Matt Patterson, MD: The PACE Model - Health, Dignity, and Connection for Seniors

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I also grew up with a mom with very serious mental illness with bipolar disorder.

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I was in the home as a young child even and tried to access health care and support for her

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in the kind of fee for service world that I lived in and helping her navigate that

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had a very, very profound impact on me and my journey because even a young age, 9 or 10 years old,

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I had the recognition that something wasn't right in the way that the system of care was designed,

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especially for those individuals with limited agency or advocacy or with complex mental health or social needs.

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Will you still be, will you still be, when I'm 64?

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And now the podcast we're together, we discuss proactive aging on your terms,

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connecting to the professional advice of our special guests, while creating better days throughout the aging process.

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Now here's your host, Mark Turnbull.

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Hello everyone and welcome back to another lively discussion on Aging Today.

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We are the podcast where together we're exploring the many options to aging on your terms.

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You can find aging today and our first eight years.

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I've been on our website for 200,000 today to follow words less.

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And then for all of you that have been listening over the years.

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And then for all of you that have been listening over the years.

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It makes a difference for us staying on the show because this was a show that was designed to help people through the aging process.

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And it's daunting.

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Thank you for listening to this today because people have been listening to this today.

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And it's daunting today.

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There's so many questions that Mark with a cable have and we want to know what your questions are.

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And if you want to have more questions, reach out to me and your host Mark.

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Also that my email will be aging today.

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Interesting to hear on aging today.

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Just reach out to me again your host and I will make sure that we get through.

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And if you have aging experts also that you feel that if you're not too busy being born.

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And today all of it just reaches me if you're 10 years old.

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And we get all aging on the positive.

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Well, one of the things that if you're not too busy with the aging population, we talk about that.

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All of the things that don't matter if you're 10 years old.

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There are 110.

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One point, I think it's one and six.

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One point.

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There are one point, I think it's one in six, one point, there's going to be two point million billion billion billion.

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Billions, excuse me, there are over the age of six.

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It's a prevalent and it's not just to the United States, but there's going to be more all-faced, well, the aging issues.

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And what do we do with the aging population out there?

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And with aging comes to many challenges, but in one of those challenges, we're all going to be addressing today.

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The aging is mental health and loneliness.

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And here to guide us down that road is mental health.

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And with aging comes matter challenges.

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And one of those challenges that we're going to be addressing today is mental health.

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What we always want to do is we're going to guide us down that road.

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You can go back to as far as you want in your childhood.

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We want to know what's in your story.

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What led you to become a doctor?

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And then what are you doing with that role as a doctor in our culture today?

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And especially in addressing mental health and loneliness?

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Well, thanks, Mark. It's great to be here.

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And I think it's a wonderful topic and I'm happy to contribute anyway I can.

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You know, my journey for what I do today, which is as a president of well, we care for very vulnerable older adults, those who might otherwise be in an institutional nursing home setting.

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And we provide kind of wrap around medical and social care that allows those individuals to remain home with greater dignity and independence.

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You know, my background leading up to that really centers around just being aligned with the mission and then also being aligned with how I could create an organizational culture that was really dedicated at mission.

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I grew up as a Navy brat was born in a Navy hospital.

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I entered practicing medicine in the Navy.

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And so I'm familiar with a system of health care for lack of a better way to put it as universal health care.

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Everybody gets it and all the incentives are aligned to simply do the right thing for individuals.

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So that was a big part of it.

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I also grew up with a mom with very serious mental illness with bipolar disorder and you know, spent time with her through some really, really challenging moments where.

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You know, she's psychotic or suicidal and I was in the home, you know, as a young child even and trying to access health care and support for her in the kind of fee for service world that I lived in and helping her navigate that had a very, very profound impact on on me and my journey because even a young age nine or 10 years old.

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I had the recognition that something wasn't right in the way that the system of care was designed, especially for those individuals with limited agency or advocacy or with complex mental health or social needs.

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So that was had a big part of me becoming a position as well as me.

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I'm gravitating in the organization that I'm at today.

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And I think I want people to understand that's why I let out in the introduction about the, you know, the vast volume of humanity that is in that aging process and going into their 60s and whatever magical about the 60s and above is when we begin to see some of the declines that traditionally happened to the human body.

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And you know, when you think about, you know, over a billion people that are going to be in that age category of 16 above, that's just amazing by the year 2030.

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Then by the year 2050, it's going to be double that, two billion, over two billion people.

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Now, what are we going to do? How are we going to address, I mean, that it's daunting to think about how we're going to address all of the special needs and in particular mental health and the loneliness that comes with the aging process.

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Yeah, you're getting at another element of, you know, the why around what I do today. I mean, our organization was founded by a group of physicians, all the kind of mission driven positions.

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And part of just the magnitude of the challenge that you're describing was another thing, which was very compelling and, you know, a big call to service.

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When I think about the developed world, I feel this is the most important challenge of the developed world. The challenge of lonely, isolated older adults using healthcare in really, you know, poor, poor ways in a poorly designed system oftentimes with not the greatest outcomes.

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And at great expense is the most pressing social challenge of our time. If we were talking about the developing world, it might be different. We might be talking about other healthcare challenges like access, so water and vaccines and medicines and things like that.

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And the developed world, this is yet. And so I feel, so for the next decade or more, more than half of our work force is likely going to be employed either directly or indirectly in providing care and services for the core of individuals who are moving through the later stages of their life.

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Yeah, so let's go into a little bit of your organization. We were going to do this at the end, but I'm going to switch it up here and let's talk a little bit about pace. And what it is, what pace is an acronym that stands for what it is and it's a group of physicians that have gotten together.

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And in what your organization is doing to address all of the issues, but then let's bring it back to specifically mental health and loneliness.

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Yeah, so well be healthy. We operate pace, we're going to pace programs.

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Pace stands for program, all inclusive care for the elderly. This is a national program in the United States. That was started about 50 years ago, little over 50 years ago as a pilot in California.

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And it's designed for those older adults with very complex medical and social needs who would otherwise be nursing home eligible, you know, by definition, have to be nursing home eligible or qualified.

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And it just provides all the wrap around services that are required for that person so that they can remain at home and aging in place.

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And so this is a program that has physical locations where participants come to you and spend time out a couple of days a week.

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And then we provide home services as well and basically access to care 24 hours a day.

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So it's physicians, nurses, dietary, mental health support, social work, physical therapy, occupational therapy, home health, home care, transportation to all appointments, transportation to and from our day center,

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delivery of medications to the home really just kind of everything you could possibly imagine one stop shop most individuals who are in pace in the United States are duly eligible have both Medicare and Medicaid benefits.

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Although not of this into a requirement for pace eligibility most nearly all individuals have Medicare and or Medicaid took to be able to afford the program.

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The eligibility is to be 55 years of age or older be eligible for nursing on level of care and they have to live within the service area of a pace program.

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We're currently.

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But you can remain independent in your own home as well.

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It doesn't have to be.

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Yeah, that's the whole point.

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The whole point is that we're we are caring for individuals before they're ending up in an institutional setting so that we can keep them home indefinitely.

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That's the goal is to keep folks home and cared for cared for with with greater independence.

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So while we have this one of many pace organizations in the in the country as you mentioned we were we were founded and were operated by physicians which is a little bit unusual for for pace organizations.

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They that's not always the case so we're unique in that way that we have a particularly a focus on clinical outcomes and clinical care in a way that maybe some other pace programs might not but we do.

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In the pace world very similarly to other other programs and that would include addressing the root causes of the things that we're talking about it's addressing loneliness isolation need for socialization all the things that are upstream of the

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what could end up as more of a clinical manifestation of mental health concerns so I'd be happy to talk about any any aspect of what the pace model does what will be helped us because I think that that could be helpful as an example for what other but other organizations might be able to do to help address the challenge.

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Now where is where is will be else located or geographically well currently operate 10 pro 10 locations in state of California as far north as stock in California in the central valley stock to in San Jose and then as far south as Long Beach.

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And a lot of a lot of places in between a lot of centers in in the Los Angeles area central valley at the area and then we are we are approved to launch a pace program in Brooklyn New York next year so be our first operation outside of state of California.

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And pace at large is open and live in I think 33 states now out of 50 in the United States.

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And it is the application to pace you know you've got a physician lead team so it's going to be maybe implemented a little bit different than maybe somebody else that's using pace in another location and not so physician heavy or you know how how do you get the how do you scale that you know so that people get the same level of care.

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Yeah pace is a pace is a highly highly regulated and regimented care model yes 50 year track record of just delivering you know outstanding outcomes on what is known as the triple name so outcomes access and cost of care so.

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The pace is a really well established track record of keeping people home out of the hospital keeping people with a very very high quality of life and satisfaction with their care and then costing taxpayers less money than they would otherwise spend for for older adults to be institutionalized and Medicaid nursing homes.

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We operate pace according to the same rules and standards is every other organization in the country so there's nothing different in terms of the way somebody might access the program if you live in the service area of a pace program and you can find this on national pace association so this would be a non plug this is just for education on national pace association is a you know not for pocket trade association that.

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That is advocating for pace you can access their website and learn where their pace programs so if you're in the location of a pace program your age 55 years of age or older and you meet eligibility criteria in that particular state for nursing home care then you're qualified for pace most pace participants who enroll like I mentioned will be do the eligible they'll have both Medicare and Medicaid benefits.

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Which cover the cost of pace and most individuals who enroll in pace have no share of cost whatsoever so it's completely no no cost to them what's the main driver that that people that seniors are utilizing pace for you know they they get to that place in their lives where you know they maybe is it they're feeling out of control or loss of control and their.

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Feel alone they don't know what to do they need assistance I mean walk us through that scenario.

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Yeah I think oftentimes it can be an older adult who has the recognition that you're describing or it can be a caregiver a family member you know son or daughter or caregiver who's close to close to that individual who might be feeling just the inability to handle the burden of the day to day care.

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That's required to keep that that person home I think also Martin you know there's there's just a more of a cultural phenomenon that I see happening now where autonomy and agency is is even even more important to build adults in our culture today perhaps even more so then longevity.

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Yeah I don't I don't have any hard data to back this up but I you know as a physician and going through training and you know learning about you know this over the years.

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I just feel as if there was a point at which individuals stopped caring so much about surviving you know the if you think about the ICU generation of care of the space age care of like doing everything that was possible just keeping people alive and that was so highly valued.

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My sense is what's valued much more today is living life the way you want to live life we're all here because we want to be who we are yeah that's that's the most important thing we'll ever do in our life I tell our team members that all the time the most important thing that we will ever do in our lives is to learn how to be to be who we are and ultimately that I think that comes down to one thing and that's love I think to be who we are is to feel loved and to love others is to is to be love.

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And so having agency and autonomy and calling things the way you want them to happen is extremely important and that's where I think pace is just this amazing model that's been around with a great track record for a long time and people are really realizing oh my gosh here's this thing that's existed for a while that's available that allow me to live life on my own terms in a way that I might not otherwise be able to do and it can help alleviate some of.

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The caregiving burden that some of my family members or caregivers have been a shoulder in for a while so I think that's what really I think we see brings people and we get referrals like other page programs do from you know housing operators of assisted living independent living locations or community community care organizations social care organizations all of those individuals agencies I should say looking out for the needs of older adults with complex needs.

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Yeah, if you were to rank the reasons why people reach out to you at well the health or and what would the conditions be in you know maybe the top three.

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Yeah, so I mean provided somebody is eligible and we're saying well why what brings you here why would you even be interested in face yeah yeah you know I think that I think it's it's one stop shop.

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It is key that's not just a medical model there's just a host of social resources and just daily life resources with with that that's very important to one stop shop the second is I want to stay home.

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And the third is I'd like to have help beyond those who I've been relying on most you know caregiver or something that's really a here's a place to get everything I need I can stay home because I don't want to I don't want to leave my own and I can I can make it a little bit easier on this around me.

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Yeah, well and that's one of the things that we do to I own an in home care agency and a hospice agency and you know we have a continuum model and the ideas to keep people independent in their own home and living their life to the to the very end whatever whenever that is and whatever that means to them.

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And you know you just need that assistance and you and my biggest concern and I don't know if this is something that you guys have addressed in order to stay at home it is so costly for professional services from caregivers from agencies much like my own where it's just prohibited for a lot of people to to remain independent in their own home.

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Is there any conversation about how we can make in home care more affordable.

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I think that's a big opportunity area I think for us and what we do we we include I mean that's that's included in our services so whatever whatever skilled or unskilled need that's needed in the home.

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We provide that and unlike unlike a lot of pace programs we in sources so well be out in source we have our own home health and home care team we don't contract out with other organizations which some others do because of their scale or their need.

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And so I you know but what I think the big opportunity is it's around those individuals who don't have that as a covered benefit yet they don't have enough they have too much income or assets.

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That they don't qualify and you know so this is I mean I'd be careful here not we're getting out completely different thread but I mean I think we're we're a little bit overdue for kind of like a big a big Medicare event.

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You know I another another wave of like a big Medicare type reform I could see happening at some point similar to what happened with the affordable care act just like a big a big thing.

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And I think what that would have to include is it would have to include a long term care type supportive services eligibility under the Medicare benefit.

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Yeah for those individuals who are stuck in what I would call the you know the the you know the the in between zone.

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I have too much that I don't qualify for Medicaid but I don't have nearly enough to be able to afford out a pocket the type of home health or home care services that I would need to stay at home.

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I think we need to address that I'd love to see pace eligibility expand to those who just had Medicare only and have it be more affordable.

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I'd love to be able to find a way that Medicare benefit could cover some of the in-home needs that you know organizations like like you have have that could provide that safety.

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Yeah and that's where the middle class or the ones that are losing out it's the low income and the top echelon the 1% you know are getting cared for.

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Yeah either by themselves or through Medicaid or medical whatever state you're in and it's the middle class that are that you know have too much money too many resources to qualify for assistance.

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So we do need to figure this out and that's not the scope of today but I thought it's an interest I was curious what whether it was that you guys were thinking because I know it's probably you know hot and heavy on your hearts and minds as well as you hear from people.

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When our seniors are aging and you get above that 60 age group and above and you know I'm personally taking care moved in with my mom and dad back into the home that that I grew up in and my wife and I are living in the bedroom that I was grew up in and we're making sure that mom is dad has since passed away but mom is getting living her life the way she wants to live it.

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And you know it's as I've watched her age and have watched her progressively losing more and more of her independence.

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If I wasn't here and again I'm not you know breaking about myself but I'm just saying if I or another family member wasn't there for the seniors.

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It's it's going to be just the scariest thing and I can't even imagine what what's the thoughts you know that are going through would go through her head if we weren't here and not everybody has that luxury of doing what we're doing and I'm not advocating that a lot of people do that I'm highly skilled I'm a paint paid professional right.

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But you know if you can do it and you can provide that type of care that's great but for those that don't it can be lonely and that loneliness leads to a lot of other symptoms of depression and anxiety and that's part of the mental health talk a little bit about what you're seeing out there and what you're doing to address mental health and loneliness.

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Yeah I mean I don't think I could I don't really I get explain it anymore personally or effectively in terms of what the situation is and then you just did I think you know what I'm reminded of is I say psychology is an undergrad into one of my my early heroes was call Rogers you invented you know kind of a pioneer of patient center therapy and empathetic listening and one of my favorite quotes is is he said what's most personal is also most universal.

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So you're describing this this this thing that we all have in common no matter what we're all going to age we we all have loved ones who are facing this you know I I I was confront receipt to you know more extreme version of this in that you know my mom had you know very serious you know access one you know illness and you know that it manifest.

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In very extreme ways but in a much more subtle and pervasive way I watched her loneliness set in over the years of her life and I mean there's there's all kinds of just very very clear evidence on the impact that this has on people's physical health and also on the society burden and you know cost of care broadly in the United States.

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Me I know you have a you have an international audience here and I think I think one of the things that happened in covid was that it somewhat highlighted the weirdness by which we operate in this country in the United States I mean we have a bit of a strange model in that.

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We have young adults who just leave the home very early and that's kind of championed and we really don't see a whole lot of intergenerational households as a norm that's that's an uncommon fairly uncommon yeah and then we also have this model that's fairly common to have individuals end up in kind of institutional settings in their later life and I think you know the covid pandemic really amplify that.

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And kind of the international community I think saw just the extent to which that happens in the United States so unless we're unless we're going to have a societal moment to undo all of those trends which have been taking place over the past you know 200 years in our country.

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We really don't have any other choice then to be able to develop more effective models to address it and so I think that's just that's just this is going to it's going to depend on the social services and the safety net that are part of our of our societal contract in the United States pasting one of them and you know other Medicaid qualified.

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Programs are are another so the secret the answer is you know it's not really it's not that complicated and they're executing it and having a resource to execute it that's where things get challenging and the answer is high touch the answer is time.

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The answer is being with somebody and listening to them and wanting to hear their story and their needs and how what they want to get out of life rather than imposing a paternalistic highly medicalized orientation towards we're going to make your glucose this your blood pressure that and your cholesterol that because that's what you know that's what's going to save taxpayers money.

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What does what does an individual want out of their life what are they trying to achieve how do they want to live every day it's having the time in the model to listen to that and care for that and advocate for that so I feel really lucky that I'm in a model that gets to do that's resource accordingly.

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We get to do that I mean we get to spend a lot of time with those that we care for and I really wouldn't have it any underway so I think I think you're going to you're going to see a lot more programs like paste and paste expand or or you or like I mentioned there's going to have to be a societal moment of this expanding the benefit definition that we typically equated.

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With low income and instead we need to start equating it with older age yeah the risk is not being low income the risk is being older and isolated and lonely.

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And I guess a little bit of a country and thing I mean I I we're fairly innovative organization that I come from a technology background as well but I'll probably say that I'm a bit I'm a bit almost disheartened by some of the.

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Over optimism I think on some of the technology front in terms of solving loneliness for an individual I think it can certainly help I think there's certain things with you know companions and artificial intelligence I can help I've seen some really interesting programs that I think are very good but ultimately I think that that we really just need more human compassion and touch and yeah society is going to pay for that if we're going to continue down the road that we've been on.

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Of promoting young adult independence from their parents and grandparents yeah I would agree with you I think there needs to be a higher touch approach to our care then even what we've been giving and I I'm all about technology I'm all about AI but I think it's limited and it really comes back to the human touch.

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Did you know that seniors enrolled in the pace program experience 24% fewer hospitalizations compared to those in traditional care by coordinating all aspects of a senior's health pace helps reduce emergency visits and support seniors in staying healthy and independent at home.

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Discover more at wellbyhealth.com

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This did you know moment is brought to you by this week's guest wellby health and our sponsor Royal Hospice of Oregon.

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When it as you approach mental health our culture is changing in its attitudes towards mental health and in particular to to seniors there's lots of different levels or ways to approach mental health but from the

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from our elders from their perspective as they age and there are mental health challenges how would you define that and so let's just start there how would you define that what does that look like.

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Yeah so well.

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I've probably the best way to I think I probably explain more in towards of like how would you in an ideal world how to go after it in a way that promotes better health for everybody step one is listen for it you know informally or formally and so.

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The nature of screening is extremely important when it comes to any care model or program or even just informal interaction that we have with each other it's listening for it's asking about it and then being okay with whatever answer comes out of just being with that not just have to fix it in a moment asking somebody how they're doing and then catching

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yourself and pausing in saying wait wait let me just take a breath how are you how are you really doing now how are you really how's it really going and slowing that out and allowing for whatever answer emerges that's the informal thing that we could use a lot more of in our society and I think we're seeing good role models you know in public settings and athletes and things like that being more forward about speaking about how they're really doing so I think that's that's the informal in care models we have to we have to listen for it more formally we have to

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screen for it and then we have to follow up on the things that we find oftentimes it's it's you know addressing some of the risk factors without jumping right into a medicalization of what's going on and so for us it's it's addressing the loneliness and so it's engaging with those that we care

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about the things that we're on a daily basis either even if it's just by phone call or a video conference on a digital device but better is bringing folks into our centers to three days a week where they can socialize and hang out with other participants and engage you know engage in activities engage in in music and dance and cooking and art and just conversation and just being a part of a community is just a massively important thing in all of our lives.

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As social animals and so that's a big part of what we do is is to engage and the other thing I was going to suggest to is that you know rightly so some of the therapies or some of the things that you can do to combat against loneliness is you know being more social going to the senior centers and things like that but for those seniors that are more that are not as mobile you know one of the things that you can do is

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not as mobile you know one of the things that that I've done with my mom in in the home is oftentimes will have I just turn on the music turn on Spotify I play music from her day and she gets up and she starts dancing and it's incredible but those are the types of things that we can do some of the really simple things it doesn't take a lot of mobility you know going outside the home but you can stay in the home.

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But you can stay in your home and engage our seniors with those activities.

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Yeah I think that's great and those would be the places where I say I do you know I'm a fan of some of the technology answers that really help especially when they're done in combination with you know a phone call or a visit from a loved one but yeah my mom my mom you know I fortunately caught her early enough to get her socialized using you know Alexa device to play music and she she has that interaction.

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And that ability to kind of engage with something that see the your feels get her familiar especially has heard memory has gotten significantly worse or cognitive function has got where she still has the ability to interact with that device and that can be a very helpful coping mechanism.

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But yeah calling you know using in a face timer or you know video conference is a really effective way to bridge the loneliness as well.

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Yeah.

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If programs are not available or people are limited in their capacity to go out but yeah I think a huge part of it is time to listen and engage and not try to fix where somebody is at and just going to be with where they're at.

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Yeah and I just take some patience and time.

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Yeah it is.

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You know provide as many meaningful activities as you can and you know some of the other things that we've done is you know she loved she grew up playing solitaire with her dad.

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So one of the things we've been doing to keep her mind active is to you know see the cards the numbers and you know all the sequence and the queuing and all those things and I have to do a lot of queuing with her.

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Because her her mind is is not as sharp as it used to be but she can still do those activities which is really kind of cool.

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Yeah.

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So with with the signs so if as an adult child to mom and dad that are in their 80s and 90s.

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What are some of the early warning signs that we should be noting and looking for to say whoa mom's mental health is not as strong or maybe there's some from a physician's viewpoint that you can train and educate us on things that we should be seeing.

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Well I think you know without without trying to get overly clinical you know I think that.

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You know it can it can you know if you're talking about mood.

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You know you depression or anxiety which are probably among the most common things that that you'll see when I want some is mental health is.

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Suffering you know that it I think it starts honestly by creating the space to notice and so I would just urge everybody to start there you know rather than looking for anyone particular sign instead maybe having a practice of being active to engage with it to just provide more space for the vulnerability to share it.

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So people's parents may not be comfortable you sharing how they're doing or feeling like they're bored and are not wanting to worry anybody without doing and so just getting in the habit of creating the space to ask somebody's really doing and just being real slow with the answer a real patient and just providing time to allow somebody to expand ask open ended questions and just say tell me a little bit more tell me more what you think in there.

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And then you know as as that emerges you know then then the things obviously to look out or just you know just the signs and symptoms of of those things which is just feeling down you know to press mood or lack of energy or sleep disturbance appetite changes.

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And then you know just losing interest in things that used to be very fun and engaging just not having as much interest anymore avoiding certain things that used to be a source of pleasure those about to be like the this.

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Yeah I think that's that's a really good list of things that people should be observing when they're around their moms and especially around the holidays holidays.

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And a lot of people you know the adult children are absent from their parents until the holidays come so we see a big uptick in phone calls that hey mom and dad need more assistance after we've spent some time with them and some of the things that I often hear is that wow mom has really declined in the way she dresses and her appearance she's not cloning her hair.

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I mean there's all kinds of you know that the litany of lists that you were just citing that we you know as adult children to mom and dad looking for those signs those symptoms that are looting towards mental health or that loneliness and depression.

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Yeah that's also something where just the like you're imagining the stigma is it's decreasing even among the medical set and so to the extent that a loved one older adult has a trusted provider doctor and respect to sure or something like that and listing their support in it.

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That can that can help that can help your loved one and your older adult love one put let their guard down a little bit they might be more willing to share something with another individual that they've had a long relationship with and your role is a loved one can simply be to provide some corroborating evidence or concern and give your give your the older adult permission to kind of let somebody know how they're doing.

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From a very practical standpoint I was thinking you know and again your physician and as layman out there that you know are living with mom and dad or observing from a distance what's going on you know some of the mental health is conditions that we need to be watching for and I think one in particular is anxiety when you see those anxious moments in mom and dad.

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Share with us a little bit about how you would coach us up on how to deal with anxiousness.

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Yeah this is so funny we're just we're hitting on all these symptoms of in my mind is kind of a society a society that's in in many ways asking for it.

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I mean I'm surprised people are not more anxious quite frankly just given just the freneticness of the way information and distraction and multitasking and sound bites come our way we we live in this extremely short attention span world and I think with that you're going to you're going to see a lot more anxiety that exists is very difficult to cope and and keep up with that.

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I think my my first rule of thumb would be similar to what I mentioned on you know a depressed mood which is simply take a breath yourself yeah take your own pulse first and I just one of the most important things that you can do for somebody who's you know suffering from any kind of emotional you know upset or you know feeling disease.

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And it's just allow space for vulnerability and so that requires you to simply be slow listening open grounded and just resisting the urge to minimize it out of good intentions.

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Okay everything is going to worry about it's going to be fine those are not necessarily going to be the most helpful things your ability to just be with the way our person is at and listen tell me more you know tell me more how you're feeling.

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How did that affect you tell me more they just listening asking open ended questions and allowing a person to process a little bit that I'll just go a long way to understanding first of all the depth to which somebody's experiencing anxiety it may be something that's very very explainable and related to something that's real and you'd be just as anxious or what you might discover is that the feelings you know to even like a typical person today society.

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Might feel disproportionate to the stimulus in other words the feeling of anxiety might be somewhat wow I said odds with the thing that you're looking at then that's that would be a trigger to say hey something might be going on a year where I might want to get some help and again that's where you can make that connection to a you know I trust it

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professional to get a further assessment yeah yeah I think what a couple other things that I would that come to mind are you know alcohol and you know because I think when when sometimes we get depressed and and you know we're lonely you know we can resort to things that are going to cover up those things that are going to help us to

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quote unquote feel good it may be for the moment that you feel good but when you that hangover doesn't work as well in helping you to fill any better and then you got all the complications with medications on top of that so how would you you know counsel an adult child of mom or dad that is suffering with mental health issues or that depression and that loneliness how would you go

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about addressing you know substance abuse yeah well there's substance abuse or just even casual I mean you know so I would just say just from a clinical standpoint I would I would make no I have no

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reservation of saying that alcohol has no place in person whose pronged anxiety I'm as I just could be unequivocal but there's no amount of good alcohol and that circumstance yeah it will not help you know it may and so I would say avoid that one and I think if there's you know more on the spectrum of somebody who is prone to abuse alcohol or has a dependence and alcohol that is one where you definitely you want to get some professional help for that.

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Yeah for that don't take that on alone yeah you know something I didn't mention before and just you know how do you handle anxiety when it comes up I felt a

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mentally you know feel free to you know feel free to also just rely on yourself that you standard logic of human human common sense of re-engaging with the person that you're

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with and something that you know can suit them music and activity something you can do together that's less stimulating for a walk on you know touch any of those things can be tremendously helpful and doesn't

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require any any training whatsoever to just be kind and loving just just be be there and I tell that to caregivers and to nurses all the time the number one

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attribute of a great caregiver slash nurse CNA whatever whatever you find yourself or even adult child as a caregiver or a spouse is a caregiver.

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Number one thing be present just be present and then put yourself in their position so that how would you want to be approached how would you

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want to be treated how would you want to be talked to how would you want to be engaged with activities you know and and that's what I often do with my mom I you know I just sit there and I go I put

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myself in her shoes and then I you know obviously I I've known her for 67 years and with that comes you know some things that I can draw upon to help her live her best

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possible. Yeah makes a lot of sense yeah and and it really comes back to the high touch approach to care that you've been talking about just being present and then finding ways to find high

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touch approaches to the care you know one of the other and I want to I want to talk one more little item about depression and loneliness and that is isolation and one of the things that I think is a

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myth and I've seen this over and over again is when mom and dad are living in an assisted living community or any kind of a community that doesn't necessarily mean that they're going to get and be surrounded by all of the different you know factors involved with being engaged in activities you can be is just as isolated in those

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rooms as you could be if you were staying in your own home and isolated from friends and family around you. Yeah it's true and I think it am I my mom has been an assisted living setting as she's in the amp sure where she lives and yeah it's I'm as a great a great

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environment is very safe is very caring but you know she's prone to isolation and we'll do that even as a coping mechanism that she thinks is the right thing to do.

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Um but so oftentimes requires active engagement to kind of help bring somebody out of what they're you know their comfort zone is to do so I think and then I think as an adult child of mom dad if you're in a you know a community of some kind or even if you're in your own home.

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You need to make sure that in an adult care community that the activity directors and all the people that are they're caring for mom dad that they're constantly knocking on the door saying hey let's get let's get engaged here into the community because I think communities are doing a better job of providing those activities but it's still hard to get people out of their

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rooms and especially when you're in a mental health state of depression and and that's the challenge and and you know from a physicians view how do you approach that how do you coach me up how do you coach communities up to help them live their best

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possible when they may not feel like that they want to do that. Yeah and this is I mean this is where you have to try to recreate to the extent that you're able to you know the best version of an interdisciplinary team that you can.

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And in an ideal world everyone who's at risk older adult especially those living alone who are isolated I deal with everybody would have their own interdisciplinary team at their disposal you know they'd have a they have a primary care doctor they'd have you know home care assistant they'd have a social worker they'd have a dietary assistant recreational therapist etc right so

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you have to understand that the right answer to the situation you're describing is hard to address without an interdisciplinary approach and so I think sometimes you have to start piecing those things together to create that for the for your loved one as best you can with the resource that you have

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and I would say that if somebody you know it has a mood disorder or condition that they're so debilitated that they really just don't they just don't even they don't want to engage on the things that would otherwise lift them up getting out of the house exercising diet all is just unwilling or unable.

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There is a there's an obvious place where you know a clinical model makes sense and can really help I am not advocating that we go and just try to medicate everybody and say that's the answer but oftentimes you have a bit of an activation energy that you have to get over that I mean this is required and so don't be afraid to get some help and and potentially even if your first step is you know medication that might be at least the most important thing is

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at least the most accessible one that you have at your disposal quite frankly given the culture that we live in and the least expensive one as well but that might be able to at least within four weeks or six weeks you start to get a little bit over just that initial barrier of resistance and then you start to create the other elements of your industry and your team what are the social needs that you know that are that are absent

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in the engagement that otherwise would help you know feel better what's the exercise that's reasonable that could get accomplished what's the dietary changes is going to start trying to bring those supports in as best as you can and provided those things go well oftentimes you find that you don't need the medic and the medication as much or any more and you can kind of work that way off but sometimes you need I need to help just to

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there's a holistic approach to the mental health and the loneliness and the depression that people are feeling and I'm glad you said something about diet because diet can play a huge role in somebody's well being mentally and I and I want to conclude with this one last question that I have you know from from a layman's perspective and the question that I have towards a doctor of your esteem how's that was pretty good wasn't it

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but a lot of times people come to me and they they say mark I don't know how to have this conversation with mom I don't know how to have it with dad I don't know how to have a conversation about their mental health and addressing whatever mental health state that they're in how do you do that how how do you coach people

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up or how would you do it give us an example do you have any stories that have been helpful to you that others have learned in from well I mean I'm reminding again what's most personal is also most universal and what you said which is you know how would you want to be treated in that moment I think the answer is there for all of us we all want to feel loves

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you know as is pretty universal yeah and oftentimes the way to do that is simply to be be allowed for the space to be can you just provide a space where where people can simply be who they are

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you don't have to talk about mental health or your mood or are you depressed or you down or you know you lacking energy you know it doesn't have to be a third degree can you simply to start practicing the space for some it is say what's on their mind and I feel

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and watch what happens next watch what you do do you often find yourself say oh it's okay oh you're not it's all right it'll get better tomorrow don't worry about that just try not doing that just start there

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just start allowing for someone to just be where they're at and just ask a question tell me more that's it yeah start there you've been maize will happen I think that the you know there's probably just like an

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inordinate amount of reasonable guidance and online and you know health plans and tutorials and videos of how to have a car station with somebody about

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doing you know avail yourself to those things but I think it ultimately come stand to simply allowing somebody to be who they are in the moment I'm not trying to edit edit that just be quiet

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ask some questions and listen just the power of listening to somebody is it very profound and honestly you know it came to my mind when you first asked me the question

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I remember you know being the navy young on acted duty and I train as a diving medicalist or side to become a Navy diver and one of those things is you have to be able to do a certain amount of pull ups

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you know I wasn't necessarily great person at pull ups and I'll never get somebody was helping me get in shape to become a Navy diver and I just say well how do I get good at doing pull ups

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do pull ups so that's really what comes to mind I mean how do I get good at having a conversation with somebody about how they're doing well you know

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try having a conversation with somebody about how they're doing yeah and you know I think it'll be I think it'll go okay yeah yeah

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and I think I loved your answer and it's just it goes back to being president it goes back to you

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we're not calling everybody out to be a approach loneliness or mental health from a clinical position yeah just just be yourself and show the love and show the support the high touch approach to care is so important and you know if

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mom's feeling a little depressed you know maybe it's appropriate turn on a little bit lively music some music of our past and then ask her you know how does that make are there any memories mom that this song can bring up

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and it's called redirection but you can do that through various techniques and it's it's not we're not asking anybody to approach it from a clinical viewpoint well I'm sorry to hear mom that you're going to mental health and that you're depressed I mean how depressing is that to hear that from that approach but yeah

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when you approach it from a very practical side you know sometimes what I'll do with my mom is as she's sitting in the chair is I'll just have her reach up into the sky and just put her hands together in prayer position and then just reach as high as she can and that generates the blood flow

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and oxygen and it's just a simple little things like that that can be you know profound I agree yeah meaningful time you know healthy food going for a walk movement yeah all of these things all of these things are our great ways to start building the space where somebody can share

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where the rat and how they're doing and do it in a way that doesn't like you say you know pile it on and progress it you know it's okay for somebody to share how they are

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and not have to you know let them tell them that they're not feeling that way but you can also do it in a way that allows them to feel better yeah absolutely

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Dr. Patterson is there if people that are listening to this program and they want to hear more from you and what you know well be health is doing and how they could maybe learn from what you guys are experiencing what's the best way to connect with you.

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Oh I mean anybody who's interested in you know in in mean and what I'm trying to accomplish you know with is you know caring for older adults and doing it through the paste model I always get me on LinkedIn and just reach out to me I'd be happy to engage with anybody those

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interested in well be health can obviously is good or our website well they help calm and learn more about what we're doing but yeah I more than anything I would just urge everyone to just be aware of the paste model of care program all inclusive care for the elderly you know that's not a plug for for me or for well be health I just think it's it's an extraordinary model for the right people and you may be surprised that you have this program that's available for somebody

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if yourself or somebody you care about and so I'd urge you to you know look it up in Google pace or look at the National PACE Association website for information about pace it could be some like be helpful for you.

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All right Dr. Patterson thank you for being on aging today you were a wonderful guest and we appreciate the wisdom that you brought to the table today in our discussion

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and we hope that many that are listening out there that are suffering with mental health disorders whatever that may be whether it's depression or anxiety and loneliness and on and on it goes we hope that you will reach out and reach out to get some help that you need

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and again thank you for being on aging today.

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Thank you Mark it was a pleasure I hope that I hope I was able to help any of your listeners so thanks for having me it's really great to be here.

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I'm sure I'm sure you have thank you for so much I learned a lot as well and this is Mark Turnbull your host and I want to thank all of you for tuning into aging today

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we are the podcast where together we're exploring the many options to aging on your terms and remember this we're all in the process of aging and as we age we really are better together so stay young at heart.

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you make me feel so young you make me feel like spring is from and every time I see your face I'm such a happy individual the moment that she speaks I want to go play hide and see I want to go and bounce the moon just like a toy balloon

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well you and I are just like a bullet hearts running across the metal pick and I've lots of forget me not so you made me feel so young

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you made me feel there are songs to be sung there will still be wrong and wonderful thing to be fun

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you've been listening to aging today where together we explore the options to aging on your terms join Mark in his guest next week for another lively discussion on proactively aging on your terms connecting you to the professional advice of his special guests with the goal of creating better days throughout the aging process

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your host has been mark turntable join mark in his guest every week on aging today your podcast to exploring your options for aging on your terms

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you make me feel so young you make me feel so young you make me feel so young you make me feel so young you make me feel so young

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