Mental health for seniors

Podcast transcript

INTRO
Welcome to Docs in a Pod presented by WellMed. Over the next half hour, Docs in a Pod will educate you about the health and wellness of adults everywhere. Co-host Dr. Tamika Perry and Carmenn Miles will share information to improve your health and well-being. And now here are Carmenn Miles and Dr. Tamika Perry.

CARMENN MILES
Hello everybody, and welcome to the award winning Docs in a Pod. I'm Carmenn Miles, and weÕre delighted to have you with us today. We come to you every week with a look on a variety of health and wellness issues as they affect almost any age, but predominantly those who are 65 and older. Our resident co-host, Dr. Tamika Perry, is with us today. She's also our guest today for our very important subject matter, which is mental health, which matters at any age. Dr. Perry is associate medical director for WellMed, and she works to support the providers in a number of WellMed clinics where they deliver quality care and a compassionate patient experience. She's been with WellMed for more than 10 years now, and Dr. Perry earned her undergraduate degree from Prairie View A&M University, then went on to Philadelphia College of Osteopathic Medicine and where she was a National Health Service Corps scholar. Next, she completed her family medicine residency at Methodist Charlton Medical Center, and she served as Chief Resident. Dr. Perry is board certified by the American Osteopathic Board of Family Physicians. She's also earned a master's in public health with an emphasis on health management and policy from the University of North Texas Health Science Center. She's also a diplomat at the American Board of Obesity Medicine. You've done a lot in a very short period of time, Dr. Perry, welcome back.

DR. TAMIKA PERRY
I know it's amazing. I'm only 19 and I got I got all that accomplished.

CARMENN MILES
I don't know how you did that. I really do not know how you accomplished it all. But you did, and we're glad about it because we get to learn from your great expertise. Thanks for being with us. We're talking mental health today. We're talking about getting older and how it brings wisdom and, in many cases, resiliency. There are some amazing seniors out there who are running circles around 20 something year olds. Getting older can also bring about some real life challenges. It can change changes to our health. We talk about it every week. Seasons of grief as we start to lose friends and loved ones around us, and subsequent feelings of loneliness. That quietly can affect us and how we feel. I think I learned earlier this week as I was preparing for this show that 14% of adults over the age of 70 live with mental health condition. Most often depression and anxiety, which I know we're going to spend a great amount of time on that. And yet, Dr. Perry, mental health in older adults is often overlooked or misunderstood. Why is that?

DR. TAMIKA PERRY
Well, it's several factors why. Sometimes the general population is not that accepting of a mental health diagnosis. When I say mental health diagnoses, we are particularly talking about anxiety and depression in seniors. In fact, according to the National Institutes of Mental Health, up to 20% of the senior population have depression, and according to the CDC, up to 25% have anxiety and depression. So, these are the two diagnosis that we're talking about in particular, but they're overlooked because depression and anxiety can present as somatic complaints, bodily complaints. With anxiety you can have heart palpitations, shortness of breath, sweating. So, when you go to your doctor and you're like, what is wrong with me? And we do this million dollar workout to find out that you're really having anxiety attacks because your husband of 30 years just passed away, and this is what's happening. He might have smoked, and every time you smell cigarette smoke, you have a panic attack. This happens a lot. The same thing with depression. Depression is overwhelming feeling of doom or sadness. Feeling down, depressed, sad or hopeless. It can also present as sleep disturbances, appetite changes, weight changes. People come in and say, is something wrong with my thyroid? Do I have cancer? What's going on? We start to talk a little bit more, and of course, we make sure there is nothing somatic going on. You are an empty nester. Your neighbor just passed away. Your spouse passed away. Your grandbaby who you loved is an adult now, and they moved to the neighboring state. These are all things that contribute to you feeling depressed. Depression and anxiety are very, very treatable. Extremely treatable. We just have to recognize it. I did a talk at a health fair not too long ago that was at a church. In my population that I serve, a lot of times if people admit they have anxiety and depression, it's also like admitting that their faith isnÕt as strong. The two are not at all mutually inclusive. They're not.

CARMENN MILES
What is that? Many seniors, when they get to a certain age, just want to live a quiet, peaceful life, and they don't want to bother or burden anyone else. I think with the older generation, they feel like I should just be strong enough to handle this. Right? Or they're often taught to stay silent or seeking help. Just be quiet. Don't be a bother or burden.

DR. TAMIKA PERRY
Right. ThatÕs not the way we want to go because we evolve throughout life, right? We're at different stages of life. When you were a small child, there were certain things you couldnÕt handle that you can handle as an adult. Even though I like to think I'm 19, I'm really not. I'm really 49. So, there's things I can handle now that I probably won't be able to handle when I'm 79 because we evolve through our life. We're always going through an evolution. When I was 19, I didn't need the fancy bifocals that I have on now. When I was 19, I didn't need tp dye my hair on a regular and consistent basis that I do now. So, we evolve throughout life and so does our emotional state. If you think about it, at one point, the senior populations, they were career people, they were moms, they were dads, they were everything. They were the bosses at their job. Then as life evolves, you kind of say, where is my place in life now? I'm an empty nester. I'm not overseeing someone else's well-being.

CARMENN MILES
Yeah. Let's take a moment, Dr. Perry, to welcome those who may have just joined us. You're listening to the award winning Docs in a Pod presented by WellMed. I'm Carmenn Miles, chatting with none other than the Dr. Tamika Perry. Docs in a Pod is available wherever you listen to podcasts. You can also find us on the radio in several Texas and Florida markets. Today we're talking about emotional well-being later in life. Normalizing mental health concerns, reducing the stigma that sometimes is attached to some of those mental health issues. And of course, rounded out with sharing some practical coping tools. Before we took this short break, Dr. Perry was discussing the stigma that is sometimes attached with mental health concerns. Go right ahead.

DR. TAMIKA PERRY
Most certainly there's a stigma attached, but it's important for us to realize that not only according to the National Institute of Mental Health, but also the Center for Disease Control, the most common mental diagnoses in the senior population are anxiety, depression and dementia. So, these are the most common ones. Social isolation is the biggest risk factor for that. In fact, social isolation, being by yourself, is not only a risk factor for loneliness, but premature mortality, premature deaths, dementia, heart disease and stroke. This is just from being by yourself. There's actually a diagnosis called broken heart syndrome. It can happen in anyone, more commonly women than men, but it can happen to anyone, and it's from a cardiac strain from stress. And yes, you can have a heart attack from stress. Can stress kill you? Absolutely. ItÕs called broken heart syndrome. So, social isolation is not something that we advocate for at all. That's why I was telling Carmenn in a previous conversation that we had that I love senior centers because people who are at the same or similar points in life get to fellowship. You find your new tribe. This is your new tribe. Your tribe before could have been a group of moms. Most of my friends now, all our kids are all friends, and that's how we became friends. Consequently, our mothers became friends because we're friends. So, there is this big group of people who hang out together, so we try to avoid that social isolation. One time you might have been stellar soccer mom and that person who you were a soccer mom who is now 40. We have issues where we can't get to their kidÕs soccer game because of a hip replacement or whatever the case may be. But places like senior centers puts you back in the groove of isolation. Everybody there has hip issues. ItÕs not a big deal. There are activities there that are geared towards the senior. So, you can have line dancing, and there's a section for people who are in chairs. It's okay if you can't do the bottom part, move your top half. Games and classes are taught there. In essence, you find your new tribe in places like that. Clubs at church, book clubs, coffee shops. Most of us have seen the group of older guys who coalesced in the morning at McDonald's or coalesced in the morning at Starbucks, that's their new tribe. There's a target around the corner that I used to frequent quite often, and there's a Starbucks in it. And when I would go there in the morning before work, I would see the same group of guys every morning. If I missed like a morning or two doing whatever in target, those guys started to say, where have you been? Because it'd be the same guys there every time. I cannot stress so much how social isolation has a negative impact on our health.

CARMENN MILES
ItÕs major risk factor for depression and cognitive decline, right?

DR. TAMIKA PERRY
ItÕs a major risk factor. In this day and age, we still have the ghost of the COVID pandemic. Well, that's what technology is for. So, I have some patients or seniors who are still kind of afraid to be in large groups. Fair enough. But you know what? They do their classes via FaceTime. They do it via zoom. They still have that interaction with their peer group. They just use technology, which I think is awesome.

CARMENN MILES
Let me tell you what, if you're having a down day, I love going to the senior centers and seeing the seniors. There's something for everyone. If you love volleyball and you were a volleyball star early in life, but you can't stand up, they've got chair volleyball. It's amazing. There's artwork and computer classes. There's so much to do. Whatever interests you're into, it's available. I just said that because I love the senior center, and I believe in that.

DR. TAMIKA PERRY
My organization will have us, from time to time, go over there. I actually do a class on a regular basis at the senior center next door to me, or we will go in like monitor or watch the physical classes. So, I used to go over with chair yoga at least once a week. Oh, my seniors, I love them. They were so strong. I was sweating. They would ask me, are you okay baby girl?

CARMENN MILES
Do you need some water?

DR. TAMIKA PERRY
You're right. You need some water? I'm supposed to be helping them.

CARMENN MILES
Oh my gosh, I love it. We're speaking with Dr. Tamika Perry about mental health. It matters at every age. Stay with us as we take a quick break. You're listening to Docs in a Pod, presented by WellMed.

AD
For over 35 years, WellMed has redefined health care for older adults and people on Medicare. WeÕre physician led and nationally recognized as an Age-Friendly Health System. Our doctors take time to listen and support your unique needs, working with Medicare and select Medicare Advantage plans to keep you healthy and independent. With 24/7 nurse support, telemedicine, in-home and office visits, care is always within reach. WellMed. Compassionate care. Proven results. Visit wellmedhealthcare.com to learn more.

CARMENN MILES
We're back on Docs in a Pod. Thanks for sticking with us. Today, we're talking about mental health for seniors. What's normal, what's not and most importantly, what helps? I've noticed just listening to you, Dr. Perry, it's kind of secular in a lot of cases. Loneliness is not just feeling bored. Someone's mental and physical state can make them not want to move, not want to leave the house, and someone who loses a spouse may not feel comfortable leaving the house without their spouse. Or maybe chronic pain keeps them in the house and they feel isolated. Then the loneliness creeps in and then the mental and possibly even physical health are adversely affected. It's very secular how it all kind of works together. I want to talk a little bit about coping with it. What can we do from a pharmaceutical approach and what can we do on our own to help keep us out of those dark places?

DR. TAMIKA PERRY
Well, what we can do on our own without going to the pharmacy or spending extra money, most certainly exercise is always free. I know people are going to say, I knew she was going to say exercise. Well, let me tell you why. Because exercise increases your happy peptide, your happy hormones, which is what I call them, in your brain. It's really serotonin, epinephrine and norepinephrine. This is what makes you feel good. So, when we hear a feel good church sermon or when we go down on a roller coaster and get that feeling we have the in the pit of our stomach, those are because there's a surge of serotonin, epinephrine and norepinephrine. So, exercise increases these. Even a little bit of exercise is going to help that. Healthy diets also aid in this. A lot of people say, I just I don't know if I can afford a healthy diet. You don't have to buy your apples from the fancy organic grocery stores. You can you can get your apples from your regular corner store. There's always a choice you can make, even if you're going to a fast food place, you want to choose a lesser of the evil. So, always just make a good choice when it comes to when it comes to time to food and remember, exercise is paramount. From a pharmacologic standpoint, if we're talking about depression, from the mid 80s onward, we have really come a long way in terms of treating depression. Prior to that some of the medicines worked well but they weren't the safest. Starting in the mid-80s there was this medicine called Prozac. Prozac, now the generic name is fluoxetine, was one of the first SSRIÕs, which stands for Serotonin Selective Reuptake Inhibitors. Remember when we talked about serotonin as one of those happy peptides? Well, when we release a bunch of serotonins, our brain quickly breaks it down. You don't have that euphoric feeling forever, but people who are clinically depressed have lower levels of it. So, what the SSRIÕs do is allow your brain to have levels to at least make your emotions stable and normal without the possibility of addiction. That's a great thing. There are newer ones like Zoloft, Celexa, and they usually take about 21 days before they become therapeutic in your system, and they're meant to be taken every day. So, it's not like you take one and go, this doesn't work.

CARMENN MILES
I keep hearing this conversation around dopamine. What is dopamine?

DR. TAMIKA PERRY
Dopamine, serotonin, norepinephrine are substances along the same spectrum. They're like 1 or 2 methyl groups, so the chemical structure is really different and one kind of transforms into the next. So, dopamine is one of those substances in your brain that naturally makes you feel euphoric or makes you feel good. There are some substances that give you a big blast of dopamine and those are the ones that can really lead to addictive potential. Street drugs give you a big blast of this. That's why you get you addicted. So, dopamine is something that was naturally placed in us or that our body naturally makes in order for us to feel good. It makes us feel good. So, that's what that's what dopamine is. There are certain drugs that target this in not just dopamine, but drugs or substances along the dopamine pathway like serotonin and norepinephrine. We increase those in our brain so we don't feel sad anymore. And honestly, that's how they work. The medicines for anxiety help calm you down. The medicines for depression help make you feel happier. Now we use it along with psychotherapy, which is counseling. So, we can identify what things may be triggering this. Was it grief? We'll identify how to deal with grief. Was it a change in life status? If it was a change in life status, like your grandbaby did move away to the next state over, your therapist may say, okay, we're going to set aside a little time and you're going to FaceTime them every two weeks. So, you still have that interaction with them.

CARMENN MILES
I love that. Set the time set aside the time to actually do that. Speaking of that, as a caregiver or a loved one, going back to depression and anxiety, of course, again, our seniors are not always forthcoming with how they feel. Or maybe they don't really know what they're feeling, right? ItÕs something they've never felt before. TheyÕre not comfortable with it, don't know how to communicate it. But from a caregiverÕs perspective or a loved oneÕs perspective, how does depression show up? How does anxiety show up?

DR. TAMIKA PERRY
Oh, that is a great question. Depression may present is anhedonia, which is the ability to neglect things that would normally give you pleasure. So, if you used to go to the movies every Friday and now you go, I don't feel like it. I'm going to be in my room by myself. That's anhedonia. Also, weight changes. You can either gain or lose weight. You could be so consumed about what is bothering you that you literally don't eat, or you can have too many of certain foods, like carbohydrates, because they release dopamine, too. They make you feel good. Yes, that wine makes you feel good for the alcohol, but definitely for the sugar in it. Yes, those french fries and ice cream make you feel better, even if it's for a short period of time. So, now you can have weight changes. With anxiety there's a lot of epinephrine running through your body because you are in an anxious state. You're in a fight or flight state so you can have heart palpitations or shortness of breath. So, if you see these bodily signs in yourself or your loved ones, you definitely need to consult a physician to kind of tease out what is really going on here. Is it a combination of a somatic complaint plus a mental complaint, or is it one versus the other?

CARMENN MILES
Yeah. And the sooner you recognize it, the better. I know mental health affects your sleep, your memory, your energy levels, your physical health. It affects a lot of things.

DR. TAMIKA PERRY
It does. With memory loss, is patient they having dementia? Is a depression? Is it a combination of both? Either way, it still needs to be addressed because the earlier the intervention, the better the long term outcome.

CARMENN MILES
Got it. Talk to us about some of the coping tools from a mental and emotional standpoint. I love to journal. I know that that helps me a lot. I don't know if that's something that a lot of seniors like to do. I see a lot of seniors doing artwork, learning how to do things on the computer. but talk to us about some coping tools.

DR. TAMIKA PERRY
You're absolutely right. Journaling, a new hobby, revisiting an old hobby that you had before. We've emphasized before, you do not want to be by yourself. Social isolation is not your friend. Even if your coping mechanism is listening to music, by all means, listen to whatever music you want to listen to. Some people, like Carmenn said, journal. I personally love to listen to music. That is one of my coping mechanisms, but important in all of this is no social isolation. If you like to knit, then give your sweater to your girlfriend afterwards and y'all talk about it. No social isolation.

CARMENN MILES
I like that. Or get your friend involved in knitting, right? Go out to a park, sit on a bench one day and just knit together.

DR. TAMIKA PERRY
I will often tell my patients, those are their homework assignments or those are your prescription. The next time I want you to come, I want you to tell me, because I'll make them tell me who's your friend? Who's your homie? All right, Miss Smith and Miss Johnson, y'all are to go out and have lunch together, or you go over her house, she comes over your house, you tell me what happened at lunch because I need you to do something. I need you to do something for you and you tell me what the outcome of that next time was you come. You'd be surprised. Sometimes you really do have to prompt people to fellowship with other people because they get in such a rut of, I'm just going to be by myself. All 65 year olds are by themselves. Not true.

CARMENN MILES
They're not. That is true. My mother runs circles around me. Get connected with the church, get connected with, like you said, a reading group. I guarantee you, whatever your interest is, there are other people who are interested too, and they're doing it. So, get with them. Find your tribe, like you said.

DR. TAMIKA PERRY
Yes, absolutely.

CARMENN MILES
I love that.

DR. TAMIKA PERRY
Let me tell you, my mom rushes me off the phone all the time, especially if her girlfriends call or they have something to do. Oh, girl, let me call you back. I got to go talk to so-and-so. I think her coping mechanism is talking about other people. Whatever works for you, mom. Medications are important. Coping mechanisms are important. Avoiding social isolation. Those would be the three take home points that I would say to combat anxiety, depression and even to a degree, dementia in the senior population.

CARMENN MILES
Yeah, I think you have to start with number three in my opinion. Reaching out is not a weakness. It's wisdom.

DR. TAMIKA PERRY
Not at all. Self-preservation is not selfish. Reach out.

CARMENN MILES
I love it. Well, we're out of time. It just flies by. Dr. Perry, thank you so much for all of your wisdom on this great topic of emotional health. Small, daily habits can protect your emotional health. You don't need to run a marathon. Just moving your body and not isolating yourself and staying connected can make a real difference. That's all for today. This is Docs in a Pod presented by WellMed. Thank you again for joining us. You can find us on any podcast platform, or you can catch us on the radio and several Texas and Florida markets. Until next time, stay well.

OUTRO
Executive producer for Docs in a Pod is Dan Calderon. The producer is Cherese Pendleton. Thank you for listening to Docs in a Pod presented by WellMed. Be sure and listen next week to Docs in a Pod presented by WellMed.

DISCLAIMER
This transcript is generated using a podcast editing tool; there may be small differences between this transcript and the recorded audio content.

Docs in a Pod airs on Saturdays in the following cities:

• 7 to 7:30 a.m. CT – San Antonio (930 AM The Answer)
• 7 to 7:30 a.m. CT – DFW (660 AM, 92.9 FM [Dallas], 95.5 FM [Arlington], 99.9 FM [Fort Worth])

Docs in a Pod also airs on Sundays in the following cities:

• 1:30 to 2 p.m. ET – Tampa (860 AM/93.7FM)
• 5 to 5:30 p.m. CT – San Antonio (930 AM The Answer)

Healthy aging Podcasts