This list is summarized from large peer-reviewed studies including The Lancet, Harvard School of Public Health, NIH, and other major longitudinal research. The following items are ranked from most to least impactful for the average adult based on strength of evidence, effect size, and reversibility.  Review these yourself and then with your primary caregiver.  

Any of these could be most important to you!

1. Control blood pressure – Blood pressure is the single strongest modifiable risk factor for stroke, heart disease, kidney failure, and vascular cognitive decline.120/80 is ideal.

2. Stay physically active – Regular aerobic and resistance exercise improves cardiovascular health, metabolic function, cognition, and mood. 7,000 steps/day and 3 days/ week for resistance or balance.

3. Avoid tobacco exposure – Smoking and nicotine exposure markedly increase cancer, vascular disease, and premature mortality. None, Nada, don’t do it!

4. Maintain healthy blood sugar – Preventing insulin resistance reduces nerve damage, vascular disease, and cognitive decline. Goal HBA1C< 5.7

5. Optimize cholesterol (LDL/ApoB) – Lowering atherogenic lipoproteins reduces heart attack, stroke, and vascular dementia risk. LDL < 55 if coronary risk; < 70 if low risk.

6. Treat hearing loss early – Get tested!  Hearing correction reduces cognitive load, social isolation, and dementia risk.

7. Address depression and chronic stress – Counseling, coaching, cognitive behavioral therapy, environmental change, exercise  and often medications and supplements can all help to improve immune regulation, sleep, metabolic health, cognitive performance and a sense of well-being.

8. Maintain healthy body composition – Reducing visceral fat lowers inflammation and cardiometabolic risk. Visceral fat is fat inside the abdominal cavity between the ribs and the top of the pelvis.

9. Prioritize quality sleep – Essential for memory consolidation, metabolic balance, and brain detoxification. Most people need 6 ½ -8 hrs.   Smart watches are very helpful monitoring this.

10. Maintain strong social connections – Social engagement is one of the strongest predictors of longevity and resilience.  Having up to three close friends that you contact regularly helps this.

11. Limit alcohol intake – Excess use increases risk of cancer, liver disease, cardiovascular disease, and cognitive decline. No current safe amounts. If drinking, daily max recs are 1/day for women, 2 /day for men.

12. Reduce exposure to air pollution – Long-term exposure contributes to cardiovascular and neurologic disease. This includes your indoor environment, and toxins in your food such as pesticides. 

13. Correct vision problems – Untreated vision loss increases cognitive load, fall risk, and functional decline.  Get tested at least yearly when you first notice decreased acuity or visual irregularities.

14. Prevent head injury/falls – Falls and repeated head trauma significantly increase long-term risk.  Usually the last person to know they are at risk for a fall is the aging individual  with an unsteady gait. Physical therapy can be dramatically helpful with this.

15. Maintain lifelong learning and purpose – Cognitive engagement builds reserve and delays clinical decline. Everything from social interaction, board games, card games, video games, puzzles, reading and especially music, dancing and any group training.  The Center at Belvedere is great for all these.

Bottom line: Small, consistent improvements across these areas compound over time preserves quality of life and meaningfully reduces disease risk.