WEBVTT - Anxiety In The Elderly 0:00:08.520 --> 0:00:11.360 This is the Anxiety Bites podcast and I am your host, 0:00:11.520 --> 0:00:18.439 Jen Kirkman. Welcome to another episode of Anxiety Bites. I 0:00:18.480 --> 0:00:23.159 am your host Jen Kirkman. Today I am talking to 0:00:23.520 --> 0:00:27.720 Dr Sharon Orange. She is an associate Professor of Medicine 0:00:27.760 --> 0:00:32.280 at keech USC and she also has a private practice 0:00:32.600 --> 0:00:36.559 um as an internist, and I have linked to an 0:00:36.640 --> 0:00:38.520 article that she wrote I've linked to in the show 0:00:38.560 --> 0:00:44.239 notes about what anxiety looks like in older adults and 0:00:44.520 --> 0:00:49.479 in the elderly. A lot of you had emailed me 0:00:49.760 --> 0:00:53.120 that you would love to do what you would love 0:00:53.200 --> 0:00:57.440 to listen to an episode about anxiety in the elderly, 0:00:57.520 --> 0:01:00.880 because I think a lot of us noticed maybe some 0:01:00.960 --> 0:01:03.960 changes in our parents or older family members, older friends, 0:01:04.000 --> 0:01:08.480 older people in our life during the early lockdown parts 0:01:08.520 --> 0:01:11.080 of the pandemic, and then of course still continuing on 0:01:11.120 --> 0:01:13.480 to today, as certain things that we may take for 0:01:13.520 --> 0:01:20.280 granted that tend to help us cope with everyday anxiety. 0:01:20.400 --> 0:01:25.160 And you know, lift our moods is is social interactions, 0:01:25.760 --> 0:01:31.039 lack of isolation, obviously being free of disease or free 0:01:31.080 --> 0:01:36.560 of fear of disease. And I think all of us 0:01:36.600 --> 0:01:42.440 experienced an optick of that and still aren't as the 0:01:42.440 --> 0:01:46.200 pandemic still goes on. But I think for the first time, 0:01:46.200 --> 0:01:49.080 a lot of people realized, oh, I don't know how 0:01:49.080 --> 0:01:51.640 to talk to my parents or anyone elderly in my 0:01:51.680 --> 0:01:55.960 life about their anxiety, and so I thought I would 0:01:56.480 --> 0:01:59.120 definitely make this episode happen, and I'm glad that I did. 0:01:59.600 --> 0:02:05.160 Um So, I talked to Dr Sharon Orange about everything 0:02:05.200 --> 0:02:08.760 that she's noticed from from working with patients. Again, she's 0:02:08.840 --> 0:02:11.920 a not a psychiatrist, but she works as a medical 0:02:12.000 --> 0:02:16.640 doctor and has a ton of insight into how anxiety 0:02:16.720 --> 0:02:23.640 presents in the elderly population, something that I don't know, 0:02:23.800 --> 0:02:26.720 this might make you feel better about. You know, if 0:02:26.960 --> 0:02:30.160 if you get to live to an older or elderly age, 0:02:30.240 --> 0:02:36.160 that anxiety, in terms of generalized anxiety disorder or certain 0:02:36.160 --> 0:02:41.520 phobias and panic disorders, that tends to sort of just 0:02:41.520 --> 0:02:46.079 start to go away as you get older. And it's 0:02:46.240 --> 0:02:49.720 very rare that an elderly person would suddenly develop panic disorder. 0:02:49.720 --> 0:02:52.760 And it all has to do with just the way 0:02:52.760 --> 0:02:56.600 that our body ages and that you know, in Layman's terms, 0:02:56.639 --> 0:02:59.360 things just tend to slow down and they're not as reactive, 0:02:59.400 --> 0:03:02.680 and so you have that to look forward to. If 0:03:02.800 --> 0:03:04.560 you know there's other things about getting older you're not 0:03:04.600 --> 0:03:07.760 looking forward to, well, if you're a panicky person, they 0:03:07.840 --> 0:03:11.880 might start to lessen. But this is a great episode 0:03:11.919 --> 0:03:16.400 because again, you may be elderly yourself someday. You may 0:03:16.440 --> 0:03:18.840 be elderly right now listening to this, Or you may 0:03:18.880 --> 0:03:21.840 have someone in your family that you want to talk 0:03:21.880 --> 0:03:26.040 to about their anxiety that you've noticed. And obviously you're 0:03:26.040 --> 0:03:27.919 doing that because you love them and you want them 0:03:27.919 --> 0:03:30.480 to realize that there's help out there. But a lot 0:03:30.520 --> 0:03:33.560 of times we can push people away that we care 0:03:33.600 --> 0:03:40.000 about by our approach, and so our homework is understanding 0:03:40.080 --> 0:03:45.120 and learning about how best to approach this topic with 0:03:45.160 --> 0:03:48.960 somebody as you try to get them the information that 0:03:49.040 --> 0:03:51.840 you think they need about anxiety. So this is a 0:03:51.880 --> 0:03:56.480 good primer on how to do it, what to look for, 0:03:57.520 --> 0:04:02.960 and maybe learning about what someone older or elderly is 0:04:03.160 --> 0:04:07.320 and probably isn't going through when you think about their anxiety. 0:04:07.480 --> 0:04:11.119 So I'll just stop talking and we'll get right into 0:04:11.120 --> 0:04:17.279 the episode. You'll learn as much as I did. The 0:04:17.360 --> 0:04:19.560 people who wrote in their parents are not saying I 0:04:19.680 --> 0:04:22.000 have anxiety? What do I do? It's like the parents 0:04:22.000 --> 0:04:24.200 are doing nothing about it. They're probably not even admitting 0:04:24.200 --> 0:04:26.000 it from what I can gather from these letters. And 0:04:26.040 --> 0:04:29.680 so I mean, just starting there before we get into 0:04:29.720 --> 0:04:33.040 all the details of elderly people in anxiety, it's kind 0:04:33.080 --> 0:04:35.719 of tough to start with. How do we help people 0:04:35.760 --> 0:04:39.320 that may not want it think they need it? You know, 0:04:39.360 --> 0:04:41.760 we were would even begin if someone has anxious parents, 0:04:41.760 --> 0:04:45.440 how do they broach that conversation? So that is exactly 0:04:45.480 --> 0:04:49.320 the right question, and and your listeners are right to 0:04:49.320 --> 0:04:51.520 be confused by it, and they're also right to want 0:04:51.520 --> 0:04:55.480 to get involved. And here's why. Only one in five 0:04:56.120 --> 0:05:00.800 older adults brings up mental health concerns to need professional 0:05:00.880 --> 0:05:03.919 so any their primary care doctor or mental health professional. 0:05:04.400 --> 0:05:07.640 So only one in five will initiate the conversation on 0:05:07.680 --> 0:05:11.040 their own of our older adults over sixty, So family 0:05:11.040 --> 0:05:14.160 members are right to want to get involved. But it's tricky. 0:05:14.279 --> 0:05:15.880 I mean, as you you just hit the nail on 0:05:15.920 --> 0:05:18.880 the head. It's hard to talk to an older person 0:05:19.000 --> 0:05:21.320 about their mental health, particularly if it was someone that 0:05:21.360 --> 0:05:25.040 you've always looked up to and relied upon. And the 0:05:25.080 --> 0:05:27.880 flip side of that is for my older folks, when 0:05:27.920 --> 0:05:32.279 we're in the office. You know, they also worry that 0:05:32.279 --> 0:05:34.200 that their family members are going to lose faith in 0:05:34.240 --> 0:05:37.440 them if they see that they're not coping. So it's 0:05:37.480 --> 0:05:42.080 it's two sided. And I think for family members who realize, yes, 0:05:42.160 --> 0:05:45.000 I need to initiate the conversation because my older parents 0:05:45.080 --> 0:05:47.440 not going to do it on their own. It's obvious 0:05:47.480 --> 0:05:51.120 to be patient and compassionate and talk openly with them 0:05:51.160 --> 0:05:54.360 about what you think is going on. The mistake that 0:05:54.400 --> 0:05:57.839 we make is to try and help and not respect 0:05:58.200 --> 0:06:00.919 their independence. So the big mistake I see and I 0:06:00.960 --> 0:06:04.160 take care of families is Mom, you're depressed. You need 0:06:04.160 --> 0:06:06.360 to see your doctor and you need something for it. Mom, 0:06:06.400 --> 0:06:08.800 you have anxiety. Dad, you have anxiety and it's a 0:06:08.800 --> 0:06:10.800 problem and you need to go fix it. So yeah, 0:06:11.320 --> 0:06:14.000 and trust me, like that's my instinct two of my parents, 0:06:14.000 --> 0:06:17.880 and we really have to control that because that's not effective. Yeah, 0:06:17.880 --> 0:06:19.839 it's tough because I mean, for me, I have a 0:06:19.839 --> 0:06:21.880 good relationship with my parents. They're eighty three, and that's 0:06:21.880 --> 0:06:25.360 how we talk. There's no warming up, gently talking the 0:06:25.400 --> 0:06:27.200 way I might be a little more formal with someone 0:06:27.200 --> 0:06:30.599 I don't know very well. And you know, I don't know. 0:06:30.800 --> 0:06:33.200 I'm sure not everyone has this kind of informality with 0:06:33.240 --> 0:06:35.440 their parents, but that's you know, I just don't have 0:06:35.520 --> 0:06:37.839 time to be like, so, how you feeling, you know, 0:06:37.880 --> 0:06:40.320 I would just be like, oh, that's anxiety. You've always 0:06:40.360 --> 0:06:43.240 had it, you know. So you're exactly right. And I 0:06:43.279 --> 0:06:46.520 think that you have to just retrain yourself to to 0:06:46.720 --> 0:06:49.920 come in, you know, to focus on the changes you've noticed, 0:06:50.279 --> 0:06:52.440 and to come in and say I care about you, 0:06:52.520 --> 0:06:55.040 I'm worried. These are the things I've seen. You don't 0:06:55.040 --> 0:06:57.919 seem like yourself. You seem more tired than usual. I 0:06:58.040 --> 0:07:01.600 notice that your sleep seems disrupted, You're irritable. You have 0:07:01.680 --> 0:07:03.600 to come at it that way because you and I 0:07:03.680 --> 0:07:06.479 Jen have the same instinct to come in problem solve. 0:07:06.560 --> 0:07:08.440 You have anxiety, need to take a medication for it, 0:07:08.839 --> 0:07:11.240 but it's not gonna work because I take care of 0:07:11.240 --> 0:07:12.920 the older folks and I hear from them, it's not 0:07:12.960 --> 0:07:16.560 going to work that way. So we really have to say, hey, 0:07:16.720 --> 0:07:20.360 mom or dad, having anxiety or depression is like any 0:07:20.360 --> 0:07:22.920 other health issue, and it will affect how you feel. 0:07:23.440 --> 0:07:25.320 I'm not sure what's going on, but I think their 0:07:25.400 --> 0:07:28.360 treatments available. Let's go to your doctor together and talk 0:07:28.400 --> 0:07:31.440 about it. This is more of a comment than a question. 0:07:31.480 --> 0:07:38.040 But it's odd. I guess it's the word that you know, 0:07:38.120 --> 0:07:41.880 most people under I'll just say under fifty, most kids 0:07:42.280 --> 0:07:44.640 of parents who are still alive. And these kids that 0:07:44.680 --> 0:07:48.280 are under fifty, we have a totally different relationship to 0:07:48.280 --> 0:07:51.960 mental health. It's still nowhere near as less stigmatized as 0:07:51.960 --> 0:07:55.600 it needs to be. But we I know for a fact, 0:07:55.680 --> 0:07:57.400 we would not lose faith in our parents if they 0:07:57.440 --> 0:07:59.080 had anxiety. We would not see it as a sign 0:07:59.120 --> 0:08:02.160 of weakness. And at the same time, I mean, as 0:08:02.200 --> 0:08:05.160 parents get older, we do lose the normal amount of 0:08:05.160 --> 0:08:06.960 faith in them, Like they're not going to help me move, 0:08:07.240 --> 0:08:10.280 you know, It's like there's things they can't do anymore. 0:08:10.280 --> 0:08:12.000 I don't expect them to cook a full things giving 0:08:12.040 --> 0:08:16.160 dinner or you know. But um so, in that sense, 0:08:16.240 --> 0:08:18.120 it's too bad that I guess they feel that way. 0:08:18.120 --> 0:08:20.480 Not odd, it's too bad because if anyone is going 0:08:20.520 --> 0:08:25.720 to understand it is this generation of adult children. Absolutely, 0:08:25.760 --> 0:08:28.360 and the way we speak about and think about mental 0:08:28.360 --> 0:08:30.840 health is much different than our older parents. And and 0:08:30.920 --> 0:08:34.800 so if talking about feelings is difficult for the older person, 0:08:34.840 --> 0:08:36.440 and I can tell you from doing this for twenty 0:08:36.480 --> 0:08:39.280 one years. It is. We just have to change the 0:08:39.320 --> 0:08:42.560 focus a little bit. And I know it's not our 0:08:42.640 --> 0:08:45.080 instinction as and I'm older than you, but as are 0:08:45.120 --> 0:08:47.920 the younger generation. But we really have to reframe it 0:08:48.280 --> 0:08:50.800 and come to them and say mom or dad, how 0:08:50.840 --> 0:08:52.440 can I help you? You know, can I do the 0:08:52.440 --> 0:08:54.840 shopping for you? I'm here, You've taken care of me 0:08:54.920 --> 0:08:57.719 for so long. I'm here to help. We can't come 0:08:57.760 --> 0:08:59.800 in and go how are you feeling? Do you think 0:09:00.120 --> 0:09:03.640 have some anxiety symptoms? It's just not going to be 0:09:03.679 --> 0:09:05.800 the effective way to do it. It's you know, at 0:09:05.840 --> 0:09:08.200 least not as a starter. I think we need to 0:09:08.240 --> 0:09:11.200 start and change the focus from feelings to sort of 0:09:11.240 --> 0:09:13.960 the problems you've noticed and how you want to solve 0:09:14.000 --> 0:09:16.400 the problems really objectively. You know what, can I do 0:09:16.440 --> 0:09:18.840 the shopping for you? Um, let's hang out, you know, 0:09:18.960 --> 0:09:20.440 or I can do it on my own without you. 0:09:20.600 --> 0:09:24.880 Just really objective problem solving. It's like, don't boss them 0:09:24.920 --> 0:09:26.920 around and tell them what they have and you don't 0:09:26.960 --> 0:09:29.960 have to suddenly be like all touchy feeling and freak 0:09:30.000 --> 0:09:32.920 them out. It's like somewhere in the middle. But that's passionate. 0:09:33.000 --> 0:09:35.600 But but solutions, you know, right, we don't come in 0:09:35.640 --> 0:09:37.880 with a problem you have anxiety, you have a depression 0:09:37.920 --> 0:09:42.360 to come in with noticing changes that we've seen and 0:09:42.760 --> 0:09:44.840 things that we think we can do that will help 0:09:44.880 --> 0:09:46.560 that problem. But if we come in and say you 0:09:46.600 --> 0:09:50.400 have a problem, it's it's a non starter for most 0:09:50.480 --> 0:09:52.720 older adults. It may work in some but for my 0:09:52.760 --> 0:09:55.640 experience has been as a nonstarter. Yeah. I find that 0:09:55.679 --> 0:09:57.840 with my parents. I I mean, I don't know if 0:09:57.880 --> 0:09:59.520 I think they have anxiety or not. I have to 0:09:59.520 --> 0:10:01.319 be honest. I noticed it more when they were younger. 0:10:01.400 --> 0:10:05.199 I think they actually were people with anxiety, either disorders 0:10:05.400 --> 0:10:08.560 or just whatever anxiety. At times in the life, I 0:10:08.559 --> 0:10:12.720 I see them as less anxious maybe maybe Uh during 0:10:12.720 --> 0:10:15.480 the pandemic, I think my mom was kind of depressed, 0:10:15.520 --> 0:10:17.800 which you know, I understand because she was saying she 0:10:17.880 --> 0:10:19.800 was named. She was telling me that she was very 0:10:19.840 --> 0:10:23.199 sad at the way she felt the elderly people were 0:10:23.240 --> 0:10:25.520 being treated in the world, kind of like well, if 0:10:25.520 --> 0:10:27.240 you die, you die, or old anyway, you know that 0:10:27.280 --> 0:10:29.640 she felt kind of put out to pasture. And my 0:10:29.679 --> 0:10:32.000 parents are very active, more active than me, you know, 0:10:32.040 --> 0:10:35.160 I'm half their age, and they're like out and about 0:10:35.200 --> 0:10:38.200 at the casino every weekend, and so for my mom 0:10:38.200 --> 0:10:40.040 and dad to be stuck at side house for a 0:10:40.120 --> 0:10:45.360 year was challenging for them. Um. And you know, I 0:10:45.360 --> 0:10:48.800 don't think we'd have these in depth conversations about symptoms 0:10:48.800 --> 0:10:51.960 and this and that, but we do have those kind 0:10:51.960 --> 0:10:53.920 of conversations. And I find if I just sort of 0:10:54.720 --> 0:10:56.680 hug my mom, you know, I mean the way you 0:10:56.720 --> 0:10:59.360 always you know, hi, goodbye hugs, but just kind of 0:10:59.360 --> 0:11:01.600 out of the blue, like aw you doing? You know, 0:11:01.679 --> 0:11:04.200 I never do that, you know. I mean I do 0:11:04.280 --> 0:11:06.840 that now, but you know, maybe when she was fifty sixty, 0:11:06.880 --> 0:11:10.840 I wasn't doing that. But um, it does help. I've 0:11:10.920 --> 0:11:14.520 seen it where they talk about their feelings, and my 0:11:14.600 --> 0:11:17.320 dad has said things about being kind of, you know, 0:11:17.880 --> 0:11:21.480 addicted to the news, like that gets him all riled 0:11:21.559 --> 0:11:24.040 up in a way that makes them happy, he thinks, 0:11:24.080 --> 0:11:25.079 you know, and he's like, well, what else am I 0:11:25.120 --> 0:11:27.600 going to do? Him? All? Like you know that I 0:11:27.640 --> 0:11:30.720 can see the kind of almost like depression in them, 0:11:30.760 --> 0:11:35.240 and I don't try. I mean again, if I thought 0:11:35.240 --> 0:11:37.600 it was like really bad, I'd probably be more solution oriented. 0:11:37.600 --> 0:11:40.560 But I just sort of tried to validy because I 0:11:40.600 --> 0:11:44.600 would be depressed too. I mean, getting older, you know, 0:11:44.640 --> 0:11:47.880 time starts to go by really fast each year. And 0:11:48.000 --> 0:11:49.760 as my grandmother used to always say to me, she 0:11:49.760 --> 0:11:54.840 lived until getting older stinks because your mind is is 0:11:54.920 --> 0:11:56.720 just as active as it wasn't. You're younger, but you 0:11:56.720 --> 0:12:00.760 can't move anything. And and so anyway, all this to 0:12:00.840 --> 0:12:04.880 say that I find that just validation can really help 0:12:05.320 --> 0:12:08.320 um if it's kind of a more mild thing where 0:12:08.320 --> 0:12:11.240 it's like intermittent, you know, depression, or just those moments 0:12:11.280 --> 0:12:13.839 where they're like, God, I feel older, I feel embarrassed 0:12:13.840 --> 0:12:16.640 that I can't help you with this, or that you're 0:12:16.679 --> 0:12:19.000 exactly right. You said two things that are perfect, and 0:12:19.000 --> 0:12:20.800 I don't know if you know how perfectly you've done this. 0:12:20.960 --> 0:12:22.839 You said no, you just say to them, how are 0:12:22.840 --> 0:12:24.839 you doing? Or you just say come here, I'm just 0:12:24.880 --> 0:12:27.160 gonna give you a hug. You're doing You are giving 0:12:27.200 --> 0:12:30.240 them the soft open space to fall right to come 0:12:30.280 --> 0:12:33.200 to you and say, hey, the pandemic has been really 0:12:33.240 --> 0:12:36.400 hard for us, increasing social isolation. I don't know how 0:12:36.440 --> 0:12:37.960 you know more than a third of my patients are 0:12:38.200 --> 0:12:40.600 over the age of sixty five. I don't know how 0:12:40.640 --> 0:12:42.640 they came through this. It's for our kids. It's the 0:12:42.679 --> 0:12:45.600 same way, but the isolation, you know, for my newly 0:12:45.640 --> 0:12:48.840 widowed older patients who were at home alone, I don't 0:12:48.840 --> 0:12:51.680 know how they got through this. What you've done is perfect, 0:12:51.720 --> 0:12:54.000 which is really just to to give them a soft 0:12:54.000 --> 0:12:58.199 place to fall with their conversations and their concerns. And 0:12:58.440 --> 0:13:01.240 that's really half the battle right there, because then your 0:13:01.280 --> 0:13:04.040 mom is going to say, Jim, this has kind of 0:13:04.080 --> 0:13:06.920 sucked for us. Yeah, and I am feeling blue, but 0:13:06.960 --> 0:13:08.520 I know there's a light at the end of the tunnel, 0:13:08.520 --> 0:13:11.199 and there's the conversation. And then you would say to them, 0:13:11.240 --> 0:13:14.240 if it wasn't getting any better, you'd say, you're not alone. 0:13:14.800 --> 0:13:17.120 We can go get help. This is something we can 0:13:17.200 --> 0:13:19.640 modify or treat. You know, if you started to notice 0:13:19.640 --> 0:13:22.840 that either of your parents was really struggling. If people 0:13:22.840 --> 0:13:24.839 have a good relationship with their parents where they kind 0:13:24.880 --> 0:13:27.640 of know them the way you know yourself, I think 0:13:27.679 --> 0:13:31.040 you can. Right, would you suggest, like, just do something 0:13:31.080 --> 0:13:33.640 if if it takes the bird enough, do their shopping, 0:13:33.880 --> 0:13:36.960 clean their house. Just don't even ask because sometimes they 0:13:36.960 --> 0:13:40.680 won't answer you. Right A thousand percent and presented exactly 0:13:40.679 --> 0:13:43.079 what you did. Don't say, hey, mom or dad, do 0:13:43.120 --> 0:13:45.200 you I'm gonna go shopping for you. Say I'm at 0:13:45.280 --> 0:13:49.120 the store chicken or steak, whole, milk or so, do 0:13:49.160 --> 0:13:51.120 it like that. And you did the same thing. I'm 0:13:51.160 --> 0:13:53.840 booking you. You know, first class, you like aisle or window, 0:13:54.120 --> 0:13:57.000 so do it like that. And and because if we 0:13:57.040 --> 0:13:59.440 walk into our parents and say because remember these are 0:13:59.480 --> 0:14:02.079 the people we relied on who raised us, And if 0:14:02.120 --> 0:14:04.000 we say, do you want me to go to this 0:14:04.120 --> 0:14:05.880 store for you, They're not going to answer it in 0:14:05.880 --> 0:14:08.880 the affirmative. So we have to just do what you 0:14:08.880 --> 0:14:10.800 you have great instincts about this, but we have to 0:14:10.840 --> 0:14:13.280 do exactly what. And the patients who sit in my office, 0:14:13.280 --> 0:14:16.040 the older patients say to me, I don't want to 0:14:16.040 --> 0:14:18.040 put out my I don't want to put my daughter 0:14:18.080 --> 0:14:20.520 out I you know she's spending all her time on me. 0:14:20.960 --> 0:14:23.440 You know, they are worried that we are spending our 0:14:23.480 --> 0:14:25.880 time on them. But if you say I'm at the 0:14:25.920 --> 0:14:28.640 store you like whole or two percent, wellcome coming by then, 0:14:28.720 --> 0:14:30.440 or I'm ordering it for you a whole or two percent. 0:14:30.800 --> 0:14:33.200 So you we just make the decisions and make it 0:14:33.280 --> 0:14:36.240 happen and take it off their plate. Is there anything 0:14:36.280 --> 0:14:39.080 to like I just was kind of came up with this, like, 0:14:39.280 --> 0:14:42.840 is there anything to grief um being the thing underneath 0:14:42.880 --> 0:14:46.600 it all that causes the irritability or something. Well, I 0:14:46.640 --> 0:14:49.120 think there is. There's a there's a change in role. 0:14:49.320 --> 0:14:52.040 So I would say the grieving is about the differences 0:14:52.040 --> 0:14:54.840 and roles. Right, So, all of a sudden, the parent 0:14:55.800 --> 0:14:58.440 is you know, who was the patriarch of the matriarch 0:14:58.560 --> 0:15:01.080 now is concerned that they will become a burden to you, 0:15:01.200 --> 0:15:04.560 to their families. They also feel slightly misunderstood by the 0:15:04.640 --> 0:15:07.080 quote unquote younger generation. That's what I hear over and 0:15:07.120 --> 0:15:10.920 over again in the office. And they really feel like 0:15:11.000 --> 0:15:14.920 they'll be treated differently if they admit to not coping. Well, 0:15:15.360 --> 0:15:17.400 So if we talk about grieving, I would say they 0:15:17.400 --> 0:15:20.200 grieve the role, right, the role of losing I'm the 0:15:20.240 --> 0:15:23.480 matriarch on the patriarch and now I'm depending on gent 0:15:23.640 --> 0:15:26.200 you know, my son or daughter. And I think similarly 0:15:26.400 --> 0:15:29.200 for the for us, these are the people that we 0:15:29.320 --> 0:15:31.400 looked up to, These are the people that raised us. 0:15:31.440 --> 0:15:34.240 And we start to say, huh, are we changing roles? 0:15:34.280 --> 0:15:37.800 Where we are the caretaker, and so yes, the grieving 0:15:37.800 --> 0:15:40.040 and sort of bereavement, I would say, is related to 0:15:40.080 --> 0:15:43.440 the change in roles that occurs naturally. And I think 0:15:43.880 --> 0:15:46.360 once we just flow into it and have open conversations 0:15:46.400 --> 0:15:49.240 about it, it's it's really nice. And then, you know, 0:15:49.240 --> 0:15:52.400 because what you said. Older adults in my office say 0:15:52.400 --> 0:15:54.680 to me, this just happened to me yesterday. Every day 0:15:54.720 --> 0:15:56.520 they say, I don't want to be a burden to 0:15:56.520 --> 0:15:59.440 my children. If I haven't finished the sentence, doctor, the biggest, 0:15:59.480 --> 0:16:01.360 one of the biggest, as I'm worried about getting older. 0:16:01.720 --> 0:16:03.840 They finished the sentence and they say, being a burden 0:16:03.960 --> 0:16:07.120 to my children, and I, you know, through tears makes 0:16:07.160 --> 0:16:09.840 me choked up. But through tears I say to them, 0:16:09.880 --> 0:16:12.320 this is what we're here for. We we are desperate 0:16:12.320 --> 0:16:14.120 to help you out. You did it all these years. 0:16:14.760 --> 0:16:16.520 We want to help you out. And I try and 0:16:16.560 --> 0:16:19.680 say them, as their doctor, your family members are here, 0:16:19.720 --> 0:16:22.200 the people who love you are dying to surround you 0:16:22.280 --> 0:16:25.400 and help you out. But it's really hard to get 0:16:25.400 --> 0:16:28.160 our older folks to accept that help. Yeah. I mean, 0:16:28.240 --> 0:16:29.720 I don't have kids in my own and I don't 0:16:29.720 --> 0:16:32.520 want to, and I'm I'm living in New York right now. 0:16:32.520 --> 0:16:35.080 My families in Massachusetts, and I'm sort of living on 0:16:35.120 --> 0:16:37.720 both coasts. But I'm like, you know, eventually, I mean, 0:16:37.720 --> 0:16:39.600 I prefer the East coast, but I'm like, I think 0:16:39.600 --> 0:16:41.960 I'll move back to New York permanently so I can 0:16:41.960 --> 0:16:43.600 be closer to my family and as they're getting older. 0:16:43.600 --> 0:16:45.640 I've never said that out loud to them, you know 0:16:45.680 --> 0:16:48.240 what I mean. Isn't that funny? And you know, with COVID, 0:16:48.280 --> 0:16:50.600 a lot of people moved back home, you know, and 0:16:50.600 --> 0:16:52.960 and start to say, wait, why aren't I staying closer 0:16:52.960 --> 0:16:55.560 to my parents? A lot of folks, I think think 0:16:55.640 --> 0:16:58.320 the way you do and haven't articulated it. And that's okay. 0:16:58.400 --> 0:17:02.360 And that's why this sentence, you know you've always helped me. 0:17:02.720 --> 0:17:06.199 I think it's time I helped you out is really 0:17:06.240 --> 0:17:08.560 affective for the older people I take when they hear 0:17:08.560 --> 0:17:11.919 that from their sons and daughters, it's really effective that 0:17:12.040 --> 0:17:14.600 one sentence. If you said I'm going to move closer 0:17:14.600 --> 0:17:16.480 to you, you'll watch your parents will say, I don't 0:17:16.480 --> 0:17:18.359 know that worked for you. I don't is that okay? 0:17:18.400 --> 0:17:21.080 Is that okay? But you just say you've always helped 0:17:21.080 --> 0:17:22.640 me out? It's time for me to help you out. 0:17:25.560 --> 0:17:33.600 We'll be right back. So I wanted to ask you 0:17:33.680 --> 0:17:37.320 just some like factoids that I got from reading your article. 0:17:37.400 --> 0:17:40.479 So let's say an elderly person is experiencing some anxiety. 0:17:40.480 --> 0:17:42.199 It's not that they have an anxiety disorder, but for 0:17:42.240 --> 0:17:45.159 whatever reason, they're experiencing anxiety. But they're not going to 0:17:45.200 --> 0:17:49.280 go to therapy necessarily, um because you know, maybe that's 0:17:49.280 --> 0:17:51.840 just not what they need. What are some like great 0:17:51.920 --> 0:17:54.600 coping tools? Is it different for seniors than it is 0:17:54.640 --> 0:17:57.879 for everybody else? Yes, So you know, we think of 0:17:57.920 --> 0:18:00.960 coping mechanisms for you and I. We think of support 0:18:01.000 --> 0:18:04.960 from others, you know, being social, going out or engaging activities. 0:18:05.520 --> 0:18:08.440 And if I'm an older person, either you know, living 0:18:08.440 --> 0:18:11.360 in a skilled nursing facility, or I'm not driving anymore, 0:18:11.400 --> 0:18:15.320 I have limited mobility, you know, limited physical activity, I'm 0:18:15.320 --> 0:18:18.919 not surrounded by the people who love me. Those coping 0:18:18.920 --> 0:18:21.240 mechanisms are going to be much different the way that 0:18:21.440 --> 0:18:25.480 I approached this conversation with my sixty five and over 0:18:25.520 --> 0:18:28.360 group who's experienced in some anxiety, instead of saying, hey, 0:18:28.359 --> 0:18:30.960 get on the headspace appter the aura app because they're 0:18:30.960 --> 0:18:33.480 gonna look at me like I'm crazy, as I say, 0:18:33.600 --> 0:18:36.480 we're going to go after this, these these anxiety symptoms 0:18:36.520 --> 0:18:39.880 the same way we go after preserving memory. So it's 0:18:39.880 --> 0:18:43.560 like brain health because older folks are afraid of dementia 0:18:43.720 --> 0:18:46.720 and memory issues, and we know that anxiety is tied 0:18:46.760 --> 0:18:49.840 to that. So anxiety disorders are a risk factor for 0:18:50.160 --> 0:18:53.439 memory and cognitive decline issues. So I'll say to my 0:18:53.480 --> 0:18:56.840 older folks, here's the multi pronged approach we're going to 0:18:56.960 --> 0:19:00.080 use to combat some of your anxiety, and it's going 0:19:00.119 --> 0:19:03.080 to help your brain and your memory as well. So 0:19:03.320 --> 0:19:06.840 no real magic here, but exercise. So both aerobic and 0:19:06.920 --> 0:19:10.240 strength training. That's real, that's not voodoo. And you can 0:19:10.320 --> 0:19:13.640 be you know, God bless you in a wheelchair and 0:19:13.680 --> 0:19:16.520 I can find home physical therapy or home occupational therapy 0:19:16.640 --> 0:19:19.480 is going to give you an exercise regimen. So exercise, 0:19:19.560 --> 0:19:23.959 both aerobic and strength training. Mindfulness, that word means nothing 0:19:24.119 --> 0:19:27.239 to my older patients. So you have to say, what 0:19:27.280 --> 0:19:30.040 does mindfulness mean for you? How do you have quiet 0:19:30.080 --> 0:19:33.080 time in your space and your head alone, whether it's 0:19:33.320 --> 0:19:37.440 you know, prayer, hot bads, candles, what you know, time 0:19:37.480 --> 0:19:41.400 and nature walking, So mindfulness, whatever it means to them. 0:19:41.440 --> 0:19:43.879 And then you know, the third thing really is cognitive training, 0:19:43.880 --> 0:19:45.800 and by that we mean, you know, using your brain 0:19:45.840 --> 0:19:50.760 in different ways. So coping mechanisms for anxiety in older 0:19:50.840 --> 0:19:55.800 patients is really exercise, mindfulness, and cognitive training. Those are 0:19:55.800 --> 0:19:57.720 the things that have data to show us that they're 0:19:57.720 --> 0:20:00.560 going to help you lessen your anxieties and m and 0:20:00.840 --> 0:20:05.520 improve your memory and lower your risk of dimension cognitive decline. 0:20:06.240 --> 0:20:07.879 So if you're at home on your own and you're 0:20:07.920 --> 0:20:10.720 not working with you know, a therapist or some kind 0:20:10.760 --> 0:20:13.119 of I don't know what someone with the brain, like 0:20:13.160 --> 0:20:17.440 someone doing cognitive coaching, would that be like doing crossword 0:20:17.440 --> 0:20:19.280 puzzles or some kind of you know those books they 0:20:19.280 --> 0:20:22.520 make for people who are trying to get their brain 0:20:22.560 --> 0:20:26.719 functions exactly, you know, like stroke or something. Right, it's 0:20:26.840 --> 0:20:28.760 using your brain in a different way. So if I 0:20:28.800 --> 0:20:31.920 was an accountant and I was retired, doing my taxes 0:20:31.960 --> 0:20:34.280 won't count for this, right, So it'll be that's the 0:20:34.280 --> 0:20:36.040 example I always give. It will be using your brain 0:20:36.080 --> 0:20:40.480 in a new way. So puzzles, uh, learning basic Italian, 0:20:40.960 --> 0:20:43.639 joining a bridge group online, you know, something that you 0:20:43.720 --> 0:20:47.000 haven't done before, So training your mind to do new 0:20:47.040 --> 0:20:49.040 things you can also do. You know a lot of 0:20:49.080 --> 0:20:52.199