Episode Transcript
Dr. Lindsey Dahl:
They always think they’re alone in what they’re going through, but to remind them that everybody’s going through similar things and you can get together and talk about those things or just find something fun to do together.
Alan Helgeson (announcer):
This is the “Health and Wellness” podcast brought to you by Sanford Health. The conversation today is a discussion about helping older adults cope with aging. Our guests are Dr. Lindsay Dahl, internal medicine physician, and Lexie Eubanks, integrated health counselor, both with Sanford Health in Fargo, North Dakota. Our host is Mick Garry with Sanford Health News.
Mick Garry (host):
What are some of the things that, with mental health and aging, what are some of the main points? What are the things that you talk to older people about?
Dr. Lindsey Dahl (guest):
There’s certainly lots of things we are going through. Lots of life changes, right? So, you can start at retirement, which I think is a huge life change, and a lot of important things need to happen then to, I think, be successful in aging. So not only managing your multiple chronic diseases you may have, then navigating finding a purpose and keeping your mind going and figuring out what you’re going to do with your day.
The thing that makes me most nervous is when I ask what matters most, or what somebody is doing with their day and they say sitting and watching TV, that’s a big red flag to me. So, I think that’s a big thing to navigate.
And then certainly there’s caregiving as we get older, you maybe take on a caregiving role of a spouse. There’s death of friends and family. There’s dealing with the changes in, in your ability to do the things for yourself and be independent. So, I think it’s a whole range of changes and different steps that we have to go through and lots of areas where we can have problems navigating and need help and interventions.
Lexie Eubanks (guest):
I would very much agree with, especially with retirement, that’s a huge time. I always call that, you know, adjusting to a new normal, right? Where our lives just look so different. And even just aging as a whole, right? We’re always just having to adjust and adjust. And so, looking at mental health from the lens of being an older person or growing older is we’re having to, yeah, adjust our entire lives around these changes in our physical abilities, losses that we experience, finding purpose, like Dr. Dahl said, that’s a huge one there too.
So, sometimes we have to get a little bit creative in that time in our lives of how we’re going to ask for support and then be willing to receive the support when it’s there.
Mick Garry:
Finding purpose after retirement, which is something you both mentioned. Could you give me a little nitty-gritty on that? What is that challenge? And maybe some typical issues and ways that you try to get out of – if it’s a funk, or, I don’t know how you would define that professionally. But just making sure that you can kind of get through that as best you can. How do you go about doing it?
Dr. Lindsey Dahl:
I think it’s hard, right? We identify either as being a parent, and your kids go off to school, or the next thing you’re identify grounded in is your career and your job, right? So, I think that’s your purpose, right? So, when we retire, you have to find a new purpose. I think you have to – actually, a lot of people have to actively seek that out. What is your purpose?
And I think I’ve always sent people to the “Blue Zones” website, because I think they’ve done a good job at helping people learn to navigate and ask the right questions to what is my purpose now that I’m no longer working? And the one thing they talk about on the Blue Zones is the napkin test. It’s grab a cocktail napkin, on it write down the following simple recipe: G stands for gifts. So, G plus P plus V equals C.
So, G stands for gifts. The gifts that you’ve been given in your life. P stands for passion. So, things that you’re passionate about. And V stands for values. And then that equals C, which is your calling, or what you can find passion and values, and all those together are your calling. And what you can call your purpose.
And so, I think you have to just ask yourself the right questions to point yourself in the right direction to figure out your new purpose, which has probably always been there. But it’s just been directed in your job or raising your kids. And so, you have to direct those things somewhere else.
Photo by Sanford Health
Mick Garry:
How do you sell that as an idea? How do you get to where there’s some motivation involved that this is going to help you? How do you get there?
Lexie Eubanks:
I think a lot of exploration of our values, right? Our values are the building blocks to who we are, the things that we find important. So, a lot of those questions around what’s important to you, right? What makes your life feel fulfilled? And as we go through different areas, our times in our lives, our purpose often changes.
And so, you know, I think that that’s a great place to start is really exploring values and having discussions about, you know, the things that make you happy and how in this time in my life am I going to be able to integrate those things into my life, right? To make changes to the things that bring us joy just based off of whatever’s going on in our lives. And sometimes, I say a lot of the time, it’s getting back to the basics. Like, let’s get back to basics, right?
Productivity is a big thing too, I feel like when it comes to purpose, right? As we wrap a lot of purpose into productivity and vice versa, that when we go to work every day, or if we’re caring for our children or even caring for another loved one, we’re feeling productive, right? We’re feeling like we’re contributing to the world around us, to our lives.
And so, whenever we no longer have those things, the productivity – we don’t feel as productive, right? So, looking at productivity through a different lens of, OK, what am I doing in my day-to-day that is still productive just with a different expectation than what it was when I was working full time, right? So, it can really affect our self-esteem, how we feel about ourselves whenever we’re not feeling that productivity piece when we don’t feel as valuable. So, purpose, right? That circles wrapped into, OK, my purpose here was being productive. Well, how can we now be looking at purpose in a different way?
Mick Garry:
I think it would also be connected here that this next one, but staying social, what goes into staying social? I mean we’re all social people, and it’s a quality for all of us regardless of age. That’s a huge piece of happiness. Maybe what are some specific challenges involved once you’re a little bit older? And how do you make sure you stay engaged? That social piece of your life is in order?
Dr. Lindsey Dahl:
That’s hard. Especially when we’re limited in mobility. It’s more difficult to go out. Whether we have heart failure or COPD and you know if some of our health conditions make getting outside of the house more difficult, if we’re no longer driving because we’ve chosen that, or felt like we’re not safe driving. I think then our world becomes very small. And there’s been lots of studies, right? Especially after COVID, that isolation and loneliness only worsen our medical conditions and lead to depression and cognitive changes.
So being social is very important, but it can be very difficult. I think you have to seek out ways to overcome those obstacles, right? And a lot of times that’s moving to a senior housing where they have social life built in, or looking into all the different kind of senior ride opportunities that they are, and that can be a lot in Fargo-Moorhead, but a little in the more rural areas.
There’s certainly senior centers in most communities. And seeking out the senior centers and doing the activities that they have there. But it’s hard to find new friends. And oftentimes, it’s difficult when we’re losing friends to find ways to meet new people. So, I think you just have to go again on what your purpose, what your interests are, and then seek out those opportunities.
Volunteering, I think there’s so much value in kind of multi-generational volunteering. So, whether it’s at schools or hospitals where you can be valuable and you gain something as well from helping out, whether it’s elementary or – my father volunteered at a university level. He wasn’t a professor, but he was an engineer. So, he went back and did some things volunteering at the university level. So, you can find those things. You just have to be willing to seek them out, right?
There’s lots of different clubs and organizations. Start a book club, right? All these things can help keep you social – cards. But I think, oftentimes, the piece that’s missing is the ability to get yourself to those situations. And then I think it’s time to consider moving to a more senior housing where those things are kind of built in.
Mick Garry:
What’s your experience in motivating people and maybe, appreciating, making sure they appreciate what may be intentional effort toward a greater social level? What can that mean for this person?
Lexie Eubanks:
Yeah. Well, and I think for one is really being able to identify how much it impacts our lives, right? When we don’t have that social piece as readily available to us. So, we’ll do a lot of discussion and exploring around, OK, how does this realistically fit into my life right now, right? What are some goals I can work toward to keep the social piece in my life? Or, maybe go a little bit outside of my comfort zone and trying something new.
So, keeping an open mind I think is a big one as well, of just, OK, we might have to be flexible in how we receive that social connection compared to how in other times in our life. So continued discussion on, OK, how do I keep that here? And then how do I keep myself, yeah, motivated, right? What are the things that are important to me collecting back on that, right? And that will then push us towards wanting to work through that goal.
You know, technology I think is great as well. It can be really intimidating too, especially maybe in the older generation where they hadn’t spent their entire lives with technology, right? But technology can be a great use of being able to stay social with your loved ones with FaceTime, Zoom. And not a whole lot of things came out great from COVID, but that is one thing is that we got really good about being able to utilize those different type of technology to keep connected with each other. So, that’s another too is kind of discussion around even technology safety, right? But then also just how can I utilize FaceTime, Zoom, all of those things to stay connected with those people that I care about if the mobility is really limited.
Dr. Lindsey Dahl:
Everybody’s in the same boat. So, you know, if you’re an 80-year-old, and you’re a widower, and you can’t get around, and you live in a place where older adults are: chances are the same kinds of things are happening to the next-door neighbor. And you guys, you know, get together and talk about it. So, I think we’re not alone. There’s people out there who are going through similar struggles, so why don’t you get together and play cards together? So that, I think one thing, they always think they’re alone in what they’re going through, but to remind them that everybody’s going through similar things and you can get together and talk about those things or just find something fun to do together.
Mick Garry:
One of the questions here, and I’m sure that you deal with this all the time, but, the transitioning from home to senior living. I know you both have alluded to it, the challenges there. But what are maybe some basic things as you’re making this significant transition from home to senior living, what are some things you should remind yourself of as you enter that part of your life?
Lexie Eubanks:
I think it can feel a lot like a big loss of independence, right? Just making this choice to move. And I think reframing the way that we look at a transition from home to senior living is that in a way, it’s really keeping your quality of life at the forefront and the biggest focus, right? That being in a setting where support can be available to you whenever you need them, is a way to continue living a safe, happy, likely healthier life based off of all the things that senior living type of setting could potentially offer.
So, for one, I think, looking at it differently instead of looking at it as a loss of independence of how, OK, the independence I’m going to be able to keep in my life because of this really, really big decision. I encourage folks when we start talking about a potential transition to start the process earlier than later because then you still feel a lot more of that sense of control of where I’m going to go. Being able to go on tours of the facility, be able to see what type of activities are offered so you really can make a good decision based off of your purpose, your importance, right? The things that are important to you in your life, being able to make the choice to – if you’re going to move somewhere that really aligns with your values and what’s important to you.
Dr. Lindsey Dahl:
I think this is a big challenge for a lot of people, is that they want to stay in their home. And I don’t know how many people who we’ve eventually got to move to the independent apartment in a senior facility or an assisted living facility when they got there, they thrive so much. I mean, everything was better, right? They ate better because they were eating socially, and who wants to cook for one person? And so, you start dwindling what you’re eating, right? So, you’re there and you have social meals, so you’re eating more, so you have more energy, you’re staying stronger, and you have a built-in social life. And so many people have commented to me, why did I wait so long to make that move? Because my quality of life is so much better at this place. So, we all don’t want to make that move, I think, because we’re thinking of it in the wrong way. And really it is adding to your quality of life.
Mick Garry:
How about keeping your mind sharp? And I know there are a lot of ways out there that accessible information that we have to this, but it seemed like it would always be something to remind yourself of that it’s not just a physical thing. That if there are exercises you can do every day that involve maintaining mental sharpness, when you’re talking to some people about that, what are you telling them?
Dr. Lindsey Dahl:
I think the biggest thing in literature for helping maintain cognition is exercise, daily exercise, a healthy diet. So, a heart-healthy diet is a brain-healthy diet. There’s been studies on berries, particularly blueberries. A half a cup of blueberries a day improves your cognition not only for study taking in younger people, but in preserving your memory throughout the aging process.
Staying socially and cognitively engaged. So, the worst thing for your brain is to be isolated and alone. You need to be using your brain.
And actually, the best activity is a complex movement activity. So, learning a new dance or yoga or tai chi where you’re having to incorporate your brain in complex movements.
Learning new things, right? We can all learn new things, we can all learn a new language, we can pick up the piano that we did as a child but haven’t done through our child-rearing years. So, all those things.
One important thing that I think we often forget is we need to have good hearing to maintain our brain function. So, if you are losing your hearing, you need to look into the hearing aids because that’s going to help preserve your brain function going on through the aging process.
So, I think all those are the most important. Getting good sleep and stress relief.
Mick Garry:
Lexie, anything to add to that?
Lexie Eubanks:
No, I think those are everything that Dr. Dahl mentioned are – I mean, we always joke and say, the best medicine is good food and exercise, right? Healthy food and exercise. And I tell a lot of my patients that we want to work through some of the stress that we have in our lives, or we’re dealing with certain symptoms of certain mental health diagnoses. We say, a great place to start is, what are we doing for exercise and keeping our bodies healthy, and what are we doing for food intake, right? To make sure we’re filling ourselves with the right things. And so, I mean, that’s kind of the surface level, right? The very bottom of where we want to start, right? With keeping our mind sharper. What are we eating? How are we moving our bodies? And then the social piece: how are we being able to still connect with others?
Photo by Sanford Health
Mick Garry:
Another one here, and this one hits close to home: my father is 87 and doing great, but my goodness, his wife, my mom, many of his best friends, are gone now and other family members. Is this a significant part of aging? I guess we assume that it is, but how do you get through that if you’re seeing these people leave all the time?
Lexie Eubanks:
Wow. Absolutely. It’s a very hard topic, right? And grief is not linear. It’s very complex. It’s a very personal journey. You know how you grieve the loss of one person in your life; you likely will grieve the loss of another person in your life completely differently. It’s really hard to even prepare for loss even when you anticipate it may be coming. So, I think a lot of it starts with just having compassion for ourselves when we are feeling all of the feels, right? Whenever we are on this grief journey, we have to have compassion for how we’re feeling. Because you experience a multitude of emotions, right? Anger, sadness, denial, sometimes relief, depending on the circumstances, right? And even that can feel really difficult to feel in a grief journey. So, starting with how can I be compassionate to myself whenever I am feeling this grief, right?
And kind of normalizing the emotions and the sense of, you know, grief is fairly universal and that everybody will likely lose someone in their lives. However, the way we grieve is all very differently. So, we have to give ourselves permission to feel the feels. We have to give ourselves permission to grieve, and we have to give ourselves compassion in those moments. You know, a lot of the time grief, if you’ve ever had a significant loss, you know that grief never really leaves you; you just grow around it, right? We just kind of figure out where it fits into our lives. So, it also definitely can have us look at our own mortality, right? Whenever we’re losing people around us who are similar in age to us. Maybe someone who’s got similar health conditions to us – we have to be really mindful to not get wrapped up in the what-ifs, right?
We can start trying to, I call it like, future telling, tell the future. We don’t have a crystal ball. We’re not able to see into the future and know what, you know, the outcomes are going to be. So, we have to be really mindful if we’re spending too much time in what I would call those anxious, what-if thoughts.
So, grief support groups are something I recommend a lot. Being a part of a support group and being around others who are maybe experiencing a similar type of grief can help you feel connected and feel a lot less alone in a journey that’s really, really deeply personal. So, and there’s a lot of challenges with loss, and being able to hear other people’s experiences can really help with processing through those really difficult times.
Mick Garry:
This is a kind of an open-ended question, as have been several of these, but is there a time when you should consider asking for additional help? How do you know? What are the signs? And, as much as you are able to realize it on your own that, OK, it’s time to change things, and my age has something to do with this.
Dr. Lindsey Dahl:
Most people know. They realize it in themselves. And family, I think, helps support those decisions and maybe often have to push in the right direction for increased support. But, it can be hard because people can be very stubborn, and their desire is to stay in their own home even though they’re struggling to keep the house together and to do the snow removal and the yard repair, right? So, it starts with just getting help with those things. And, you know, when you’re not able to shovel the walk anymore, so, either you hire out the help or you decide you’re going to move to a place that can help you do that.
It’s harder when family members don’t see it or don’t want to recognize it in themselves, and it’s your mother or father, and you’re having to watch them, and they don’t want to listen to what you have to say. That can be a much more difficult situation, and it’s what they want. And trying to show them the pieces that would make their life better if they chose a different route and got some help, right? If we got help in this area, then you would be able to do this, which matters to you, right? So, I think it’s a lot of reframing to show what more supports or different living situations, what you would gain from that, right?
Lexie Eubanks:
And asking for help doesn’t take your autonomy away. If anything, it keeps you in control. Help comes in lots of different shapes and sizes, and you don’t really know what’s available out there to you for support unless you’re asking. So, again, kind of reframing of when I’m asking for help, it’s not because I’m defeated, right? Or that I’m giving up control over my life and my decisions by asking for help. That’s keeping you in control, right? And then we circle back to quality of life. What’s going to give me a good quality of life? That sometimes, it does come down to, I’ve got to ask for some help here so that I can continue to do the things that are important to me.
Mick Garry:
If you are a loved one, and you see issues here that your loved one is not probably realizing as well as they should, that it’s time for these types of changes. What are some basics involved? If you’re a, let’s say, a son or a daughter and you want to have this conversation, and I know that’s a long one and it’s a complex one, but maybe some basics on how to approach that.
Dr. Lindsey Dahl:
I think the biggest thing is sitting down and having those conversations and saying, look, we want to keep you as independent and healthy as possible, and we’re seeing some of these things that concern us. So, how can we help you address those to keep you doing as well as you are, right?
Sometimes, I think, it’s definitely going to the medical appointments with your loved ones. Asking them who you can come along so that you can help support them and be there for them. So hopefully they’re open to that. But going along to medical appointments, knowing what medications they’re on, and not because you’re taking those things over and you don’t think they have control and are doing the right things, but just so that you are aware and can help support should something change, right?
Mick Garry:
Just not being able to do some of the things that you used to be able to do and the frustration that would come with that. And then perhaps some level of depression involved in just seeing these things – seeing your whole life, all of a sudden, you’re not able to do them. How do you attack that?
Lexie Eubanks:
There’s been different times in all of our lives where what we were able to do in our 20s and 30s we might not even have been able to do in our 40s and 50s compared to now, maybe in our 80s, right? And so, we’ve done a lot of adjusting throughout the lifespan. It just maybe didn’t feel as heavy as it is now in this time in our lives.
And so, think some reflection back of, like, OK, think about if you’re a parent. When you became a new parent, right? And how much adjusting was done during that time in your life? And there might have even been some loss in there, and where your time is then spent, right? Caring for your kids compared to doing other things. And so, I think, reflection of when have you done really hard things before, right? How are we going to do a hard thing now?
Also, identifying the things we can still do, right? Yes, there may be some things we’re not able to do anymore, but there’s likely a ton of things we are still able to do, right? So, keeping track of those things, writing those things down, being reflective in your day of, you know what, I might not have been able to do this anymore, but I can still do this, and this is something that, you know, keeps me feeling really independent.
So, continuing to celebrate those wins and the things we’re able to, and still do, can help lessen the blow a little bit when it comes to adjusting to changes in maybe our mobility or our mind. But certainly, you know, we see some symptom – there can be some symptoms of depression or more anxiety around what I can and can’t do and sadness for loss. So really, it’s like back to reframing, right? Circling back to that, let’s look at this differently, and what can I still do? What is still keeping me be independent? And you know, where in my past life have I done something really hard and gone through it? We’re very resilient. Humans are very resilient. We don’t give ourselves enough credit, right? Highlighting that resiliency can be really helpful.
Dr. Lindsey Dahl:
And I think also taking those things to your primary care office visit. If you really want to be able to walk up the stands to watch your grandson play football and you think you can’t do that, why do you think you can’t do that? Bring that to your doctor’s appointment because is it pain? Have we exhausted all the things that we needed to do to treat that pain so that we can keep you climbing up the stands to the football game?
I think we very much can help you maintain those things if we know what your goal is, right? So, I think, and that may be different for your doctor to go with, this is my goal; help me make it, right? Than just going through all your problem lists. Say, this is what I want to do, and I’m upset right now and depressed right now because I haven’t been able to do it. Maybe framing it that way.
Your physician will come up with some ideas to help treat that thing better. I don’t have energy to do this. Well, maybe we need to hear it in that way to say, oh, we haven’t done a sleep study. We need a CPAP. Right? And then there’s the motivation to, oh, maybe I would wear a CPAP if I had energy to be able to take care of my grandkids. Right? So, I think it’s making your provider aware of those things so that they can act on them too. Because it might show something in a different light or a way to take care of a medical problem in a different way to help you maintain those goals.
Mick Garry:
What are resources we have available at Sanford to handle it? I mean, I’ve presented you with a number of challenges here for older people. What are things they can do? How can they reach out and contact somebody?
Lexie Eubanks:
If you live in a region where you have integrated health therapists or counselors, kind of go by both names in your primary care clinic; they’re a fabulous resource from a mental health aspect, right? Whether we’re doing the therapy or the counseling piece, or even if it’s just connecting you to resources in the community for mental health support, especially through big transitions, grief, loss. So, definitely a fabulous resource as well.
If you happen to have clinic social workers in your clinic too, they’re a great option as well that get you connected to some more supports and really help problem-solve and explore different areas in your life. Biopsychosocial piece of, OK, all of these things, maybe let’s get you some resources and continuing to be able to live a good, happy life. So I think both of those are fabulous resources within the Sanford system if available in the region you live.
Dr. Lindsey Dahl:
Yeah, I mean, I think a lot of health systems are providing things like balance and stability clinics. If you’re falling and have mobility issues, there are multidisciplinary teams that can help keep you mobile. There’s a bunch of different, and probably different in every area, but for caregiving support, whether that’s through Alzheimer’s Disease Association or memory cafes or just through Sanford Health, we have some different supports for that. So, I think it’s just asking around is the first step, right? Because there’s tons of resources out there. We just have to ask the right questions, I guess, usually to get pointed in the right direction.
Mick Garry:
Anything else that I didn’t ask you about that you think is a vital part of the messaging here?
Dr. Lindsey Dahl:
My grandmother lived to 107, and she always said, when you’d ask her why she lived that long, she said: she chose to be happy, she was always looking for her new adventure, she laughed every day, and she said a little nip of scotch never (laugh), never hurt, although I never saw her drink.
But I think she had wise words, right? And she stayed relevant. She was 107, but she could have a good conversation; she could get on Facebook, right? So that, how do you keep your sense of purpose? You keep learning new things. We can always learn a new thing.
Mick Garry:
My goodness, 107. That’s unbelievable.
Dr. Lindsey Dahl:
Yeah.
Mick Garry:
Lindsay, you’re about 25, so you got about a hundred years left.
Dr. Lindsey Dahl:
I’m 48 (laugh), and I make sure I, you know, what I recently started doing, which I know as a geriatrician what I see all the time, I certainly eat healthy, but I just started lifting weights, like actual heavy weights. And I think that’s going to be helpful for me to age well, to be strong.
Lexie Eubanks:
I’m going to go home and eat my blueberries (laugh), about a cup of blueberries.
Dr. Lindsey Dahl:
For sure.
Lexie Eubanks:
That’s a good place to start, right?
Dr. Lindsey Dahl:
Exactly.
Lexie Eubanks:
I think it’s hard from a health care provider standpoint, right? We got to practice what we preach sometimes. I tell my patients that a lot when I see them in the mental health space of, you know what, this is such a journey. And to be able to do it with each other, right? To be able to come to a doctor’s appointment and be connected with the right types of folks, who really do care about you and your well-being, right? Like, you know, what a privilege to be able to do that, to be able to do that for others. So, I think that’s always my takeaway.
And even just having discussions like this today that this is such a relevant topic and so important. And aging can be very taboo, it can feel – talking about it can feel very taboo, right? So, having these really open discussions about it, I think it can be so helpful just giving those folks the push they need to ask for that support.
Mick Garry:
Fantastic. Thanks so much for helping us out today.
Alan Helgeson:
This episode is part of the “Health and Wellness” series by Sanford Health. For additional podcast series by Sanford Health, listen wherever you hear your favorite podcast and on news.sanfordhealth.org.
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