Episode 19, the first episode on Aging and Mental Health, received an overwhelming response, full of thoughtful and far-reaching questions. In this episode, Valerie and Helen look for answers with Dr. Cherie Simpson, a Clinical Nurse Specialist who works with geriatric psychiatric patients. The amount of expert information will enlighten listeners, regardless of age.
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Aging and Mental Health, Part Two: An Expert Speaks
Episode 21
Helen Sneed: Welcome to Mental Health Hope and Recovery. I'm Helen Sneed.
Valerie Milburn: And I'm Valerie Milburn.
Helen Sneed: We both have fought and overcome severe chronic mental illnesses. Our podcast offers a unique approach to mental health conditions. We use practical skills and inspirational true stories of recovery. Our knowledge is up close and personal.
Valerie Milburn: Helen and I are your peers. We're not doctors, therapists or social workers. We're not professionals. But we are experts. We are experts in our own lived experience with multiple mental health diagnoses and symptoms. Please join us on our journey.
Helen Sneed: We live in recovery.
Valerie Milburn: So can you this podcast does not provide medical advice. The information presented is not intended to be a substitute for or relied upon as medical advice, diagnosis or treatment. The podcast is for informational purposes only. Always seek the advice of your physician or other qualified health providers with any health related questions you may have.
Helen Sneed: Welcome to episode 21, Aging and Mental Health Part 2. An expert speaks Valerie and I have had a phenomenal response to our first episode, the intricate relationships between aging and mental health. I should say our first episode on this subject we got this enthusiastic feedback and it was full of thoughtful and far reaching follow up questions, some of which we couldn't answer. With that in mind, we decided we needed to turn to an expert in the field for the best information and insight on the topic of aging and mental health in all its many aspects. Now, research has shown that our mental health affects the aging process and the aging process affects our mental health. It's on both sides of the coin. We're going to explore the intricate relationships between aging and mental health again in this episode.
Valerie Milburn: To begin with, the subject of aging affects millions of Americans of all ages and it continues to escalate. Adults age 65 and older currently make up more than 12% of the American population, but will grow to 20% of the population by 2030. That's less than eight years from now. Those statistics are from the U.S. census Bureau. The center for Disease Control estimates that 20% of people aged 55 and older experience some type of mental health concern. This rapid growth in the older adult population requires much professional attention. The demand for mental health services is likely to increase as they age. Baby boomers, those currently ages 62 through 76, tend to use mental health services more frequently than previous groups of older adults, and they are less stigmatized by seeking mental health care. A major concern is that by 2030, the United States will have less than one geriatric psychiatrist per 6,000 older adults with mental or substance use disorders. Today, to explore and explain the impact of aging on mental health, and vice versa, we have turned to an expert. We are thrilled to have with us a seasoned advanced nurse, specialists in the field. Through her
Valerie Milburn: perspective and professional experience, we can delve more deeply into this complex subject.
Helen Sneed: But first, our objectives, which we always like to give. I mean, what do we want to cover today? All right. First, to determine what is normal in the cognitive aging process, Both the challenges and the positives. To explore the causes of mental illness in the elderly. To define the impact of the aging process on mental health and to define the impact of mental health on the aging process and to investigate treatment methods and coping through skills, strategies, relationships for those who have mental health issues and those who love and care for them. Now, it is my unique pleasure to introduce Dr. Cherie Simpson. Dr. Cherie Simpson is a clinical nurse specialist with senior adults, specialty health care and research. That's in Austin, Texas, where she performs the medical management of geriatric psychiatric patients. She also participates in research studies for new drugs in the treatment of Alzheimer's disease. Dr. Simpson was an assistant professor at the University of Texas school of Nursing and conducted research to improve sleep in family members. Caring for a loved one with dementia. You can see that she really has an extensive knowledge of what we're discussing today. Cherie, welcome. We're glad to have you.
Speaker A: Thank you, Helen and Valerie, for having me today. I'm excited to be here.
Helen Sneed: What we're going to do is just ask a series of questions, and then we just want you to tell us everything that we need to know. First of all, though, I'm curious. When did you become interested in mental health and aging?
Speaker A: That is one of those. What sometimes happens, a personal experience So I had been working in healthcare for 20 years as a physical therapist. And in those 20 years, I had worked in a variety of settings. I had worked with a variety of doctors. I knew a lot about Medicare and insurance. I knew about housing like assisted living and skilled nursing facilities. But then my mother developed dementia and I became this child with all of my smarts having left my brain and made some critical mistakes and things. Like the first placement we made in an assisted living facility was not appropriate, so we had to move her twice. And that was traumatic. And then there was the experience where I was sitting in front of her primary care doctor and we had this issue of a low blood count and the doctor thought she must have internal bleeding. And the next thing I know, I'm sitting in front of a specialist who wants to do a colonoscopy. Now we're talking about, my mom had advanced dementia to the point where it was difficult for her to sit in the waiting room. And we finally got that worked out and we didn't do the colonoscopy. But it made me wonder, if I'm having so much trouble doing these decision making and caregiving, how does someone without my background and experience know how to navigate this? And so that led me on a career path change. It ended up to be nursing with the intent of getting my PhD to do research and health promotion for caregivers. But along the way, I got my master's as a clinical nurse specialist. And so that's what allows me to do the direct treatment. And I fell in love instantly with the older population, although I had worked with them before. And I did all my clinical work with Dr. Winston and fell in love with the practice. And so I've been very fortunate to, to work with senior adult Specialty healthcare since 2005 in different capacities until I came on full time.
Valerie Milburn: Oh, thank you.
Helen Sneed: I'm glad you did.
Valerie Milburn: Yeah, I'm so glad you did. I mean, without people like you, I would not have been able to navigate the journey we went through with my dad's dementia. So thank you for all the people you've helped. One of the things we want to talk about is in the normal aging process, what changes can be expected? And also, do you find that people can misconstrue some of these normal changes to be a mental health issue?
Speaker A: I think that's a great question, and I think it's a two part question for me because I think when we talk, when we say the words mental illness, people traditionally think of things like depression and anxiety, but actually the Centers for Disease actually cause mental illness, both anxiety, mood disorders, and severe cognitive changes, which equates to dementia. If we look at the cognitive changes, I would say that's where people have the tendency to misconstrue what is normal aging
Speaker A: and what is pathology. I called them, and we call them in our practice, the worry. Well, maybe it's because they have always been a high performer and the changes are harder to accept, or perhaps it's because they've had a family history of Alzheimer's in their family and they're suspecting that they're going to get it, too. The normal aging changes that you guys covered so nicely in your first podcast, we really have to do with the fact that our brain changes just like our other organs change. I always use the example of our skin because, you know, as we age, we lose that fat content. We get the wrinkles, we get the brown spots. And then actually with our brain, when we're born, we're born with more neurons than we'll ever use. And as we learn and grow, some of those neurons pass on as we don't use them to their full extent. About the age of 30, that neuronal loss changes. Now we start to have neuronal loss more because of the aging process. The things that happen are things like actual neurons die. The myelin sheath that covers them die. This causes a shrinkage of the brain. So our brains are shrinking every day. And because of that shrinkage, which is both a physiological as well as a chemical and structural change, we do have then functional changes. As you talked about in your first podcast, those are things like processing speed, how fast we can process all the information that comes into our brain. You have to think about. It's not just the external things that are happening, but all the internal things. How's my blood pressure right now? How's my temperature? Do I need to move because I'm getting stiff? All that information is being processed, and as we get older, it slows down. The other one that changes that I think is most significant is filtering how your brain takes what comes in and decides what's important to pay attention to now, what's important to file away, to pay attention to later, and what's okay to dream away and get rid of later on. The combination of those two changes and cause us to have those senior moments where we put down our glasses and we don't remember even though we put them down the same place all the time. Or you walk in a room. My favorite example is you walk in a room and you lay down your keys, but you don't remember them because there's a light on in the other room and you don't remember why the light was on. So you start focusing on that and don't register where the keys went. And so those senior moments are normal aging, as is the name bank. So everybody has a different size name bank. Mine's very tiny. I have a hard time remembering names now. But for people who have very big name banks as they age, names have to go. Either new ones can't come in or old ones go out. And forgetting names is a part of normal aging. The other thing about memory is that there are two types of memory. There's lots of ways of talking about knowledge and memory, but one of the ways to describe it is declarative versus non declarative. Declarative is that knowledge that we have, that autobiographical. Those things that we have accumulated all through our lives as well as learned knowledge. And those facts seem to go away as we age. Different than the non declarative knowledge, which is routine things that we learn to do like tie or shoe or ride or bike. And that's why someone who has dementia, who fractures their hip can learn to walk again because it's that non declarative knowledge of how to walk. And so that memory change, processing speed, names, all of that leads to cognitive changes that we call sinensis or benign memory loss. By benign we mean that it doesn't interrupt your function. You're not able to drive. It's not that you can't work, it's not that you can't do all the things you normally do. It's just annoying. And a conversation people have over coffee comparing the problem when you say that's.
Helen Sneed: Good to know because that's what I hear constantly now is that people, the annoyance of it, the inconvenience, it's when.
Speaker A: It starts to become more noticeable to other people, like mom. You've told me that three times, honey, I just told you that. Then we start to move into other stages that become more pathological. Mild cognitive impairment and dementia. To answer your question, yes, people do construe normal aging to being pathological problems sometimes. But on the flip side, when we talk about the mental health that is more traditional
Speaker A: depression and anxiety, I would say there more people have a tendency to not be aware and observe and understand that they have a mental health issue. And they're more likely to blame it on aging and say, well, I'm getting old, aren't I supposed to get depressed? I'm getting Old. Shouldn't I not sleep the way I used to? It continues to promote the fact that depression and anxiety, mental health is still underdiagnosed and under treated in the older adult. This becomes a problem with patients then not seeking the right help because they oftentimes are looking for cures to these physiological problems. I'm not eating, my stomach hurts, my chest is palpating so hard. And they end up in the emergency room, oftentimes thinking they're having a heart attack, when in fact it's anxiety. And that's sometimes the first time they learn about it. But it's not even that. It is definitely depression and anxiety which are the leading causes of mental health. But I even have two examples of patients who have something called parasitosis where they think they see and feel and see bugs. And they went to many doctors. One patient was two years going to dermatologists and all sorts of other doctors trying to find a cure, when in fact it is all a visual hallucination for her. Visual and tactile. Again, sometimes people misperceive mental health as other physical problems and don't take care of it as they should. And so that leads to other problems.
Valerie Milburn: Right. And that's, you know, really sad and unnecessary because anxiety and depression are so treatable. So, yeah, it's really unnecessary suffering.
Speaker A: It is, it is.
Helen Sneed: Well, I'm curious about. Gosh, I want to be sure that I'm sort of phrasing this right, but the. The impact that. The difficulties of the aging process, some of which you just really talked about so eloquently, how can that have an impact on someone's mental health? In other words, say you're older and so many of your close friends have died. That kind of thing, or loneliness or solitude or lack of a community, the stigma. Are there certain things that. That lead, you know, aspects of living a life as an elderly person that sort of point to developing mental problems?
Speaker A: Yes, very much so. There are very many consequences of normal aging. But let me first say I have a joke in my office about normal. And I tell people it's only a place on your washing machine because everything else is very definable about what's normal for you. But yes, when you talk about some of the consistent experiences that people have and what is considered normal aging, when we talk about those physiological changes, there are impacts in several different areas. So for instance, there are people who have had lifelong depression and anxiety, and so they experience it like a chronic disease. And so that has consequences as you age, but yet there Are other people that experience it's late onset depression and anxiety. So it comes for the first time. So some of those issues about how normal aging impact mental health are different because they're more like what you're talking about. Some of those experiences, multiple death, loss, having to change homes, things like that. What I think is important to talk about is some of those physiological changes that have impact on mental health, especially for those people who have been experiencing chronic disease through their life.
Valerie Milburn: Yes, that is you mentioned that a little while ago that people who have had chronic depression or anxiety, how that does indeed impact aging. And we talked about that in the first part of in the last episode about this topic. And there is a lot of research about how lifelong mental health struggles impact aging. And if you could talk about that for a minute, that be fascinating.
Speaker A: There's two ways to look at it with the normal aging and how it impacts mental health. The first thing is about the physiological changes because as I mentioned about the brain shrinking, There are a lot of physiological changes that happen in the body that affect medication. As we age, the impact on our medicine can be a factor. The fact that medicine has to be brought into the system, it has to be broken down, distributed to the place it needs to
Speaker A: to go and then be eliminated. All of that can be impacted by changes in the physiology. Things like the fact that we don't have as much water in our body as we age. We have more fat in our body than we have a muscle mass. We have changes in the villa of the lining of our gut that has to have an impact on absorption. All of those things can make changes in how medic can be utilized by the body as we age and therefore cause problems with medications as you age. Either get more side effects, be more sensitive to it, have more chances for it to not work for you appropriately. So it's really important to know that that can happen. Especially those for those people who have been taking medications for a long time throughout their life. And some of the medications do have metabolic impact over time. They can make high cholesterol difficult to manage, obesity difficult to manage and metabolic syndrome difficult to manage over time. Mental health, physiological changes, long term use of medications can lead to other health issues as well as make it difficult to manage the mental health issues. Then to what we were talking about before with the fact, especially with people who have more late onset depression and anxiety, there are a lot of consequences that happen with aging. Isolation is huge. You can talk to. I'll give an example of. We had people who wanted to participate in Research for cognitive changes from memory. And one of the criteria is that you have to have somebody who knows you well enough to be able to say, I see you once a week. I can tell if there's changes. Many, many people couldn't participate because they didn't have someone in their life that knew them that well. And that's just sort of, that's a sort of a statement to the loneliness that is out there for people. And then there's the issues with other chronic illnesses and comorbidities like high blood pressure, diabetes, neuropathy, that all those things can then in their own right, create depression. I have many people who see me because their expectation for retirement in the golden years was not for their body to poop out on them and their body's pooping out on them, whether it's physiologically or cognitively because of changes in their thinking. Those are the risk factors that come with aging that can then impact the older adult's mental health.
Valerie Milburn: So a lot of opportunity for that aging process to impact mental health. And the other side of that that I wanted to talk about for a minute is how the long term living with the mental health condition impacts the aging. You know, for example, the research shows that people who have had mental illness in early life are actually shown to age faster and be in worse health in later years. You know, things the research shows along those lines, it shows that men at middle age, people with the history of mental health problems, were literally aging faster at a faster pace. Those kinds of impacts that a long term mental health has on the aging process, can you address that for a few minutes, please?
Helen Sneed: Do you see that in some of the people that you work with?
Speaker A: Yes, in the sense that again, when you talk about what's normal, I have patients who are 70 years old that are ready to die because of their long term depression. That just never seems to be controlled. And so they don't want to live their life like this anymore. And at 73, they feel like they've done it longer than they should have. And even in people who have had relatively good control of their depression, for example, when other life things start to pile up with them, especially health issues, then that's more likely for them to be much older than their chronological age in their ability, their mobility, their ability to function in what we call instrumental activities of daily living, which are the higher order things of managing your finances, driving. And when those things become more difficult, then people have a tendency to start to have more of a depression. And therefore, then they start to become less Functional and
Speaker A: act as if they are older than their age. Yes, I do see it. Some of the reasons why, when we talk about what is the aging, what does that look like? I think it is, again, when you talk about people aging faster, it's their functional age that doesn't meet their chronological age. Again, the reason those things happen is oftentimes when people have dealt with mental health throughout their life, they've been less likely to take care of other aspects of their life. They don't go to the doctor as often as they should. They don't choose to handle other comorbidities like keeping their diabetes under control or. Or they may pursue other unhealthy choices like smoking or drinking, which then leads to more health issues with COPD or chronic obstructive pulmonary disease or emphysema, which then when you have that, that is functionally going to age you because you can't do things that you used to do. You can't get out and walk a mile. You can't. And then the other. Besides the not managing the comorbidities, then they also do things like start to withdraw. They don't have a social network to support them. And so then that compounds the aging process because, again, isolation and loneliness, you're not actively stimulated. I make a zoom call periodically to a client who has to clear her throat. She says, I haven't talked to anyone all day long, and so she has to physically get talking again. And other people who say the same thing. And I have to think, I can't find my words because I haven't been talking to anybody for. For a while. And so again, you're functioning, going to look much older when the impact of depression and anxiety keep you from doing other healthy things that can keep these other things that age you faster, more under control, if that makes sense.
Valerie Milburn: Yeah, it does. And this is where Helen and I both addressed the deep gratitude last episode, the deep gratitude we have for our recovery, because we are now in a place where we are well enough, you know, to face the aging process with health and vigor and recovery and mental health stability. Because everything you talked about is something we could have faced. And now with our recovery and the massive amount of work we do to stay in recovery, we feel like we're going to be able to do a good job as we age, you know, or be lucky.
Helen Sneed: I hope so, because I think according to some of the. Some of the research that we did, both of us are supposed to be dead.
Valerie Milburn: Yeah.
Helen Sneed: So we're supposed to live 10 to 20 years less than a healthy person. And. Yeah, so we're still here. And I for one am very grateful.
Valerie Milburn: Yes, grateful.
Helen Sneed: Well, we've looked at sort of the issues and the problems that face people, you know, in this. Oh, gosh, in this aging process, which is again, not for sissies. But I'm wondering what you have found in terms of treatment methods that can help these people. You know, there's individual therapy and group therapy and skills and relationships and all that stuff. What have you found to be effective?
Speaker A: Well, again, everybody's different and everybody brings to the table when they want help, kind of what they're willing to do. Research is very clear that a combination of medication and therapy, talk therapy, is going to work better than either one alone. But either one can have an impact on mental health. Right now we're really talking more about the mental illnesses of anxiety, depression, mood disorders. The issue is getting the person to understand that my analogy is a three legged stool and that keeping depression and anxiety balanced on a three legged stool requires work in all areas. The first leg is medication. I hate to say it, but I don't live in an exact science world. There are a lot of antidepressants out there, but all of them have the equal opportunity of working or failing depending on the individual and how that body responds to that drug. And so sometimes it's a journey finding the right one. And many people do have to take more than one medication, whether it's a dual therapy or antidepressant and augmentation. So finding the right combination of medication is a journey. But oftentimes
Speaker A: the medication I tell people, in my opinion, and this is purely my opinion, does not solve world problems, nor individual problems. All it can do, in my opinion, is give you the emotional mental space to do the work you need to do. And the work you need to do comes in those other two legs. And one leg is talk therapy. And again, because it helps to have a professional guide you through that, the best way is through therapy, whether it's individual, group, intensive, outpatient, whatever is needed at that time for the individual. The third leg though, is the behavioral. If you don't try to make change, no matter how much medicine I throw at you or how often the therapist talks to you, if you aren't willing to take on the change in the work to do, the balance isn't going to be there. So whether it's as simple as you get out and start walking every day to increase your exercise, or it's you learn many other strategies, like how to use your social Network to keep from being isolated. If it's how you use the things you learn in therapy, whether it's dialectical behavioral strategies, meditation and relaxation from anxiety therapy, unless you use those and incorporate them into your life, the stool won't be balanced. So all the things that you mentioned, the medicine, the different kinds of therapies, as well as having a plan, having structure to your day, having built in places to take care of yourself, it's got to be a combination. And when that works all together, that's when I see the best outcomes. And when it doesn't, it doesn't work quite as well.
Valerie Milburn: It's a wonderful.
Helen Sneed: Well, I'm sure again, it's very individual. And I just am so overwhelmed to think of all these people that need the help from someone like you and that there's just such a paucity of people in the psychiatric field that are dealing with the geriatric psychiatry, whatever you call it. And this is just something, this is just a sort of. I'm getting on a sidebar question here, but do you see any improvements in that and more people, young people coming into the field or is it just. Are you just kind of off on the side?
Speaker A: No, unfortunately, I don't know the statistics of how many board certified geriatric psychiatrists are being produced each year. And so that is a challenge. And in our area, I've always seen Texas, I saw this even as a physical therapist that every state has a different opinion about what we call extenders. In Texas, with physical therapy, there weren't enough physical therapists to go around, so physical therapist assistants filled a big role. Advanced practice nurses do the same thing for physicians in different capacities. As a clinical nurse specialist or a nurse practitioner, we work as extenders to the physician. There are more programs for offering geriatric. No, no, no. I'm sorry. There are more programs for nurses to offer psychiatric nurse health practitioners available out there. So I'm hoping more people will graduate from that. But going into geriatrics is almost a passion. You really need to love to work with older adults to do it. And to be real honest, oftentimes in healthcare, what you see now is that the healthcare practitioners are having a hard time with reimbursement. More and more doctors are doing less and less Medicare, which in our practice is our biggest payment source. That's just what we do and we're quite fine with that. But other doc, I have patients who will tell me I can't find a primary care doctor because there's nobody taking Medicare. I have somebody Trying to find a therapist, a talk therapist. And their profile says they take Medicare, but they only take two a month. They don't. Their whole practice has to be balanced because of the financial aspect of it. So there's a lot of different components that are pushing on, making it difficult for geriatric patients to get the psychiatric services that they need.
Helen Sneed: Well, I just was hoping that it was a happier, you know, outcome for people. But may, I don't know, maybe there'll be change. It's just, you know, life.
Speaker A: We can be optimistic. Yes, we can be optimistic.
Helen Sneed: Yeah. So here's something that I was so pleased to see that you had worked with families
Helen Sneed: in your research. This is a question that I think is really, really important for people who are. Because I think it's a little bit like what you talked about earlier, that if you're faced with caring for the person in this situation for the first time, you are clueless. It's so easy to make mistakes and to not be able to help the person as efficiently as you would like. Also, I think people need to remember, they need to take care of themselves. You know, all caretakers really have to do that. So what is. Do you have advice for families and caregivers who may be facing this for the first time or maybe getting burned out because they've been doing it for years or whatever?
Speaker A: Right. And here my background and personal interest, of course, was dealing with family members who are dealing with a loved one with dementia. But I think that, that it applies to family members who are dealing with somebody with depression or bipolar or anxiety, because it is a long journey and an up and down road for people who have had lifelong depression and anxiety and bipolar disorder. But I think the first thing is that the family members have to be comfortable with starting a conversation, whether it's the fact that, you know, this person has had depression and it's been well controlled for a long time, or I have another example where I have a patient who had bipolar disorder. And the last episode that she had was when her husband was alive. And he was a really good cover. He didn't really let the four daughters know the extent of the illness. And so, unfortunately, after he passed, mom was doing great until something triggered and she went into a bipolar episode of depression and paranoia. And the girls were blindsided because they had. They've never had to deal with this or have any experience with it and didn't really know what they were dealing with. And so again, whether it's been a lifelong issue or a new issue, somebody's going to be experiencing as a caregiver for the first time. And so starting the conversation is really important. And, and I know as a nursing student because I was a little bit older and more experienced when I started my career and I had worked with patients before. Some of my classmates who had not were sort of apprehensive about the questions about depression and suicide. They were like, but what if I ask that might make them think about it? I'm like, yeah, if they're thinking about it, they're going to tell you, you know. But to the point of families need to start talking about it. And I think a really huge pearl of wisdom about doing that is starting with I conversation and not with you. So dad, you look depressed to me. Dad, you're not taking care of yourself. But starting out with dad, I'm really concerned. I see that you're not taking a shower like you used to and you were always so well groomed and now I'm concerned that something's going on. Can you help me understand? So bringing it from what I see and doing it with open ended questions that are leaving out the why question is really important in trying to start a dialogue. So I think that starting the conversation is important.
Valerie Milburn: I wanted to play a wonderful resource called Conversation Starters that's available from NAMI Central Texas. It's called Conversation Starters and you can get it online and you just Google NAMI Central Texas and it's wonderful to help start that conversation. So just throwing that out there, it's.
Speaker A: A good resource and I appreciate that because that again is another issue is people don't know what their resources are. If you don't know what you're asking for, how do you know to ask the question? And so that I find is one of the big things is people don't know where to go to find the answers. And so thank you for sharing that one. And that's the next thing is about educating yourself about the disease. Whether it's dementia and any of the different types of dementia or it's depression or bipolar, understanding what the symptoms are, understanding what the treatment options are. And those are all huge because I feel like knowledge is power. And the more you know, because I'm also a control freak, the more I know, the more I feel like I can be in control of the situation. And not knowing is hard for me. So education, education. And then the third thing is when you have that knowledge is being okay with understanding what the warning signs are. So again, like a lot of my patients will have very clear, I Know my depression is starting when I can't sleep at night. I know my depression starting when I don't feel like taking a shower. And so knowing what those triggers
Speaker A: or markers look like is really important to help start to get involved in a treatment program before it escalates into another level. The same thing with oftentimes understanding that in both depression, anxiety or dementia, a lot of the times the person experiencing the disease process are not in a good place to make rational decisions. And so asking questions like, well, do you want to go to therapy? What's the first thing that's going to come out of the mouth? No, the path of least resistance. And what I think is really important, whether it's depression or anxiety or cognitive changes, oftentimes when the person is in the midst of that, they don't have the ability to make good rational decisions. And so asking them about wanting care will oftentimes have a negative response because it takes energy and effort to get up and do what they don't want to do the most, which is get out of bed, get dressed, go to the doctor, go to the therapist, whatever. And so the loved one, the caregiver, needs to understand how to break down those barriers. And sometimes that's just in the communication and the way you present options. And sometimes it's actually taking action and just saying we're doing this because getting them moving in the right direction will get them in a path to treatment and or recovery or minimizing what could be an exacerbation of the problems. Then I think the last thing is, as you said, it's about taking care of yourself because that's where a lot of my research was in establishing the need for my research program was the fact that caregivers, and again I focused on dementia caregivers live a much shorter life than non caregivers. And once again, it's because they stop taking care of themselves. They don't go to their doctor's appointments, they don't follow up with their necessary mammograms, whatever. They don't take time to exercise for themselves, they don't sleep well. And so poor sleep leads to other health issues. So if a caregiver doesn't take care of themselves, they're going to have more mental health and physical health issues that can actually shorten their life.
Valerie Milburn: That's really true. My dad died after eight years of living with Alzheimer's and my mom was 80 when he died for one year. I am not exaggerating. Every time my mom sat down, she fell asleep she was exhausting, exhausted. She had not taken care of herself and just was taking care of him. So that's just wonderful advice that you're giving to take care of yourself. And what you were talking about, learning to listen when someone is helping you see your warning signs and see your actions. That is an intricate, intricate dance between the person telling what they're seeing and the person hearing what they're being told. We had to work really hard on that for me to learn to say, okay, I understand what you're saying, thank you, instead of saying, what do you know? So we learned how to do that, and it was really an important part of healing. So I love that you're talking about that because it can be so helpful to the person who is struggling to learn to take in what their loved ones are telling them in a loving way.
Speaker A: And I really try to talk to the care recipient when I'm in the position to build that level of trust and to remind them when they're in a good place, how much that caregiver loved one does love and want their best interest. And that taking the time to take a deep breath and remember that and then be able to hear is an important thing.
Valerie Milburn: Yeah, that's great because like I said, it's a dance. Both, both members of that conversation, both participants have to learn to to dance well together.
Speaker A: Good point.
Valerie Milburn: I want to look forward for a minute. What's on the horizon, what's on the horizon in new treatments, research, science, genetics, neurobiology, all of that. Tell us everything you know about what's happening.
Speaker A: When I, when I knew that you might ask me that question, I thought, oh, we might need another podcast. But, but I can tell you that there's a lot going on and so some of the newer treatments that people aren't as aware of are things like transcranial magnet stimulation. And now that is becoming more, more popular or at least more available to people. But it is an FDA approved treatment for depression paid for by Medicare, but it's also approved for anxiety and PTSD I believe. So it is a non medication treatment that sort of works to do what medicine does by stimulating a very specific place in the brain to generate that neurotransmitter and to reduce the depression. Another area that's more in line with medication and where research and change has happened and it's now come to market is ketamine. And so when you think about the traditional drugs that we've been dealing with, which are things that want to increase serotonin and dopamine and norepinephrine, and these are neurotransmitters, I'm sorry, that are of one kind of neurotransmitter, monoamine. And the ketamine works in a different line, if you want to say that. So in my mind it's a different approach to a chemical approach to the treatment of mental health illnesses, depression. And I think it's going to move into other areas. What's changed about it is that when I first heard about it several years ago, when it was still being kind of more of in a trial, it had amazing response to people who had suicidal ideation. It like almost went away immediately, but it didn't last very long. And so now through different chemical compounds and changes, they've been able to sustain the benefit from it so that you can have it through infusions, injections, oral and nasal sprays. So that's a new treatment that I think will gain more popularity as more practitioners get used to using it. Another one is moving into the psychedelic world. And so the study of mushrooms or psilocybin. Yeah, so that is something that's been around for a long time but is just now really gaining research backing. And so Here at our own ut, they currently are doing a study working with PTSD in veterans, and I think they're going to be doing one on depression. So that's another area when it comes to chemical changes in the brain. But the good news is that people are looking in all sorts of areas. I just got a blip on the study of vitamin B12 and I think B6 or B1 in the treatment of anxiety. People are still looking even though depression and anxiety have. Well, depression has a lot of medicine that's available. Anxiety specifically, not so much. But people are looking for alternatives to the medicines that we have that have less side effects and negative impact over time. So that's. That's a good thing. And then when it comes to the genetic testing, what really has become more mainstream use is genetic testing where we're able to show how you individually metabolize drugs. So unfortunately, it doesn't tell me exactly which antidepressant or antipsychotic or anti anxiety medicine is going to work specifically for you. But if you remember when I talked about how your body metabolizes a drug, it has to be broken down, absorbed, moved to the right place, and eliminated. That is determined by your genetic makeup. And how your liver spits out enzymes that do
Speaker A: those jobs is the main one from breaking it down. And so sometimes people's genetic makeup makes them a fast metabolizer, a normal metabolizer, or a slow metabolizer. And so with the testing that we have now, it can look at all the psychotropic drugs and say, yes, you metabolize this drug the way that the manufacturer thought you would when it was studied in the beginning, when they looked at how it came through the body in what's called pharmacokinetics, how it moves through the body. The other aspect of it is that it can tell you whether your genesis have a moderate or a more significant interaction so that you might need more drug because you're a fast metabolizer or less drug because you're a slow metabolizer. So it gives us some guidance, an explanation of why you may not have responded to a low dose of a particular drug. We hope that they'll continue to build on this body of knowledge so that one day I won't need Dr. Spock's, what was it called, tricorder, where he would on the TV show just run up and down the body and go, oh, yeah, this is what's wrong and you're fixed. I'm looking for that, that a magic wand. But someday, hopefully, we'll have something that tells us more specifically what is going to be efficacious for your body and your makeup. Well, we're not quite there yet then. I think the other areas when you talk about the neurobiology, is that there's been constant research going on in imaging to actually show that the structure of brain that has experienced depression is wired differently than brains who don't experience depression. And those. All those things help to move us forward in the science to find better, earlier diagnosis as well as better treatment methods. So, yes, it is definitely an area where everything is moving forward, just not fast enough at our desire, because we all want to be fixed right now with the first pillar. Same thing with Alzheimer's disease. There has been breakthroughs in new kinds of drugs, monoclonal antibodies that have had more impact on the symptoms of Alzheimer's dementia. So far, none of them actually stop the disease or reverse damage, but we're still looking for that drug. So everybody is working on many different aspects of how to cure Alzheimer's disease. That's the ongoing research.
Helen Sneed: Well, that's pretty exciting. I'm like you. I want someone, frankly, just to wave a wand again, or as you say, just one pill, that'll be fine. But it is so encouraging to hear about this. I guess that leads to one of our final questions, which is something that I'm so curious about. Someone with your perspective, and you're up to your eyebrows in working with these issues and people. What is it that gives you the most hope for people with mental health and aging issues?
Speaker A: I think, personally, what gives me the most hope is to keep perspective. The stats that Valerie gave in the beginning, that the aging population does have a percentage of depression, anxiety, mental illness. And we know that the population that is growing with dementia continues to grow as we age, that this is still a small percentage of the overall group of aging people. And so there are a lot of people that experience mild depression or mild anxiety that doesn't really fit the criteria of clinical depression. That says there are a lot of people out there that are functioning without mental illness. And so I need to keep perspective. But for the people who do have mental illness, whether it is the neurodegenerative that leads to dementia or the mental health of mood disorders and anxiety, I have to be optimistic that it is an area of growing research and continued research, and that there are people working on it at many different levels, and some with medication, but also with other ideas that are not just medication. So that ideas of environmental changes or different types of therapy that may be helpful so that the research keeps going on and on. And I think that is really optimistic. But it's not an overlooked area of research.
Valerie Milburn: Right. I like that and I love that. Keep a perspective. And I know what gives me hope. And thank you for sharing that. It leads me to what gives me hope. And the positive response to our first episode on this topic of the relationship between aging and mental health is what gives me hope, that positive
Valerie Milburn: response, because our listeners responded by telling us that the positive aspects of aging we presented were new to them and that those positive aspects gave them hope as they are aging. They told us that the strategies and skills we offered were helpful and practical and encouraging. And those strategies and skills gave them confidence that they're going to be able to handle aging with grace. And that makes me hopeful.
Helen Sneed: Well, and I am going to talk about as usual, I have to admit that I have been terrified of aging my entire life. I think after all this investigation that we've done, and especially hearing you today, Cherie, I think what gives me hope is the fact that things will become more difficult with the aging process biting you in the ankle. But there are solutions to these challenges. I don't care if it takes me longer to do something, as long as I can still do it and make it happen, I have hope. As long as I am able to continue to contribute in some way in work and in relationships, then I will consider myself to be aging in a positive way.
Speaker A: Can I just also say, because I try not to get too theoretical, but there are many theories about aging, and one of them that is about healthy aging is this idea that as we age, we do start to shrink down in the things that we do. We learn to compensate and we learn to make adjustments for things. And so two things that you said that are so important, Helen, and what I see all the time is that people haven't figured out how to find a purpose as they move forward as they age. And so a lot of times it's because they didn't plan earlier on. They didn't have hobbies. They didn't have a social network. They just had work. And when that stopped, they didn't have anything else. So finding places to have that sense of purpose is huge. But also because you may not do things at the same level that you used to do, understanding that purpose can come from the smallest of things. Dropping a line to somebody, a note card, a call on the phone, saying hello to somebody. You know, it can be so small that can have such a huge impact on the individual and yourself. I have to so many times ask my older adults why they don't think they can get to a senior activity center or to church. To church. And they said, well, you know, somebody would have to drive me. And there's this person from church that would. But I just don't want to be a burden. And I had to tell her, you're not being a burden. She offered to do it. So that means she wants to give, and you, by taking that ride, are allowing her to give. So you're not a burden, you're a joy. And you're going to make her life better because she was able to contribute. And so, again, just thinking about all the ways and helping people understand how they can find purpose and understanding it can be small is really big. So thank you for saying that.
Valerie Milburn: Thank you. Final question. What did we forget? Do you have anything we didn't ask? Do you have any final advice, anything you want to say?
Speaker A: Well, I think that to your point, that people found it hopeful because they heard positive things about mental illness and aging. I think that another thing that is so important is just this podcast that people are hearing about it. And I applaud every famous and semi famous person who talks about their depression in public or talks about their eating disorder in public so that it becomes more of a topic of conversation. And that to help people who have the illness over time, that if they would look at it as a chronic disease, and I always use diabetes as an example because you can't change the fact that your pancreatic cells stop producing insulin, but you can manage it extremely well through behavioral activities, through monitoring, through following up with your doctor's appointments. And you can live a life with your diabetes under control and not have the side effects that can come with it if you don't. And that's the same thing with mental illness. If you work to control it over time using all your avenues and tools, you can live a very healthy life and an older aging life with great value and contributions to society with that. And so I think that is really kind of one of the most important things that people can do is just take care of themselves.
Valerie Milburn: Right. Thank you.
Helen Sneed: Oh, gosh. Oh, cherie.
Helen Sneed: Oh. I just. I have learned so much. My head is spinning. And I just wanted to thank you for your expertise and your wisdom and your great generosity, you know, with your time and with what you know and what you have, so much that you have to give to us and to our audiences. I also just want to comment on the very clear example that you give of the compassion that you have for those people that you treat and work with. And that is something that, that's the kind of lesson that I think that I want to see more of this as I live in America today. And I'm so happy that I got to see it in you today.
Valerie Milburn: Yes. Thank you so much.
Speaker A: Thank you.
Helen Sneed: Yeah. So thank you. Thank you. And this does bring us to the close of our topic. Obviously. We've learned so much today from Cherie. We hope that you feel much better informed about this critical subject because we all encounter it in many different phases throughout our lives. We ask you to remember old age is not a disease. It doesn't cause significant damage to the brain's neurons. It's the same as your body parts working somewhat less efficiently due to age. I mean, the brain is no different. We hope you can see that it's a natural process that can be dealt with in a number of effective ways. Now, Valerie will lead us in a mindfulness exercise.
Valerie Milburn: Thank you. Yes, I will. Well, we will close this episode as we traditionally do. Kind of traditionally, instead of our traditional mindfulness exercise, I'm going to do something a little different today. Since our topic has been about aging, I thought that instead of a mindfulness exercise, I would give some mindful meditation tips for us in our senior years. These tips are Adapted from the MindWorks Mindful Meditation blog. Now, if you're not in your senior years, perhaps there's someone in your life you'd like to share these tips with. And many of these tips can be incorporated into our mindfulness practice in any stage of our lives. First of all, there are countless resources explaining meditation for beginners that apply to seniors as well. If you're an older adult and this practice is new for you, you may be happy to learn that you can meditate on a chair, lying down, standing, or even walking. Here are a few simple meditation tips for seniors. If your mind is prone to wandering or tuning out, try simple guided meditations that take the guesswork out of these practices and that you can easily become familiar with. There are numerous guided meditations online and meditation apps are available. If you are able to maintain an upright sitting posture, this will help keep the energy of your mind focused. But if your body tires easily, try lying down or sitting in a comfortable chair and focusing on a series of physical sensations. One type of physical sensation mindfulness exercise is called the body scan mindfulness technique, and many options for this wonderful body scan exercise are available online. Another tip is to use short mini sessions. Mini sessions are recommended for seniors who find it difficult to maintain a physical posture or who find it difficult to focus for any significant length of time. And this is important for everyone to remember. Simply being present and aware during a few breaths, just a couple of minutes, is an excellent practice. One more tip. Finding a word or sentence such as a prayer, a motivational phrase or a mantra, something that speaks to you and you can come back to, is a form of meditation that can offset anxiety and may have spiritual or psychological benefits as well. Now, why should we meditate and practice mindfulness? We've talked about this a lot on the podcast, but here are some of the benefits we can gain from mindfulness practices, including the practice of meditation. Benefits for us in our senior years and at any age. Studies suggest that meditation can improve brain power. It enhances long and short term memory, enhances the ability to focus, and enhances resilience. The well documented stress reduction results of mindfulness practice come with a host of related physical benefits, including lower blood pressure and inflammation. Psychological benefits may include a sense of well being, an improved
Valerie Milburn: ability to cope with loneliness and sadness, and increased empathy. And I want those benefits now and I want them for all the rest of my years.
Helen Sneed: Oh, thank you Valerie. That was fascinating. Here we are. We are immensely grateful to Cherie and to all of you listening for being with us to learn more about our shared humanity, which I think is really what this is all about. And in our next episode we'll have two guests from the music world who have amazing stories to tell about their struggles along the path to recovery. We'll explore the much debated roles that mental health and substance use disorder play in the life of the artist, their work and the creative process. And we'll have the chance to explore the healing power of music in song.
Valerie Milburn: Yes, we're going to have, we're going to have Anders Osborne and Ben Anderson, so don't miss the next episode.
Helen Sneed: Yeah, it's going to be great. And in the meanwhile, before you join us in this next one, let us hear from you. Our email is so easy. It's mental healthhopeandrecoverymail.com and we would like to learn from your comments and questions because we want to get better at this and we also would love to hear from you in another way and that's by having you rate and review us on whatever platform you're listening on now. This helps other listeners find us so that we can share our hope and recovery with the widest audience possible. And so thank you so much and I leave you with our favorite word, Onward.