Social Connection and Memory Cafes

Welcome to the Sound of Ideas from IDSTREM public media. I'm Stephanie Haney. Thank you for being with us. As a country, we're living longer than ever before. The average life expectancy in the United States is now seventy nine years old, according to the Centers for Disease Control . But how are we doing when we get to our golden years ? In Ohio, the answer is not necessarily the best, according to the latest America's Health Rankings senior report. This study from the United Health Foundation ranked Ohio thirty six th in the country in overall health for seniors. Some major concerns include suicide rates, drug related deaths, poverty, and food insecurity concerns, and also potential issues with level of physical activity and other general wellbeing. When you add in concerns about mental function and emotional well being, there is a lot to think about as we age. So today we're looking at what we can do in our younger years to try to maintain our mental, emotional, and physical health for as long as our bodies will let us, if we even have any control over that at all. Joining us today for this conversation, we have Dr. Gary Grossell, Chief Medical Officer for United Healthcare of Ohio. This is an institution that is involved with the United Health Foundation. Dr. Groslle, thanks for being here. Thanks for having me, Symphony. Also with us, joining us by phone, we have Olympic athlete Lester Carney. He's an active runner and golfer at the age of ninety two , and just so happen to win a silver medal in the two hundred meter dash at the nineteen sixty summer Olympics in Rome, Italy, and also be the grandfather of our sound of ideas producer Aya Kathy Lester. Welcome to the Sound of Ideas . Thank you very much. I'm here. We appreciate it. Also with us we have Dr. Robert Brimell, a staff neurologist and director of the Neurological Institute's Mellon Center for Multiple S clerosis at the Cleveland Clinic. Dr. Bramel, thank you. Happy to be here. Thanks so much, Stephanie. And joining us on video call, we have Dr. Rupa and Mol Singh, lead geriatrician for community programs at the Cleveland Clinic. Dr. M Anolnes ing, thanks for being with us. If you would like to join us for this conversation, maybe you have a question about what you can do to preserve your health as we move through the trajectory of life, or maybe you're in your fifties, six ties, seventies, eighties, you want to share some knowledge with us about what's got you feeling good? Please give us a call. The number is eight six five seven eight zero nine zero three. You can also email us at SOI at ideastream. org or you can send us a message on Instagram, we're at the sound of ideas. Now, doctor Grossell will start with you and ask you, how is Ohio doing well when it comes to the health of our seniors? Let's start there. Sure . So you know, Ohio itself, as you said, is thirty sixth out of the fifty states and right now . The that's kind of in the that lower third for the states , but we are doing well in that early death rates have decreased . And what that really means is from the age of sixty five to seventy four , we have a decrease in early death rates . Also, overall , nationally, there is increased geriatrician and home health care. So those taking care of the elderly are increas ing. Now Ohio isn't quite at that level, so we'd like to get it there. The physical inactivity, although it's improved , that is still pretty high and obesity is pretty high in Ohio. And then those are some of the areas that we really need to start focusing on because those lead to many of these chronic conditions that happen. And Dr. Grassau you mentioned an increase not necess,arily where it want to be, but an increase in geriatricians. As I mentioned, we have a geriatrician with us, doctor An Mal Singh. So can you explain what a geriatrician is and how that works in tandem with a primary care physician . Are you hearing me now, Stephanie? We are. Thank you so much, Dr. Andolsing. We appreciate it. And we'd love to hear more about your work as a geriatrician. Excellent. So geriatrics is a specialized field of medicine that basically focuses on the health care of older adults, particularly those adults with multiple or multi system s , persons with frailty , we look at the social aspects and preventative as well as rehabilitative care . We look at the social aspects of the elderly and maintenance of health function and independence. So it's a multi dimensional approach that we take with geriatrics and we incorporate five specific principles with geriatric care . So when I talk about complicated patients right we're looking at patients with multiple simultaneous interacting multimoridities. We look at persons with polypharmacy more than five medications. We look at persons with cognitive impairment, dementia. We look at frailty . Then we also look at personal care goals. So we sit with an older person and their caregivers and decide , but what do they want for themselves? What's their goals of care, right? What's their advanced directives? We also look at their physical function, right? Because again, with mobility and physical functioning, that's why you maintain independence and obtain a quality of life . And our discipline is one that's multidisciplinary so we coordinate care with other specialties in medicine , not only just physicians but also whether it's ancillary therapies like physical speech, occupational therapies, social work and nursing staff . And then finally, we look at the actual physiologic aspect of aging and how it impacts on your homeostasis, your resilience. So putting all of that together, that's why it's more of a multi dimensional approach rather than specific disease processes that may be targeted by primary care . And Dr. Anolseng, at what age should people start to think about incorporating a geriatrician into their care team ? So majority of all patients are aged sixty five and older, although we do accept anyone who's fifty years and older . Okay , so that feels very young . It does, it certainly does . But that's what we're here to talk about today is prevention and what we can do to feel good as long as we can for as long as we were on this planet, which hopefully continues to be longer and longer. Now, Dr. Brumel, as a neurologist, who is an appropriate patient for you? When should people think about adding a neurologist to their care team? Well, I think that neurologists traditionally take care of people with brain diseases. Brain disease, the prospect of brain disease is quite scary. So when you think about things like Alzheimer's disease, Parkinson's disease, multiple sclerosis , very scary prospects . The good news is that I think people even as early in the thirties, forties, and fifties can begin to prevent those brain diseases with some very actionable items that they can work on in their day to day life. So keeping your brain healthy, I like to think of the brain as a muscle sometimes. And so if you think of your brain as a muscle, you need to have good blood supply to your brain. So stroke prevention, taking care of high blood pressure, cholesterol, healthy diet, you want to exercise , and that gets the blood pumping to that muscle. Certainly, you need to get the muscle rest and so adequate sleep for your brain is very important. And of course, one piece of guidance we give everybody is please wear a helmet. Protect that muscle as well. So whether you're downhill skiing or cycling or any sort of high velocity injury for sure, wear a helmet . And I think if the good news is a study in the Lancet from twenty twenty four actually showed that we could prevent or delay about forty five percent of brain disease that happens in older age with some of those activities. It's actually fourteen of those actionable things that you can do. I rattled off a few, but we are sort of more empowered than we think to keep our b odies and our brains healthy . And I think building those good habits probably starts in your thirties and should continue on into your forties and then in your fifties having to start to get pretty serious about managing to the numbers around some of those things . Yeah, sure. Lester, we'd like to get to know you a little bit here. Can you tell us as a ninety two year old, what's a typical day look like for you? Typical day for me is get up bright and early , have breakfast , exercise , and just do what comes naturally . That sounds like a great day. What kind of exercise are you talking about, Lester? What does that look like for you? Is it still running ? Not running , but walking. Normally my wife and I to Harvest Park two or three times a week, sometimes more , walk around the track , oh, it's not a track. It's like a park and we walk around that two or three , four times at a fairly good pace , but running . And then you know , when we get through , sometimes we go have lunch and sometimes we just come home , but try to do that, you know, regularly. Okay . And can you tell us, Lester, what does your care team look like right now? Do you have a primary care doctor or any doctors that you see regularly? Yes . I have Dr. Hirschberger . He was my physician. I used to have Dr. Platt , and I was with him for a number of years . And any time that I went through to him two or three times a year regularly and if he felt anything that was different in my regular heartbeat asthma outside sent me to a specialist and that's when I got glasses, hearing aids and so forth. And just try to stay one step ahead any serious complications . Speaking of staying one step ahead, we cannot have you on this show without asking you about your silver medal win. You were many steps ahead of the people in that race. So can you tell us just a little bit about what it was like to win the silver medal in Rome in nineteen sixty in the two hundred meter dash? Well , that's an honor for one of the I say an individual in his or her lifetime . I can remember starting off in the two hundred in the final . I ran about twenty thirty meters and I saw Rayne Norton who,'s an American to my left, I was in lane nine . And I saw him over my left shoulder , and I said to myself , I'm behind . And the next thing I knew we were crossing the finish line . And at that point, I was running well ahead of everybody except one person that was the Italian who won with a time of twenty point five and they gave me a time of twenty point six . That was the old world's record . And today's timing electronically , I would have probably do twenty point five one we broke the tape and then standing on the podium , seeing the American flag go up and knowing that at that given moment you're the second fastest person in the world What a feeling . Wow. Thank you for sharing that with us. Lester, we're going to hear a little bit more about a little bit more about your health journey as the show continues. Thank you for sharing that piece of it with us. If you're just joining us here on the Sound of Ideas, we are talking about aging well . We are talking about the fact that Americans are living longer than they ever have before, and what we can do to make sure when we all get to that point that we are feeling as good as possible. We have several doctors here with us. We have a healthy active ninety two year old person with us who's sharing their perspective who just so happens to be an Olympic athlete. If you want to give us a call, the number to call in with a question or a comment is eight six six five seven eight zero nine zero three . You can also email us at SOI at ideas stream. org or send us a message on Instagram at the Sound of Ideas. So now we're going to switch to talking about some specific things that people might need to be aware of to take care of themselves as time goes on. Dr. Immul Singh, I'd like to talk to you about proper dental care when it comes to aging well. A lot of people may not necessarily realize how integral this can be to your overall health and well being. So can you tell us about some of the risks associated with not taking care of your teeth and what you recommend for your patients ? Sure . So again, you know, a simple issue as dental kill, like you said, but it can have a major impact on your overall quality of life. So physically, I mean, if there are cavities or maybe tooth infection abscess , you know, these things can cause a medical emergency , right? Some sort of infection predisposes you to sepsis, you end up in the hospital, right? So one, that's more physical and pathological disease. Number two, you don't have proper teeth, you can't eat and so that affects your nutritional status and then eventually can lead to frailty as you're getting older. So that's important because again frailty can compromise you having a good quality of life . And then there's a social perspective as well. If you don't have good teeth, sometimes that may prevent people as you're getting older from interacting, right? You're embarrassed to talk because you don't have proper teeth or even dances to replace it. So overall, it can affect your overall quality of life physical, social, and some to point psychological as well. Dr. Brumel, you mentioned to me previously that what's good for the heart is good for the brain. So what does that mean when we're in our thir ty and for'tsies when we have to think about good heart and brain maintenance. Yeah. So when we think about heart health , brain health, diet, exercise , and healthy sleep. So people always ask, well, what kind of diet do you recommend ? And I think that when you're in your thirties and forties and fifties, this is a marathon. It's not a short race. And so building good habits early on and thinking about, for instance, a Mediterranean diet, something that's relatively evidence based and somewhat easy to maintain throughout your lifespan is a good thing. Exercise, we talk about a couple of different kinds of exercise that are important, probably Stephanie. One is aerobic exercise. So something that gets your heart rate up. That's good for your heart health, it's good for your brain health. It dilates those blood vessels. It gets your blood pumping and keeps your blood pressure healthy . But we also talk about maybe flexibility . And this is particularly important as people get older , that things like yoga and Tai Chi and even pates we've seen become more popular , exercises that focus on stretching strengthening your core can be equally as important as that aerobic exercise. So mixing those things together , I think, is a good set of habits for most people to get into. When we think about some of that mobility that you're talking about there , the yoga, the taichi, the pilates for people who that might sound intimidating for, you know, it can it be as simple as what if we're just bending over and touching our toes every day if we're able to do that? Does that have similar benefits? I think the theme is working on flexibility and core strength, and you can absolutely do it at home. And in fact, it's more accessible than ever now. So I have so many people that tell me that they access these sorts of workouts on YouTube, for instance, or other online outlets that they're available to them for free . I think it's even better if you can incorporate a little bit of a social component in it. And so if you have a neighbor or a friend or a family member that you can meet a few times a week do the workout with. That adds another element that I think is really important. Sure, the buddy system, the socialization, we'll talk more about that in a minute. Dr. Grossal, I want to talk to you about the people who are seeing doctors regularly . So we do know from the Americas Health rankings senior report, ninety eight percent of their people in the late sixties here in Ohio have a primary care doctor. I know from my own struggles with getting my parents to the doctor. That feels like a really high number . Can that really be true? ninety eight percent of our seniors have a primary care doctor? It is true that they do have them. The problem is, are they seeing them? You know, are they calling, talking to the nurse at the office? Are they going in for their annual appointments? And the other thing is if they are going, we're obviously seeing some health issues that are continuing and getting worse as we'll continue to talk about. But you know, because of that, that I feel that sometimes some of the primary care doctors are just looking at the patient as a disease like, okay, let's talk about your kidney disease right now as opposed to looking at them holistically . And you know, to look at them not just physically , but from socio and economic standpoint and from a mental standpoint, if you combine all of this together , you'll health in your sixty five and older age group range will improve. And so just saying that we have primary care it's important, but you got to go see them and maybe we need to look a little bit more holistically . So speaking of holistically, Dr. E nwols somethingon, that Lester mentioned to us was eventually making the decision to get a hearing aid with his care team. Can you tell us how something like that making sure that your hearing and your vision are taken care of, how that can be impact ful to the overall health as we go through our lives. Right. So again, it's something that kind of affects multiple variables, right? So hearing from a neurological standpoint, there is evidence that says hearing losses related to brain health as well. So we want to always make sure if there is a deficit in hearing, we want to maximize it, you know , screen, get your hearing aids. So number one, brain health, number two, again it can if you do have hearing loss, is there something additional that's happening with the hearing loss that could be related to your middle ear or a different part of the air that could contribute to balance. If you're off balance that can predispose you to fall. So again, something patholog . Hearing very important for socialization because again, sometimes people may mistake hearing loss, you're quiet, you're not responding for , hey, this person may actually be confused when it simply is they didn't hear what you said, right? So again , being part of that social circle, ensuring that you do have hearing aids allows you to keep your independence by staying social . I think those are probably the three more important aspects. Okay . Lester, can you tell us a bit about what it was like for you when you came to that realization that a hearing aid would be helpful to you and how you ultimately decided to go that route? Well in conversations before I was using them , I would always say , what did you say ? Would you repeat that ? And primary doctor said, you know, just get them checked . And I had a friend who was a hearing aid specialist and I went to see him. He checked and he said I think in your left ear , you know, you could use one Let's try them and see. We try them . I end up getting a set and boy turn ed out magnificent after that. I didn't say what did you say? I was going Thank you. That was nice conversation . Let me expand on what you just said and it just worked out well. Great. Do you remember when that was Lester about what age that was for you ? ninety two now, I would say seventy five or eighty , maybe yeah, about seventy five or eighty years old. I've had them now twelve, fifteen years it's magnificent. Great. If you're just joining us here on the Sound of Ideas, we are talking about things that we can do in our younger years to make sure we are in our best possible situation in our older years as Americans are living longer. If you have a comment or a question, you can call us at eight six five seven eight zero nine zero three . You can also send us an email at SOI at ideas stream. org or you can send us a message on Instagram at the Sound of Ideas. We have an email from Tom, Tom writes in. One of my daily morning activities that I have incorporated for the purpose of keeping the brain sharp is formulating a question or comment to send to this show . Tom, we love that. Thank you so much. Tom goes on to say a shot of coffee and some critical thinking seems like a great way to start one's day and get different areas of the brain moving. Thank you for the opportunity. Tom, thank you for being a part of this on of Ideas. We really appreciate that. We do have a caller with a question now. We've got Jim from Cyuahoga Falls calling in. Jim, welcome to the sound of ideas. Please go ahead. Nice, Stephanie. Yes . I'm seventy five, and I've had relatively good health. I also have doctor Hirschberger as a doctor, which the gentleman has. My question is I just recently had an issue with blood clots and the blood clot went to my lungs and caused me to have shortness of breath . And my question is what type of doctor or what type of should I see going forward with this type of situation and does the medication make the blood clots go away? Thank you for that question. I think Dr. Nulsing may be suited to answer this question related to lung care. Dr. Imolsing, do you have a thought on this? Sure. So you can see a vascular medicine doctor. I mean, some pulmodologists can also keep an eye on things, but I would say the phys eral would be best sort of to vascular medicine. All right, thank you for that. We have another call now from Arvin in Cuyahoga Falls. Arvin. Welcome to the Sound of Ideas. Please go ahead with your question . Hello, wonderful show today. My question is to the neurolog ist , what is the belief in the medical profession about supplements that are sold commonly over the counter to assist in memory to help memory to make sharper . Good question. There's a lot of information out there about that, Dr. Brumell. Great. So thanks for asking that question, Arvin. You know, I mentioned before how we can build strength in that muscle of the brain , I think throughout the years , by a lot of the activities, including the mental exercise that was brought up by our previous caller . And I think a lot of the supplements and things that you see are based in people's desire to avoid brain disease in the future to potentially have some control over heading that off . Part of that's rooted in the fear of brain dise ase, I think, and fear is a very powerful motivator for a lot of people . And so that leads to an opportunity, I think, to sell things to people, for sure. I wish I could tell you that there was one kind of magic bullet that could fix that and head these things off, but there's really no evidence that a single supplement or combination of supplements in and of themselves can prevent brain disease or prevent memory loss or keep us sharp in our older years. That being said, I think that good nutrition and things like multivitamins are really part of brain health overall , but I would certainly mix it in with all of the other wellness aspects that we discussed. Thank you for that. We've got an email now in from Dave. Dave writes. I'm sixty five years old and have recently made major changes to my diet. When I started, I was two hundred and eighty nine pounds, and now I'm down to two hundred and twenty eight pounds. It's made big improvements in my life in my health. I'm off to two diabetic medications and one blood pressure medication. My A one C has gone down from seven point five to five point four. I'll be asking for a definition on A one C from our Dr. Grossell here in just a moment. Dave says, My biggest take away realizing just how carb addicted I was. Dave, thank you for sharing that with us. Congratulations on the health improvements. doctor Grossell, you mentioned that weight and obesity is something we can work on here in Ohio. So what can you tell us about that? Yeah, first of all, that's great that you were able to lose that weight , especially maybe not with GLP ones, which everyone is kind of doing these days, but being able to do it with physical activity and bringing that hemoglobin A one C down , we like to see that below six when it starts rising. It's kind of a if you think about it an average of what your blood glucose is doing for the last three months. It kind of gives you a picture when it's above that . That's when we're starting to talk about prediabetes and diabetes and things like that. But yeah, and the whole obesity and physical inactivity is just a vicious cycle because it just increases your risk with chronic conditions , which then increase other areas, depression, social isolation , you know, and this builds over time in your twenties, thirties, forties, fifties and then, you know, in the elderly . And if we can somehow out of the habit and start doing , you know going with a lot of what Dr. Brimel said with the physical activity, the sleep, the nutrition, all of those , you're going to start getting more in the habit of that's what you'll be doing in your sixty five and you'll become more healthy at sixty five. I mean, if you look at two seventy year olds and one of them did all these things that we were talking about and the other did not they can biologically be fifteen years different. Wow . That's powerful . If you're just joining us here on the San of Adias, we are talking about aging well and what we can do in our younger years to make sure as Americans are living longer, we feel our best for as long as we are here, as long as we can be. We're going to take a short break now. When we return, we'll come back with more insight from our doct ors and also our ninety two year old guest on our panel today. This is the Sound of Ideas. I'm Stephanie Hane. Stay with us. Welcome back to the Sound of Ideas. I'm Stephanie Haney. Thank you for staying with us today as we are talking about aging well and the things we can do in our younger years to make sure we are feeling as good as possible as we get into our older years. If you want to be a part of this conversation, you can give us a call at eight six five seven eight zero nine zero three. You can also send us an email at s o at ideas stream. org or you can send us a message on Instagram at the Sound of Ideas. If you're just joining us, our panel today includes Dr. Gary Grossell, the Chief Medical Officer with United Healthcare of Ohio. Also here with me in studio, we have Dr. Robert Bermell, a neurologist with the Cleveland Clinic. Joining us on video call, we have Dr. Rupa and Mol Sing, a geriatrician with the Cleveland Clinic and also calling in, we have Lester Carney, Age ninety two, an Olympic silver medalist . So as we get back into this conversation, I want to talk about some new developments that are coming here to Northeast Ohio. And in light of this, Dr. Bermal, we do know it's been reported that one in three people will be affected by a neurological disease in their lifetimes. Now the Cleveland Clinic will be opening a brand new neurological institute on its main campus that's expected to happen in january twenty twenty seven, I believe. So tell us about what will be available there for people for assessment. Thanks, Stephanie. I think that Lester talked about his race and being in lane nine and winning that medal in Rome. And I think the reality is we are in a race against neurological disease. Those of us in our fifties and sixties feel like we need to make strides and get ahead so that the science can advance and we can actually treat these things. The new neurological institute building on the Cleveland Clinic Main Campus is a million square feet opening in january twenty twenty seven. It's all the neurological subspecialties all together, so think stroke, epilepsy, multiple sclerosis, Parkinson's , brain health, Alzheimer's, psychiatry, psychology, rehabilitation, all under one roof. The building's fourteen stories, inpatient and outpatient care . Physically very impressive, but what's even more impressive than that is the idea behind the building, which is that this building itself will actually function as a caregiver that patients coming into this building for care and physicians working in that building, literally physicians moving to Northeast Ohio to work here will have tools that no one else will have to take care of neurological patients . And when I say the building is a caregiver, I truly mean it. So if you're an inpatient hospitalized there , AI tools to help prevent falls in patients who are hospitalized in the building , new communication tools in the building . And one of the ones we're most excited about is what's called an assessment center where patients coming for ambulatory or outpatient appointments will have not only standard vital signs taken, blood pressure, pulse, you know, respiratory rate, things like that that we've talked about previously, but also what we would call neurolog ical vital signs. So very detailed assessments of patients' gait , their cognitive abilities, brief cognitive tests that a patient can do themselves , and even something as advanced as a speech pattern analysis or voice pattern analysis that can give us the very earliest signals of any neurological condition. And so we think that incorporating these readouts, these very detailed analyses of neurological function into outpatient visits will help us to identify neurological disease even before people have symptoms potentially , because the time to identify and the time to treat these things is not once they become very severe, but really as early as possible so that we can delay and prevent. Wow . Tell me a little bit more about the assessment piece where people will be walking through the space and having the way they walk assessed. How is that helpful for people in the neurological space? Someone's gait or the way they walk is we think of it as a neurological vital sign. We talk about the risks of falling when people get older and it is certainly a risk, but it also even a very subtle differences in gait can signify neurolog ical conditions and things that are very actionable with things like physical therapy and rehabilitation . So a neurologist will typically watch a patient walk, you know, walk twenty feet and eyeball them and see what their gait looks like . We've developed a system between neurolog y and biomedical engineering and collaboration at Cleveland Clinic that uses seven cameras where a patient walks down a hall, doesn't need to wear anything special , just walks down a hallway, and basically the cameras turn them into the equivalent of a stick figure in the computer and cranks out all kinds of measures about their gait to give the neurologist tools to assess exactly what's going on. So to give you an example somebody, with early Parkinson's might have asymmetry at their gate where one side is stiffer than another or their arm swing is a little bit off. I think many of us are familiar with if you wear fitness devices, sometimes it gives you measures about your health , even something as subtle as heart rate variability some of us are getting used to looking at. Well, neurologists are getting used to looking at something like step length variability. That's something I can't eyeball myself , but in this building we'll have this tool that will help to give these very, very precise measures of someone's gait . And the numbers go into the patient's chart, they inform their care, we can track them over time . And we think it's going to give us a leg up in this race against neurological disease. I love all these word choices. We're making leg up, race, race against time, it's perfect. That brings me back to Lester. Lester, you are an Olympic athlete. You won your silver medal for the two hundred meter dash in Rome in nineteen sixty. Have you ever had your gait the way you walk or run assessed by a medical professional or by a trainer ? Not really , but hearing what the doctor just said a few minutes ago , when we walk at Harvesty Park two or three times around five hundred, six hundred yards . Walking , we walk on a similar path and I walked with my hands open because back when I was running track , if you had your hands in a ball , you could run at a good pace , with your hands open and at a good pace, which we do walking around Harvest Park . Mini yards or meters is at a faster pace , a slower pace , but a steady pace . And that gives you your rhythm and timing you try to make it even but steady and works your entire body at the same time and doing your walking and exercising . Thank you for that. Quick follow up on that, Dr. Bermell. When I've been walking out with friends, you know, I pump my arms. Is that helpful? Is that not helpful? Does it make any difference for what I'm doing from a lifelong health perspective . I think it definitely increases the aerobic exercise and it's definitely a good thing to do and it helps your balance too. I mean, the reason why we swing our arms when we walk is because it balances out the way your leg strides. And so having that healthy arm swing, I think is a good component of balance for sure. Good to know. All right, glad to know we're doing something right. Lester, please go ahead. It helps your breathing , you know, and you don't get tired because you're going at a different pace at certain parts of the walk and so you get the exercise , you get your lungs working at a good pace , your breathing is better and you just feel more comfortable and you keep your balance not going too fast or too slow and walking in a path . Very good to know . We have a call now from Anita in Cleveland Heights, Anita, please go ahead . Hello, can you hear me? Yes, we can. Please go ahead, Anita. Yes I'm a senior citizen on Medicare, traditional with supplements. And I just got my Medicare statements and I was absolutely shocked because apparently Ohio is one of six experimental AI states that Medicare is experimenting with, where we seem to need to have some pre approv al before seeing a physician. So from January, the statements just came. And I owe close to a thousand dollars according to this new system, and there's an appeal system, but I'm not quite sure how we do this or when this happened or how does this happening? And at this point, I'm going to reschedule all my appointments that I have, my annuals, I'm going to push them forward until I could figure out how this is happening because I do pay quite a bit in annual premiums for the Medicare and my supplemental, and this now is on top of this. Can anybody speak to what's happening in Ohio with this? Hm . Thank you for that, doctor Grissell do you have any thoughts? Sure. So yeah, I'm sorry that you're going through that right now. I would say that probably the best thing to do is to call your medical plan who's covering the Medicare and talk to them about exactly what's going on and why we have that you are getting this increase in out of pocket costs for this and why they have decided to ask for a prior approval before seeing a physician. But that's probably the best way right now is to talk with your health plan to see . , thank you for that. We've got a call now from Audrey in Shardin. Audrey, welcome to the Sound of Ideas. Please go ahead. Yes , I've been listening to you and you do are saying some good things . But when you bring on a person that's your average elder person , he's more of a self made, more self pushing in the majority of eighty four the elder are in sanitary and what you're trying to hit or not self motivated, and you've got to start them out doing something that they think they can really do on their own Oh , not everybody wants to go to the gym three days a week or four days a week and push a lot of heavy weights and whatever . I was forty and being sanitary . And my doctor said, I'm going to gain some weight. And that's all he said I must be somewhat of a self motivator because I started walking , but that's something , you know, that's easy that people could do . And they don't have to do , you know, an hour and a half at a gym and lots of weights and do tough things start out with things that are pleasant and easy for them to do. Thank you for that, Audrey. We appreciate that note. And I'll ask you to weigh in on that, doctor Emmel saying what are some things that you would recommend that people do in their earlier years and also at any age that are maybe a little less intimidating that aren't requiring so much self motivation? Yep. So thank you, Audrey. That's an excellent point . So I'll just answer the beginning first. So I agree starting low and gradually progressing , but Sydney, if someone has no self motivation , you know, sometimes it's worth having that discussion with your physician, right? Is there something that's causing that lack of motivation or was this who you've always been the last seventy, eighty years, right ? And again, just educating a person in terms of just how effective exercise is on your overall quality of life and keeping you out of the hospital, right? Exercise is one of the most effective non pharmacological interventions we have for healthy aging . And so when you asked about what can we do in our younger years , you know, starting in your thirties, forties , that's when you have to basically kind of create that mindset and habit, right ? And make those lifestyle changes that's going to take you to that healthy aging situation . So everything we kind of talked about , right, you know, the exercise . And certainly, like I said, starting low and gradually progressing, you don't have to go to a gym now. There's ample opportunities, you know, with YouTube or even physician offices have exercise programs. We have one specifically called Matter of Balance , which is very low impact, but targeted towards people who are at risk of faults. So physician offices, community centers, right? The why , which kind of brings in, again , multiple aspects, being able to socialize, yet exercising, right? And we have staying physical . And so you're tackling multiple domains that takes you to healthy aging . We talked about talking with your neighbors. If you're not somebody who wouldn't want to go to a gym, have a group session at your home in your backyard and just start moving slowly and building it up. Yes, the recommendation is one hundred fifty minutes of exercise a week, moderate intensity . Yes, the research says moderate intensity is better than low intensity , but again doing something is more than doing nothing, right? So creating that lifestyle change as we're getting into an older age , but we're looking at exercise, we look at nutrition . You look at weight, we look at sleep. We look at habits of smoking, alcohol use . And also a part of healthy aging is making sure in your forties , your preventive screenings are being done with your primary care physician . If you're just joining us here on the Sand of Ideas, we're talking about aging well and what we can do in our younger years to make sure we feel as good as possible as life goes on. If you have a call or a question, a comment or a question, you can call us at eight six five seven eight zero nine zero three. You can also email us at SOI at ideas stream. org or send us a message on Instagram at the sound of ideas. A couple of emails now from audience members. John Elyn writes in. I recommend seniors take advantage of the Project Sixty Program at public colleges and universities in Ohio, which allows anyone sixty and over to take classes for free. John Allen says they've been doing this since two thousand eight. It provides me with a routine exercise, getting to Cleveland State University, socialization across generations, in addition to learning about things I'm interested in, I can't imagine retirement without it. Thank you for the tip there, Jonalin. We've also got an email now in from Robin, who is a registered dietician. Also, this is a family show here on the Sound of Ideas Today happens to be the mother of our deputy editor Rachel Rude. Robin writes in, healthy food and exercise is important for everyone, but also consider stress and anxiety and perhaps include meditation to relax and lower stress. Also, healthy food is the best way to get good nutrition because you have no idea what is put in supplements. Robin goes on to say it might not be what you purchased, not to mention the cost . old Forer adults being social is important to stay healthy. Take classes, lunch with friends, and family, etc . Thank you very much for the comments, Robin. We appreciate it. We've got a couple minutes here and I want to talk about some social factors. Dr. C,ro Ice'llll turn to you on this. What are some of the factors outside of our control that might be impacting the health of Ohioans later in life? Yeah, so I would say, you know, a real concern is social isolation that occurs and with that depression loneliness . And you know, that is not just something that increases someone to be on their own and so increases some of their mental aspect because it does do that obviously , but also it can affect physically. I mean, we have seen that social isolation will increase cardiovascular disease. It also can play a part in diabetes . And why that happens because we get chronic stress with isolation and it's a vicious cycle again . But the chronic stress causes increased cortisol, increased adrenaline, nor adrenaline. Those things increase a lot of the inflammation inflammatory responses, that can increase cardiovascular disease , that can also cause increase in blood glucose or blood sugars . So to get that . Dr. Inmulsing, something that you're passionate about is memory cafes. That's something that you're highly involved in. Can you tell us about that initiative? Sure . So memory cafes for those of you who are not familiar with what they are, they're basically safe spaces for persons with memory loss, dementia to come with their caregivers, a loved one and spend an hour once a month . It's a venue where we promote persons with memory loss to remain active, mentally, physically and socially. So as of today, Center for Geriatrics, we've launched three memory cafes , one at the South Euclid Public Library, one at the Cleveland Heights Libr ary, and one at Utler General Hospital, the World Sauditorium. And it happens weekly. So we focus on cognitively stimulating activities, whether it's music, art , collages, try to force patients to use their imagination. So for instance, this week is travel to Europe . We try to recreate the whole trip . We do physical exercise fifteen minutes during that session with exercise to music so that they're having fun and enjoying it. And then socializing where we're sitting together as a group and encouraging people to talk with each other, right Not only just the patients or persons with memory loss , but it also creates a space for caregivers as well because it gives them a different rule at the memory cafe where, they're just spending time with mom rather than being the actual care giver . And they also allow the caregivers to form a network amongst themselves and support each other. So certainly something I'm very passionate about and the hope is to continue growing this more and offer it in different locations for the clinic. Okay . As we start to wrap things up here, Dr. Brumal, I want to ask you about two things. If you can give us any quick things that we can do to kind of keep our memory as strong as we possibly can. And also I want to ask you about the brain study that you have going on for healthy brains. Sure thing. So I think that on the first piece, of course, mental exercise and I think people like using crossword puzzles as an example is kind of the prototype. But there's many, many different ways to engage your brain. I think reading is a very healthy one, engaging in conversation. And again, thinking of your brain like a muscle and really exercising it is important as we age . On the topic of healthy aging , I mentioned how we do really feel that we need to identify neurological disease earlier when it might be much more treatable and we are working really hard in Cleveland to identify the earliest signatures of that. Think of maybe even a blood test someday that would identify risk for dementia that would be modifiable for someone . It seems like science fiction now, but it's actually really happening here. So at Cleveland Clinic we're enrolling a study called the Cleveland Clinic Brain study where people fifty years or older who are healthy, who do not have neurological disease can enroll and undergo a neurological screening visit once per year , including things like sleep studies , MRI scans, fancy retina scans and other tests that we're hoping will help to identify the risk of neurological disease. So people can go to our website for that cleavlinic. org slash brain study and look into enrollment. Perfect. I want to thank our panel for participating with us today. Here in studio, Dr. Gary Grossell, Chief Medical Officer for United Healthcare of Ohio, also doctor Robert Bermell, staff neurologist with the Neurological Institute's Mellon Center for Multiple Sclerosis at the Cleveland Clinic. Joining us on video, Dr. Rupa and Mul Sing, lead geriatrician for community programs at the Cleveland Clinic, and our Olympic athlete Lester, Carney, grandfather of our Aya Kathy here. Thank you very much for being part of the panel. We appreciate it. Thanks for having us. If you missed any part of today's show, you can hear a rebroadcast tonight at nine on eighty nine seven W KSU , you can also find us wherever you get your podcasts and on YouTube. You can get the last word on today's topics emailing us at SOI at ideastream dot org dot You can also send us a message on Instagram at the Sound of Ideas . We'll be back with you tomorrow on the Sound of Ideas, talking about end of life options from cremation to green burials and everything on both ends and in between. I'm Stephanie Haney. Thank you for keeping this conversation going. We'll see you back here tomorrow on the Sound of Ideas