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Social Determinants of Health

A Prescription for Kindness

Bui, Simonetti, Benson, Malek and Anderson

Published 04/26/2016

A 66-year-old woman presents for her annual wellness visit.  She is concerned about occasional forgetfulness and would like to be screened for dementia.  Her past medical history is significant for knee osteoarthritis and depression.  She lives by herself and recently retired from her work as a librarian for 20 years.  She spends her free time reading novels, watching television, trying out new recipes and emailing her family and friends.   She used to walk 5 miles every day to and from work and is concerned that she is less active now despite continuing to walk two miles a day for exercise.  She reports good pain control with daily acetaminophen and naproxen as needed.  She stopped taking citalopram last year because her mood and stress had improved since retirement.  She denies anhedonia, fatigue, poor sleep, change in appetite or weight, dizziness, fall or incontinence.   She has never smoked.  Family history is significant for dementia in her father and osteoarthritis in her mother.

On physical examination, temperature is normal, blood pressure is 124/72 mm Hg, and pulse is 82/min. BMI is 30. Musculoskeletal exam does not reveal joint effusion, warmth or erythema.  Neurologic exam is normal without sensory deficits, cerebellar signs or abnormal gait.  With Mini-Cog testing, she is able to recall 3 items after delay and her clock draw is accurate.  She is up to date with age-appropriate immunizations and cancer screening.

Laboratory studies show normal TSH and B12; total cholesterol of 190; HDL 40; A1C 5.2.  


She would like to know if there is anything else she should do besides keeping up with daily exercise and healthy eating.  Which of the following advice might offer benefits in preventing physical disability and preserving cognitive function?

  1. Recommend a high protein diet rich in anti-oxidants

  2. Encourage her to volunteer for a school or service organizations in her community

  3. Advise her to take fish oil supplements

  4. Start her on statin to reduce her risk for stroke and dementia

  5. Encourage her to do crossword puzzles and play board games everyday

Fast Fact:

Volunteering is associated with reductions in symptoms of depression, better overall health, fewer functional limitations, and greater longevity for the elderly. Cognitive activity embedded within social settings may confer significant cognitive benefits for older adults.  Studies show that omega-3 fatty acid supplementation does not prevent cognitive decline in healthy adults.  


Anderson ND, et al. The benefits associated with volunteering among seniors: a critical review and recommendations for future research. Psychol Bull 2014; 140:1505-33

Barron JS, et al. Potential for intensive volunteering to promote the health of older adults in fair health. J Urban Health 2009; 86:641-53

Sydenham E, Dangour AD, Lim WS. Omega 3 fatty acid for the prevention of cognitive decline and dementia. Cochrane Database of Systematic Reviews 2012; 6: 6:CD005379. doi: 10.1002/14651858.CD005379.pub3