Sarah Lock on AARP and the Business of Brain Health
Sarah Lock
Senior VP Policy & Brain Health, AARP; Executive Director, Global Council on Brain Health
What makes you feel like a grown-up?
That my siblings are getting older. My next oldest sister is just eligible for a Medicare card and she's freaking out. And my oldest sister is 80. So when I hear them talk about their ages, I realize that I am becoming a grown-up.
What book has changed the way you think about your brain health?
A whole host of books—and I'm constantly getting more—have helped me understand how the brain works. At the moment, I’m reading How to Break Up with Your Phone; because right now I'm less interested in the science of the brain and neurons than I am in the practical things I can do to help my brain function better. Another is also by Catherine Price, The Power of Fun. Lastly, I really like Remember by Lisa Genova, specifically about the science of paying attention. I read it cover to cover—it's very helpful to connect how memory works.
In the Business of Brain Health
THE VERSE: Most of us have heard of AARP, but may not appreciate all you do—can you fill us in?
SARAH LOCK: AARP’s mission is to empower people to choose how they live as they age. That does cross a lot of territories, from health to economics to well-being. There's a great banner I put up behind myself when I'm giving talks that says AARP helps your health, happiness and money last as long as you do. The importance of empowering people, instead of telling them what to do or how to do it, is transforming membership in AARP. We're trying to provide tangible value to many different groups of people, at a time when no one tends to join groups anymore. I think we have very powerful reasons to come together as we age. The other thing is that we are a nonpartisan nonprofit. We're addressing all the social issues pertinent to people as they age, which cross every kind of line.
How did your career evolve to working on brain health?
I was the "oops" child, so I grew up with AARP because my parents were older adults. Actually, as a child of AARP members, I got my first car insurance through an AARP endorsed product. When I came to work at AARP in my early thirties, I was already aware that they were a good organization focused on aging advocacy.
I arrived as AARP Foundation Litigation was first created, to do healthcare impact litigation—to find impact cases that could make a difference for older adults’ health. I was well into my career here when my dad developed dementia; I realized that AARP really was not focused on that topic. We were all over Social Security and Medicare, but we really hadn't zeroed in on the relationship of aging and brain health. We were working on healthcare reform and other issues, but I realized I had spent a lifetime in healthcare advocacy, and had no real idea how to help my parents navigate this quintessential issue of aging and health.
So I began looking at brain health and began researching the issues and policy solutions, and AARP supported me in those efforts because they realized how important this is both for individuals and for society to get this right. We're now working on prevention, care and cure in this space. And we're focusing a lot earlier in the lifespan on prevention because the science was developing around brain health, but the advocacy wasn't. So that's how we came to focus on brain health as a thing.
What is the mission for the Council on Brain Health?
Our mission is to drive consensus around the state of the evidence, so we are providing credible, trusted information to people as they age.
When we began this work, we were actually investing a bit to help support an effort of the Institute of Medicine, which was doing a report on cognitive aging—not from a dementia perspective, but rather from a staying-sharp perspective. Like what could you do to preserve your brain as you age? The very day that the IOM report came out, The Lancet published a study that basically said, "If you want to stay sharp as you age, you should carry a little extra weight on you through middle age." We were fascinated by this because it was exactly opposite to what the IOM had just said. And so we thought, "What are ordinary people to do with these conflicting reports?"
It was really that simple. And we were like, "Okay, let's get to the heart of this. Let's figure out what you would tell Aunt Sally, if you needed to tell Aunt Sally something." That's why we got the best scientists on the planet working on these issues, together to ask them, "We need to make a decision. What's the evidence? What are we going to tell people?" We wanted to be able to tell them not only what's good for their brain health, but also what they shouldn’t waste their money on.
So we've done work on supplements. We've done work on brain games, and distilled the research and evidence down into simple messages that individuals can do every day.
What has surprised you about the brain and aging?
I think that your brain can generate new nerve cells throughout your life is something that is surprising to the regular person on the street. I don't know about you, but I grew up with, "Don't drink too much alcohol, you'll kill all your brain cells." A fixed set of brain cells, and that's it.
But what has really been surprising is that neurogenesis and the science that's been about 20 years in the making is only just now starting to get out into the public in a real way. The fact that you really do have control over a lot in your brain, and that genetics are only a small part of it. Things like your education and how you grew up are really important. But if you take all of those things together, that amounts to about half of your pre-destiny when it comes to your brain. The other half, that's you and that's now, and that is modifiable.
There's a powerful amount that you can influence, and that it's never too late to do something. It's not just hopeful thinking.
Of course, you can do everything right and still get dementia. But there is a lot you can do to maintain and improve your brain health. Even for people who have dementia, the very same interventions that reduce your risks are the things that can improve your quality of life. Nobody wants dementia, but if you are doing these things while you have dementia, you actually can have and manage the disease more as a chronic condition if you follow these things. So, no matter where you are in your brain health journey, healthy interventions are surprisingly powerful.
What challenges do people face in achieving better brain health?
We actually have surveys on this, asking what are the barriers to implementing brain healthy behaviors. Most people report that they don't know what's good for them, and then secondarily, that people around them do not choose brain healthy behaviors. Only about half of adults claim to be doing those things like exercising and eating a healthy diet that are known to help your brain health; far fewer actually do them. Life gets in the way—it’s busy and pulls us in ways that are not supportive of sustaining brain-healthy habits .
But now we’re looking at how people can repurpose their free time in ways that help sustain brain health, and how we can make it easier for people to choose to adopt the 6 pillars of brain health. We've got a new behavior change report where we list out for policy makers, individuals and communities, how they should go about promoting brain health. It's not all just an individual choice—your work environment, your community, whether you're in a place that encourages walking or not, all influences how easy it is for you to choose and sustain healthy behaviors.
What should all of us want from a policy standpoint as it relates to brain health?
I think it's just important to focus on brain health. I know this sounds so trite, but an ounce of prevention is worth a pound of cure. We're spending billions on developing a cure. But we would save so much money if we structured our communities and public health in ways so that people never got dementia in the first place. Our economy would be stronger and our tax base would be better if we maintain our brain health through our lifespan—and exploited the incredible richness of older brains.
Our investment in fundamental basic science of the brain and circuitry is paying off and beginning to give us dividends. But what if we realized that the brain develops not only in childhood and through 12 years of education, but also across your lifespan and that we could cut the incidence of dementia in half through modifiable lifestyle factors? If we implemented the societal mechanisms to make it easier for individuals to be social, engage their brains, manage stress, get ongoing exercise and restorative sleep, and eat right then we would significantly reduce cognitive decline and we would save so much money. We would save Medicare and Medicaid. We would save lives. We would save the terror of families. We need to understand that what we do to promote brain health will help us in every single category. It would be a huge culture change, and something that the government could very powerfully do. And it is totally nonpartisan.
Is there anything that you personally have started doing as a result of your learnings?
The number one thing is sleep. I have been very bad all of my life in getting sleep because there's a million other things going on. But once I did a meeting of the council on sleep, it was sort of like a light bulb went off and my life got a lot better. Now instead of setting an alarm to wake up, I set an alarm to go to sleep.
