393: How Dementia and Cognitive Decline Increases the Need for a Comprehensive Longevity Plan with Chris Heye, PhD
Today, I’m speaking with Dr. Chris Heye, CEO and Founder of Whealthcare Solutions and Whealthcare Planning. Chris is an entrepreneur, writer, researcher, and speaker working in the unique intersection of physical, behavioral, mental, and financial health.
His specialty is longevity and cognitive decline risks in retirement, and today’s conversation is all about the conversations you need to have with your financial advisor, your estate planning attorney, and even with yourself in order to prevent elder financial abuse.
In this episode, Chris and I dig into the experiences with dementia that led him to pursue his career path, how cognitive decline directly impacts one’s ability to make sound financial decisions, and when to start making emergency plans to protect yourself, your family, and your legacy.
In this podcast interview, you’ll learn:
- Why elders suffering from cognitive decline lose millions of dollars every year.
- How psychiatrists and other specialists define cognitive decline and the associated conditions–and how this leads to impulsive behavior and overconfidence.
- Why we’re still so far away from a cure for Alzheimer’s and other forms of dementia.
- How to put together a team to help take over your financial decision making if and when the time comes–and how to have the important conversations with your family members who don’t want to talk about it.
- Why it’s never been more important to stay active, maintain meaningful relationships, take on new challenges, and surround yourself with people you love late in life.
- How Medicare and Medicaid do (and don’t) help with long-term care.
- "Your brain is a muscle. The more you use it, the healthier it will be. So, continue to challenge yourself even in retirement, intellectually, and that should help you stave off dementia." - Chris Heye, PhD
- WhealthCare Plan
- Chris Heye on LinkedIn
- Marshal Johnson
- EP# 335: Unbiased Investment Advice and How to Filter Out Financial Media Noise with Bob French
- Robert French
- Financial Planning Association
- Massachusetts General Hospital
- Anthony Weiner, MD
- Andrew Lo
- Massachusetts Institute of Technology
- Dr. Ned Hallowell
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Casey Weade: Welcome to the Retire with Purpose podcast. My name is Casey Weade, where is my mission to deliver clarity and purpose and elevate meaning in your life through personal and practical financial strategies. But we do that in a couple of different ways. Not only are we having financial conversations, we’re also having non-financial conversations.
Every single Friday, my good friend, Marshal Johnson, and I, we get together and we discuss in-depth one of our Weekend Reading articles with you, that Weekend Reading email that goes out every single Friday for trending topics in a variety of different areas of your financial and non-financial life. You can sign up to get that email, and as someone that’s signing up for that email, you’ll also be invited to co-architect these interviews that I’m conducting today. It’s very easy to get signed up. Just shoot us a text, texting the key letters WR to 866-482-9559. It’s more than just an email. You have to get this resource.
And then, what we’re doing today, it’s Monday, and every other Monday, we get together with one of our world-class guests to bring you a conversation on a variety of different topics as well in long form. And today, boy, we do have somebody world class. Today, we have Dr. Chris Heye joining us.
And he was actually referred to us from Episode Number 335. Bob French actually referred Dr. Chris Heye over to us, and I was thrilled to have this conversation. What an amazing background, but definitely, a different conversation than what I would say we normally have here on the podcast, and a conversation that is absolutely necessary for you to be having with your family, with your financial advisor, with your estate planning attorney, with yourself, for that matter.
This is a technology entrepreneur, a writer, researcher, speaker in the fields, residing at the intersection of physical, behavioral, mental health, and financial well-being. Dr. Heye specializes in longevity risks and cognitive decline risks in retirement. Those are the kind of conversations we’re going to be having.
And before you go, “Oh, I don’t want to talk about cognitive decline. That’s a conversation I don’t want to have,” please stick with us. This is a vital conversation for us to be having here today with the CEO and Founder of Whealthcare Solutions and Whealthcare Planning. He is a regular columnist for the Journal of Financial Planning and a member of the Financial Planning Association’s FinTech advisory group.
Casey Weade: With that, Chris, I’d like to welcome you to the podcast.
Chris Heye: Thanks, Casey. It’s great to be here.
Casey Weade: I’m excited to have you here, as I stated, because this is such an important conversation for people to be having. And you really know just how important this conversation is to be having because you lived it, you experienced it, confronting dementia in your family and witnessing elder financial abuse yourself. Let’s start there. How has your past and your experience in these areas with your family and friends shaped your thoughts and shaped your career?
Chris Heye: Yeah, I mean, Casey, a lot of people ask me like, “Why did you get into this area?” And for me, it was very personal. So, my mother had dementia, her sister had dementia, her mother had dementia. Her mother, my grandmother, whom I loved, that was sort of my first exposure to it when I was, I guess, probably in my 30s. I watched that, and then towards, my mother by the time she got into her 70s, I’d say, she was getting a little forgetful. And by the time, she got into her 80s, clearly, it was obvious that something was happening with her.
So, she eventually did get dementia. She had to be moved to a memory unit. She was in memory unit for almost four years. I was the closest family member, so I spent a lot of time with her and the other members of the memory unit. And then, also sort of around that same time– my mother’s passed away since then. But around that same time, I was hearing how the two of my friend’s parents, through some combination of being scammed and poor financial decision making, lost literally millions of dollars. We’re not talking about thousands, hundreds of thousands of dollars. They literally lost millions of dollars.
And it just seemed like not enough was being done. In this area, there’s a lot of stigma around it, around mental health and behavioral health, especially among older adults. And I just said, “Enough, I need to do something.” I’m fortunate to be close friends with the head of geriatric psychiatry at Mass General Hospital. I know some other psychiatrists living in the Boston area. You can’t walk 10 feet without bumping into a psychiatrist, it seemed. And I just had a lot of these discussions.
And anyway, I decided there wasn’t enough being done. I got involved and helped design and lead a clinical trial at Mass General Hospital that was designed to better understand these relationships between cognitive impairment, aging, and financial decision making, worked with Dr. Tony Weiner, the head of geriatric psychiatry at Mass General Hospital, also worked with Dr. Andrew Lo, who was at MIT, the head of the finance lab at MIT, put together a little protocol.
Anyway, so we did this study. And I found the results kind of interesting. I didn’t think they were counterintuitive, but they weren’t– and especially, at that time, a lot of people were talking about dementia and Alzheimer’s and memory loss and focusing on the memory loss. And I think, in some ways, memory loss is kind of a euphemism for cognitive decline.
And so, in the study, we did discover that memory loss did appear to have some detrimental impacts on financial decision making, but what really seemed to come out of the study was what psychiatrists call executive function. So, people’s ability to plan, to organize, to connect the dots, those capabilities seem to be most important for sound financial decision making.
And so, that started me thinking about, so then what we could do to get people to be more aware of that? That led to a development of a cognitive and behavioral assessment, which we can talk about. And then I started just working with some other financial advisors, financial planners, psychiatrists, geriatric psychiatrists, and just trying to put together some planning guides and road maps and assessments that help older adults and their families plan for what looks to be, for many of us, a very long life.
Casey Weade: I see that it can be easy to dismiss these things, especially at a younger age. I know, for myself, the first time I had this experience where dementia touched my life was with my grandmother. I spent the whole day at the assisted living facility with her, was there the whole day, but I was there for a few hours with my now-wife. And then the next day, she called my father and said, “Well, I haven’t seen Casey in a while.” And I was there all day yesterday and I didn’t realize that she was actually suffering from dementia, Alzheimer’s, somewhere along those lines until that day.
And it broke my heart. I spent all that time with her, showering her with love as she’s at the end of her life. And she doesn’t even remember that. And I wish in a lot of ways, I could have gotten ahead of that if I could have figured that out. And that’s why I don’t want this to be dismissed. And so, many people are touched by this. I can’t imagine anyone at some point in their life is not touched by dementia, Alzheimer’s, cognitive decline, even if it’s not yourself.
And you shared some of this data as you pointed to an investment news article a few weeks ago, where you shared that a half of people develop mild cognitive impairment or dementia by their mid-80s, 80% have some type of chronic illness by age 55. And when I look at those statistics, well, I think it’s easy to go, well, I mean, at what level? Did I forget my keys? Does that count? Because if that’s the case, then, well, I’m already experiencing dementia. But if it’s broader than that or if it’s more refined, what exactly is cognitive decline, I guess, and what makes up this blanket of cognitive impairment?
Chris Heye: Usually, when psychiatrists and other specialists talk about cognitive decline, it’s frequently in the context of the ability to perform what they call the activities of daily living. So, that’s just like getting up, can you get dressed? Can you toilet? Can you make yourself dinner? Can you drive a car? Basically, can you take care of yourself in a normal day-to-day setting?
And people with what’s called mild cognitive impairment, there’s sort of three levels. There’s kind of what they call normal aging. So, as you get older, you tend to forget stuff. That just happens. That happens to everybody. And as long as it doesn’t, again, interfere with your activities of daily living, people don’t have to worry about it.
One thing that I read is that, as you get older, you basically have more data in your brain, right? You’ve got more experiences. So, it takes longer to find stuff sometimes. So, if you’re an older adult and you forget things once in a while, it’s probably not a big deal. Now, again, mild cognitive impairment is a situation beyond that where it can start to affect your activities of daily living, or at least you may need some strategies to help you cope.
You can still get through the day usually, but you may have some difficulties. And then dementia means you can’t get through the day. I mean, I’m sure you saw it with your grandmother, these memory units. My mother had a room that was literally right off the cafeteria, and there’s no way she could have found her way back from the cafeteria to a room. And it was just like right over there. She needed help getting dressed. She needed help with everything.
So, that’s the point. That’s kind of the tipping point is when the cognitive decline, or one tipping point is when it affects these activities of daily living. I would say another tipping point is when it starts to affect your decision making. So, one thing, again, that we probably don’t talk about enough is these sort of behavioral consequences of cognitive decline.
Again, we talk about memory loss, but it can also have behavioral– for some people, as they get older, when I was talking about executive function, executive function also is kind of like a governor. It’s the thing that keeps you from saying, when you meet some at the party and you think they are dressed really poorly, it’s a thing that prevents you from saying, “Hey, that’s a really ugly dress” or “that’s a really ugly shirt.” So, it controls your impulses.
And when that starts to come off, when those governors start to weaken, that can be very dangerous. And that’s something we do see in some older adults, in younger adults as well, is this lack of impulse control. And when that starts to go, or if you’ve never had that, that can be a problem.
So, to the extent that cognitive decline can include these behavioral issues, like lack of impulse control, overconfidence is another one. There are studies that show that overconfidence is a risk factor for poor financial decision making or scamming. So, I would say those are kind of the two buckets. The one bucket is the sort of activities of daily living and the other bucket is ability to make sound decisions, including financial decisions, sort of rational, sound, non-impulsive decision making.
When either of those start to go, those are real red flags. And if you’re part of a family, we see that in your father, your grandmother, whatever, those are some red flags, and we can talk more about that. But those are things that I would strongly recommend looking out for. And those two things, unfortunately, are going to happen to most of us at some point.
Casey Weade: I find that most people that have this concern have experienced it with a parent or a grandparent, where they actually have this concern from themselves, where I’ve seen this in my grandmother and I see the concern in my father. He has that concern that, well, that’s going to happen to me because it’s genetic. And yet, my mom’s not concerned because it wasn’t really in her blood. We didn’t see that dementia happen on that side of the family.
Is it really genetically exclusive? I know it seems that the research is saying that the prevalence of dementia and Alzheimer’s is accelerating. Does that mean that people that don’t have it genetically in their past are now starting to see it? Just speak to that a bit.
Chris Heye: Yeah, I mean, there’s a few things in that. First, I want to say, there’s a lot of things that we don’t know, right? There have been something like 150 failed Alzheimer’s trials. I think that’s a big number. Just think about there’s some really, really, really smart people, smart doctors who have tried to figure out this dementia thing and have not been able to. So, this is difficult.
There does appear to be some form of inherited symptoms, but also, people think now there may be environmental impacts, just the environment, the pollution that we’re living in could be accelerating this. The other thing is people are just living longer. So, our ancestors, we didn’t need a brain when we were 65 because we were dead. The life expectancy up to about, 150 years ago, was 40 or less. So, most of us, we died of burst appendix. We died of an infection. We died of cancer. We died of a heart attack. So, we didn’t really need a brain later in life.
But now, we’re getting better and better at keeping people alive, right? We’re getting better with heart disease. We’re getting better with cancer. We’re getting better with kidney disease, so able to keep people longer. But sort of one of the last pieces that we haven’t quite figured out is to keep our brain functioning properly. So, just by sheer fact that people are living longer means that you’re just more likely to have some form of cognitive decline.
But getting back to your point, if you do have a family history of it, it’s something you should keep in mind because there probably is some sort of genetic component to at least some of this. It does seem to hit women harder. Women are more likely to have Alzheimer’s and dementia frequently, twice as likely or more. I mean, in my family, either side of the family, it’s only been the women. So, that’s something to keep in mind, but it’s not something that we’ve 100% fully understand right now.
Casey Weade: Yeah, we don’t really know what’s causing it. We don’t really know what’s going on.
Chris Heye: We don’t. And there’s even some studies now, there’s some people who have the main biomarker for Alzheimer’s, we’re finding out people who have that and they’re fine. So, why are they fine and other people are not fine? So, again, we’re still figuring this out. Unfortunately, these trials and this research take a long time. And there’s just came out a drug now that might help slow things down a little bit, but we’re probably, unfortunately, still years away, if not decades away, from having any sort of thing close to a cure.
I mean, Alzheimer’s is the only major cause of death for which there’s no drugs. I mean, there’s drugs for everything else and treatments for everything else to at least slow down a condition. And up until recently, there was nothing. And even this latest drug, a lot of doctors have questions about. So, we’re still in that first or second inning when it comes to curing any kind of cognitive disease.
Casey Weade: Yeah, I would venture to guess, most people aren’t even thinking about doing some of the planning that you recommend until they get to be 55, 65. More likely, and maybe you can speak to that, maybe it’s more like 75 or 85 when they actually start to take these seriously and put together these seven components to a comprehensive longevity plan that we’ll get to later. The reality is that it can happen much sooner, right? So, at what point do we start having these conversations? At what point are we really at risk of dementia or Alzheimer’s, 25 years old, 75 years old? What’s the point of concern?
Chris Heye: Yeah, there’s a few things. Well, the one thing I like to point to, there was a major study conducted at Harvard. This is about 10 years ago, that sought to determine what they call the peak age of financial decision making. And they determined that age to be 53. So, not 63, not 73, but 53. So, that’s earlier than a lot of people think.
Casey Weade: That’s when most people start doing their planning.
Chris Heye: It can all be fine until you get to your 70s and 80s, but 53, there’s another study that suggested, it was like maybe even closer to 50. So, it’s certainly not too early to start planning when you’re in your 50s. Early onset dementia can happen. I’ve heard and seen cases certainly by early 60s, unfortunately. Even late 50s, occasionally, someone can have difficulty with financial decision making and going through those activities of daily living. So, I would say, certainly by the time you’re in your 50s, it’s not too early. We can talk more about this.
I just wrote a paper in the Journal of Financial Planning about the importance of planning for longevity when you’re even younger. When you think about someone like your age or maybe my kids’ age, I mean, you might live to 90, you might live to 100. You could live 20, 30, or more years past the traditional retirement age of 65.
And most younger people, they say, “Oh, I want to retire at 65.” A lot of them say they want to retire at 55. That’s great. But you got 30 years of potentially not making a lot of money. So, that’s why I think it’s incumbent on younger people, in some ways even more incumbent on them to start planning early because they could be living for a really, really, really long time, which is great, but it’s probably still not going to be cheap. We could talk more about the costs of some of this stuff. And the one hand, it’s never too early to get started. But I would say, certainly by the time you’re in your 50s, you should start thinking about putting together some sort of longevity plan.
Casey Weade: What’s that mean? Yeah, I think for most, peak age for financial decision making, age 53, and most listeners are going to be beyond that age of 53. And what does that mean exactly? I shouldn’t be making financial decisions anymore? I need support in making financial decisions at this point? But I can’t do that.
Chris Heye: It’s a great question. It’s a great question. What I like to talk about, and this is what the psychiatrists I work with, I work with some just topnotch, I know and work with topnotch psychiatrists, like Dr. Tony Weiner, Dr. Ned Hallowell. They consistently over and over talk about the importance of putting together a team. Dr. Ned Hallowell likes to say, one of his favorite sayings is never worry alone. So, for example, if you’re a daughter and you’re taking care of your mother or your father, if it’s just you, that’s a lot, it can be a lot of work. So, you need to get help.
So, what I say is, at some point, all of us are going to reach a stage where we should not be making important financial decisions on our own. So, I think that’s really important for your listeners to hear and try to have a little bit, I like to talk about this idea of sort of self-awareness and this idea of not being overconfident. So, just look at yourself in the mirror and say, “Hey, I may feel great and I might think I’m doing great, but I may not be doing as great as I think I am and I may need a little bit more help than I think I might need.”
And then the flipside is, as you get older, do you really want to have to deal with all this sort of financial minutia? Wouldn’t you rather have that stuff kind of on autopilot and not worry about paying bills and making investments and making big financial decisions? So, start building a team, build that team with your kids, with your spouse, with friends. Financial professionals have a team that can provide a check on you, especially in big financial decisions, make sure that you’re just not going at this alone, make sure...
Casey Weade: How do we know when it’s time to build the team? Is it when we’re 53, 50, 45? Are there some things that we should say, “All right, At this point in my life, it’s time for me to build a team”?
Chris Heye: Yeah, it’s a great question. I would say by time, again, when you’re in your 50s, start thinking about it because in your 50s and if you have kids, they’re in their 20s now, probably 20s or 30s, so they’re becoming adults. Many of them may have the capacity, whatever that is. I have a son who is very involved with finance. A lot of people have sons and daughters who are nurses, who are involved in the health care profession. I mean, those people can help very early on.
So, I would say, start putting that team together. And hopefully, by the time you’re in your 50s, you’ve got a good primary care physician. You maybe have a good specialist. You may want to start talking to a neurologist, a psychiatrist. So, it’s really important to have a team that can provide that checking, that can monitor your behavior. And again, if you have some concerns about giving up financial decision making, just think about, “Hey, there’s a bunch of stuff maybe I don’t need to worry about anymore. I’ve been worried about my whole life, and now, maybe I don’t have to worry about it.” And that’s a good thing.
Casey Weade: I’ve got to imagine the biggest challenge here is as we experience cognitive decline, you’ve said we experience overconfidence simultaneously. So, if we’re experiencing cognitive decline, we’re experiencing overconfidence, and we’re supposed to build a team, but we don’t want to build the team because we’re confident in our ability, especially overconfident in our abilities, it just seems like a real challenge.
Chris Heye: It is a challenge. And so, this whole giving up control over financial decision making can be a very challenging subject. And we probably should talk about that for a few minutes because again, there’s this issue of overconfidence. There was a great study that basically asked a group of older adults. First, they gave them a little assessment, a financial literacy assessment, and then they asked them to sort of self-assess.
And this research also found a similar pattern where people’s capacity tends to go up over time and then it starts to go down in 53, whatever. It did vary through. At 50, 60, at some point, people’s financial decision making capacity goes down, but their perception of that capacity stays up. So, there’s this widening gap over time between the actual capacity and the perceived capacity, and that can get you in trouble.
So, there are some people, probably more frequently men, especially older men, who basically say, “I’ve been doing this my whole life. I don’t need any help.” And as Dr. Ned Hallowell say, “The people who say they don’t need help are probably the ones who need the most help because they’re probably the ones who are most overconfident.”
So, how do you initiate those conversations? So, if you’re the son or a daughter or a friend or a spouse of someone that you’re concerned is possibly going to be making bad financial decisions because they’re overconfident, there are certain ways to talk about this. And one thing to say is that if you’re giving up, what appears like giving up control now, if you give up some control now, you’ll actually have more control later because if you start getting yourself into trouble, you’re going to totally lose control. Who knows? Lawyers might start getting involved. The courts might start getting involved.
So, you’ll actually have more control now in many ways than you will later. If you start putting together your will, putting together a power of attorney, putting together this team now, it’s likely going to be much more beneficial than if you’re sitting in a hospital bed or you just lost $250,000 somehow. So, emphasize the importance of doing things early. Tell this person you’re actually going to have more control if you do it now.
You also want to start talking about the pros and cons is that advice I’ve gotten. Especially what are the downside? What if we don’t do anything? What’s likely to happen if we just continue the course? We continue the course. Again, you’re going to get sick, you’re going to have to go to the hospital. Your cognitive decline might accelerate. So, if we don’t start talking about this stuff now, it’s just going to get harder in the future.
I was going to say there’s also something about planning early. There’s kind of a behavioral psychology around planning, right? So, if you put together a plan with your parents or with your spouse, you put together a plan, and then a year goes by, nothing happens, and you revisit the plan. So, yeah, we’ve got a plan. And a couple of years go by, you keep revisiting, we’ve got a plan. So, then when something bad happened, you say, “Oh, yeah, we have a plan. We’ve been talking about this. We’re going to implement the plan.” So, it’s not only good to be prepared sort of legally, financially, but also having a plan helps prepare you kind of emotionally.
Casey Weade: And I would say that most probably aren’t going to go down that road of creating this plan until they have some of these signs, or maybe they’ve done an assessment where they’re doing these screenings. You talked about having a neurologist. You talked about yourself having an assessment, but you also wrote in a 2022 Retirement Income Institute literature review paper, where you stated that individuals who can pass a cognitive screening test commonly used by medical practitioners could still be highly susceptible to poor financial decision making or to being exploited. What’s going on there?
Chris Heye: Yeah, so that gets back to these behavioral issues that I was talking about. So, one of my personal experiences was with a friend, a woman friend whose father was a very successful entrepreneur, made a fair amount of money. But she told me that recently, about $300,000 was leaving his account every month. And she wasn’t quite sure why. This is a very, very smart woman.
Father was divorced, seeing some younger people, meeting some new business partners, and I think he was in his 70s. So, he’s the kind of person who I think– the basic cognitive tests, I’ve taken them, and for the average person, they’re pretty easy to pass. I mean, it’s pretty basic stuff, but it doesn’t measure impulsivity, it doesn’t measure loneliness, it doesn’t measure anxiety, it doesn’t measure depression. And all those...
Casey Weade: You mentioned a word there, impulsivity. So, I don’t know that we’ve hit on that yet. You’ve talked a lot about overconfidence or forgetfulness, but you’ve also– just hit on that. What do you mean by impulsivity? You talk about them making decisions based on emotional factors.
Chris Heye: Yeah. Psychiatrists call that inhibitory control. So, again, it gets back to this ability for your brain to stop you from doing things without fully researching them. Gut-decision making can sometimes be a form of that. I find myself doing this. I’ll go online, I go on Amazon and go, “Oh, that’s really cool, I should buy that.” And then I step back, I say, “Wait, do I really need that?” But really, it’s almost like you got to count to 10.
But that seems to be an important factor in financial decision making, is this ability to not make these rash decisions. And I think and I’ve talked to other psychiatrists and what I’ve seen in the research and my own experience is that this desire or this ability or disability to control these impulses is it can be really important for good financial and other types of decision making.
Casey Weade: And what you’re saying is that’s something that’s very challenging to measure, and then maybe you haven’t found a way to assess that.
Chris Heye: Well, we try to do that in our assessment, which you can talk, whether it’s based on the clinical study. So, we try to, in our assessment, the way I look at this is sort of three areas that can affect your financial decision making really at any age. One is these cognitive issues. So, if you’re experiencing cognitive decline, again, if you have trouble planning, you having trouble organizing, trouble connecting the dots, you’re going to have difficulty making financial decisions. So, that’s the one. And those people should not be making major– if you have trouble with that, if you don’t do well in these cognitive tests, then you certainly shouldn’t be making important financial decisions on your own. So, that’s the cognitive piece.
The other piece is what I call the behavioral piece. So, this is the one that’s related to things like this ability to control impulses, overconfidence, anxiety, loneliness. I mean, the former surgeon general of the US described loneliness as the number one disease in America. And there does appear to be some correlation between loneliness and poor financial decision making. So, that’s the second bucket.
First bucket is what I call the cognitive bucket, the second bucket is the behavioral bucket, and then the third bucket is just financial literacy. So, younger people can get themselves in trouble just because they don’t have good financial literacy, and then some older adults as well. I think we all know some really smart people who just don’t have good financial literacy. They may be really great lawyers or doctors or whatever, but they never acquire that financial literacy. So, those are the three buckets and those are the three influences that we’re trying to capture in our assessment.
So, on the behavioral assessment, we ask you how you go about making financial decisions. Do you do a lot of research or do you just make decisions based on gut feeling? Do you talk to people on the phone you don’t know? Do you buy stuff online or on a TV? Do you gamble? So, we’re trying to tease out potential behaviors that could get you in trouble when it comes to making good financial decision making. But again, those are harder, but we take a stab at it.
Casey Weade: So, with cognitive behavioral literacy, and the second one being behavioral, you mentioned loneliness. And loneliness, is this cause or effect? When it comes to Alzheimer’s, you’re finding Alzheimer’s, dementia, cognitive decline individuals that are experiencing that, they’re experiencing loneliness. That feels more like I could see a world where loneliness leads to the cognitive decline and not the other way around. How is this being viewed?
Chris Heye: It can be both. Certainly, loneliness, if you’re lonely and you’re not communicating, loneliness is related, obviously, to social interaction. And there are now a lot of studies that suggest that being socially isolated is a really bad thing for your health, for your mental health, for your physical health. I mean, COVID was unfortunately a nice natural experiment for people to go in and try to understand more about loneliness because people were more isolated. And not surprisingly, loneliness went up during COVID. Financial scams went up during COVID.
And loneliness, I’ve heard stories from psychiatrists of they have patients, I’ve heard one horrible story. A woman was in her 50s and she got in a romance scam. Smart woman, capable woman. She was lonely, found some guy online. The guy said he was former military, and she ended up getting him, I think, at least tens of thousands of dollars, hundred thousands of dollars giving away to this guy because she was lonely. I think, the example I gave where the father was losing $300,000 a month, I think he was lonely, too.
So, loneliness, I think, it’s a risk factor for poor financial decision making. But you’re right, there’s almost kind of a bad feedback loop because once you start to acquire dementia, a lot of people kind of pull in. And I’ve seen this with family members and friends, you lose confidence, you get a little embarrassed, and you start withdrawing into yourself. And that can often lead to loneliness as well.
So, you’re right. You can get into this bad sort of negative spiral where you’re a little bit lonely and that accelerates the dementia and the dementia accelerates the loneliness. It’s something that people should really pay attention to. And unfortunately, more and more psychiatrists are getting involved in this area and just, again, realizing the importance of social interaction, especially as we get older.
Casey Weade: I feel like that comes up time and time again in our conversations here in the pod around just having relationships and the importance of cultivating deep, meaningful relationships in that second phase, not just creating a team, but ensuring that inside of that team are people you truly love and have these deep, meaningful relationships with. Let’s get to brass tacks. You’re talking about seven components to a comprehensive longevity plan. Number one, financial plan, of course, I mean, get to number two. Number two, wealth transfer plan, and in order to get into this question, I thought it might be a good way to do it by providing one of our questions from our Weekend Reading subscribers.
So, one of our Weekend Reading subscribers submitted a question last week asking, this came from Mark. Mark, thank you for your question, saying, “I am hoping the topic of power of attorney for financial affairs will be discussed. I understand that some companies won’t accept a general document when needed. So, maybe we speak to that, when it comes to POA, may we elaborate on that in the way of other legal documents that we should have in place.”
Chris Heye: Yeah, it’s a great question, and I’m glad he brought it up. I think the power of attorney is probably the most important legal document. And I’ve had some discussions with the state attorneys and they agree that, and I’ve seen it again. I’ve seen it with my mother. We got on that pretty early. But it’s part of that planning process. It may be one of the most critical parts of that planning process is to make sure you have a power of attorney because, again, bad stuff is going to happen and you want to make sure that, if and when you become incapacitated, it may even be temporarily, that you have someone who can step in and make good financial decisions for you. So, that’s a very important document.
Now, I agree that sometimes it can be difficult to get institutions to accept that. That’s usually the biggest challenge is getting the bank or your financial services company to accept it. And sometimes, these documents can get a little long. But I would suggest, try to keep it short because if you have a 40-page power of attorney document, I think that’s going to turn off a lot of financial institutions like, “Well, I don’t know if I want to get involved in that.” Try to keep it short, try to keep it simple. There’s templates you can find online. Every estate attorney will have some form of a draft document you can use. So, it’s a great question.
And again, if someone asked me if you were going to have one document, I’d say there’s really two, we’ll get to that in one minute. One document that’s going to protect you from bad financial decision making or scams is the power of attorney.
Casey Weade: And when we look at all these documents, when we look at this wealth transfer plan, that’s really our estate planning documents, right?
Chris Heye: It’s the basic estate planning. I mean, probably, you want to have a will. Most people need a will. Not everybody, but most people need a will. Some people might want to have a trust, but at a minimum, I think most of your audience, you’re going to want to have a power of attorney and a will, if only a simple will. Because again, you see what happens when somebody doesn’t have a will when they die, you read these horror stories. So, I want you to think of this way, don’t do it for yourself, do it for your kids, do it for your spouse, put that together because you could get hit by a bus tomorrow.
Casey Weade: Could kind of see this as the financial plans for you, wealth transfer plans for everyone else, and then you have your health care plan. What exactly is the health care plan? Some might think of that as, say, an advance directive, but maybe that falls into the wealth transfer plan. Are these discussions, these documents? What’s the health care plan exactly?
Chris Heye: Yeah. So, there’s a bunch of different components. One is the documents for sure. So, I include the health care proxy, that’s the second really, really important document. It’s a power of attorney for health care decisions. So, you want to make sure you’ve appointed someone you trust to help you make health care decisions in the event that you become incapacitated. So, that’s really, really important.
The other important document are what they call advance directives. And they can take different forms, like what’s called a living will, or you’ve seen the do not resuscitate orders. But basically, you also want to have something that says, “Okay, if something bad happens to me and if I look like I’m going to be permanently incapacitated, what do I want my kids, or the people I appointed to make financial decisions, what do I want them to do? If I become permanently, if I look like I’ve only got six months to live, what should they do? Should the doctors continue to try to treat me or should they just sort of let me go, put me in a hospice care?” So, those kinds of questions, that’s the most extreme version.
But again, those are emotional decisions and they can be really costly decisions. I mean, most people can spend a huge amount of money towards the end of life. That’s usually when the health care bills get the highest as we get older. I have somebody that says, “Hey, if the bad stuff really starts to happen, don’t bother. Don’t bother treating me. Don’t give me that extra two months of chemotherapy. Just let me go.” And I’m not saying everybody should feel that way, but at least it’s really important to let other people know how you want to be treated under those circumstances. So, that’s the important part of the health care plan.
And also, health care plan is just, do you have a primary care physician? Do you go see that physician? Do you get your annual physicals? Do you have other specialists? Do you have a health care team? It can also mean just, especially as you go look, do you have a list of medications around? I can’t tell you how many times I was asked for my mother’s list of medications. Most older adults take three or four or five meds at a time. So, that’s all part of the plan. So, again, the documents, and then have the medical team that can help you make financial decisions and also make sure that your wishes are being met as you get older.
Casey Weade: So, we have a financial plan, we have a wealth transfer plan, a lot of legal documents, their health care plan, legal documents, but also our medical team. And then we get to our insurance plan. And then, getting into this, I think there’s a lot of confusion around insurance, long-term care, Alzheimer’s, dementia.
We had a question from one of our Weekend Reading subscribers. Carolyn said, “How does Medicare help with the costs of early Alzheimer’s? When does that help end?” I assume Medicaid doesn’t help with the long-term part, correct? So, let’s just talk to the insurance plan, and maybe that’s a good jumping off point.
Chris Heye: Unfortunately, yeah, long-term care is really expensive, especially if you have dementia. With my mother, we were paying about $10,000 a month in a memory unit, which is about twice as much as you’d pay in a normal assisted living unit. Fortunately, we had some long-term care insurance that covered about 30% of that. But yeah, it’s expensive. I mean, obviously, you want to have just basic health insurance. You may probably want to have life insurance. Again, it depends on your situation.
Long-term care insurance is tricky, it’s expensive, but you may want to look into that as well. There are some new products that are starting to come out, these sort of hybrids of life insurance and long-term care insurance. So, in my opinion, something’s got to be done. There’s just too much of a demand for this. It’s gotten so expensive. So, talk to an insurance agent, talk to your financial advisor.
You may also want to look at the– I know people don’t always like to talk about annuities, but there are some newer annuities that can help protect and provide some sort of guaranteed income over time. So, that’s something else you should look into because it’s expensive. And Medicare will cover some of these, but chances are, it’s not going to cover your memory unit costs. It’s not going to cover as much as you want to. This is a big problem. And I’m hoping that some of the larger financial services companies, and I know they’re working on it, but this is something to keep an eye out for because it’s reaching a point where it’s almost a crisis in our country.
Casey Weade: So, we mentioned the financial plan. We talked about the wealth transfer plan, the health care plan, the insurance plan. There’s a financial decision making plan. Talked about building a team there. We’ve got the living transition plan. I just want to jump to one because there’s one that really stood out to me, and I think it’s one that I know, I wish I would have had in place for my grandparents. I know my mom would have loved and her siblings would have loved to have this in place. And then it’s this driving transition plan and creating a driving agreement. I mean, okay, it sounds like a great idea. I’m not sure grandpa would have been open to this conversation. I’m not sure at what point he would have been open to this conversation, but boy, it was scary.
Chris Heye: It’s another tricky one. Yeah, my mother got in an accident and that helped. She ran a stop sign and T-boned someone. Fortunately, the person was okay. It’s another tough one, and it’s another one that you should start having conversations about. I mean, in our application, we have some agreement to say, “Hey, I will stop driving if I get into two or more accidents.” There’s some conditions, or “I’ll only drive during the daytime” or “I won’t drive when it’s raining,” but it’s something that’s important.
I mean, the nice thing is that there’s now these ride services, Uber and Lyft. So, that’s something that wasn’t around 10 or 20 years ago. So, it’s good, when you’re having these discussions, especially if you live in sort of a more metropolitan or suburban area where Lyft and Uber is available. Just put the app on your mom’s phone or your dad’s phone, teach him how to use that, because studies show that it’s unclear if older drivers are actually worse drivers, but they do tend to suffer more serious injuries when they get in an accident.
So, mom may not be as bad a driver as you think she is. I mean, she may be, but a mom gets in an accident, she’s probably going to be in worse shape than have you gotten an accident. And again, just say, “Look, you don’t have to drive anymore. Wouldn’t that be great? You don’t have to drive. On this phone, just punch it in or just give me a call. If you live locally, just give me a call and I’ll take you over.” And you can reach some sort of agreement, maybe you say, “Hey, Mom, you’re going to give me 50 bucks a month and I’ll drive you around.” But again, talk about it, have some sort of agreement, and keep mom and dad safe.
Casey Weade: Yeah, well, let’s talk more about that. And I would say, right now, I’d be happy to sign an agreement like that. I’d be happy to sign an agreement, draft agreement, “Hey, if these things happen, then great. Take my keys.”
I think if we fast forward, though, and I’m actually starting to experience some of these things, you’re not getting me to put that agreement together, right? Because I’m overconfident, I’m acting emotionally. I’m not going to do it. I’m not letting you take away what is seen as my freedom. If we haven’t done this and if we haven’t already put this together, maybe we are the son or the daughter or the grandkid, what do we do? How do we have that conversation in a way that isn’t offensive? And I think it’d be so challenging.
Chris Heye: Yeah. I mean, again, if it points to doing things earlier and being poor, you always want to try to be proactive rather than reactive. That’s not always the case. But again, having these conversations, there’s a couple of tricks that I’ve learned. One is this gets back to that comment I made previously talking about the pros and cons. Okay, Mom, we don’t talk about this. Great, we won’t talk about it, and someday, you’re going to get in a bad accident.
And the cars, it’s kind of easy. It’s kind of easy to figure out what the cons are to not talking about it. The cons are you going to get in an accident and you may hurt somebody else, say you may hurt that, you may actually run over that nine-year-old girl. So, again, talk about the pros and cons.
And then another trick, and I’ve used this in all kinds of situations, personal situations. It’s basically, you start the conversation, you acknowledge the difficulty of the conversation. So, you say, “Hey, Mom” or Dad, “I know this is a hard subject to talk about it. I know how important driving is to you.” And then there comes the but, right? So, basically, you say, “Look, Mom, I know this is a hard topic. I know this is difficult. I know this is personal. I know this is scary.” Start that way. Acknowledge and say, because there’s something about acknowledging the difficult nature of a subject that can help lower the other person’s defenses, right? Because a lot of times, people are going to be defensive, “Oh, you’re telling me I’m old and I can’t do stuff.”
The wrong way to go about is say, “Mom, what are you doing? You’re crazy. You can’t be driving anymore.” How far is that going to get you? It’s not going to get you anywhere because that’s immediately going to put mom or dad on the offensive. So, the technique that I’ve learned and heard about from experts is show empathy. Empathy is incredibly important. Try to build that alliance, “Okay, Mom, you and I, we’re on the same team. We all have the same goal here. We’re trying to keep you healthy and safe. I’m not trying to take away your independence. I’m trying to keep you healthy and safe.”
So, those are some of the really important tips. But again, start the conversations by saying, “Hey, Dad, yeah, I know you love your car. That’s an awesome Mustang. But here’s some things to think about.” So, these approaches I would take really to having any sort of difficult conversation around driving, around financial decision making, around health care decision making. Show empathy, build an alliance, and acknowledge the difficult nature of the conversation.
Casey Weade: And I think that’s the most important thing that you mentioned there, just empathy, truly empathizing. But I don’t know, that’s typically the first place that we go because we’re scared, we’re fearful, and that fear can come out in anger at times. So, that’s lead with empathy, for sure. And you’ve experienced a lot of this yourself. And you’re very much in this industry and there’s a lot of talk around medication uses and their impact on our cognitive function and cognitive decline and some of the things that we should be doing. NAD, there’s some of the research that’s happening around NAD+ and AAIC and some of these different vitamins that are out there that we should be taking.
I’m curious, since you’re so in this, what are you doing? We know you’re doing a lot of the tactical planning, the written agreements, the legal documents, building the team. What kind of actions are you taking from a health perspective to try to ensure that you avoid some of these things that you’ve seen your mother and grandmother experience?
Chris Heye: Yeah, that’s a great question and a really practical question. I mean, there is more and more research that’s looking at the sort of lifestyle implications for cognitive and behavioral health. So, there’s more studies now that we can lean on. And almost all of the studies point to some very important factors versus exercise, right? Exercise is probably the number one. If you’re going to, let’s say throughout the genetic stuff, throughout just what anyone can do to probably, likely help at least delay the onset of cognitive decline is exercise more.
And the good thing is the studies have shown you don’t have to train for marathons. I mean, 20 minutes, a half-hour a day of exercise, just brisk walk, actually, brisk walk in the woods. If you live near the woods, walk in the woods. It’s crazy. There have been studies saying that people who walk in the city and walk in the woods and they do a cognitive test afterwards, and the people who walk in the woods do better. So, exercise, the number one thing.
Again, if you don’t, let’s say you haven’t exercised in 10 years, that’s okay. Walk down to the end of the street and back tomorrow. Just do that. Do that, try to do a little bit every day, and then build up. So, as you get older, you build up. So, I try to exercise as much as I can. I try to at least go walking every day, I swim, I take exercise classes, I run a little bit, but exercise, really important.
The other studies have also said the importance of diet. I mean, these are nice, obvious things that people can do, especially the Mediterranean diet. Most of your listeners are probably familiar, what’s called the Mediterranean diet. It’s the most studied diet. It’s basically fruits, vegetables, nuts, seeds, a little bit of fish, very little bit of meat, whole grains, not a lot of carbs, not a lot of sugar. It’s hard for me. I have a sweet tooth, but I try to do that as close as possible. And when anybody brings up like, “Oh, this is new diet. And this was 62% of this and 17% of that,” I just kind of roll my eyes. Mediterranean diet, Google it. Try to do that.
The other thing, unfortunately, because I like to have a beer now and then, alcohol, even a little alcohol may not be good for you. The latest study suggests, we’ve been hearing for a long time that a little bit of alcohol is good for you. Now, they’re not so sure. So, when in doubt, limit your alcohol consumption.
Now, there are some people who believe that there’s a social aspect to drinking, and that can be positive. Again, if it takes you out of that social isolation, then it can be a good thing. You go out, if you’re having dinner with friends and you have a glass of wine, that’s probably fine. But just alcohol seems to be more of a risk factor than we previously thought.
Lower your stress level. There seems to be a direct correlation between stress and cognitive decline. Your body just can’t– moments of stress are good for your body, that’s been shown. But continual stress is not good for you. So, if you’re stressed out all the time, that’s not good for your brain. It’s just not.
And then the last one is sleep. People used to say, “Oh, I’ll sleep when I’m dead.” And I like to say, “If you don’t sleep, you will be dead.” We need sleep. We still don’t know why we need sleep, but we need sleep. Poor sleeping habits, lack of sleep has also been shown to be a risk factor for dementia. So, if you sleep in, don’t feel guilty about it. If you take nap now and then, don’t feel guilty about it, it’s probably really good for your brain.
Casey Weade: It’s pretty common sense.
Chris Heye: Yeah, that’s why it’s great. Most of this stuff, it’s common sense. It’s not difficult to understand and it’s not that difficult to do.
Casey Weade: But that’s not fun. And you’re telling me I got to work out, I got to eat right, I got to avoid alcohol, I got to avoid stress, I got to meditate, and then I got to sleep well and get to bed on time, not stay up late. Can I just take a pill? Or is there a pill that I can afford it?
Chris Heye: There aren’t a lot of pills out there, I mean, there just aren’t. And also, I always find the more I exercise, I just feel better. You get those endorphins. You get that natural runner’s high. So, I think if you can, I find that I can get in these positive feedback loops where you’re eating better, so you’re feeling better, so you exercise more, and then you eat better. So, you want to try to stay in that loop.
And I have a friend who has recently turned 65. And he basically said, “This is my job. Part of my job is to focus on my health.” And every day, do your job. And so, I think that’s a really great way to think about it. Especially as you get older, that’s a priority. Make it a priority. I mean, when you think about it, what’s a bigger priority than your health?
Casey Weade: Yeah. There’s a personal question that I have, but I think it applies to probably 65% of our audience and a random number that I’m going to throw out because I believe, most of us listening, especially as we age, myself, I have high cholesterol and my doctors prescribed statins and I go, well, I don’t want to take the statin because I’ve heard that the statins will increase your risk of cognitive decline. Is that true? Do you have any knowledge around that?
Chris Heye: I’ve seen some of that. I mean, statins, I’m a little skeptical. My cholesterol’s a little bit high, but I haven’t taken a statin. For people with high cholesterol, I mean, I’m not a doctor. So, first of all, talk to your doctor, talk to your primary care, talk to your cardiologist. I did see my cardiologist. And he looked at my levels, he said, “You’re fine.” My primary care wanted me to maybe do a statin and I didn’t want them. My cardiologist says, “Don’t worry about it.” He said, “Get out and exercise more.”
So, there’s a lot of things you can do to lower your cholesterol. Again, if you exercise more, if you drink less, if you eat a better diet, you’re going to lower your cholesterol, likely lower your cholesterol. So, I would say, the first thing, again, I’m not a doctor. Talk to your doctor. But the first question I would ask myself if I’m in that position is, could I exercise more? Could I eat better? Can I sleep better? And if the answer to all those things are yes, try those first.
Casey Weade: Yeah. And as we bring things to a close here, I think this is a great question to ask. And most are approaching this subject in a state of crisis. Something has happened. They’ve experienced an incident or a health event. What would your advice be to someone right now that is experiencing this crisis, this health event with themselves or a loved one? What should they do right now?
Chris Heye: Yeah, it’s a great question because, again, a lot of times, we tend to be more reactive. I love Dr. Hallowell’s advice, never worry alone. Never worry alone and don’t try to do everything on your own. So, if you’re caring for, if a loved one is having a health event, try to get other people involved in the team. It is also just there’s too many statistics about people who had to quit their jobs and/or have had some just a major emotional distress trying to take care of someone else. And we haven’t talked too much about caregiving, but that’s also in our future.
But get that help. While you’re getting that help, I’m thinking now for a person who’s helping, go back and think about, well, does mom or dad, do they have that power of attorney? Do they have those estate documents or does have those health care proxy? So, one of the parallel tracks is to make sure you’ve got all those legal and health care documents in order.
But build a team, be careful yourself, watch out for your own personal health. Too many caregivers are in poor health because they don’t have time to do the exercise and eat well because they’re taking care of someone else. So, don’t lose track of your own situation in terms of your own health.
Yeah, I mean, and if you’re going through it yourself, that’s difficult, but also make sure you’ve got all those documents in order. Make sure you’re not lonely. Make sure you’re getting that best health care possible. I think, in our health care system, it’s difficult to navigate, but do your best to make sure that you’re working with the best possible doctors who are trying to keep you healthy. Again, make sure that they’re part of that team.
Casey Weade: And we’re going to include this great chart that we have Dr. Heye put together that you can see if you’re on YouTube right now. We’re going to have that in the show notes. If you’re going through a health event, that really gives you a checklist of what to do next. And final question, you’re on the Retire with Purpose podcast, what does retire with purpose mean to you?
Chris Heye: For me, I need to have that purpose. I like to do things. So, for me, it’s going to be some combination of being, for as long as I possibly can, I want to be both physically and mentally active. So, for me, retirement means more chances to exercise, but it also means continuing to stimulate my mind and be intellectually creative.
It’s hard for me to see a time when I’m going to completely stop working. I like to do stuff. So, I think, unless and until I get really too sick, I’m going to continue to, I don’t know, continue to write, I hope, continue to build software products because I like it and it does stimulate those brain cells. And also, one thing we didn’t talk about, but your brain kind of is a muscle. The more you use it, the healthier it will be. So, continue to challenge yourself even in retirement, intellectually, and that should help you stave off dementia.
Casey Weade: I’m talking to someone with a high sense of purpose. And I think, just as by a default of having that high sense of purpose is that you stay physically active, you stay mentally engaged, and you ultimately limit, mitigate, reduce your risk of experiencing cognitive decline or impairment in some way. Chris, thank you so much for this conversation. It’s been fantastic. I can’t wait to see more and more your research and work positively impact so many other lives.
Chris Heye: Thank you. Thanks for having me. I really had a good time. Thank you.