In 2014 a newer model of assessment and treatment for older adults was promulgated. This chapter explicates a Watch and Wait model that pays attention to the nuanced differences in treatment (one antidepressant vs another, one psychotherapy vs another, meds vs psychotherapy), but more importantly devotes time to the whole older person and their "real world." In effect, we expand on this model (and book) and argue that knowledge and actuarial foundations are necessary but not sufficient for

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... ing older adults. We explicate the two parts of this model; (1) A case-based and deliberative unfolding of a plan, applying psychoeducation, assessment, validation, alliance building, monitoring, and use of treatment modules; and (2) The five areas of "just-sufficient" concern involving depression, anxiety, cognition, health (especially morbidities and pain and sleep, as well as lifestyle habits), and life adjustment (unmet needs in the community). We base this model on Primary Care Clinic data of 500 older patients. We elaborate on an assessment battery for each area using standard screens and a short neuropsychological battery, and secondly a metric for designating whether the patient met criteria for each domain; Mild, Moderate, or Problem. After the identification of the profile, we apply an empirically supported plan of selected modules for each domain and monitor these. shows no vascular side effects and Phase II moderate level AD and attacked beta amyloid); intravenous infusions (gammagard as human immunoglobulin. Brain shrinkage slowed); and genetic manipulation to improve Nerve growth factor (NGF--CERE-110 injected into brain stimulates NGF). That said, two studies are noteworthy test this reality:Pathology is not destiny. In study 1 at Rush Memory and Aging Project and the Religious Order Study 3000 older adults were tracked over 2 decades [6] . Their brains were assayed and monitored. After looking at brains at autopsy, the authors said this: "Autopsies showed that some mentally spry individuals had extensive signs of cellular damage and others with substantial problems of cognitive decline in their later years had few signs of these cellular abnormalities. There was then a disconnect with cellular pathologies and cognitive decline." Clearly there are issues with any one model of the degeneration. In study 2 results have pointed to a mixed pathology for dementia as well. Dementia is not a single disease. White and colleagues followed 334 nuns and 774 Japanese American men had multiple cognitive assessments and autopsied [7] . Average age was 90. Five different brain pathologies are studied: AD (plaques and tangles), Lewy Bodies, hippocampal sclerosis, microinfarcts, and brain weight. Of the 279 with AD, ¾ had at least two of the brain pathologies; half who had AD had no AD-type abnormalities. The authors conclude that a combination of impairments correlated best with cognitive impairment with worse outcomes related to having greater than one type of pathology. Perhaps Gary Small has it correct. Special Factors: Lifestyle, MCI and Function There are two overall trends that have influenced all aspects of aging in the last decade. These are lifestyle and MCI, the borderland between health and degeneration. For lifestyle life discipline is now common sense. Lifestyle especially matters. The positive features are good diet, moderate exercise, good body fat %, and non-smoker; only 2.7% of U.S. achieves all 4; 16% had 3; 37% had 2; and 34% had 1; 11% had 0. (N=4745). Convincingly positive lifestyle habits assist biomarkers of cardiovascular health. Psychosocial habits (attitude, connection, gratitude) count also. The value of exercise, cognitive training, leisure pursuits, stress reduction, diet, positivity, and good general health monitoring, vie for the relative influence of their impact on longevity and quality of life. Even self-rated health matters. The Million Women Study is a prospective study of UK women recruited between 1996 and 2001 and followed electronically for cause-specific mortality. Three years after recruitment, the baseline questionnaire for the present report asked women to self-rate their health, happiness, stress, feelings of control, and whether they felt relaxed. During 10 years follow-up, 4% of participants died. Self-rated poor health at baseline was strongly associated with unhappiness: Better health, better life satisfaction. Aging requires many factors to maintain and to survive in a happy way. One example of seemingly less relevant variables makes the point. Worry andsubjective memory evaluations matter. Adults (N=2415) were asked if memory were a problem and, if so, did they worry. The outcomes were WMH volume. Cohorts starting at age 60 and evaluated every five years were evaluated pre and post subjective memory impairment (SMI) and ratings were clear: WMH volume increased over a five year period especially for those who has somatic concerns five years prior. Specifically, subjects with SMI and worry were six times more likely to develop AD as no SMI; subjects with SMI and no worry were only two times more likely to develop AD as no SMI; and subjects with MCI were at a ten-fold risk for any dementia and twenty times for AD. Simply ranking ones somatic problems has an impact on WMH volume. Of course, not all people with SMI convert to dementia and not all people with dementia went thru SMI [8]. In another study (BIOGARD) the combination of symptom onset, cognition, brain structure, brain proteins that predict MCI conversion to dementia was evaluated.