Additionally, the cost of caring for those affected by Alzheimer’s and other forms of dementia was estimated to total $236 billion in 2016 and this number is predicted to increase to $1.1 trillion by mid-century. However, this memory loss problem has specifically impacted the state of Michigan. Not only is the financial burden of dementia in Michigan about $5 billion per year, but dementia is also the 6th leading cause of death in Michigan. For example, in Michigan specifically, the number of deaths from Alzheimer’s disease in 2013 was 3,220 and there was a 96% increase in Alzheimer’s deaths since 2000. Similarly, in 2017, it was found that 180,000 Americans living in Michigan who are age 65 and older were diagnosed with Dementia and this number is estimated to increase to 220,000 by 2025 (a 22.2% increase). Therefore, compared to other states, Michigan is the 8th state that is most affected by this disease behind CA, FL, IL, NY, OH, PA, and TX. With that being said, considering its profound impact on caregivers, dementia thus affects at least 400,000 people in the state of Michigan.

With the abundant amount of people affected by this disease in Michigan, it is of crucial importance to resolve this issue and help prevent students from being a part of this disturbing number of individuals who experience memory loss. Although it was originally believed that little could be done to help people diagnosed with dementia beyond providing a safe environment and comfort care, there are now effective ways to improve and maintain memory starting at an early age. For example, there is much research that links Alzheimer’s disease with diet, exercise, emotional support, brain exercises, etc., and if students implement these habits within their daily routines early on, they will be more likely to maintain a healthy brain throughout their lives. I look forward to conducting more research regarding the requirements of Michigan school health classes, as I believe a possible solution to this issue is to increase the awareness of the preventative measures that can reduce memory loss at an early age.

Sources:

https://www.alz.org/documents_custom/facts_2016/statesheet_michigan.pdf

http://www.michigan.gov/documents/michigan_dementia_planshort_84926_7.pdf

https://www.alz.org/documents_custom/2017-facts-and-figures.pdf

https://www.aarp.org/health/brain-health/info-2017/foods-decrease-alzheimers-risk-fd.html?intcmp=AE-HEA-CND-EOA1-FD

Potential Solutions:

Describe three reasonable, feasible potential solutions or approaches that would help address this problem.

SOLUTION 1:

It is essential that students are taught about the preventative measures that can reduce memory loss at an early age before it becomes too late. After reading Michigan’s Health Education Content Standards and Expectations for grades K-8 created by the Michigan Department of Education, it is clear that effective health education helps students increase their health knowledge and improve their health skills and behaviors. Although the Centers for Disease Control and Prevention (CDC) emphasizes the importance of focusing on behaviors that have the greatest effect on health, such as those related to nutrition; physical activity; violence and injury; alcohol and other drug use; and tobacco use, I believe that it is important that students are aware of how to maintain their healthy brains in order to avoid the possible cognitive decline that can occur with age. For example, in grade one, Michigan students are being taught how physical activity, rest, and sleep help a person stay healthy, but I believe it is important to illustrate how these behaviors help maintain a healthy brain as well. I also believe it is important to teach students additional strategies that can help enhance their memory throughout their health education.

https://www.michigan.gov/documents/mde/HealthK-8_313770_7.pdf

SOLUTION 2:

Similar to how individuals obtain a discount on their automobile insurance by taking driver safety courses because these courses not only save lives, but also reduce the number of claims that the insurance company will receive, I believe this same policy should occur with memory courses. It is the insurance companies that pay for medical bills, nursing homes, and any other additional medical requirements for those diagnosed with Dementia, so I propose that Michigan insurance companies should provide medical insurance discounts to those who take a memory improvement course. This type of online course will not only save lives, as it will help people keep their minds healthy, but it will also reduce the amount of medical insurance claims that can occur later on in life.

SOLUTION 3:

It has been found that Benzodiazepine use is linked to Dementia and for this reason I propose that drugs such as Valium and Xanax should be taken off the market in Michigan. Although people who had taken a benzodiazepine for three months or less had about the same dementia risk as those who had never taken one, according to a research study published by Harvard Medical School, taking the drug for three to six months raised the risk of developing Alzheimer’s by 32%, and taking it for more than six months boosted the risk by 84%. Additionally, another study that collected data over 22 years, investigated the long-term effects of benzodiazepine use and dementia risk and found that of the 1,134 men, 103 (9.1%) showed a noticeable increased incidence of dementia. Therefore, the elimination of these types of drugs can lead Michigan one step closer in reducing the amount of people who are affected by Dementia.

https://www.health.harvard.edu/blog/benzodiazepine-use-may-raise-risk-alzheimers-disease-201409107397

https://www.ncbi.nlm.nih.gov/pubmed/22034632

Reaction or advice from a Topic Coordinator:

You must solicit a critique from a topic coordinator, and explain the impact that advice has had on the final draft of this proposal.

My topic coordinator, Glen, was very helpful in guiding me to my final proposal. During my early phases of research, Glen informed me that my issue of memory and aging was too broad and that it would be beneficial to specify how this issue affects individuals living in Michigan. After I found statistics to show how Michigan is specifically affected, he urged me to highlight these important statistics in my proposal. Additionally, Glen is very resourceful as he has shared articles on my memory loss topic and even recommended places I should reach out to for my consultations. After meeting with Glen in person, he helped me better understand what to include in my clauses and provided me with tips on how to better my proposal. It has been a pleasure working with Glen.  

Research process:

Describe your research process — indicate who you talked to (including but not limited to consultants), what you read, what your thinking was, how it changed over time, and how your consultants changed your thinking. This description of your research process definitely could include “dead ends,” or ideas you had that didn’t ultimately bear fruit.  In short, we want to know what you did and how it led to your legislation, and we also want you to give us a window into your thought process.

Since the beginning of my research, I knew I wanted to resolve the issue of memory and aging. First, I found an abundant amount of statistics on the number of people who suffer from memory loss and disorders such as Dementia. After speaking with my topic coordinator, he informed me that this is a world-wide issue and that it is important to focus on how this issue specifically affects that state of Michigan. Therefore, after more research, I found that thousands of Americans living in Michigan are diagnosed with Dementia and the number is only estimated to increase. I then compared these statistics to other states to strengthen my proposal and show that Michigan is the 8th state that is most affected by this disease and affects at least 400,000 of its residents. After realizing how many people are affected by this memory loss problem, I started looking into the possible causes of cognitive decline as well as tips for improving and maintaining memory. For example, I read many studies that suggest that training your brain with mental exercises can help prolong the cognitive decline that can result from aging. Therefore, in order to prevent younger adults from being a part of these disturbing statistics, I came up with the solution of an online memory course that will teach participants how to implement brain activities into their daily lives. After coming up with this solution, I then thought of a practical way to ensure that young adults actually participate in these courses. This led me to my idea that Michigan insurance companies can provide medical insurance discounts to those who partake in these courses similar to how individuals obtain automobile insurance discounts if they take driver safety courses. This insurance discount can motivate people to take these memory courses and as a result both the individual and the insurance companies will benefit as both parties will not have to deal with the burdens of Dementia such as medical bills, nursing homes, and any other additional medical requirements.

Author contributions:

Please delineate--in detail--who made what contributions to the process and to the finished proposal? Who took on which responsibilities in researching ideas, drafting language, etc.?


 

===FORMAL PROPOSAL===

The sections below should comprise your final proposal language, submitted for consideration by your peers and potential inclusion in the MSC Platform.

Preambulatory clauses

These set up the PROBLEM, but not the solution.

WHEREAS....Dementia is the 6th leading cause of death in Michigan. Compared to other states, Michigan is the 8th state that is most affected by this disease behind CA, FL, IL, NY, OH, PA, and TX.

WHEREAS....In 2017, it was found that 180,000 Americans living in Michigan who are age 65 and older were diagnosed with Dementia and this number is estimated to increase to 220,000 by 2025 (a 22.2% increase). 

WHEREAS....Considering its profound impact on caregivers, dementia thus affects at least 400,000 people in the state of Michigan.

WHEREAS....The financial burden of dementia in Michigan about $5 billion per year.

WHEREAS....About one-third of cognitive decline in older adults occurs because of physical abnormalities in the brain such as plaques of amyloid beta proteins linked to Alzheimer’s disease, but the amount of cognitive activity throughout a person’s lifetime could explain an additional 10% of their cognitive decline.

(Add more "Whereas" clauses if necessary.)

Operative clauses

These describe in detail, the solution you are proposing (not the problem itself; those should go in the "Whereas" clauses above).

THEREFORE BE IT RESOLVED....

1. Emphasizes that Michigan must ensure that younger adults partake in brain training activities if they want to prevent these individuals from being a part of the disturbing statistic regarding the number of people who are diagnosed with Dementia in Michigan.  https://www.livescience.com/37958-brain-activities-alzheimers-memory.html

2. Declares that the Michigan Department of Health and Human Services create a free online memory course that not only includes tips for how to improve and maintain memory, but also teaches participants how to incorporate cognitive activity into their daily lives. Many lessons on improving memory already exist such as those found at https://www.udemy.com/topic/memory/.

3. Affirms that Michigan insurance companies will provide individuals with health insurance discounts if they partake in MDHHS’s online memory courses. This insurance discount can motivate people living in Michigan to take these memory courses and as a result both the individual and the insurance companies will benefit, as both parties will not have to deal with the burdens of Dementia.

4. Notes that there are a variety of ways to obtain auto insurance discounts for Michigan drivers, so these same discounts should occur with health insurance. For example, there is a Michigan defensive driving course, also known as a Basic Driver Improvement Course (BDIC), that was approved by the MI Secretary of State where driver’s can possibly earn an auto insurance discount after completion. https://www.dmv.com/mi/michigan/traffic-school

(Add more "Resolved" clauses if necessary.)

Counter-arguments:

What are three reasonable arguments against this proposal?

1. Some believe that there is only so much that lifestyle can do and if individuals have enough pathology in the brain, they will get symptoms regardless of if they are cognitively active. Although there are many studies that show how modifying lifestyle factors can make a difference in cognitive decline, there is not enough clinical trials to actually prove this relationship.

2. Some believe that brain exercise can delay, but cannot prevent, Dementia. For example, according to a study at Rush University Medical Center in Chicago, participants who remained intellectually stimulated, such as by playing cards or other games, were diagnosed with dementia later than those who were not as cognitively active, but once their Dementia set in, the group who participated in these mental activities experienced a much more rapid cognitive decline. http://content.time.com/time/health/article/0,8599,2015622,00.html

3. Some may believe that mental activity programs that encourage brain games such as crossword puzzles and anagrams might do more harm than good. Not only may these mentally stimulating activities offer false hope for individuals, but those who do develop Dementia might blame themselves due their failure in exercising their brains.

Costs and funding:

What will your proposal cost (in direct expenses, lost tax revenue, lost economic opportunity, and/or non-monetary costs)? How will you pay for your proposed legislation? Where will/could the funding for your proposal come from?  Who might object to dedicating resources to your proposal (competing interests)?  

According to House Bill Number 4866, the department will provide grants for projects that demonstrate ways to integrate mental health services for older adults, and I believe that online memory courses would qualify for this grant. These types of memory courses already exist, so there will be no fee in creating these lesson plans. The goal is to try to motivate people to participate in these memory courses as opposed to creating these courses from scratch. Therefore, these tax reductions will be free as well, as it will prevent insurance companies from having to pay even higher medical bills for their clients later on in life.

References:

These can include websites or other information you have found about the issue.

https://www.alz.org/documents_custom/facts_2016/statesheet_michigan.pdf

http://www.michigan.gov/documents/michigan_dementia_planshort_84926_7.pdf

https://www.alz.org/documents_custom/2017-facts-and-figures.pdf

https://www.aarp.org/health/brain-health/info-2017/foods-decrease-alzheimers-risk-fd.html?intcmp=AE-HEA-CND-EOA1-FD

https://www.livescience.com/37958-brain-activities-alzheimers-memory.html

https://www.dmv.com/mi/michigan/traffic-school

https://www.udemy.com/topic/memory/

http://content.time.com/time/health/article/0,8599,2015622,00.html

 

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Total votes: 30

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