Grit and Brain Health
- Dr Em Wong
- Jan 30
- 8 min read
When you notice that a loved one is sometimes forgetful, it’s hard to know what’s normal and whether or not to be worried. What’s best in such moments is to remind ourselves that we get to be human, and that human brains are normally flawed and imperfect—at any age. It’s tempting to get drawn into a story that your brain creates to make meaning of what’s happening, but the reality is that it takes time and patience to figure out what’s really going on.
Meichun’s story
When Meichun first began showing signs of forgetfulness at the age of 88, she and her family believed that she was getting dementia. She seemed to lose the thread of conversations and had to ask the same questions repeatedly. Her physical strength had been declining after a minor stroke left her with some leg weakness, and she seemed to prefer to sit alone in her wheelchair at home most days. Meichun’s family decided to put her name on the 3-year waiting list for government senior care homes, anticipating that full-time memory care would soon be needed. The social worker who came to assess her agreed that this plan made sense.
Meichun’s daughter Eliza was sad about her mom’s declining health and agreed with her brothers that senior home placement might be needed, but she also saw how depressed and withdrawn her mom became whenever the topic came up. Eliza decided that she would try to help Meichun to enjoy her remaining time at home as much as possible.
She insisted on taking Meichun out for excursions with friends on the weekends, even though her mom always complained and resisted ahead of time. Nevertheless, Meichun always had a good time once she was out and about, and Eliza even noticed her mom laughing out loud at times—something that never happened at home any more.
Elders need us to be patient, sensitive, and supportive
Eliza found a deal on family portraits and got Meichun to come sit in the studio with her for a family photo, something their family had never done before. Eliza also encouraged Meichun to stand for longer periods at home with her walker, and taught her caregiver to lead her in doing simple knee lift and leg extension exercises together, so that she could help build more strength in her weak leg.
One night when Eliza was staying overnight with Meichun, she realized that her mother was getting up at least 10 times to go to the bathroom. The next morning, Meichun admitted that she had been sleeping poorly for many years, because she was scared of wetting the bed at night. It took many months to address Meichun’s anxiety around bedwetting by normalizing the idea of sleeping with adult diapers and a mattress pad, but eventually she was able to get longer periods of continuous sleep.
Two years later, when the government social worker came to assess Meichun for senior home placement, they were surprised to find that she was doing better than expected. Social workers were used to finding that clients were weaker and less responsive with each passing year, but Meichun was able to stand up to greet them and answered their questions clearly. The social worker decided that Meichun was not suitable for senior home placement after all, and enrolled her instead for an in-home physical therapy program that was designed to help her with strength and mobility, thus allowing her to age in place at home.
So what was the story behind Meichun’s remarkable turnaround? There were many factors, both ordinary and extraordinary. While it’s true that memory declines gradually with age, there’s a huge range of mental sharpness amongst elders, as there is with physical abilities. Just as it’s not inevitable that all elders will end up in wheelchairs, not all elders will develop dementia. The reality is that forgetfulness can occur at any age, especially when illness and stress are at play, affecting the brain’s ability to function optimally.
Figuring it out by trial-and-error
We are experiencing cognitive impairment when we have difficulty thinking, learning, concentrating, or decision-making. Such difficulties often show up as brain fog, missing appointments, miscommunication, or misjudgment. When cognitive impairment happens in young or middle-aged people, we usually try to figure out what’s going on.
Chances are that it wasn’t so long ago that you felt like your brain was functionally suboptimally. Were you perhaps overworked or exhausted, fighting a virus, experiencing medication side effects, or even hungover? It’s also possible that you were chronically sleep deprived from shift work, jetlag, or late nights. These kinds of situations are so common that they’re considered to be normal for much of the population. Sometimes we’re stuck with the situation, like working the night shift, and sometimes we’re complicit, like when we decide to have “just one more” drink.
Multitasking, phones, and mental overload are huge contributors to forgetfulness
When cognitive impairment happens in elders, there’s more of a tendency to accept that it’s completely normal and nothing can be done about it. Doctors and other health professionals are often quick to label such conditions with diagnoses based on objective criteria. But it only makes sense to do so when we have treatments and specific interventions to offer that effectively address symptoms or reverse the condition. For Meichun, what mattered most was not so much her diagnosis or prognosis, but rather her functional ability to remain in her home with support.
In retrospect, Meichun’s cognitive impairment was largely due to sleep deprivation caused by fear of wetting the bed, an extremely common situation. Her forgetfulness was further compounded by depression, which led to inattention and apathy when she felt ashamed and believed herself to be a burden to her family.
Elders experiencing memory loss will commonly also develop anxiety, which typically worsens sleep problems and brain function. These ordinary factors will typically lead down the default pathway to senior home placement as planned.
Fortunately for Meichun, Eliza was focused on the pragmatic. The best way that she knew to take care of her mom was by being extraordinarily patient and gritty in working with Meichun to socialize more and strengthen her body. She even eventually figured out that Meichun’s fear of bedwetting had been getting in the way of her getting a good night’s sleep for years.
Eliza intuitively knew that cognitive deficits often do worsen with age, but it didn’t necessarily mean having to go to a senior home. Her goal was to support Meichun with sensitivity and understanding while working through a process of trial-and-error to figure out what would allow her age in place at home. Eliza often had to remind herself that no matter how frustrated and helpless she felt, it was much worse for Meichun who was no longer capable of making a plan of action.
Meichun and Eliza‘s story serves as a good reminder that time and effort are required to figure out what may be contributing to impaired brain function, but it’s definitely worth the investment. Our beloved elders may naturally resist this kind of exploration, because it often requires them to participate in experimenting with different approaches. Eliza’s respectful determination in the face of Meichun’s resistance to going out with friends was an experiment. If Meichun had seemed worse or exhausted after an outing, Eliza probably would not have pursued such activities. But neither of them could know how she would respond, until they tried.
What’s normal brain ageing?
People of all ages often tell me that they feel like their brain isn’t functioning properly. They describe experiencing brain fog or slips in memory that seem inexplicable. It all comes down to the question, “Is my brain normal?”
The answer is that it’s completely normal to experience memory problems at any age. They can show up in teenagers, busy parents, stressed professionals, and retirees alike.
We’ve all experienced walking into a room and forgetting why we’re there, not remembering parts of a conversation and losing track of our phone, keys, etc. But it turns out that memory isn’t the issue here.
What may have happened is that you were distracted and not paying attention. Multitasking, phones, and mental overload are huge contributors to forgetfulness, no matter your age. Most of us have too much going on chronically.
Our brain health depends on our grit and determination to figure out what’s needed
Mental health also plays a huge role in cognitive function. Sometimes I’ll find that my mind has gone completely blank when it’s my turn to speak at a meeting. Turns out that’s a common reaction to feeling stressed. Anxiety has the ability to distract the mind with worry and threat, leaving fewer cognitive resources available for concentration and recall. Additionally, depression often reduces motivation and processing speed, creating a kind of “brain fog.”
Ageing typically impacts speed and retrieval rather than volume of knowledge. Of course it makes sense that we’ve accumulated more and more information with age, and it can take a while longer to find what we want. When this happens to me, I try to envision my internal librarian (who isn’t as young as she used to be) taking a moment to put on her glasses and get up to find the information I want. I find it helps to think of her with compassion and a touch of humour, rather than becoming disgusted or impatient. After all, she’s certainly still serving me well by carefully sorting through those internal archives, and I don’t want her to fall off a ladder just because I’m in a hurry.
At any given moment, when you aren’t sure if your brain is functioning normally, it’s worth asking yourself if you know where you are, who you’re with, and what day it is. This basic orientation to place, person, and time relies on a baseline level of brain function that we tend to take completely for granted. And yet they are cornerstone questions used to rule out serious neurological problems.
Another reassuring clue that your brain is functioning as it should is self-awareness. Our ability to think about our thinking is a higher order function requiring complexity, as is our ability to manage daily life like finances, cooking, driving, and conversations.
The reality is that our brains will slow down a bit, as our bodies do, with age. And we can help ourselves by using reminders or lists, by giving ourselves more time to learn new technology, and by trying to avoid multitasking where possible.
Embracing the ageing process means that we fully expect our brains and bodies to change with the passage of time. We’ll do our best to stay strong and mobile, but there may come a time when reading glasses, hearing aids, and cataract surgery will be needed. Apart from sleep deprivation and obstructive sleep apnea, many medications are known to interfere with optimal cognitive functioning, including most sleep aids. Alcohol and cannabis adversely impact brain function, as do thyroid disorders and vitamin B12 deficiency.
The Vibrant to 100 project is about arriving at the age of 100 still engaged, capable, and enjoying the life that we’ve intentionally built along the way.
This requires us to make small, consistent choices today about moving our bodies, nurturing relationships, and taming our stress. We can’t be sure of what we’ll encounter on our ageing journey, but our brain health depends on our grit and determination to figure out what’s needed.
Dr Em journaling prompts
As you consider elders who you know or whom you may have cared for, what challenges do you notice or anticipate that they may be dealing with—physical changes, losses, uncertainty, or shifting roles? What do you admire or what would you do differently yourself?
Looking ahead, what will grit look like for you in the “third act” of life? Recall a time when you encountered something difficult and had to overcome a challenge. What did that experience teach you about your capacity to endure, adjust, and grow? How does that experience serve you in meeting future ageing-related challenges with resilience, purpose, and confidence?
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