Despite wearing a wide brim hat and sunscreen on my daily morning walks, my dermatologist detected a basal cell carcinoma (BCC) about the size of a small freckle on my hairline. BCCs are the most common form of skin cancers.
Despite wearing a wide brim hat and sunscreen, the author's dermatologist detected a basal cell carcinoma (BCC) about the size of a small freckle on her hairlineThe Skin Cancer Foundation cites about 3.6 million new cases of BCC in the U.S. each year. The second most common form is squamous cell carcinoma (SCC) with an estimated 1.8 million cases diagnosed annually in the U.S. Two other types of skin cancer include melanoma, which resembles a mole, and Merkel cell carcinoma, which appear as firm, painless lesions on the skin. It's a rare and aggressive skin cancer.
"The risk of melanoma increases as we age." 
When I got my diagnosis, I erroneously thought it was a mistake. Wouldn't the sunscreen, my hat and thick curly hair covering the area make it impossible for a BCC to form in that part of my head?
Obviously, the answer is "no."
"That's because it's cumulative," says Dr. Cindy Wassef, assistant professor and residency program director at Rutgers Center for Dermatology in New Jersey. "Wearing a wide brim hat and sunscreen with SPF (Sun Protection Factor) of thirty or higher counts. However, the cumulative effect of walking your dog every day, gardening for twenty minutes a few times a week, or taking out the trash without wearing sunscreen or a hat is exposure to the sun. It's small increments that add up."
For those of us who spent our childhood summers lying on the beach or beside a pool in the sun trying to go from pasty white to glorious bronze, we may pay the price. Back then, we didn't know about the sun's harmful rays.
"The risk of melanoma increases as we age," Wassef says. "The average age of people [who] are diagnosed is age 65. And melanoma occurs at all ages, even among those younger than age 30."
Skin Cancer Affects Everyone 
Skin cancer is 20 times more common in white people than in Black people because there's less melanin in lighter skin, which makes it easier for ultra violet light to cause skin damage. Few statistics are available regarding people of color as noted in a 2020 paper highlighting the lack of diversity in scientific trials and studies.
Despite few studies on the subject, everyone needs to protect their skin while outdoors in the sun. Instances of melanoma include:
1 in 38 for white people1 in 1,000 for Black people1 in 167 for Latinos2 to 4% in AsiansAs they age, men have higher rates of melanomas than women and before the age of 50 those rates are higher among women.
Symptoms of Skin Cancer 
It's important to take a look at any changes in your skin such as a new growth, a sore that doesn't heal, or changes in an old growth. Here is the A, B, C, D and E of melanoma:
Asymmetrical: Does your mole or spot have an irregular shape with two parts that look different?Border: Look at the border of the mole or spot. Is it jagged? Is it bigger than a pencil eraser?Did the color change? Is the color uneven? Are there two or more colors in the growth?Diameter: Has the mole or spot grown?Evolving: Has your mole or spot changed within the last few weeks or months?If you notice any of these changes, schedule an appointment with a skin doctor.
Protect Yourself From the Sun All Year Round 
Before going outdoors, apply sunscreen to your face, neck, back of your neck, hands, arms, legs, feet, and any other exposed areas. Wassef recommends using sunscreen with an SPF of 30 or higher to protect against UVB and UVA rays.
"If you run or take walks, do it early in the morning or later in the evening when the sun isn't as strong." 
"And apply sunscreen every 2 hours," she says. "I also recommend wearing UPFs (ultraviolet protection factor) clothing if you spend a lot of time outdoors."
Also known as wearable sunscreen, UPFs block out the sun's harmful rays. You can purchase UPF T-shirts, hats, shorts, and pants online and at some retail stores. UPF clothes have tighter weaves and mostly come in darker colors to block the sun.
"And, if possible, try to avoid being outside between 10 a.m. and 2 p.m.," Wassef says. "That's the hottest part of the day. If you run or take walks, do it early in the morning or later in the evening when the sun isn't as strong."
"Summer is when most of us think about skin cancer because we spend more time outdoors," Wassef says. "It's possible to get skin cancer in the winter, too. That's why everyone should wear sunscreen if they're going to be outdoors and schedule an annual visit to the dermatologist. If skin cancer is detected early, most procedures can be done in your dermatologist's office and the outcome is a high survival rate."
Genetics Play a Role 
"Most skin cancers are caused by environmental factors," says Wassef. "Some skin cancers can be genetic."
The National Cancer Institute found genetics is linked to some types of skin cancer. "If there is a history of skin cancer in your family," Wassef says, "talk to a dermatologist."


The A, B, C, D and E of Skin Cancer Symptoms

Michele C. Hollow

Mary, whose husband is in memory care, wants to know how to mourn someone who doesn't remember her. She and Dan have been married for 50 years. "He was my best friend," she says.
"Ambiguous loss is a unique form of grief that occurs when a person is physically present but psychologically absent," Feyza Marouf, M.D., saysMark describes how hurt he feels when his wife, Allison, fails to recognize him. "We're sitting on the couch and making conversation, almost like it used to be. Then she'll say, 'This has been nice. You're a very kind man. I've really enjoyed our talk, but now I must go home to my husband. My husband is waiting for me.'"
Feyza Marouf, M.D., geriatric psychiatrist and executive medical director at Author Health, treats Dan and Allison (all parties requested using only first names for this story). "The first time Mary asked to meet with me separately from her husband put the reality of ambiguous loss to me very poignantly," she explains. "Prior to Dan's Alzheimer's dementia diagnosis, they had been looking forward to retirement as a joint adventure, with a long list of activities they planned to pursue. Mary was grieving the loss of that future, in addition to the specific loss of her companion."
"Some days they may recognize their loved ones completely, while other days they might not." 
"Ambiguous loss is a unique form of grief that occurs when a person is physically present but psychologically absent," Marouf says. "It's often experienced by families caring for loved ones with dementia. Unlike the finality of death, ambiguous loss is particularly challenging because it's an ongoing process of losing someone gradually while they're still here."
According to Marouf, the process varies significantly for each individual. It typically unfolds over months or sometimes years. "What makes it incredibly complex is that people living with dementia may have periods of clarity interspersed with times of confusion," she says. "Some days they may recognize their loved ones completely, while other days they might not. This fluctuation can make the experience particularly emotionally challenging for caregivers."
In Dan's case, his sense of humor often broke through. He might smile when he entered a room, shake hands with someone, or sit still and listen. "At our initial evaluation, he answered my questions in short concrete sentences," Marouf says. "Over the next year or so, there was less and less detail. His responses eventually trailed off to a word or two. He was no longer the quick-witted, constantly busy contractor his wife fell in love with, but a person Mary considered a stranger."
Mary described her husband as a person with different energies, emotions, conversations and interests.
"Although I was asked to evaluate Dan's dementia, my real patient was his grieving spouse," Marouf says. "Her grief took different turns. She was shocked to see the change in him, frustrated and angry at the impact on their future, resentful of being trapped at home, and tearful to feel so alone and exhausted. She felt enormous guilt about wanting to do things outside the home by herself. As Dan's dementia progressed (over several years), her husband grew quieter and tended to follow her from room to room. The only time he would get upset was when Mary attempted to leave the house without him."
"She was shocked to see the change in him, frustrated and angry at the impact on their future, resentful of being trapped at home."
When Mary tried to leave the house, Dan followed her to their car. At home, Dan annoyed Mary by reloading the dishwasher with clean items that had just been removed, or putting folded laundry back into the washing machine. When she saw these behaviors, she would break down in tears.
Marouf encouraged Mary to consider a day program to give Dan structured time with staff familiar with managing dementia. Dan took to the day program as if he was going off to work.
The hours of respite Mary had between drop-offs and pickups allowed Mary the space she needed to recalibrate internally. Her depression lifted. "Most importantly," Marouf says, "Mary found she was able to be present in a different way in the hours they shared at home. She was not constantly comparing Dan to his former self or irritated by the changes between them. She could acknowledge the impact of his illness while maintaining a connection to his presence, expressing her affection and care more openly as a new relationship developed."
Finding Relief
Allison's aloofness, indifference, mistrust and unpredictable emotional distress remained an enormous heartbreak for Mark. He found relief in connecting with his two adult children who were experiencing a similar sense of loss and estrangement. They spoke regularly on the phone, and both daughters traveled from out of state to spend time with Mark.
As Allison's illness progressed, she slept more comfortably if she was in a separate bedroom. Otherwise, she would wake up startled to see Mark next to her, confused by who he was and agitated that she absolutely had to leave. It was painful for Mark to recognize that Allison did better alone.
"Mark worked hard to find the right caregivers for Allison," Marouf says. "It gave him a sense of agency even while he felt estranged. He spoke with several care managers, and eventually found Deborah who connected with Allison. With Deborah, Allison was able to take short walks for ice cream, work on puzzles, bake cookies, watch television shows without any restlessness, or look through old photo albums."
"Sometimes I've had to pick up the phone and act like I was calling her husband so he can reassure her that everything is OK."
Weekends without Deborah's help were hard, as Mark struggled to manage Allison at home.
"Sometimes I've had to pick up the phone and act like I was calling her husband so he can reassure her that everything is OK, that she can stay where she is. I'll go into the other room and while she's talking to me she knows my voice, she knows I'm Mark, but when I walk back into the room she has no idea who I am."
With encouragement, Mark reached out to a man he knew from work whose wife was also diagnosed with dementia. Connecting with a peer who had been through a similar journey helped Mark feel less isolated. For Mark, who was generally hesitant about support groups and any formal therapy, finding a way to ask questions, compare notes and talk aloud about his experience with someone he knew and trusted had major therapeutic value.
Coping Strategies
Marouf counsels spouses and adult children caring for someone experiencing ambiguous loss to:
Acknowledge and express their feelings.Find a support group.Maintain meaningful rituals: Even if a loved one doesn’t remember shared histories, people can create new moments of connection by sitting outdoors together, sharing an ice cream, looking at photos together, listening to music, or taking walks together.Remember that a loved one’s inability to recognize their family is part of the disease.Reduce stress through exercise, meditation, gardening, socializing or other activities that bring joy.Seek mental health support.Focus on the present rather than on memories.Maintain one's own identity and relationships outside of caregiving.Take breaks when needed and know that good self-care makes for a better caregiver.Encourage grandchildren to continue interacting with their grandparents while providing emotional support and answer their questions honestly.

How to Care for Yourself After Your Partner or Parent No Longer Recognizes You

One wall in my dining room contains a few hundred books. Two of the shelves, however, house my cats' ashes. They're stacked neatly in tins, and one is in a carved wooden box.
I no longer grieve over the loss. I do think of them and, of course, miss them. My current cat is almost 13. We adopted her when she was a kitten. She's not a replacement. Each cat was distinct and quite charming.
Memorializing your cherished companion is exceedingly personal, and the decision can be overwhelming during your time of grief and sorrowThe three tins and one wooden box sometimes collect dust. I think about planting them in my garden; then I wonder, what if I move? Should I dig them up and take them with me?
Another friend told me she had her cats cremated and left instructions with family to place those remains in with her ashes.
I'm a person with practically no attachments to things. Yet, these remains were once living companions. I'm definitely attached to my cat. Actually, my husband jokes that my pecking order in our house is: "Cat, kid, and him."
I questioned a few friends about what they did with their pet's remains. One scattered her dog's ashes in his favorite place at the park. When she walks by, she says, "hello."
Another friend told me she had her cats cremated and left instructions with family to place those remains in with her ashes.
A Tough Decision 
"Goodbye is always hard," said Bethany Hsia, DVM and co-founder of CodaPet, a startup supporting a network of veterinarians serving pet and pet parents with end-of-life pet care at home. "Our pets are usually our biggest fans and give so much love. The bond we share with our pets is so strong and beautiful and that bond is altered when we lose a pet."
"Memorializing your cherished companion is exceedingly personal, but the decision may overwhelm you during your time of grief and sorrow."
She added, "Understandably, it's hard to decide how best to shape that bond without losing it completely. Our pets live in the moment and don't worry about how they will be honored or what will happen to their bodies once they pass; this can be a freeing thought as it allows the bereaved to choose what will help them to heal best."
A Personal Choice 
Despite many options, it's not easy figuring out what to do with your pet's remains. "Memorializing your cherished companion is exceedingly personal, but the decision may overwhelm you during your time of grief and sorrow," said Dani McVety, DVM and founder of Lap of Love Veterinary Hospice, a nationwide practice of mobile veterinarians offering in-home hospice and euthanasia services across 39 states.
A few options she suggests include creating a keychain or piece of jewelry from your pet's ashes or fur. "It's an excellent way to keep them close," she said. "A small amount of your pet's ashes or a fur clipping can be mixed into a gorgeous necklace pendant, ring, pair of earrings or keychain, allowing you to keep part of your pet with you at all times."
My choice to keep my cats' ashes in my home is common. According to Kathryn Dench, VetMB and chief scientific advisor at Paw Origins, approximately 40% of pet owners choose to keep their pet's ashes with them at home, while around 20% opt for scattering. "The rest look for unique, personalized ways to memorialize their pets to honor the love they shared," she said.
Commission an artist to paint a portrait of your dog or cat and include a small amount of your pet's ashes into the painting. 
A few more suggestions include:
Burying your pet’s ashes and using a biodegradable urn that merges with the earth over time. You can plant flowers, a tree, or a plant where you can take a cutting if you move.Commission an artist to paint a portrait of your dog or cat and include a small amount of your pet’s ashes into the painting. You can also have an artist create a sculpture for your home or garden. The sculpture can house some of your pet’s ashes.A handful of companies can turn your dog’s or cat’s ashes into smooth stones to either place in your garden or in your home.Some pet parents scatter their pets’ ashes into the ocean. One company, called Eternal Reefs, mixes your pet’s ashes into environmentally safe materials to form an artificial reef, which is placed in the ocean. These reefs support marine life.Make a donation in your pet’s name to your favorite animal shelter or veterinary school.Donate your pet’s leashes, collars, bedding and toys if they are in good condition. Many animal shelters will welcome receiving them.Ask your family veterinarian if the practice has an “angel fund” that helps cover treatment costs for sick pets, and consider contributing.As for me, I have a stained glass stone a family member gave me. It's designed for placement in my garden. I think I'll bury my pet's ashes in the garden near the stone. I'll keep them in their tins and wooden box, just in case I decide to move.


What Should I Do With My Pet's Ashes?

Last Sunday morning, I accompanied a friend visiting her 91-year-old mom; my friend's mom lives in a nearby nursing home. We played cards, joked and enjoyed the time together. We left after lunch.
"It's easy to feel overwhelmed when a loved one is experiencing sundowning. Reminding them that they're safe and that you're there for them can make a significant difference," says Barbara SparacinoMy friend tries her best to visit her mom in the morning or on her lunch hour to avoid the confusion and anxiety her mom exhibits as the day wears on. "It's as if an alarm goes off around 3 p.m. and she changes," my friend tells me. "It gets worse when we turn back the clocks and it gets darker earlier in the day."
She used to visit her mom after work. That changed after she found her mom tossing and turning in bed with the covers up to her neck. "Wanting to sleep, showing signs of forgetfulness and confusion often happen after 3," she says. "That's why I schedule my visits at lunchtime or earlier."
My friend's mom has sundown syndrome. It's also called sundowning and according to UCLA Health, it affects approximately 19% of people with Alzheimer's or some form of dementia.
What is Sundowing?
"Sundowning is a term used to describe a state of confusion or agitation that tends to worsen in the late afternoon and evening," says Barbara Sparacino, M.D., and an adult and geriatric psychiatrist with The Aging Parent Coach where she counsels adults caring for their older parents. "It's commonly seen in people with Alzheimer's or other forms of dementia. The exact cause isn't fully understood, but it's believed to be related to changes in the body's internal clock and the brain's ability to process cues from the environment, like fading daylight."
"The exact cause isn't fully understood, but it's believed to be related to changes in the body's internal clock and the brain's ability to process cues from the environment,"
In addition to confusion and agitation, Sparacino notes other signs of sundowning include:
Increased restlessnessFatigueIrritabilityPacing as the day goes onBeing disorientedAsking repetitive questionsMood swings"It's not uncommon for them to have trouble distinguishing reality from confusion," she adds. "It's incredibly distressing for them and their caregivers."
Depression and nighttime wandering can also be signs of sundowning. "These symptoms often persist into the night, causing difficulties in falling asleep and staying asleep," says Meredith Bock, M.D., a board-certified neurologist and chief medical officer at Remo Health, which is a virtual comprehensive care company for people living with dementia and their caregivers.
"Sundowning can be one of the most challenging aspects of dementia caregiving."
Missing a Good Night's Sleep
Restlessness as the day progresses can disrupt sleep, making it rare for someone with sundown syndrome to get a good night's sleep. To combat this, Mari Baxter, chief operating officer of Senior Helpers, an in-home care company for older adults, suggests engaging in more activities during daylight hours to keep your loved one awake.
She also recommends maintaining a routine, keeping more lights on in the evening hours to reduce shadows, eating a larger lunch and a lighter dinner, and limiting daytime napping.
There are a number of factors that can exacerbate sundowning, including:
BoredomPainDepressionDehydrationAlcoholA lack of sunlight during the dayAdjusting to a new environmentSide effects of some medicationsAsk your family member's doctor if any of the medications your family member takes can cause sundowning. Some bladder control, digestive system and brain medicines can interfere with one's sleep cycle.
Reducing Triggers
Sparacino tells her clients to create a calm environment. "Dimming lights, closing blinds and turning off the TV can reduce overstimulation, which can help ease their anxiety," she says.
She agrees with Baxter that sticking to a routine helps. "Structure and familiarity can be comforting for someone with dementia," she says. "Keeping a consistent schedule for meals, rest and activities can help reduce the disorientation that comes with sundowning."
If your family member is up to it, exercise can help curtail sundown syndrome. Daily walks each morning or in the early afternoon can ameliorate the symptoms of sundowning according to a study published in the International Journal of Older People Nursing.
"Keeping a consistent schedule for meals, rest and activities can help reduce the disorientation that comes with sundowning."
She also recommends redirecting your family member's energy. "If agitation starts to build, gently redirect their focus," she says. You can do this by having your family member do simple acts like folding towels, listening to calming music or looking at old photos. These activities "help distract them and reduce anxiety," she says. "The key is to help them feel engaged without becoming overwhelmed."
She tells her clients to have their loved one limit caffeine and large meals late in the day. Coffee, tea and a large meal can make restlessness worse. Instead of caffeine, offer soothing herbal tea and light snacks.
"Above all," she says, "remain patient and reassuring. It's easy to feel overwhelmed when a loved one is experiencing sundowning. Reminding them that they're safe and that you're there for them can make a significant difference." 
"Sundowning can be one of the most challenging aspects of dementia caregiving. Take small steps: routine, calm surroundings and lots of patience can help you and your loved one navigate these difficult moments together."


Signs of Sundown Syndrome

What works for neurotypical kids isn't always a remedy for neurodivergent children. Try telling that to some family members who believe a brief time-out transforms negative behaviors into positive ones.
It's not a one-size-fits-all strategy.Many parents of children with autism believe their parents don't understand why their grandchildren behave differently than children without autism. At family functions, they question why their grandchild sits alone while his cousins interact. Most know their grandchild is autistic, yet they don't understand what they see as quirky behaviors.
"My parents want my daughter to behave like other kids when it's just not possible." 
Attending family gatherings distresses many parents of autistic children. I've heard all too often from parents who don't want to participate when their families get together. One mom told me that her father said all his grandson has to do is "follow the rules" to fit in. Another mom said her parents want her to stop making excuses when their grandchild acts up. Others thought their grandchildren were rude for sitting and playing by themselves.
"My parents want my daughter to behave like other kids when it's just not possible," said Sarene Leeds, mom to 8-year-old Diana who is autistic and has ADHD (Attention Deficit Hyperactivity Disorder).
Leeds, a writer and podcast host of Emotional Abuse Is Real, said her mom offers several neurotypical suggestions for how she could help her daughter. "They'll tell her to simmer down or tell me to take her computer screen away from her. They put a lot of blame on me and my husband for not disciplining her."
A couple of years ago, Leeds' parents took the family on vacation. She, her husband, Diana and Leeds' sister went. At times, Diana was disruptive. "My parents wanted peace and quiet," Leeds said. "They are planning another family vacation. I asked my mom if she was sure she wanted to do this again. My mom said, 'Diana is older and will behave better.' Yes, she's older, but she'll still be autistic."
"My mom said, 'Diana is older and will behave better.' Yes, she's older, but she'll still be autistic."
Not a One-Size-Fits-All Strategy 
It's not a one-size-fits-all strategy. "A meltdown in neurotypical children usually arises from common issues like frustration or fatigue and is often quickly alleviated once their needs are met," explained Kristie Tse, founder and clinical director of Uncover Mental Health Counseling, PLLC. "In contrast, sensory temper tantrums in neurodiverse children, particularly those with autism, are triggered by sensory overload. This overload may be due to overwhelming stimuli such as lights, sounds or textures, making the situation intensely challenging for the child to process." 
Tse continued, "Unlike neurotypical children, who might still communicate or be reasoned with during a tantrum, neurodiverse children in meltdowns are often unable to. For example, exposure to loud music or crowded places may make them inconsolable. It is crucial for grandparents to understand these triggers and create a sensory-friendly environment to better manage such situations."
Why Some Grandparents Don't Understand Autism
According to recent research from the CDC (Centers for Disease Control and Prevention) about 1 in 36 children are identified as autistic today, compared to 1 in 150 just 24 years ago. 
"Involving grandparents in therapy sessions can be beneficial." 
"The older generations were not exposed to autism and other disabilities as much as younger generations due to a lack of inclusion and institutionalization," said Julia DeNey, a former special education para professional and the founder of Sense-ational You, a sensory clothing company for people on the autism spectrum.
Other reasons she gave for lack of understanding include:
Professionals were not as good at identifying, understanding or diagnosing autism. Those with lower support needs were overlooked and labeled as “disruptive,” “unmotivated,” or “disrespectful.” Since autism is a spectrum developmental disorder, people in the spectrum  range from low to high functioning.Often autism is genetic. For grandparents who were never diagnosed, they may see similar traits or behaviors in family members, but not see those traits or behaviors in themselves.How to Foster Understanding 
A way to get grandparents to understand your child is to make them part of a therapy session. 
"Involving grandparents in therapy sessions can be beneficial," said Devora Fromowitz, vice president of operations at Achievements ABA Therapy. "Explaining an autism diagnosis to grandparents can be challenging due to a combination of emotional factors, generational gaps in understanding, and preconceived notions about child behavior."
"Emphasizing that autism is not a result of poor parenting or something that can be fixed, but rather a different way of experiencing the world, is crucial."
"Autism is a complex developmental disorder, and it often requires a nuanced approach to explain its characteristics and implications," Fromowitz continued. "Grandparents may have grown up in a time when autism was less understood or even stigmatized, leading to difficulties in accepting and comprehending their grandchild's condition."
By having grandparents be part of the therapy session, they can observe their grandchild in a supportive environment that can demystify the condition and foster empathy. Fromowitz also suggests sharing books, articles or videos that explain autism in simple terms. Use everyday examples to illustrate how autism affects their grandchild's behavior and interactions. 
"For instance, explaining that their grandchild may have sensory sensitivities helps them understand specific behaviors in context," she said. "Emphasizing that autism is not a result of poor parenting or something that can be fixed, but rather a different way of experiencing the world, is crucial."
The Importance of Routine and Education
One family Fromowitz worked with had difficulty explaining their child's need for routine. By inviting the grandparents to a therapy session and demonstrating how small changes in routine could lead to significant distress for their grandchild, "[the grandparents] could see firsthand the importance of maintaining consistency," she explained. "This experience educated them and helped build a stronger support system for the child."
Fromowitz explained that emotional factors like denial could stem from a deep-seated fear or sadness about their grandchild's future. Providing continuous education and support, patience and understanding can gradually help grandparents come to terms with and embrace their grandchild's needs.


Helping Grandparents Understand an Autism Diagnosis

My mom began her career as a reading teacher and later taught fifth graders at a public school in the Bronx, New York. She shared her love of books with me and with her students. Long after she retired, she continued to read a wide range of genres.
A year ago, at age 91, signs of dementia appeared. Shortly afterwards, her reading habit ceased. Focusing on several words on a page became difficult.
"Reading a children's book is similar to that of music. Just as familiar music can engage Alzheimer's patients, prompting them to sing, move and enjoy themselves, reading a book can have a similar effect."On a recent visit, I gave my mom the children's picture book, "Pedal, Balance, Steer: Annie Londonderry, the First Woman to Cycle Around the World," by Vivian Kirkfield. She opened it immediately while her aide and I watched how engrossed she became. After she finished, she told us exactly about Londonderry's life. She seemed hooked.
"Just as familiar music can engage Alzheimer's patients, prompting them to sing, move and enjoy themselves, reading a book can have a similar effect."
Observing her made me question if picture books would spark her interest in reading again. I work as a journalist, mostly covering health. I looked for studies focusing on dementia and reading children's books. I found one showing a connection linking frequent reading to a reduced risk of cognitive decline in older adults.  
While it's good to know reading reduces the risk of dementia, that study didn't answer my questions about children's books. I decided to ask the experts.
No Evidence Yet
"I haven't seen any evidence-based studies on this," Michal Schnaider Beeri, Ph.D., director of the Herbert and Jacqueline Krieger Klein Alzheimer's Research Center, said. "Reading a children's book is similar to that of music. Just as familiar music can engage Alzheimer's patients, prompting them to sing, move and enjoy themselves, reading a book can have a similar effect."
She's heard anecdotes, but nothing scientifically based. "It's possible to hear positive responses from clinicians who have witnessed dementia patients sharing examples of how reading plays a vital role for people with dementia," she explained. "Other clinicians won't have the same positive results. Reading that children's book could have sparked a memory for your mom since she spent years reading children's books."
Pamela Gray, activities director at White House Healthcare Center, (a nursing home in New Jersey), agreed that the children's book my mom read might have tapped into a memory. "She read children's books to her students and enjoyed reading children's books on her own," she said. "It's familiar."
The large print, few words on a page, and the art that breaks up those words make reading easier. At the nursing home where she works, Gray explained the books in the library are large print and words are spaced apart making it easier to read.
"It's a memory muscle," she said. "Like singing old familiar songs such as "Oh Susannah," "You Are My Sunshine," and holiday classics. Often you hear those songs at senior centers because we grew up singing them and many of us remember all of the words."
For Some, Reading Gets Harder 
As we age, reading becomes difficult for some. Eyesight can dim, and some forms of dementia make it hard to focus. Children's books, large type novels, and magazines and newspapers, where stories are broken up with photographs and ads, make reading easier.
"The familiar narratives and illustrations from the childhood books offered the client comfort and a tangible connection to her past." 
"Reading is a powerful activity for individuals of any age, but it is especially important as we age," said, Joel Frank, licensed clinical psychologist and neuropsychologist at Duality Psychological Services. "Even if individuals with dementia have declined in their reading and attention abilities, reading any book, even children's books that tend to be more visually stimulating and contain simpler words, helps stimulate the brain. Reading can be a powerful tool or activity for individuals facing cognitive decline and is something I typically recommend following dementia evaluations."
Finding the Positives of Reading 
The daughter of one of Frank's clients who has early-onset dementia brought children's classics to the nursing home to read with her mother. These were stories the client used to read to her daughter. 
"The familiar narratives and illustrations from the childhood books offered the client comfort and a tangible connection to her past," Frank explained. "This engagement with familiar stories helped maintain her language skills and provided shared experiences with her family, creating new memories while cherishing the old ones. The activity blended past and present, fostering emotional bonds and cognitive stimulation."
"Reading poetry aloud became a shared activity with her family, sparking moments of joy and a sense of accomplishment." 
Another client, according to Frank, found solace in poetry. "Initially, her family noticed her growing detachment and frustration with complex conversations," he said. "Introducing short poems into her daily routine became a turning point. The rhythm and familiarity of the verses provided a comforting structure, helping to soothe her anxiety." 
Frank continued, "Reading poetry aloud became a shared activity with her family, sparking moments of joy and a sense of accomplishment. This simple yet profound engagement with poetry not only improved the client's mood but also seemed to slow her retreat into isolation, bridging the gaps dementia had created in her life."
Sparking a Memory 
In my mom's case, children's books were familiar. Frank, Gray, and Schnaider Beeri believe familiarity plays a role. Frank mentioned a client with vascular dementia who was passionate about wildlife. His family introduced him to wildlife magazines to reconnect to his interests. 
"The photographs and short, engaging articles captured his attention, encouraging him to read and share facts about animals and nature," Frank said. "These magazine moments nurtured his cognitive abilities by engaging his attention and memory and reignited his spark for conversation, significantly enhancing his overall well-being and sense of identity."Encouragement should be gentle, without pressure for correct understanding or recall, to ensure the experience remains positive. Personalizing the choice of material to align with the patient's interests and history is key, as it can enhance engagement and enjoyment.
You can also try e-reading devices, which allow readers to adjust type size. Reading lights, book holders and audiobooks are good options, too. Reading aloud to your family member or friend is another way to bring you closer together.


Can Children's Books Keep Aging Minds Engaged?

On a recent book tour visit at an assisted living home, Elaine Durbach, of Maplewood, New Jersey, addressed a roomful of older adults in wheelchairs. They sat motionless with their eyes open. No one appeared interested until she asked, "How many of you remember your first love?"
Vaudeville Visits’ Dikki Ellis as Dapper Dan and Ilene Weiss as Beatrice, star of stage and screen, work together entertaining older adults with dementia and Alzheimer’s at several hospitals"That's when the wicked grins and broad smiles formed," Durbach says. "Some sat up and raised their hands, offering to share their stories." They listened when she read from her novel, Roundabout, which is about a long-ago first love. 
"She tapped into an important memory," says Sam Fazio, senior director of Quality Care and Psychosocial Research at the Alzheimer's Association. "It's a memory most of us can recall quite well. It also opens up our emotions when we connect to something important to us or something we care about."
I noticed this when I brought my young child to visit a friend's mom living in a nursing home for people with Alzheimer's disease. My friend's mom and the others in the unit slumped in their chairs and showed no emotions. 
We could see them through a glass partition. They sat like statues. When I opened the door, and people saw my two-year-old, almost everyone became animated. They wanted to hold my child and talk to him.
To get a response, you must make the right connection with the individual. It's like listening to music. What we like is personal. 
"The child sparked an emotion in some people," Fazio says. "Not everyone responded. Perhaps a dog would get a response from others in the room. To get a response, you must make the right connection with the individual. It's like listening to music. What we like is personal."
According to Fazio, several studies prove music benefits those with Alzheimer's. Scientists have observed significant improvements in memory, orientation, depression, and anxiety in people with mild and moderate Alzheimer's who listened to music. 
"Getting a reaction comes down to your musical preferences," Fazio says. "If you love classical music, you'll respond. If you don't, you won't respond."
Old-Time Tunes and Laughter
Deborah Kaufmann, the co-founder of Healthy Humor, an arts organization that brings music, laughter, and joy to older adults and children in several U.S. hospitals and senior residential care facilities, remembers one patient lying in bed staring at the ceiling. 
"He was unresponsive for a while," she says. "I took his hand in mine, talked to him, and suddenly he started singing 'I Can't Give You Anything But Love Baby.'" 
Kaufmann and another performer of Healthy Humor's Vaudeville Visits, a program specifically designed for older adults, sang it a second time. "This time, I stopped after "I can't give you anything but," and he filled in the blank," she says.
Vaudeville Visits' performers create easily recognizable iconic characters from the stage, screen, and culture. These include a Hollywood song and dance team, a chef, a bride, a used car salesman, and others. 
"Our primary goal is to move eldercare to a place where all care and support are person-directed."
In addition, the performers use music, juggling, puppetry, storytelling, and improvisation to entertain and engage. "When Vaudeville Visits' performers entertain, we don't rush," Kaufmann says. "It may take a bit of time to connect with someone."
Penny Cook, president and CEO of Pioneer Network, a nonprofit organization working to transform the institutional culture of nursing homes to person-centered care, agrees, "we need to take the time to connect. Our primary goal is to move eldercare to a place where all care and support are person-directed; it's taking time to know the person and engaging with them."  
Person-Centered Care
"Person-centered care means listening to our patients and focusing on their needs," Cook explains. "It's about setting up the day to make it enjoyable. For instance, most of us enjoy that first cup of hot coffee in the morning. It's a simple pleasure we miss when we don't have it. But missing it can change the trajectory of the day."
"That cup of coffee is a simple pleasure that makes such a big difference. It's important to provide that to people as they get older," she says, adding they know this small gesture of person-centered care benefits the patients.
At age 93, Cook's stepfather moved into a nursing home. He had dementia and mobility issues. At the assessment, the nursing home staff asked personal questions and found out he loved listening to classical music; they placed a CD player by his bed. 
"He had no idea how to use the CD player," Cook says. "And it was placed in a hard-to-get spot that my mom couldn't reach when she visited. It would be so easy having a staff member press 'play.'"
A Collaborative Approach
Patients, especially those in long-term care, want their doctors to know their likes, dislikes, and needs. In addition, studies have shown that collaborative care can improve physical and psychological health and strengthen a patient's confidence. 
Laughter makes people more accommodating.
"The staff also benefits," Fazio says. "They interact more with their patients, and there's less turnover."
Dikki Ellis, who has performed with Vaudeville Visits, often hears praise and thanks from overworked medical personnel. When visiting patients, the mood on the floor is light and joyful. "Laughter makes people more accommodating," Ellis says. 
"Someone who may not be cooperative or in a bad mood is easier to work with because of the humor from these interactions. It's something the staff appreciates," he adds. 
Often the mood is joyful. Sometimes sorrow appears. "Either way, we have to be there for the patients," Ellis says. "Using humor, song or dance creates pathways to their memories. We enter the patient's room and look around for clues. There might be a photograph we can discuss. It might be a song or a joke."
One woman started weeping when they played a song that reminded her of her husband. "All of a sudden, she wanted to talk about him," Ellis says. "She missed him, and despite the tears, we didn't back away. We listened. It was an honor to be there."
Finding Clues to Memories
The nurses' station is one of the first stops in a hospital or elder care facility. Ellis and the other Vaudeville Visits performers inquire about the patients, their likes, and their ages. "Age can tell us about the music they grew up listening to," Ellis says. 
One woman, who didn't communicate, loved bubbles. "There's a child inside each one of us, and the bubbles brought the kid out in her," he says. "She watched the bubbles and smiled. She has adult memories and childhood ones. We touched on one of those memories."


How Music and Laughter Can Tap Into the Emotions of People with Alzheimer's

If you undergo atrial fibrillation, also known as Afib, and your medication stops working, your physician may recommend a pacemaker to regulate a slow heartbeat. It's not uncommon, and the results are usually positive. Further, approximately 2.7 million Americans live with Afib, and the Center for Disease Control and Prevention expects that number to increase to 12.1 million in 2030. 
After being diagnosed with atrial fibrillation or Afib, your doctor may recommend a pacemaker, or an atrial defibrillator. Both work to reset your heartbeat to a normal pace.What is Afib? 
Afib occurs when your heart has an arrhythmia, an irregular heartbeat that beats too fast or too slow and blocks your heart from pumping enough blood to the rest of your body. In the U.S., however, the reason for a rise in Afib cases is age. (The U.S. Census Bureau notes that people older than 65 will make up 21% of the population starting in 2030.) 
"It is more common in older adults," Jim Liu, a cardiologist and clinical assistant professor of internal medicine at The Ohio State University Wexner Medical Center, says. "Young people can get Afib. But unfortunately, when that happens, it's often associated with other heart conditions." 
"Young people can get Afib. But unfortunately, when that happens, it's often associated with other heart conditions."
Afib Diagnosis 
An Afib medical interpretation may involve blood clots, stroke, or heart failure, which sounds frightening. Yet, it is reassuring to learn that Afib is one of the most general conditions treated for heart arrhythmia and isn't life-threatening.  
When it comes to medical diagnosis, during Afib, your heart's "upper chambers beat irregularly and out of sync with the lower chambers," Liu says. "Your heart can feel as if it's pounding or beating too fast. As a result, you might have shortness of breath and feel weak. And some people have no symptoms." 
Treating Afib 
"Treatment for atrial fibrillation can include medications, therapy to reset your heart's rhythm, and catheter procedures to block faulty heart signals," Liu says, which is also known as cardioversion or resetting your heart's rhythm. Two types of cardioversion are performed in a hospital: electrical cardioversion (an electrical shock that resets your heart's rhythm to a normal beat) and cardioversion, wherein your doctor gives you anti-arrhythmic drugs in pill form or intravenously. 
Still, one of the most common options is cardiac ablation, which includes these three types of procedures: 
Catheter ablation happens when your doctor inserts a catheter through a vein and into your heart. Maze procedure occurs during open-heart surgery. A.V. node ablation is when your doctor connects your heart's upper and lower chambers with a catheter (you'd also require a pacemaker to monitor your heart and normalize its rhythm). First Options Other than A Pacemaker 
After learning you have Afib, your doctor will share a few different options before suggesting a pacemaker. 
"Your doctor may recommend a pacemaker, or an atrial defibrillator. Both work to reset your heartbeat to a normal pace. Defibrillators are larger and can have pacemakers built in them to correct your heart's rhythm," says Liu. 
Further, Liu explained a pacemaker sends electrical signals to take the place of the mixed-up heartbeats, so your heart beats at the right pace. "It's a monitor that tells your doctor what's going on in your heart; it can also stop AFib symptoms." 
The Pacemaker Route 
The pacemaker surgery is minor and requires an overnight stay in the hospital. Pacemakers are about the size of a half-dollar coin and weigh between one and two ounces. The device is placed in your chest just below your collarbone. 
Below are a few tips to consider if you have a pacemaker: 
Take your medications Keep track of your heart rate by checking your pulse. In addition, you might want to purchase and wear an Apple watch or other smart device that monitors your heart rate. Keep pressure off your chest where the pacemaker is located Talk to your doctor about exercise and physical activity Pacemakers and Electronics 
Common electronic gadgets may interfere with your pacemaker. To be on the safe side of cell phones, for example, hold them on the opposite side of your pacemaker. 
According to the American Heart Association, these are other electronic devices that might interfere with your pacemaker: 
MP3 player headphones with magnetic pieces can change your pacemaker's rhythm.  Metal detectors at security checkpoints can affect your pacemaker. If you are at an airport or any other place where you have to walk through a metal detector, tell the security guards you have a pacemaker. You might want to carry a note from your physician. The Afib Takeaway 
"Pacemakers are not a stand-alone treatment for Afib," says Janice Johnston, chief medical officer and co-founder of Redirect Health. She adds that there are various lifestyle, diet, and health-inspired practices to consider.
Eat a healthy diet of fruits, vegetables, whole grains, and lean protein. Limit caffeine because coffee, black tea, sodas, and energy drinks might make your heart race. Cut back on alcohol consumption. "Too much alcohol can set off Afib symptoms," she says. Move and exercise Stop smoking Relax and meditate to ease any stress in your life Aim for eight hours of sleep each night Talk to your doctor about which medications you can and cannot take. Make sure all of your doctors are aware of the medications they prescribed for you. Some over-the-counter medications can cause your heart to beat faster.  The same goes for prescription drugs, decongestants, and supplements or naturopathic remedies.  


How to Manage Atrial Fibrillation When You Have a Pacemaker 

While telling my mom about the next medical procedure I scheduled for her, she replied, "Enough with the doctor visits."
She has a point. In the previous six months, I had arranged for her to be questioned and examined by an army of medical professionals, including an audiologist, a geriatrician, a physical therapist and several specialists at Montefiore Medical Hospital's Center for the Aging Brain in Yonkers, New York. She wants these appointments to stop.
It's not a one-size-fits-all yes or no answer. You have to look at your age, your health, and have to talk to your doctor and ask, 'Why are these tests being ordered?'In my defense, I hoped for solutions to the aging-related problems she suffers from. In her defense, the geriatrician said my mom was relatively healthy for a 90-year-old woman and recommended she take a daily vitamin with iron, vitamin D and calcium.
"You have to talk to your doctor and ask, 'Why are these tests being ordered?'"
Getting hearing aids was necessary, too. So were more trips to the Center for the Aging Brain. The last doctor who examined her at the Center nixed medication because the side effects were harmful. He said he believed her lack of hearing contributed to her mild cognitive decline.
That doctor noticed my mom shuffled her feet when she walked and recommended I take her to a physical therapist. The physical therapist gave her the option of walking on her own every day or coming to the therapist's office three times a week and exercising daily at home. My mom chose walking.
Do You Really Need a Colonoscopy at 80 or 90?
"This is not a one-size-fits-all yes or no answer," says Dr. Suneet Singh, an emergency department physician, assistant professor at the University of Texas Austin Dell Medical School, and medical director at CareHive. "You have to look at your age, your health, and your life's goals. You have to talk to your doctor and ask, 'Why are these tests being ordered?'"
"Do you have a history of cancer?" he continued. "A colonoscopy can screen for polyps. Most are benign, but some can eventually become cancerous, and early detection is when cancer treatments work best."
Like other doctors, Singh discusses with his patients the risks and benefits of surgeries and other medical procedures. "I also talk to them about their goals in life," he says. "If you're in your eighties and nineties, in good health and want to see your granddaughter walk down the aisle, then yes, maybe you do get that colonoscopy."
Look at your age. "For example, current research shows colonoscopies could prevent death from colon cancer in patients with life expectancy of greater than ten years," says Dr. Eric Chyn, geriatrician, assistant professor and director of the geriatric medicine fellowship program at Rutgers Health New Jersey Medical School and University Health/Ambulatory Care Clinic.
For older patients in excellent health who are expected to live 10 years or longer, Chyn said he believes a colonoscopy "will likely bring more benefit than harm."
If a patient is in fair health and expected to live another five years, "then the benefit of colonoscopy is unclear," he says. "Therefore, a shared decision is particularly important. If the patient is in poor health and has less than five years, then prioritizing care that improves a patient's quality of life would have more benefit than a colonoscopy."
"However, this is not an overall statement that a colonoscopy is never appropriate for older adults living with poor health," he says. "If there are concerns of life threatening internal bleeding, a colonoscopy would still be offered for the purpose of diagnosis and treatment."
Roll Back or Stick With It?
Chyn and Singh point to the U.S. Preventive Services Task Force (USPSTF), which keeps an up-to-date list of recommendations for different medical procedures for people of all ages. For example, the Task Force recommends biennial screening mammography for women aged 50 to 74 years. After age 75, the USPSTF sees little evidence for women to have mammograms.
"An older patient in excellent health may choose to stop proton pump inhibitors to avoid lung infection and weakened bones."
"We consider the patients' medical comorbidities and prognoses," Chyn says. "We explore the patients' goals of care. We enable patients by explaining the likelihood of benefits versus harms within the context of their personalized health profiles so they can arrive at decisions that align with their goals of care."
The USPSTF recommends against PSA (prostate-specific antigen) screening for prostate cancer in men 70 years and older because of potential harms, such as false-positive results that lead to more testing, overdiagnosis, overtreatment, and treatment effects such as incontinence and erectile dysfunction. "This again comes down to talking to your physician and making an informed decision," Singh says.
Do the Positives Outweigh the Negatives?
A good example is a proton pump inhibitor, which is great at controlling heartburn. It's also associated with increased risk of bone weakening and lung infections. "An older patient in excellent health may choose to stop proton pump inhibitors to avoid lung infection and weakened bones," Chyn says. "On the other hand, a nursing home resident in poor health may value heartburn symptom control as the top priority."
Women, ages 65 and up, and men, ages 70 plus, should schedule routine bone density scans for osteoporosis. Symptoms for osteoporosis are often undetected until a bone fracture occurs. According to the American College of Obstetricians and Gynecologists, osteoporosis occurs five times more often in women than in men.
Men, ages 65 to 75 with a history of smoking, should schedule an abdominal aortic aneurysm screening. The screening can detect an aneurysm before it ruptures.
Too Many Meds?
"Many older adults take five or more medications each day," Singh says. "It's called a polypharmacy. Is it too much? Again, you have to look at the benefits and the risks by talking about them with your doctor."
Chyn asks his patients what bothers them the most and then focuses on improving his patients' quality of life. "After establishing if it's important to my patients, I then prescribe or deprescribe accordingly," he says. "It's another example of shared decision-making and personalized health profiles to guide treatment plans."
To find out about drug side effects and if your new prescription interferes with an old one, keep all of the doctors you see in the loop. You can also check out the American Geriatrics Society's Beers list, which posts inappropriate medications for older adults.


Are All These Doctor Visits Necessary?

Look at your feet. Does your big toe lean towards your other toes? Over time, a bump forms on a joint at the base of your big toe. It's a result of pressure from the big toe pushing against the first metatarsal bone in your foot. That bump is a bunion.
Bunions, one of the most common foot deformities, occurs more among older women, and because of this, many foot doctors point to tight fitting high heel shoes as the main culpritEach time you walk, you put all your weight on that part of your foot and with each step, your shoe rubs against it causing calluses. It doesn't happen overnight. This takes years to develop; that's why bunions are more common among people aged 65 and over than for younger folks.
"Ill-fitting shoes make bunions more likely." 
Bunions, one of the most common foot deformities, occurs more among older women, and because of this, many foot doctors point to tight fitting high heel shoes as the main culprit. The science is mixed; some doctors believe high heels and shoes with little room aren't the main causes of bunions.
"High heels and pointy shoes are one of a few causes," says Sheldon S. Lin, an orthopaedic surgeon at Rutgers North Jersey Orthopaedic Institute and an associate professor at Rutgers New Jersey Medical School. 
He points to these other factors:
The Causes 
Genetics: “Bunions can run in your family.”Flat feet: Having no visible arches can also run in your family.Shoes: “Ill-fitting shoes make bunions more likely.”Arthritis: Rheumatoid arthritis (RA), an inflammatory type of arthritis, can cause bunions. It’s not uncommon for people with RA to develop deformities in their feet.The Symptoms 
If you see a bump on your big toe, it may be a bunion. Often bunions form on both of your big toes. Here's what to look for:
Swelling in the shape of a bumpRednessIt feels sore when you touch itPain that comes and goes or is ongoingNumbness in your big toe or in the joint where the bunion has formedCallused feet, corns, or hammertoes (A hammertoe is a joint on your toe that points up instead of lying flat.)The bump can look shinyThe bump feels warm"Your symptoms may be mild and some people have no symptoms at all," Lin says. "Some bunions are painful and can feel like there's pressure placed on the area."                                       
                                      
Treating Bunions 
According to Lin, "It's more of a case of managing bunions. The treatment focuses on relieving the symptoms. Bunions don't go away unless they are surgically removed."
The first step is to change your shoes. "Wear comfortable shoes with a wide toe area that takes the pressure off your feet," Lin says. "Squeezing your toes into a pair of shoes is uncomfortable. And talk to your doctor about orthotic devices. These can be over-the-counter or, better yet, custom-made."
You can purchase custom-made orthotics from your foot doctor. Some health insurance companies cover custom-made orthotics. You can also buy commercial ones in pharmacies and online.
"The problem is once the deformity has occurred, it's difficult to non-surgically force the big toe in the right position." 
If you Google "bunion correctors" or "bunion pain relief," several products pop up on your computer's screen. They include bunion pads that cushion the foot, numerous toe straightening devices that move your big toe from pointing inward so that it appears straight, and several types of corrective shoes.
"The problem is once the deformity has occurred, it's difficult to non-surgically force the big toe in the right position," Lin says. "These products may offer some relief. Changing your shoes so that your toes aren't crowded together and there's space and comfort is the best non-surgical option."
"It also comes down to your level of pain. You won't need surgery if there's no pain. Let it be. Change the shoe to fit the foot. Don't change the foot to fit the shoe," he adds.
Other Treatment Options 
Massage, physical therapy, and ultrasound therapy can break up soft tissue and reduce pain and inflammation. Acupuncture may relieve pain, too. Over-the-counter nonsteroidal anti-inflammatory drugs such as aspirin and other common pain relievers can help you manage any pain. Ice packs reduce pain and swelling, too.
If the pain persists and you want to avoid surgery, you can try steroid injections to reduce pain and swelling. This is more of a last resort before considering surgery. Steroid injections shouldn't be used often because too many injections can damage the joint.
"Consider surgery when nonsurgical treatments don't help and the pain is overwhelming," Lin says. "If walking becomes too painful, then surgery becomes an option."
What's a Bunionectomy? 
This surgical procedure "is minimally invasive and can be done in your doctor's office," Lin says. "You're in and out of the office the same day."
"It's done," he explains, "by removing the bunion and realigning the bones in your foot so your big toe is in its proper position."
Lin performs lapiplasty surgery. It's a 3D corrective surgery. He taught the procedure to surgeons through a medical company called Treace Medical Concepts, Inc.
Before considering surgery, Lin suggests talking to your foot doctor to discuss the various types of treatments.
"Get an accurate diagnosis and ask your doctor to consider all non-surgical options first," he says.  


What Causes Bunions and How You Can Manage Them

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