He Thinks His Wife Died in an Understaffed Hospital. Now He’s Trying to Change the Industry.
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For the past year, police Detective Tim Lillard has spent most of his waking hours unofficially investigating his wife’s death.
The question has never been exactly how Ann Picha-Lillard died on Nov. 19, 2022: She succumbed to respiratory failure after an infection put too much strain on her weakened lungs. She was 65.
For Tim Lillard, the question has been why.
Lillard had been in the hospital with his wife every day for a month. Nurses in the intensive care unit had told him they were short-staffed, and were constantly rushing from one patient to the next.
Lillard tried to pitch in where he could: brushing Ann’s shoulder-length blonde hair or flagging down help when her tracheostomy tube gurgled — a sign of possible respiratory distress.
So the day he walked into the ICU and saw staff members huddled in Ann’s room, he knew it was serious. He called the couple’s adult children: “It’s Mom,” he told them. “Come now.”
All he could do then was sit on Ann’s bed and hold her hand, watching as staff members performed chest compressions, desperately trying to save her life.
A minute ticked by. Then another. Lillard’s not sure how long the CPR continued — long enough for the couple’s son to arrive and take a seat on the other side of Ann’s bed, holding her other hand.
Finally, the intensive care doctor called it and the team stopped CPR. Time of death: 12:37 p.m.
Lillard didn’t know what to do in a world without Ann. They had been married almost 25 years. “We were best friends,” he said.
Just days before her death, nurses had told Lillard that Ann could be discharged to a rehabilitation center as soon as the end of the week. Then, suddenly, she was gone. Lillard didn’t understand what had happened.
Lillard said he now believes that overwhelmed, understaffed nurses hadn’t been able to respond in time as Ann’s condition deteriorated. And he has made it his mission to fight for change, joining some nursing unions in a push for mandatory ratios that would limit the number of patients in a nurse’s care. “I without a doubt believe 100% Ann would still be here today if they had staffing levels, mandatory staffing levels, especially in ICU,” Lillard said.
Last year, Oregon became the second state after California to pass hospital-wide nurse ratios that limit the number of patients in a nurse’s care. Michigan, Maine, and Pennsylvania are now weighing similar legislation.
But supporters of mandatory ratios are going up against a powerful hospital industry spending millions of dollars to kill those efforts. And hospitals and health systems say any staffing ratio regulations, however well-intentioned, would only put patients in greater danger.
Putting Patients at Risk
By next year, the United States could have as many as 450,000 fewer nurses than it needs, according to one estimate. The hospital industry blames covid-19 burnout, an aging workforce, a large patient population, and an insufficient pipeline of new nurses entering the field.
But nursing unions say that’s not the full story. There are now 4.7 million registered nurses in the country, more than ever before.
The problem, the unions say, is a hospital industry that’s been intentionally understaffing their units for years in order to cut costs and bolster profits. The unions say there isn’t a shortage of nurses but a shortage of nurses willing to work in those conditions.
The nurse staffing crisis is now affecting patient care. The number of Michigan nurses who say they know of a patient who has died because of understaffing has nearly doubled in recent years, according to a Michigan Nurses Association survey last year.
Just months before Ann Picha-Lillard’s death, nurses and doctors at the health system where she died had asked the Michigan attorney general to investigate staffing cuts they believed were leading to dangerous conditions, including patient deaths, according to The Detroit News.
But Lillard didn’t know any of that when he drove his wife to the hospital in October 2022. She had been feeling short of breath for a few weeks after she and Lillard had mild covid infections. They were both vaccinated, but Ann was immunocompromised. She suffered from rheumatoid arthritis, a condition that had also caused scarring in her lungs.
To be safe, doctors at DMC Huron Valley-Sinai Hospital wanted to keep Ann for observation. After a few days in the facility, she developed pneumonia. Doctors told the couple that Ann needed to be intubated. Ann was terrified but Lillard begged her to listen to the doctors. Tearfully, she agreed.
With Ann on a ventilator in the ICU, it seemed clear to Lillard that nurses were understaffed and overwhelmed. One nurse told him they had been especially short-staffed lately, Lillard said.
“The alarms would go off for the medications, they’d come into the room, shut off the alarm when they get low, run to the medication room, come back, set them down, go to the next room, shut off alarms,” Lillard recalled. “And that was going on all the time.”
Lillard felt bad for the nurses, he said. “But obviously, also for my wife. That’s why I tried doing as much as I could when I was there. I would comb her hair, clean her, just keep an eye on things. But I had no idea what was really going on.”
Finally, Ann’s health seemed to be stabilizing. A nurse told Lillard they’d be able to discharge Ann, possibly by the end of that week.
By Nov. 17, Ann was no longer sedated and she cried when she saw Lillard and her daughter. Still unable to speak, she tried to mouth words to her husband “but we couldn’t understand what she was saying,” Lillard said.
The next day, Lillard went home feeling hopeful, counting down the days until Ann could leave the hospital.
Less than 24 hours later, Ann died.
Lillard couldn’t wrap his head around how things went downhill so fast. Ann’s underlying lung condition, the infection, and her weakened state could have proved fatal in the best of circumstances. But Lillard wanted to understand how Ann had gone from nearly discharged to dying, seemingly overnight.
He turned his dining room table into a makeshift office and started with what he knew. The day Ann died, he remembered her medical team telling him that her heart rate had spiked and she had developed another infection the night before. Lillard said he interviewed two DMC Huron Valley-Sinai nurse administrators, and had his own doctor look through Ann’s charts and test results from the hospital. “Everybody kept telling me: sepsis, sepsis, sepsis,” he said.
Sepsis is when an infection triggers an extreme reaction in the body that can cause rapid organ failure. It’s one of the leading causes of death in U.S. hospitals. Some experts say up to 80% of sepsis deaths are preventable, while others say the percentage is far lower.
Lives can be saved when sepsis is caught and treated fast, which requires careful attention to small changes in vital signs. One study found that for every additional patient a nurse had to care for, the mortality rate from sepsis increased by 12%.
Lillard became convinced that had there been more nurses working in the ICU, someone could have caught what was happening to Ann.
“They just didn’t have the time,” he said.
DMC Huron Valley-Sinai’s director of communications and media relations, Brian Taylor, declined a request for comment about the 2022 staffing complaint to the Michigan attorney general.
Following the Money
When Lillard asked the hospital for copies of Ann’s medical records, DMC Huron Valley-Sinai told him he’d have to request them from its parent company in Texas.
Like so many hospitals in recent years, the Lillards’ local health system had been absorbed by a series of other corporations. In 2011, the Detroit Medical Center health system was bought for $1.5 billion by Vanguard Health Systems, which was backed by the private equity company Blackstone Group.
Two years after that, in 2013, Vanguard itself was acquired by Tenet Healthcare, a for-profit company based in Dallas that, according to its website, operates 480 ambulatory surgery centers and surgical hospitals, 52 hospitals, and approximately 160 additional outpatient centers.
As health care executives face increasing pressure from investors, nursing unions say hospitals have been intentionally understaffing nurses to reduce labor costs and increase revenue. Also, insurance reimbursements incentivize keeping nurse staffing levels low. “Hospitals are not directly reimbursed for nursing services in the same way that a physician bills for their services,” said Karen Lasater, an associate professor of nursing in the Center for Health Outcomes and Policy Research at the University of Pennsylvania. “And because hospitals don’t perceive nursing as a service line, but rather a cost center, they think about nursing as: How can we reduce this to the lowest denominator possible?” she said.
Lasater is a proponent of mandatory nurse ratios. “The nursing shortage is not a pipeline problem, but a leaky bucket problem,” she said. “And the solutions to this crisis need to address the root cause of the issue, which is why nurses are saying they’re leaving employment. And it’s rooted in unsafe staffing. It’s not safe for the patients, but it’s also not safe for nurses.”
A Battle Between Hospitals and Unions
In November, almost one year after Ann’s death, Lillard told a room of lawmakers at the Michigan State Capitol that he believes the Safe Patient Care Act could save lives. The health policy committee in the Michigan House was holding a hearing on the proposed act, which would limit the amount of mandatory overtime a nurse can be forced to work, and require hospitals to make their staffing levels available to the public.
Most significantly, the bills would require hospitals to have mandatory, minimum nurse-to-patient ratios. For example: one nurse for every patient in the ICU; one for every three patients in the emergency room; a nurse for triage; and one nurse for every four postpartum birthing patients and well-baby care.
Efforts to pass mandatory ratio laws failed in Washington and Minnesota last year after facing opposition from the hospital industry. In Minnesota, the Minnesota Nurses Association accused the Mayo Clinic of using “blackmail tactics”: Mayo had told lawmakers it would pull billions of dollars in investment from the state if mandatory ratio legislation passed. Soon afterward, lawmakers removed nurse ratios from the legislation.
While Lillard waited for his turn to speak to Michigan lawmakers about the Safe Patient Care Act in November, members of the Michigan Nurses Association, which says it represents some 13,000 nurses, told lawmakers that its units were dangerously understaffed. They said critical care nurses were sometimes caring for up to 11 patients at a time.
“Last year I coded someone in an ICU for 10 minutes, all alone, because there was no one to help me,” said the nurses association president and registered nurse Jamie Brown, reading from another nurse’s letter.
“I have been left as the only specially trained nurse to take care of eight babies on the unit: eight fragile newborns,” said Carolyn Clemens, a registered nurse from the Grand Blanc area of Michigan.
Nikia Parker said she has left full-time emergency room nursing, a job she believes is her calling. After her friend died in the hospital where she worked, she was left wondering whether understaffing may have contributed to his death.
“If the Safe Patient Care Act passed, and we have ratios, I’m one of those nurses who would return to the bedside full time,” Parker told lawmakers. “And so many of my co-workers who have left would join me.”
But not all nurses agree that mandatory ratios are a good idea.
While the American Nurses Association supports enforceable ratios as an “essential approach,” that organization’s Michigan chapter does not, saying there may not be enough nurses in the state to satisfy the requirements of the Safe Patient Care Act.
For some lawmakers, the risk of collateral damage seems too high. State Rep. Graham Filler said he worries that mandating ratios could backfire.
“We’re going to severely hamper health care in the state of Michigan. I’m talking closed wards because you can’t meet the ratio in a bill. The inability for a hospital to treat an emergent patient. So it feels kind of to me like a gamble we’re taking,” said Filler, a Republican.
Michigan hospitals are already struggling to fill some 8,400 open positions, according to the Michigan Health & Hospital Association. That association says that complying with the Safe Patient Care Act would require hiring 13,000 nurses.
Every major health system in the state signed a letter opposing mandatory ratios, saying it would force them to close as many as 5,100 beds.
Lillard watched the debate play out in the hearing. “That’s a scare tactic, in my opinion, where the hospitals say we’re going to have to start closing stuff down,” he said.
He doesn’t think legislation on mandatory ratios — which are still awaiting a vote in the Michigan House’s health policy committee — are a “magic bullet” for such a complex, national problem. But he believes they could help.
“The only way these hospitals and the administrations are gonna make any changes, and even start moving towards making it better, is if they’re forced to,” Lillard said.
Seated in the center of the hearing room in Lansing, next to a framed photo of Ann, Lillard’s hands shook as he recounted those final minutes in the ICU.
“Please take action so that no other person or other family endures this loss,” he said. “You can make a difference in saving lives.”
Grief is one thing, Lillard said, but it’s another thing to be haunted by doubts, to worry that your loved one’s care was compromised before they ever walked through the hospital doors. What he wants most, he said, is to prevent any other family from having to wonder, “What if?”
This article is from a partnership that includes Michigan Public, NPR, and KFF Health News.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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With Medical Debt Burdening Millions, a Financial Regulator Steps In to Help
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When President Barack Obama signed legislation in 2010 to create the Consumer Financial Protection Bureau, he said the new agency had one priority: “looking out for people, not big banks, not lenders, not investment houses.”
Since then, the CFPB has done its share of policing mortgage brokers, student loan companies, and banks. But as the U.S. health care system turns tens of millions of Americans into debtors, this financial watchdog is increasingly working to protect beleaguered patients, adding hospitals, nursing homes, and patient financing companies to the list of institutions that regulators are probing.
In the past two years, the CFPB has penalized medical debt collectors, issued stern warnings to health care providers and lenders that target patients, and published reams of reports on how the health care system is undermining the financial security of Americans.
In its most ambitious move to date, the agency is developing rules to bar medical debt from consumer credit reports, a sweeping change that could make it easier for Americans burdened by medical debt to rent a home, buy a car, even get a job. Those rules are expected to be unveiled later this year.
“Everywhere we travel, we hear about individuals who are just trying to get by when it comes to medical bills,” said Rohit Chopra, the director of the CFPB whom President Joe Biden tapped to head the watchdog agency in 2021.
“American families should not have their financial lives ruined by medical bills,” Chopra continued.
The CFPB’s turn toward medical debt has stirred opposition from collection industry officials, who say the agency’s efforts are misguided. “There’s some concern with a financial regulator coming in and saying, ‘Oh, we’re going to sweep this problem under the rug so that people can’t see that there’s this medical debt out there,’” said Jack Brown III, a longtime collector and member of the industry trade group ACA International.
Brown and others question whether the agency has gone too far on medical billing. ACA International has suggested collectors could go to court to fight any rules barring medical debt from credit reports.
At the same time, the U.S. Supreme Court is considering a broader legal challenge to the agency’s funding that some conservative critics and financial industry officials hope will lead to the dissolution of the agency.
But CFPB’s defenders say its move to address medical debt simply reflects the scale of a crisis that now touches some 100 million Americans and that a divided Congress seems unlikely to address soon.
“The fact that the CFPB is involved in what seems like a health care issue is because our system is so dysfunctional that when people get sick and they can’t afford all their medical bills, even with insurance, it ends up affecting every aspect of their financial lives,” said Chi Chi Wu, a senior attorney at the National Consumer Law Center.
CFPB researchers documented that unpaid medical bills were historically the most common form of debt on consumers’ credit reports, representing more than half of all debts on these reports. But the agency found that medical debt is typically a poor predictor of whether someone is likely to pay off other bills and loans.
Medical debts on credit reports are also frequently riddled with errors, according to CFPB analyses of consumer complaints, which the agency found most often cite issues with bills that are the wrong amount, have already been paid, or should be billed to someone else.
“There really is such high levels of inaccuracy,” Chopra said in an interview with KFF Health News. “We do not want to see the credit reporting system being weaponized to get people to pay bills they may not even owe.”
The aggressive posture reflects Chopra, who cut his teeth helping to stand up the CFPB almost 15 years ago and made a name for himself going after the student loan industry.
Targeting for-profit colleges and lenders, Chopra said he was troubled by an increasingly corporate higher-education system that was turning millions of students into debtors. Now, he said, he sees the health care system doing the same thing, shuttling patients into loans and credit cards and reporting them to credit bureaus. “If we were to rewind decades ago,” Chopra said, “we saw a lot less reliance on tools that banks used to get people to pay.”
The push to remove medical bills from consumer credit reports culminates two years of intensive work by the CFPB on the medical debt issue.
The agency warned nursing homes against forcing residents’ friends and family to assume responsibility for residents’ debts. An investigation by KFF Health News and NPR documented widespread use of lawsuits by nursing homes in communities to pursue friends and relatives of nursing home residents.
The CFPB also has highlighted problems with how hospitals provide financial assistance to low-income patients. Regulators last year flagged the dangers of loans and credit cards that health care providers push on patients, often saddling them with more debt.
And regulators have gone after medical debt collectors. In December, the CFPB shut down a Pennsylvania company for pursuing patients without ensuring the debts were accurate.
A few months before that, the agency fined an Indiana company working with medical debt for violating collection laws. Regulators said the company had “risked harming consumers by pressuring or inducing them to pay debts they did not owe.”
With their business in the crosshairs, debt collectors are warning that cracking down on credit reporting and other collection tools may prompt more hospitals and doctors to demand patients pay upfront for care.
There are some indications this is happening already, as hospitals and clinics push patients to enroll in loans or credit cards to pay their medical bills.
Scott Purcell, CEO of ACA International, said it would be wiser for the federal government to focus on making medical care more affordable. “Here we’re coming up with a solution that only takes money away from providers,” Purcell said. “If Congress was involved, there could be more robust solutions.”
Chopra doesn’t dispute the need for bigger efforts to tackle health care costs.
“Of course, there are broader things that we would probably want to fix about our health care system,” he said, “but this is having a direct financial impact on so many Americans.”
The CFPB can’t do much about the price of a prescription or a hospital bill, Chopra continued. What the federal agency can do, he said, is protect patients if they can’t pay their bills.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
USE OUR CONTENT
This story can be republished for free (details).
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
Subscribe to KFF Health News’ free Morning Briefing.
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Fast. Feast. Repeat – by Dr. Gin Stephens
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We’ve reviewed intermittent fasting books before, so what makes this one different?
The title “Fast. Feast. Repeat.” doesn’t give much away; after all, we already know that that’s what intermittent fasting is.
After taking the reader though the basics of how intermittent fasting works and what it does for the body, much of the rest of the book is given over to improvements.
That’s what the real strength of this book is: ways to make intermittent fasting more efficient, including how to avoid plateaus. After all, sometimes it can seem like the only way to push further with intermittent fasting is to restrict the eating window further. Not so!
Instead, Dr. Stephens gives us ways to keep confusing our metabolism (in a good way) if, for example, we had a weight loss goal we haven’t met yet.
Best of all, this comes without actually having to eat less.
Bottom line: if you want to be in good physical health, and/but also believe that life is for living and you enjoy eating food, then this book can resolve that age-old dilemma!
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What is PNF stretching, and will it improve my flexibility?
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Whether improving your flexibility was one of your new year’s resolutions, or you’ve been inspired watching certain tennis stars warming up at the Australian Open, maybe 2025 has you keen to focus on regular stretching.
However, a quick Google search might leave you overwhelmed by all the different stretching techniques. There’s static stretching and dynamic stretching, which can be regarded as the main types of stretching.
But there are also some other potentially lesser known types of stretching, such as PNF stretching. So if you’ve come across PNF stretching and it piques your interest, what do you need to know?
Undrey/Shutterstock What is PNF stretching?
PNF stretching stands for proprioceptive neuromuscular facilitation. It was developed in the 1940s in the United States by neurologist Herman Kabat and physical therapists Margaret Knott and Dorothy Voss.
PNF stretching was initially designed to help patients with neurological conditions that affect the movement of muscles, such as polio and multiple sclerosis.
By the 1970s, its popularity had seen PNF stretching expand beyond the clinic and into the sporting arena where it was used by athletes and fitness enthusiasts during their warm-up and to improve their flexibility.
Although the specifics have evolved over time, PNF essentially combines static stretching (where a muscle is held in a lengthened position for a short period of time) with isometric muscle contractions (where the muscle produces force without changing length).
PNF stretching is typically performed with the help of a partner.
There are 2 main types
The two most common types of PNF stretching are the “contract-relax” and “contract-relax-agonist-contract” methods.
The contract-relax method involves putting a muscle into a stretched position, followed immediately by an isometric contraction of the same muscle. When the person stops contracting, the muscle is then moved into a deeper stretch before the process is repeated.
For example, to improve your hamstring flexibility, you could lie down and get a partner to lift your leg up just to the point where you begin to feel a stretch in the back of your thigh.
Once this sensation eases, attempt to push your leg back towards the ground as your partner resists the movement. After this, your partner should now be able to lift your leg up slightly higher than before until you feel the same stretching sensation.
This technique was based on the premise that the contracted muscle would fall “electrically silent” following the isometric contraction and therefore not offer its usual level of resistance to further stretching (called “autogenic inhibition”). The contract-relax method attempts to exploit this brief window to create a deeper stretch than would otherwise be possible without the prior muscle contraction.
The contract-relax-agonist-contract method is similar. But after the isometric contraction of the stretched muscle, you perform an additional contraction of the muscle group opposing the muscle being stretched (referred to as the “agonist” muscle), before the muscle is moved into a static stretch once more.
Again, if you’re trying to improve hamstring flexibility, immediately after trying to push your leg towards the ground you would attempt to lift it back towards the ceiling (this bit without partner resistance). You would do this by contracting the muscles on the front of the thigh (the quadriceps, the agonist muscle in this case).
Likewise, after this, your partner should be able to lift your leg up slightly higher than before.
The contract-relax-agonist-contract method is said to take advantage of a phenomenon known as “reciprocal inhibition.” This is where contracting the muscle group opposite that of the muscle being stretched leads to a short period of reduced activation of the stretched muscle, allowing the muscle to stretch further than normal.
What does the evidence say?
Research has shown PNF stretching is associated with improved flexibility.
While it has been suggested that both PNF methods improve flexibility via changes in nervous system function, research suggests they may simply improve our ability to tolerate stretching.
It’s worth noting most of the research on PNF stretching and flexibility has focused on healthy populations. This makes it difficult to provide evidence-based recommendations for people with clinical conditions.
And it may not be the most effective method if you’re looking to improve your flexibility in the long term. A 2018 review found static stretching was better for improving flexibility compared to PNF stretching. But other research has found it could offer greater immediate benefits for flexibility than static stretching.
At present, similar to other types of stretching, research linking PNF stretching to injury prevention and improved athletic performance is relatively inconclusive.
PNF stretching may actually lead to small temporary deficits in performance of strength, power, and speed-based activities if performed immediately beforehand. So it’s probably best done after exercise or as a part of a standalone flexibility session.
Static stretching may be a more effective way to improve flexibility over the long-term. GaudiLab/Shutterstock How much should you do?
It appears that a single contract-relax or contract-relax-agonist-contract repetition per muscle, performed twice per week, is enough to improve flexibility.
The contraction itself doesn’t need to be hard and forceful – only about 20% of your maximal effort should suffice. The contraction should be held for at least three seconds, while the static stretching component should be maintained until the stretching sensation eases.
So PNF stretching is potentially a more time-efficient way to improve flexibility, compared to, for example, static stretching. In a recent study we found four minutes of static stretching per muscle during a single session is optimal for an immediate improvement in flexibility.
Is PNF stretching the right choice for me?
Providing you have a partner who can help you, PNF stretching could be a good option. It might also provide a faster way to become more flexible for those who are time poor.
However, if you’re about to perform any activities that require strength, power, or speed, it may be wise to limit PNF stretching to afterwards to avoid any potential deficits in performance.
Lewis Ingram, Lecturer in Physiotherapy, University of South Australia and Hunter Bennett, Lecturer in Exercise Science, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Dental Diet – by Dr. Steven Lin
10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.
As it turns out, there’s a lot more to healthy teeth than skipping the sugar and getting some calcium.
The author’s journey started with the realization that most of his work as a dentist should be unnecessary, and not just in the “you should have been flossing” sense. Rather, he came to the same conclusions as his fellow dentist Weston Price before him, and this time (unlike Price) he stuck to his own field, dentistry—meaning that the conclusions he kept were the more valid ones.
Another thing he does better than Price is that he contextualizes the information—we don’t need, for example, to be eating seal fat as a main component of our diet, but we do need to be getting sufficient amounts of certain fat-soluble vitamins. And most people aren’t. Same with what’s good or bad for our oral microbiome, and by extension, our saliva, and by extension, our teeth and gums.
There’s a lot of nutritional information in here; macros and micronutrients alike, but the book goes further than that, to also recommend minimally-processed food that requires more chewing, for example. Not just for its nutritional content, but because that helps our teeth move to (and then stay) where they are ideally supposed to be. No amount of perfectly-blended nutritional supplement drink will align your maxilla for you, say. But chomping on raw carrots? Different story.
Dr. Lin offers a 40-day meal plan, but aware that if you’re vegetarian or vegan you’re probably going to have to rethink it yourself using the information he gives, because his meal plan includes animal products.
Bottom line: if you’d like to eat for better oral health (nutritionally, physically, and for your oral microbiome), this book has all the information you’ll need.
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Digital Minimalism – by Dr. Cal Newport
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There are a lot of books that advise “Unplug once in a while, and go outside”. But it doesn’t really take a book to convey that, does it? And it just leaves all the digital catching-up once we get back. Surely there must be a better way?
Rather than relying on a “digital detox”, Dr. Newport offers principles to apply to our digital lives, that allow us to reap the benefits of modern information technology without being obeisant to it.
The book’s greatest strength lies in that; having clear guidelines that can be applied to cut out the extra weight of digital media that has simply snuck in because of The Almighty Algorithm—and even tips on how to engage more mindfully with that if we still want to, for example using social media only in a web browser rather than on our phones, so that we can ringfence the time for it rather than having it spill into every spare moment.
In the category of criticism, the book sometimes lacks a little awareness when it comes to assumptions about the reader and the reader’s social circles; that (for example) nobody has any disabilities and everyone lives in the same town. But for most people most of the time, the advices will stand, and the exceptions can be managed by the reader neatly enough.
Stylistically, the book is not very minimalist, but this is not inconsistent with the advice of the book, if you’re curling up in the armchair with a physical copy, or a single-purpose ereader device.
Bottom line: if you’d like to streamline your use of digital media, but don’t want to lose out on the value it brings you, this book provides an excellent template
Click here to check out Digital Minimalism, and choose focused life in a noisy world!
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How To Reduce Your Alzheimer’s Risk
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Reduce Your Alzheimer’s Risk
Alzheimer’s is just one cause of dementia, but it’s a very notable one, not least of all because it’s
- a) the most common cause of dementia, and
- b) a measurably terminal disease.
For that reason we’re focusing on Alzheimer’s today, although most of the advice will go for avoiding dementia in general.
First, some things not everyone knows about Alzheimer’s:
- Alzheimer’s is a terminal disease.
- People who get a diagnosis at age 60 are typically given 4–8 years to live.
- Some soldier on for as many as 20, but those are rare outliers.
- Alzheimer’s begins 20 years or more before other symptoms start to develop.
- This makes this information very relevant for younger people approaching 40, for example.
- Alzheimer’s accounts for 60–80% of dementia, and affects around 6% of people over 60.
- By the age of 65, that figure is 10%. By the age of 70, however, the percentage is still about the same—this is because of the mortality rate preventing the accumulation of Alzheimer’s patients over time.
Want to know more? Read: 2023 Alzheimer’s Disease Facts And Figures Special Report ← this is a very comprehensive downloadablereference, by the way, including a lot of information about diagnosis, treatmentpathways, and earlyinterventions.
Speaking of diagnosis…
Know what the symptoms are… and aren’t!
Forgetting your car keys can be frustrating. Forgetting them frequently can be worrying.
But: there’s a difference between forgetting your car keys, and forgetting what car keys are used for. The latter is the kind of memory loss that’s more of a red flag for Alzheimer’s.
Similarly: forgetting someone’s name can be embarrassing. Forgetting someone’s name, asking them, forgetting asking them, asking them again, forgetting again (lather rinse repeat) is more of a red flag for Alzheimer’s.
There are other symptoms too, some of them less commonly known:
❝Difficulty remembering recent conversations, names or events; apathy; and depression are often early symptoms. Communication problems, confusion, poor judgment and behavioral changes may occur next. Difficulty walking, speaking, and swallowing are common in the late stages of the disease❞
If you or a loved one are experiencing worrying symptoms: when it comes to diagnosis and intervention, sooner is a lot better than later, so do talk to your doctor.
As for reducing your risk? First, the obvious stuff:
The usual 5 things that go for almost everything:
- Have a good diet—the Mediterranean Diet is once again recommended (we expect this will not be a surprise to regular readers!)
- Get regular exercise—in the case of avoiding Alzheimer’s and other dementias, typically the most important thing here is heart health, so getting regular cardiovascular exercise, such walking, running, or dancing is great. Cycling too. Swimming, not so much. Not that swimming’s bad or anything, it’s just that when your body is horizontal, the heart has less work to do, especially in the upper part of the body, because it’s not defying gravity. Similarly, yoga is great for the health but won’t particularly help with this, nor will weight training.
- Get good sleep—as we get older, we tend to need less sleep, and tend more towards the lower end of the standard “7–9 hours” prescription, but getting at least those 7 hours makes a huge difference.
- Cut down (or eliminate) alcohol consumption—and especially avoid binge-drinking. While “binge-drinking” is typically associated with young people, that Christmas party where that one uncle gets very drunk is also binge-drinking, for example. Plus, heavy drinking in early life has also been correlated with higher risk of Alzheimer’s later.
- Don’t smoke. It’s bad for everything, and Alzheimer’s risk is no exception.
How much do lifestyle changes alone make a difference?
They make a big difference. This 2022 population-based cohort study (so: huge sample size) looked at people who had 4–5 of the healthy lifestyle factors being studied, vs people who had 0–1 of them. They found:
❝A healthy lifestyle was associated with a longer life expectancy among men and women, and they lived a larger proportion of their remaining years without Alzheimer’s dementia.❞
The numbers of years involved by the way ranged between 3 and 20 years, in terms of life expectancy and years without or with Alzheimer’s, with the average increase of healthy life years being approximately the same as the average increase in years. This is important, because:
A lot of people think “well if I’m going to go senile, I might as well [unhealthy choice that shortens lifespan]”, but they misunderstand a critical factor:
The unhealthy choices will reduce their healthy life years, and simply bring the unhealthy ones (and subsequent death) sooner. If you’re going to spend your last few years in ill-health, it’s better to do so at 90 than 50.
The other thing you may already know… And a thing about it that not everyone considers:
Keeping cognitively active is important. This much is broadly known by the general public, and to clinicians, this was the fourth “healthy factor” in the list of five (instead of the sleep that we put there, because we were listing the 5 things that go for most preventable health issues).
Everyone leaps to mention sudoku at this point, so if that’s your thing, great, enjoy it! (This writer personally enjoys chess, which isn’t everyone’s cup of tea; if it yours though, you can come join her on Chess.com and we’ll keep sharp together)
But the more parts of your mental faculties you keep active, the better. Remember, brainpower (as with many things in health and life) is a matter of “use it or lose it” and this is on a “per skill” basis!
What this means: doing sudoku (a number-based puzzle game) or chess (great as it may be) won’t help as much for keeping your language skills intact, for example. Given that language skills are one of the most impactful and key faculties to get lost to Alzheimer’s disease, neglecting such would be quite an oversight!
Some good ways to keep your language skills tip-top:
- Read—but read something challenging, if possible. It doesn’t have to be Thomas Scanlon’s What We Owe To Each Other, but it should be more challenging than a tabloid, for example. In fact, on the topic of examples:
- This newsletter is written to be easy to read, while not shying away from complex ideas or hard science. Our mission is literally to “make [well-sourced, science-based] health and productivity crazy simple”.
- But the academic papers that we link? Those aren’t written to be easy to read. Go read them, or at least the abstracts (in academia, an abstract is essentially an up-front summary, and is usually the first thing you’ll see when you click a link to a study or such). Challenge yourself!
- Write—compared to reading/listening, producing language is a (related, but) somewhat separate skill. Just ask any foreign language learner which is more challenging: reading or writing!
- Journaling is great, but writing for others is better (as then you’ll be forced to think more about it)
- Learn a foreign language—in this case, what matters it that you’re practicing and learning, so in the scale of easy to hard, or doesn’t matter if it’s Esperanto or Arabic. Duolingo is a great free resource that we recommend for this, and they have a wide range of extensive courses these days.
Now for the least obvious things…
Social contact is important.
Especially in older age, it’s easy to find oneself with fewer remaining friends and family, and getting out and about can be harder for everyone. Whatever our personal inclinations (some people being more introverted or less social than others), we are fundamentally a social species, and hundreds of thousands of years of evolution have built us around the idea that we will live our lives alongside others of our kind. And when we don’t, we don’t do as well.
See for example: Associations of Social Isolation and Loneliness With Later Dementia
If you can’t get out and about easily:
- Online socialising is still socializing.
- Online community is still community.
- Online conversations between friends are still conversations between friends.
If you don’t have much (or anyone) in the category of friends and family, join Facebook groups related to your interests, for example.
Berries are surprisingly good
^This may read like a headline from 200,000 BCE, but it’s relevant here!
Particularly recommended are:
- blueberries
- blackberries
- raspberries
- strawberries
- cranberries
We know that many of these berries seem to have a shelf-life of something like 30 minutes from time of purchase, but… Frozen and dried are perfectly good nutritionally, and in many cases, even better nutritionally than fresh.
Read: Effect of berry-based supplements and foods on cognitive function: a systematic review
Turmeric’s health benefits appear to include protecting against Alzheimer’s
Again, this is about risk reduction, and turmeric (also called curcumin, which is not the same as cumin) significantly reduces the build-up of amyloid plaques in the brain. Amyloid plaques are part of the progression of Alzheimer’s.
See for yourself: Protective Effects of Indian Spice Curcumin Against Amyloid Beta in Alzheimer’s Disease
If you don’t like it as a spice (and even if you do, you probably don’t want to put it in your food every day), you can easily get it as a supplement in capsule form.
Lower your homocysteine levels
Lower our what now? Homocysteine is an amino acid used for making certain proteins, and it’s a risk factor for Alzheimer’s.
Foods high in folate (and possible other B-vitamins) seem to lower homocysteine levels. Top choices include:
- Leafy greens
- Cruciferous vegetables
- Tomatoes
Get plenty of lutein
We did a main feature about specifically this a little while ago, so we’ll not repeat our work here, but lutein is found in, well, the same things we just listed above, and lower levels of lutein are associated with Alzheimer’s disease. It’s not a proven causative factor—we don’t know entirely what causes Alzheimer’s, just a lot of factors that have a high enough correlation that it’d be remiss to ignore them.
Catch up on our previous article: Brain Food? The Eyes Have It
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