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By 2050, 13.8 million people in the US will likely have Alzheimer’s disease, and two-thirds will be women. The economic cost is staggering, as it is estimated to rise to more than $2 trillion. Women are at the epicenter of this because the economic threat is especially dire for women, given they are an increasingly powerful element of our global economy and the vast majority of unpaid caregivers. Thus, maintaining intact memory starting early in midlife with the transition to menopause is critical not only for women themselves, but also for their families, society, and our economic health.

Preventing memory decline starts in early midlife

The decline in cognitive ability is not limited to neurodegenerative diseases like Alzheimer’s disease (AD), but also part of healthy aging, with consequences for our quality of life. Most studies of aging and cognitive decline, particularly studies of AD, begin in people in their 70s. However, understanding factors that happen earlier in life, and how they impact age-related brain changes, is critical for developing prevention strategies for one of the major public health challenges of our time.

What happens to women’s brains through the transition into menopause?

In addition to chronological aging, women undergo reproductive aging in early midlife: menopause, during which they experience a depletion over time of ovarian hormones such as estradiol, the primary form of estrogen that works in the brain. Our research team and others have demonstrated that estradiol directly relates to changes in memory performance and reorganization of our brain circuitry that regulates memory function. Thus, women and men undergo different aging processes, especially in early midlife when reproductive aging is more critical for women than chronological aging. However, cognitive aging is rarely considered a women’s health issue. This is essential, because viewing brain aging as beginning in early midlife, and understanding the impact of menopause on the brain, will allow for development of strategies to prevent memory loss for women.

On average, women perform better than men on measures of verbal memory, beginning as early as post-puberty. However, women’s advantage for verbal memory performance is reduced with menopause. Many women report increased forgetfulness and “brain fog” during the menopausal transition. All women eventually undergo menopause, but there is a large age range for when it begins (from late 40s to early 60s), and substantial variation in women’s experience of its impact.

Over the last 15 years, an increasing number of studies are mapping out the intricate ways in which menopause affects the brain and what helps maintain intact memory. For example, menopause can affect how brain cells are generated, connect with each other, and even die, and these processes impact brain regions that are critical for memory. Menopause also lowers the level of glucose in the brain, the primary fuel used by brain cells. The brain then looks to other metabolic sources to provide the necessary fuel to function — that is, the brain adapts to a new hormonal environment in order to maintain functioning.

Further, women with other medical conditions like diabetes and hypertension are at increased risk for cognitive decline. Research into understanding this is focusing, in part, on how the brain and body share similar processes to produce energy to function (metabolism), and how blood pressure and other aspects of the vascular system function similarly in the brain and body.

Can hormone replacement treatment help?

Research shows that timing matters. Initiation of hormone replacement (HR) in perimenopause (roughly four to eight years before menopause) or early menopause may have positive effects on brain activity and memory function, although systematic HR trials have not been conducted during perimenopause. Initiation of HR in late menopause may have adverse effects on the brain, and increase risk of disorders like Alzheimer’s disease. Research is critically needed to establish the most effective timing of administration, hormonal formula, dose, route of administration (for example, orally or by skin patch), and duration.

Further, to date much of the HR research has been conducted in healthy women, and little is known about its impact in women with chronic diseases such as diabetes and hypertension. Finally, there may be differences in responses in women who are genetically at high risk for brain disorders, like AD, that show increased benefits for using HR. Research shows us that one size does not fit all, and precision medicine is needed to identify which women may benefit the most. One example is for women with bilateral removal of the ovaries, particularly at a young age, for whom HR has been found to be very beneficial for brain function. In some women HR may not be an option, and alternative mechanisms may need to be identified, such as targeting levels of glucose and other effects associated with estradiol regulation of the brain.

What can women do to maintain brain health?

There are three major pillars for maintaining intact memory: effortful physical activity, effortful cognitive activity, and social contact. Research shows that the first two of these have direct beneficial effects on the brain, even at the level of cellular function. Social contact is another form of keeping our brains active by external stimuli, novel experiences, and perspectives outside of ourselves. Dietary habits (such as the Mediterranean diet, or intake of omega-3 fatty acids like in fish oil) have also had beneficial effects on memory function. The good news is that these are modifiable lifestyle habits, which may be particularly important for women with hypertension or diabetes who are at higher risk for cognitive decline.

Finally, adequate sleep (currently suggested as seven hours a night) is critical for brain health. Research has shown that during certain periods of sleep, learning is consolidated; that is, sleep plays a key role in storing and maintaining what we learned during the day, and even helps in clearing the brain of amyloid, one of the markers of potential AD pathology. More research is required to fully understand the beneficial impacts of these modifiable lifestyle factors. However, the time to start incorporating them into your life is now.

The holidays are supposed to be a time of joy and celebration, and the meal is a centerpiece of the occasion. But when you’re a caregiver for an aging parent, the joy can be overshadowed by stress.

Whether you’re observing winter holidays — such as Hanukkah, Christmas, Kwanzaa, or New Year’s Eve — or holidays that fall during another time of year, take steps in advance to ensure that you and your loved one can enjoy the meal together with as little stress as possible. These tips can help.

Consider the dining schedule

Your mom or dad might normally eat at a different time than the planned holiday meal. If the meal times don’t match, give your parent a nutritious snack to stave off hunger, or find out if it’s possible to serve the holiday meal at a time that’s good for your parent. If other festivities are on the docket, consider that timing as well. Your parent likely has a limited amount of energy to spend visiting with others, so allow plenty of time to eat.

Serve your parent easy-to-eat food

Holiday meals often feature special-occasion foods that may be overly rich or hard for your parent to cut, chew, swallow, or keep on a fork or spoon. Talk about this beforehand, if that’s possible. Know which foods your parent should avoid, such as nuts. Serve safer choices in small amounts, and help by cutting up hard-to-eat foods before they come to the table or arrive on a plate.

Another option is serving something simple for your parent to eat that won’t need much supervision and won’t make a mess. Rice or fine pasta with vegetables, pureed beef or fish stew (no bones!), or mashed root vegetables and beans are some examples. If you’re not hosting the holiday event, ask if it’s okay to bring a meal that’s right for your parent.

Remember medicines

If your parent normally takes prescribed drugs at meals, don’t let this holiday be a time to get off schedule. Go over the medication list in advance and set a timer on your phone to remind you of dosing times.

Work in shifts with other guests

Have a conversation ahead of time with other guests who can help. When assisting a parent during a meal, you may not get much of a chance to eat your own food or chat with people at the table. Build in a break by arranging for another guest (perhaps a sibling) to take a turn helping out.

Plan the bathroom break

When you have to go, you have to go. And aging parents, like young children, sometimes need to excuse themselves mid-bite. A bathroom trip before the meal might reduce that risk, but it’s no guarantee. Work out in advance who’s going to assist your parent if nature’s call arrives during the meal.

Keep fluids handy

Make sure your parent is staying hydrated and getting enough fluids before, during, and after the meal. Also, keep an extra glass of water handy, and a straw if necessary, in case your parent is having a hard time swallowing food. Note also that moistened food is easier to swallow, so consider adding a little extra sauce to a parent’s meal.

Watch alcohol intake

While alcohol may be offered at the holiday meal, it doesn’t mean it will be safe for your parent. Alcohol consumption can lead to falls in older adults, and can interfere with medications. Ask your parent’s doctor if a little libation is allowed. such as a half-glass of wine. If not, consider offering your parent non-alcoholic beer, wine, or champagne if they’d like it. And mind your own alcohol intake: while you’re acting as a caregiver you’ll need to stay in control.

Arrange your parent’s exit well in advance

Gatherings can be tiring and stressful for older adults, and your parent might be ready to leave before the holiday meal officially concludes, especially if guests linger. Decide on a realistic exit time and let other guests know about it in advance, so everyone can plan accordingly.

If all goes well, you and your parent will both enjoy the holiday meal and wind up feeling the glow of meaningful family connection, sharing, and love — all of which are great for health.

All parents want their children to be successful in life — and by successful, we mean not just having a good job and a good income, but also being happy. And all parents wonder how they can make that happen.

According to Harvard’s Center on the Developing Child, it’s less about grades and extracurricular activities, and more about a core set of skills that help children navigate life’s challenges as they grow. These skills all fall under what we call executive function skills that we use for self-regulation. Developing strong executive function skills, and finding ways to strengthen those skills, can help people feel successful and happy in life.

What are five important core skills?

• Planning: being able to make and carry out concrete goals and plans
• Focus: the ability to concentrate on what’s important at a given time
• Self-control: controlling how we respond to not just our emotions but stressful situations
• Awareness: not just noticing the people and situations around us, but also understanding how we fit in
• Flexibility: the ability to adapt to changing situations.

While these are skills that children (and adults) can and do learn throughout their lifetimes, there are two time periods that are particularly important: early childhood (ages 3 to 5) and adolescence/early adulthood (ages 13 to 26). During these windows of opportunity, learning and using these skills can help set children up for success. In this post, we’ll talk about that first window of early childhood.

The best way to learn any skill is by practicing — and we are all more likely to want to practice something if it is fun and we feel motivated. Here are some ways that parents can help their children learn and strengthen executive function skills.

Planning

It’s natural for parents and caregivers to do the planning for young children, but there are absolutely ways to get them involved, such as:

• Planning the day’s activities with them, whether it be a school day or a play day. Talk about all the day’s tasks, including meals, dressing, bathing, and other things; help them see it as part of a whole, and something that they can help manage.
• Cook or bake something together. Put together the shopping list, go shopping, go over the recipe together, and help them understand all the steps.
• When getting ready for a holiday or a party, include them in thinking about what everyone would like to do and how to do it.

Focus

The explosion of device use has definitely caused all sorts of problems with focus in both children and adults. There is an instant gratification to screens that makes it hard to put them aside and focus on less stimulating tasks. Now, more than ever, it’s important to:

• Enforce screen-free time, even if they complain (parents need to abide by this too).
• Have the materials on hand to make or build things. Find projects that will take an hour or two. Do it with them!
• Read print books out loud together, including chapter books. Having to picture things themselves rather than seeing it on a screen helps children learn to focus.

Self-control

This is one where being mindful of your own reactions to situations is important. How do you react to anger and frustration? Is road rage a problem for you? Remember that children always pay more attention to what we do than what we say. To help your child learn self-control, you can:

• Talk about feelings, and about strategies for managing strong emotions — like taking a deep breath, stepping away from the situation, screaming into a pillow, etc.
• Help them understand how their behavior affects others, and why it’s important to be mindful of that (which also teaches awareness).
• Debrief after tantrums or upsets. What could everyone have done differently?

Awareness

This one can be fun to teach.

• Go for walks. Visit places together. Listen and watch. Imagine together what people might be doing or thinking.
• Join community service activities; show children that anyone can make a difference.
• Have rituals of checking in as a family, like at dinner. Give people a chance to talk about the best and worst parts of their day, and talk about ways you can work better as a family and treat each other well.

Flexibility

We tend to cater to our children and their needs, making our schedules and plans around them. Some of that is pure parenting survival. But ultimately, it’s not always helpful; life has a way of messing up even the most careful plans. Kids need structure, sure, but they also need to be able to adjust to the inevitable curve balls.

• Don’t always say no to something that might happen during a naptime or mealtime. It’s okay if schedules occasionally vary.
• Be spontaneous when you can. Go for an unplanned outing, and otherwise make last-minute plans sometimes.
• When plans change or fall through, be upbeat about it and make the most of it. Be a role model.

In helping your children learn these skills, you might just learn something about yourself — and learn some new skills too.

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If you frequently find yourself stepping on a building block, tripping over a doll, or stumbling over a race car, then you know the challenges of getting younger children to put away their toys. Below are a few strategies to encourage children to clean up after themselves and keep the house tidy.

Make specific and focused requests

Asking your child to put many different things away all at the same time can leave room for children unintentionally to forget at least one of your requests — or intentionally skip a few. Make one specific request at a time, such as "Please put your blocks back in the bin on the shelf." After your child has finished one task, then you can request that your child puts a different toy away.

Make requests in the form of a command, not framed as a question like "Will you please clean up your blocks?" Asking a question leaves room for the child to reply, "No." Also, unless you want this to be a group activity, frame the request for just your child: "Please put your blocks back in the bin on the shelf" instead of "Let’s clean up the blocks."

Give your child time to comply, and repeat yourself only once

Children, especially young children, take more time than adults to process information. Count to five in your head after you make an initial request, to give a child time to process what you said and to comply.

If you don’t see the required action after five seconds, repeat your request in a neutral tone followed by a potential logical consequence. For example, "If you do not put your blocks away in the bin on the shelf, then you will not get to play with the blocks for the rest of the day. You can play with them tomorrow."

Count to five in your head again. If your child still does not do what you asked, say the following in a neutral tone: "Okay, you did not put the blocks away in the bin on the shelf, so you do not get to play with them for the rest of the day. You can play with them tomorrow." You can then put the blocks away and out of reach from the child so that the toys are not in use for the remainder of the day.

Stay calm and choose logical consequences

Two key elements of this approach are to remain as calm as possible and create a logical consequence.

• Staying calm helps. Understandably, you may be very frustrated. However, it’s best to give as little attention to noncompliance as possible. Attention, even in the form of a negative tone, can make the behavior happen more often.
• Logical consequences matter. Creating consequences that are for extensive periods of time and do not make sense to the child may spark more frustration and refusals. For example, it would not be logical for the child to lose TV time for a week if the child did not put their blocks away. Instead, limiting access to the toy is a logical consequence.

Praise behaviors you want to see

Shine attention on behaviors you’d like to see more often. Any time your child does put toys away, praise them specifically. "Good job" can confuse: the child will not know exactly what was good — sitting quietly, putting toys away, or something else. Instead, say, "Great job putting the blocks in the bin on the shelf!"

Praise with enthusiasm, and use touch, such as a pat on the back, to strengthen a behavior. If you have a child who has sensory processing difficulties, especially with tactile stimuli like a pat on the back, you can reinforce the behavior with a nonverbal gesture, such as a thumbs up.

Your days of repeating commands until you’re blue in the face and cleaning up after your children do not have to continue. The steps above can give you a breather and help your children learn to pick up after themselves.