Support & Care for Yourself and Others, Part 3: Aging Well

Episode Topic: Aging Well

How can we age gracefully, resiliently, and mindfully? How can we best take advantage of all the opportunities offered by the aging process, such as the growth of our wisdom, experiences, and relationships? Join Notre Dame psychology professor Cindy Bergeman and her guest, family medicine practitioner Dr. Thomas Larsen of the South Bend Clinic in the final live session of the series as they discuss how we can learn to lean into change whether it is one we choose or not.

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This podcast is a part of the ThinkND Series titled Support & Care for Yourself and Others. 

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Transcript

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Hi. I wanna thank you for participating in our series Seasons of Change, support, and Care for both yourself and others, where we're gonna continue to discuss how you might age in a more resilient way, and it's our hope that over the course of this series, you have had the opportunity to connect with people globally about the kinds of materials that have been presented. We hope that you'll, you've found that your experience with this session will be insightful and engaging. We invite you to stay connected not only to us here at Think Indeed, but also to the learning with your family and with your friends. At this time, I would like to thank all of the co-sponsors of the Seasons of Change, support, and Care for yourself and others. The Department of Psychology, the College of Arts and Letters. The Notre Dame Alumni Association and this series is also co-sponsored by the Notre Dame Senior alumni, the Notre Dame Women Connect, and the class of 1983, who are celebrating their 40th reunion this year. Congratulations. We really appreciate your willingness to help us share this series. Each of the team members have put in so much time and lent their talents to bring this program to life from its original conception. This week in our final session of the series, I'm really delighted that we have the opportunity to continue this series with our final focus on aging well, and I'd like to welcome Dr. Thomas Larson, who joins me in this discussion. Dr. Larson practices in the family medicine department at the South Bend Clinic here in South Bend, Indiana. He's board certified in family medicine and he's professionally certified in outdoor emergency care, and he's Amer a member of the American Board of Family Medicine. Dr. Larson graduated from Ahu University in Denmark in 2008. He did his residency at Memorial Hospital here in Stock Bend, and he, I think most importantly, he really considers it a privilege. To get, to be part of his patient's life stories when it comes to their health. He strives to listen and understand and, to the best of his training and knowledge to provide, options for diagnostic workups and treatments. He really sees that good patient physician relationship is really a partnership when it comes to health. And I know this to be true because he is my personal physician. He may be tsking and shaking his head when I'm talking about things that you can do to age well when he knows that I may or may not follow my own advice all of the time. But I, I think. Many conversations that we've had as a patient and a physician I think can really help to inform our topics of discussion today. So today we're talking about aging well, and I think, we all want to age well, but how do we know whether or not we're actually aging well? What is successful aging? Is it something that's in the eye of the beholder? Some people have suggested it's long live longevity. If you live a long life, you've been successful. But I would probably argue that most of us would prefer quality in our later years, and not just quantity. So maybe successful aging has to do with our health, and maybe it's our physical health. Maybe it's our mental health. Maybe it's maintaining our cognitive capacities. For other people, it might be they wanna be happy, they wanna have good quality friends and close family. And as we're talking about these issues today, just keep in mind that there really are no right or wrong answers. But I really wanna start by asking you, when you think about successful aging, what comes to mind for you? Or alternatively, how would you know if your patients were aging Well? Yeah. Yeah. Thank you Cindy. And thank you for the invitation. I'm excited to be part of this today. Yeah, I think when we talk about successful aging, when we use that term we typically related to being free of of chronic disease and being able to function well both physically and cognitively. So that would be a little bit of a, like a a medical definition there. And sometimes we talk about people being, patients being essentially healthy and that means that their chronic conditions are well controlled. They haven't gone through a major trauma or cancer disease and they have, may have chronic medical diseases, but they're well controlled and they're not affected affecting their ability to function physically or cognitively. So those are terms we would use in a medical setting. So they essentially healthy person and the person who are successfully aging. I really I think the way, we could say successful s being free of disease, but many of us may not be, but what we do about those diagnoses, how we care for ourselves, et cetera, can certainly be really important. So even if we have chronic diseases we can, from your definition, we can still age well, yeah. It's how we do with that. Maybe the adaptations that we have to make to compensate for these problems. I guess I would like maybe to come back to this idea of, longevity. I think Oliver Wendell Homes has a quote that if you wanna live a long life, you should come from long-lived people. I guess I've wondered whether there's a gene, if you will, for longevity. Or if really what we inherit from our families are risks for disease. So maybe we don't inherit a long life, we inherit diseases that may shorten our life. I just didn't know if you had any sort of thoughts about that. Yeah. No, I think it's a good it's a good point that if you really want to have a, a healthy life with lots of longevity, you have to choose your parents wisely. We know when we check a person's cholesterol as simple as the cholesterol, the main determinant of your cholesterol is your parents' cholesterol. And then you have lifestyle that can modify that certainly in many ways, and medications. But I think, yeah, I think it's a, it is always gonna be always gonna be a mix of genetics and your lifestyle and just the way you grew up as well. And there are certainly been studies showing that certain gene variants and that is associated with. Slower cell aging than when the cells divide they become less damage than what normally happens. So they, they're, they've definitely been some, evidence of that. So how long we might live, on the one hand, it was the luck of the draw, the parents that we got, the family that we got, because, often you get the double whammy in terms of that early lifestyle and your parents' history of chronic diseases as well. But on the other hand, I do agree with you that there are things that we can do to compensate for some of these genetic mechanisms. A genetic mechanism by and large is, doesn't mean that. We're destined to get. In some cases it does, but if we know that we carry the gene for alcoholism, for example, that doesn't make us an alcoholic. You have to drink to be an alcoholic. So there is this dynamic, I think, between, the genetic makeup that we have and the ways in which it actually plays out in our lives. Yeah. AB absolutely. Yeah. It's interesting when you look at studies that, that looks at longevity, where you start out with, longitudinal study with middle-aged folks and follow them over a number of years. It's interesting to see what actually comes out as significant predictors. And like you said, genetics or what you, how old your parents got to be is very important. And socioeconomic status is still one of the most important determinant factors. Now, does that mean that more education makes you live longer or does it just mean that the upbringing you got you a good education and you lived in an environment where where that was where, yeah, where that was common. But socioeconomic status. And then after that, then you have smoking status. Obviously, non-smokers, they do live longer than smokers in general. And even even just educational level that is actually only significant for men, interestingly. It might change as this, we have more recent studies and yeah, so there are certainly things, diet, di diet is a significant predictor of longevity as well. And we are not talking about low fat diet versus low car diet or a Atkins versus paleo diet because there's not a great. Difference actually in longevity but more having a diet that's rich in antioxidants. So we are talking about yeah, whole grain foods fruits, vegetables, berries limiting the consumption of red meat, saturated fat. So that has been consistently shown as well be associated. Yeah. Yeah, so especially shopping around the perimeter of the grocery store where you get the fruits, the whole grain bakery the meats, but the fresh food as opposed to the middle of the grocery store where there's a lot more processed food as well. So let's. Let's talk maybe a little bit about how we might optimize our aging process and we can move back and forth. I think there are physiological pieces to that. I think there are psychological pieces, there are certainly social pieces, and you mentioned smoking. We know, we all know that smoking is not good for us. It will shorten our life. But what are some other things, maybe in addition to your thoughts about diet and smoking? Yeah. So in addition to diet and smoking of course alcohol is another common conversation we have in the office Alcon in excess. So that typically is more than two drinks a day for men and more than one drink a day for women. With some studies suggesting that one drink a day, May actually have cardiovascular benefits reduce risk of heart attack, cardiovascular disease, stroke but that comes with possibly increased risk of of breast cancer in women more than or one drink or more a day. So there's some, it is off that is offset a little bit. But I think in terms of of risk a lot of non yeah, non, non where say like non dietary issues can affect longevity, just having a positive outlook on life which causes less stress, better sleep. And having that reduction in the activation of your sympathetic nervous system, that's your fight and flight system that is really important for longevity. And it's interesting in some studies, it actually shows that self-reported health is associated with longevity as well, or hard art hard outcomes, which is like heart attack stroke and death. So basically for two people who objectively have the same risk factors, if one thinks I'm great, health have less worries, that person's gonna fear better. So it almost becomes a self-fulfilling, prophecy if you have more of it doom and gloom. Outlook on your life. Yeah, I think that's really interesting. I do think, mind over matter is really important for a lot of the issues we've talked about. So in the first session, we've focused a lot more on stress and the negative health consequences. So we've got a system that is beneficial in the short term. If you're in a dangerous situation, it serves you well, right? But when you have chronic stressors or stressors that just, your life is one stressor after another, we do know that has a real detrimental effect on health and wellbeing. And I agree. Things like, a positive outlook, how you manage your stress, how you think about your stress. So often we can reinterpret. A stressful situation, not as a threat, but as an opportunity or as a challenge. Gosh, I can, this will allow me to grow in these kinds of ways. And even, pivoting a little bit to these more positive ways of thinking can have really important sort of long-term ramifications. Yeah. Think it was Go ahead. Yeah, just on, on that though. So we are just coming out of Lin season and I came across a quote from Martin Luther who said that even the, our worst trials, our most tragic things that happen in our lives God, God can use that to create something new. And I think that's a universal truth that through even through suffering, we can actually We can actually learn to make that our benefit. And we all know those people, the awful things happen, but they're able to turn that into see the good in what happened. Yeah. With even when it's when it's regarding your own health. And I guess I related to that, I do feel like even if it is difficult, you're developing sort of strengths and skills that you can use again in the future. I remember when my brother died, I think it was very hard for my mom to adapt to that. But when my dad died, which was really 18 months later, she knew it was going to be okay in the end. It felt bad now, but she knew it would get better. And that knowledge. That there would be a positive point in the future, I think was very helpful in dealing with that. So what do you think then, you mentioned too much alcohol. Obviously smoking is not good. We all enjoy some vices. Mine might be coffee and sugar cookies. But, some people enjoy a cigar, some people like a glass of wine with dinner, when do these sort of vices that give us joy, if you will. Yeah. When do they move from potentially, I'm gonna say being okay. I'm not I'm not gonna say they're good. I'm gonna go with, go. Ok. Yeah. When do those move to, you really are doing something that is having a detrimental impact on your health and future wellbeing. Yeah, I think the way I think about this is probably important to distinguish is your vice because you are coping with something in your life, or is it because you are really enjoying life and a glass of wine can be a way of coping with a hard day at work, or it can be just, increasing the pleasure of having dinner with your wife. I think when we start using it can be alcohol, it can be food, when we're using that as comfort when we are alone and just wanna feel better because we are in a hard place, I think that's when tho those things become really bad for our health. Developing unhealthy alcohol habits addictions and obesity. So I think there's a room there. I think there's room for most vices. I would say probably the exception of cigarettes. Yeah. Cause it's, even a cigarette a day actually has a remarkably detrimental effects on a body. But in terms of, having the, and, an extra serving of ice cream or having, even, a soda drink once in a while that's not gonna ruin, ruin our health. And if it enhances our sense of wellbeing, I think it's really good for us. But I think it's important to think between habits. What are habits and what are things that we do when we are celebrating and are just enjoying ourselves. So our habits should be eating oatmeal every morning with blueberries, for example. Yeah. And yeah. And having that ice cream should be maybe once a week on Saturday night, or, yeah. Yeah. So we don't wanna cope using Ben and Jerry's, or, having a drink. I know sometimes I come on from work and I feel stressed and I feel, I think to myself, I need a drink. And then I think, no, this is the time when you don't have that drink. You're not enjoying it. Like you said, you're having that drink to compensate for a bad day or to try to forget about what happened. And so I like that differentiation of what are your motivations for having, that drink that ice cream, whatever, is it to cope with the things that are happening in your life, or is it truly enjoying them, enhancing the experience of, your dinner or enjoying your weekend or whatever. Yeah. And then getting the habit of really enjoying it. So if you really like chocolate, Then buy the really nice chocolate and then really enjoy it when you enjoy it. And yeah, can I quote you on that? No, I think that's really a good point. Sometimes having a little bit is more satisfying than having a lot and having better quality might be better than, having a lot of less than optimal quality. So yeah, sometimes I would talk my, to my dad, he's not been in the greatest health the last year but he started running long distance of marathons when he was in his fifties. And he was still smoking at that time, and then he ended up quitting smoking because it really helped his running if he didn't smoke. But he would still to this day, say of the years where he smoked, Those were really good days. My, my dad was a smoker and he quit when I was in fourth or fifth grade. And he told me in his later life, he saw if I knew I was gonna die tomorrow, I would stay up all night and smoke. And I was like, what? But, those are hard habits. Yeah. We think to break and it's easy for us to say, don't smoke, quit smoking. But, if people can look for the benefits like your father did, you know he can enjoy something else more. Exactly. If he quit smoking. Yeah. That's almost a better kind of motivation to, to try to make that's a Yeah, you're absolutely right. Because there has to be something that takes the place of that. Smoking, it releases dopamine. It. That's a sense of wellbeing. It makes you feel good. And if you just take that away it is a, it is very difficult to, to still feel like you Yeah. That, that you're not missing something in your life and having something else that can in other ways release dopamine from the brain. Spending time in nature, succeeding in, yeah. Like in my dad's case, running his first marathon, that then almost became a habit because that gave him another sense of wellbeing. That was a healthy sense of wellbeing. Another, we should all run marathons. But finding that one thing that really becomes a good habit. Yeah. That's really beneficial. And being able to draw on those things can help people age in a much more positive way. And I think the other thing, That I heard you say, which I thought was really interesting is, it's not too late to start. Some of us think that our running days have passed us up or, that we can't make these major changes. We've done things for so long. But in your father's example, he started running that had a positive impact on his life, which, helped him to maintain that. But, we may be in terrible shape right now, but that doesn't mean we can't, pivot and start aging in a more positive way and have, potentially better outcomes. Down the road. Yeah. Yeah. And that's there's still hope for me. I think you're doing pretty well, Cindy. One of the things that I've been really interested in is I'm interested in stress and the role that stress plays in our lives. And, stress often produces these negative emotions, fear and worry, and those are really protective. There's a reason why we're afraid of things or, maybe worry is not quite so beneficial. But these negative emotions I think, clearly play a role in our lives. They help us get ourselves outta danger. Maybe they motivate us to do things that, that we need to do, but there's been some more recent work that looks at the role of joy and laughter and these positive emotions. And again, do they play an important role in our lives? And so we might think from an evolutionary perspective, negative emotions are great, but could we think from an evolutionary perspective that positive emotions are also very beneficial? And there's this interesting theory, it's called broaden and build. And basically it's this idea that positive emotions can trigger these increased sp spirals of emotional wellbeing. And they do that by increasing our scope of attention and cognition. So we might start increasing more novel lines of thought. They might help us think about great ideas or, want to read poetry. I don't know. But joy stimulates this idea of play and, interest encourages us to explore. So the idea of this theory is with these new ideas and actions people can build, they create this impetus to build physical, intellectual, and social type resources. So to some extent, it made me think about your dad. That the running Gave him joy, at least it was positive, gave him a sense of self and I think helped turn his turn aspects of his life around, which then helped him obviously build sort of physical capacity. But probably also social if he's, running marathons. He's getting to know new people. And so I guess I wonder in from your perspective how you see these more positive emotions, maybe the importance of those. Yeah. I think it has of course we all know what a really good laugh with good friends. Yeah. That'll dissipate. Yeah. Yeah. You are letting down your guards and you are yeah. You feel, you just feel a whole different way of relaxing afterwards. And I will say I'm I'm not the person who has a whole, a ton of jokes that I of my head and but when I see patients in my practice who are going through cancer treatment and maybe it's just palliative treatment for a incurable cancer I would say there's such a big difference in quality of life for those who are just overwhelmed with fear. Maybe because of lack of support system and those who have a really good support system. Who would oftentimes start by asking me how my kids are doing or or just show this excess ability to yeah. Empathize with other people too. Yeah. And those conversations, we typically will, laugh several times during the conversation, even though we are here to actually monitor something that's really grave and that will eventually take the life of that person. So I think, yeah, I think laughter is in incredibly important, but what would you say, Cindy? I'm curious this probably even more your specific, so if a lot of men we're talking about the loneliness epidemic especially for middle-aged men, what would you say to the more the lonely person who Yeah. Who has like long hours of work how does how do we start cultivating like laughter and joy in their lives? Yeah. Yeah. I guess for any given individual, it is a matter of thinking about reframing your life and, people have opportunities for social interactions. Obviously some people are more outgoing, others are more shy. I love it when I go into the grocery store and kind of in that coffee eating area. There's a group of men that are all talking to one another. I have to sneak over there and talk with them a little bit too, because I think that they are so cool and. They have so much to add. You are more likely to see a group of women doing that than a group of men. But I do go outta my way to encourage these guys that are really enjoying each other's company. I know my husband and I delivered Meals on Wheels for years. And what I really wanted to do is not deliver someone's meal, but gather up all of the people in the car, take them somewhere and have them have their meal together. So you could come in, you could interact with them but you only had a few minutes cuz you had hot meals that you needed to get to other people. You just saw their isolation and loneliness and. Sometimes that happens because people have come very withdrawn. Sometimes it happens because of physical changes, and they're no longer able to get out as easily as they did before, so they can't visit people. Some of the people that they would visit are no longer available to them. Maybe they've passed, maybe they've moved away. I think it's a real issue. I think that social isolation and loneliness is one of the greatest stressors for people, especially in later life. We saw a lot of that during covid, when people were much more isolated, and especially older adults. Some of them would say I'm always by myself. So it wasn't that big of a change, but for other people, especially people who enjoyed a strong social network, I think that was particularly difficult. Even so online conversations, if you could set that up, I had an undergrad who wanted to get a group of students. I taught a class in mental health and aging, and he wanted to get students from that class to sign up to pair with older adults in nursing homes via the computer. To set up these regular engagements. And I think is a great idea, some of the technology behind it. Yeah. Still needed some development, but Yeah. Even the opportunity to talk to people online, I think is also a positive outcome. If you're fairly isolated. Yeah. So I probably don't have a good answer for your lonely middle-aged man. But if you hang out at the grocery store with a cup of coffee, you might find some other folks. Yeah, I think you example is very good. By volunteering at, you are able to give something and it feels good to, to give something to other people. And especially in a program like meals on Wheels where you can make a positive, a very positive difference, somebody else's life. And also through a light in an action and laughter, you can make that person feel like you also made my day, right? Because we had this joyful conversation. While we out delivering, the meal to you. And then it becomes that, that community, I know we've talked about when we talk about longevity and the centenarians in certain pockets of the world where in terms of the longevity and aging wealth, it ties so beautifully into how involved you are in your community. Do you feel a sense of purpose and worth in the community? Do you have a place that's important to other people in that community that you don't feel like you're a burden? Even if you're not aging successfully? Even with ailments, you're not a burden to society. Which I think we can feel very easily in our western world. Yeah. Cause if I can't do anything, then where is my worth? And maybe that's a little bit more men than women that feels like that way. But I think we, we all can feel that. If we can no longer provide and we just need help more and more, so am I still, am I still valuable as a human being? Yeah. That's interesting. And I think sometimes women go through that transition when their kids leave home. Especially if they've primarily been I don't know what the politically correct term is, but if they've been in the home and their sort of primarily focus was, rearing children. I think men often, when they retire, they lose a lot of, a sense of self. Maybe a sense of power, depending on the type of job that, that they might have been in. But, I do think that's a transition. It's a transition. I'm interested in. Retirement broadly, but that transition between who you were and who you're becoming. And how people navigate that. Yeah. And our society is not very good at helping us with that. Oh no. Because we work, most of us will end up working really hard and then we have just a hard stop. And then there's a vacuum. If you have not been planning carefully and in some of those other non-Western cultures, there is a very blurred line between work, life and retirement. And some people probably never retire fully, but also the Yeah. There's not this whole concept even of retirement. Yeah. My husband and I are practicing being retired with property in Colorado. We go out there, we see what it's like. Do we still like each other? After a few weeks together. But I do think that gradual transition is really important. Yeah. I wanted to circle back to something you said. There's a really interesting Ted Talk. I think there's a book, I know there's a Time magazine or National Geographic issue on these blue zones. And I think at the core of some of the things that we're focusing on here today, what is it about these populations that live well into their hundreds, but do so in a very healthy way. So they're still out, working. I think there's one example where an older I think he was 103 or something like that, and he was out working, I think horses. And it said in the morning he's working horses with horses and in the afternoon he's in the operating room, and so you think he's had a heart attack or something like that, but it's as the surgeon in that operating room. Yeah. And I think there's lots of good information in that video that really talks about the, important things that people can do to stay healthy. And to age well in a much more positive way. Yeah. And I, it's, I feel like it's or I think it's very fascinating when you look at the pockets around the world that has longevity and when you look at the things that we think it's important what do they eat? What kind of diet. How much exercise do they get in? Do they do cardio and strength or just cardio? And all those pockets are very diff different when it comes to that. The the people live in. Okay. Now I have a primarily high carb diet. I think that in terms of calories, I think there's 10 times as many calories coming from carbs than fat. So there's a very low fat diet, but it's healthy everything that they eat. So that's one. One one thing that's interesting and then looking at other cultures like in Italy for example where there are certain areas where there's also great longevity and it's a higher fat, unsaturated fat diet. And still the maintain longevity. And I think it has a lot to do with the community and also in movements throughout the day. And many places people don't have furniture, not because they can't afford it, because it's just tradition. You sit on the mat, on the floor when you eat, when you have visitors come in, you sit on, on, on the floor. So you have to get up and down all the time. And here we are looking for the most comfortable lazyboy or recliner. And the softer the better and the less effort we need to do to get in and outta that tier the better. And maybe that's not. Yeah, maybe that's not good. Yeah. From my understanding, it is, it's not exercising for exercise sake, it's really building activity into your life just as, yeah. As you were describing, I think someone said that, a great indication of how healthy you are is can you cross your legs and sit down on the floor and stand back up without using your hands and all of the muscles in your legs, your trunk, et cetera, are all in play. Your senses of balance, I've tried it, I can get down, I can't get back up. I need to get out of that Lazyboy chair and start sitting on the floor. Yeah. Switching gears a little bit, what might you tell. Someone who's really worried about losing their memory. I, when I work with older adults, I think that's a real concern that I'm gonna lose my memory or I'm gonna be a burden on my family. Yeah. How might you respond to people who Yeah, no, that's a very relevant question and it's very, that's a very frequent chief complaint memory deficit. And in most cases, if a person's coming in alone with a personal concern of memory, typically if we do a standardized dementia test, typically that person will pass that with pretty well when we just screen for dementia. But when we're talking about, mild cognitive impairment or just that fear of the, maybe both of that person's parents have Alzheimer's. And you're starting seeing some of the same symptoms in yourself. Obviously looking at the medication list, is there something that we are prescribing that can affect memory? Yeah. And then looking at some underlying conditions like med medical causes hypothyroidism is the thyroid function. Okay. Is there some nutritional deficiencies that can be causing the memory? So always get a good standard, blood panel and if there's some neurologic deficits that are vocal or localized, maybe that person needs a brain MRI just to make sure we're not missing anything. And then we move on to look at what is the sleep pattern like. Could there be a sleep disturb, sleep disorder undiagnosed sleep apnea. Common cause of decreased cognitive function. And then when we talk about depression, which is also really important, we actually, there's a term called pseudo dementia where the person will check all the boxes for dementia, but it's really caused by depression. That's depressing. Cognitive function. And they actually, those presentations, they respond well actually to an antidepressant. And it's amazing to see how memory and cognitive function improves. So yeah, I think all of those are great. Probably self-reported cognitive decline probably isn't the best indicator and there are lots of ways to assess it more explicitly. But I think, we often associate older people with memory loss and. We don't always, really work to sort through what else might be going on. Are they depressed? Sometimes their hearing is poor, and so they're very isolated. Because of that, they don't really hear what people are saying, and it's harder for them to remember information that they never processed very well. But again, the medications, dehydration, a lot of things that are common and can be associated with normal aging, with medication, with disease processes can mimic a lot of the symptoms of cognitive decline. Yeah. Yeah. And then, yeah, then, we'll, oftentimes in most cases, we find well every, there's no underlying condition here, and then we look at the evidence. What can you do to enhance your memory or slow down the decline? And there's not a, that, when you look at the evidence, there's so many interventions tried. I think exercise is probably exercise and sleep is probably where most of the significance is. And you just have to be mild to moderate exercise, like you were talking about, just getting more movement into your everyday life. It's been very pop popular to keep your brain sharp during crossword puzzles or other brain games. And they actually help, at least in the short run. Retaining memory and problem solving skills. But long term, the even the evidence is not great actually, in terms of preventing Alzheimer's. It probably extends the time to yeah. To, yeah. To more severe decline. Yeah. And of course, telling the person who is try not to worry because if you worry about it, then it oftentimes gets worse. Yeah. And that, that's a cheap answer to, an important question. Yeah. And some people are losing their memory. You can't, that's the other side of it that, there are some changes, but I, I think your suggestions, what I've seen in the research literature about exercise, diet, staying active, are all things that we can do that are as beneficial as potentially other treatments. And there's a tremendous amount of research, especially on Alzheimer's disease, looking at interventions. There's some suggestion that. You can pick up some of the early symptoms, maybe 15 years before you begin to see the clinical symptoms. Yeah. And if we have those types of tests that such that we could identify someone who's in the beginning stages of Alzheimer's, it may be that we could intervene at that point before the changes in the brain becomes so detrimental that, there really isn't treatment available for that. Yeah. Where you could actually, you can you can, be more severely in terms of life, lifestyle changes as well. If, you have this high risk, like you mentioned, the person who has a strong family history of alcoholism, that person should probably be very careful ever drinking alcohol alone. Yeah. And hopefully we'll have better treatments. Treatment options for Alzheimer's in the future. So you can actually intervene early. Yeah. And change the faith. So we really talked about a lot of things today. Some of those things are under our control. Some of those things are not. I also think that we may have talked about things today that for some people could be very helpful. Maybe there are other things we talked about that are helpful to other people. So there isn't one magic answer. So some of these things will help for some people, but not others. But if you could give us one sort of piece of advice about aging well what do you think that would be? Yeah, just one. Yeah, one thing. It would probably be notice the little beautiful things in your life every day. No notice something beautiful and good in your life every day. And maybe adding on enjoy nature and cultivate relationships. So being very engaged in your life and being engaged in the moment and not regretting things from the past or worrying about things in the future but being really involved. I think I might circle back to something what you talked about earlier is have a reason to get up every day this purpose in life and feeling useful. Some of the research has suggested that. That is one of the best predictors of people who are aging well or who live a long life. I do think there's lots of important health things that we can do, but I think from a psychological and a social perspective, there are also really beneficial things. We've got some questions. I'm gonna read the question and then, maybe you and I can take a stab at them. Sure. So one of the questions is, dementia feels very scary to me, especially with my maternal grandfather and my father both having it. Does diet and healthy lifestyle really help to prevent this? Lifestyle? Yes. When we are in terms, yeah, in terms of prevention, that's a good question. Does prevent it or just prolong the time to onset? So there, there are things that we know prolongs the time to onset, and that will be educational level. So the higher the education, the older you will get before you have the manifestations because you have a higher reserve cognitive reserve, basically. With exercise regular exercise. So every day, 30 minutes a day versus no exercise has shown significantly to help either prevent or prolong the time to onset if that person were to develop. Yeah. Alzheimer's. And then with diet, I think the research is not all that conclusive. On, on, on that actually. But there there are some suggestions that diet that's more anti-inflammatory than proinflammatory may be helpful because of the amyloid plaques in the brain that builds up in Alzheimer's disease. That is a highly inflammatory process. Yeah. And actually stress can trigger. The inability to have a good inflammatory and immune response. And good stress regulation across your lifespan, again can give you better brain reserve. Potential capacity. But I think unfortunately, especially with the dementia like Alzheimer's, it's not my sense that we don't have a cure for it. We can't make it go away once you begin to see the onset. But as Dr. Larson has mentioned, there really are the ability to postpone or extend the mild cognitive decline period before you get a much more major onset. So it won't fix it, but it does help give you more quality in, in your years. Another question. What advice do we have for caretakers of parents with memory loss and stubbornness? When balancing quality of life versus quantit of time, left meaning forcing them to do what's best for them versus what they really want or don't want to do. So if you have someone with memory loss, they're stubborn, they wanna do certain things, how much should a caretaker really try to force them to do the right things? Yeah. That's a, oh, that's a great question. Probably very individual from families to family. And it's always, yeah, having that balance between autonomy the aging person's autonomy versus safety, where is the right balance? And I think we have to sacrifice a little bit of safety and maybe even longevity in order to preserve quality of life in many cases, especially when we're talking about memory decline and dementia. It's a little bit easier when you think you can at least rationalize with them why what you're suggesting is a better option. But I think you're right. And I've thought a lot about this security versus control and, you can think about an older adult who's living independently. They have lots of autonomy and they can do what they wanna do when they wanna do it, but they are also in a potentially risky environment that is, yeah, they could fall. There's maybe not someone there to help them. They may not be able to operate a stove properly, et cetera. And then you have an institutional setting, let's say a nursing home where every need is being met. But you have a. No autonomy. You can't decide what you're going to eat, what you're often, what you're gonna wear, what day you're gonna have a bath, et cetera. So how do you find that perfect tipping point, if you will, between maintaining their autonomy, their confidence, their positive sense of self, and keeping them as safe as you possibly can. And there are no right or wrong answers to that. There would be nothing worse than, allowing your family member to have a lot of autonomy, have something happen to them, and then you internalize that and it's a really negative experience for you. Yeah. You yourself have to be okay. I think with that decision that, that you make. Yeah. That's a good point. How do you think what are the differences in the ways introverts versus extroverts can approach having a strong social network, as a component of a healthy life? So do you think there are differences in the way with different kinds of personalities? Age? I'll take a little bit of a first Yeah. Approach to that. I think that there are some real interesting things between extroverts and introverts. And often when introverts create social relationships, they do it in such a way that they're very close, intimate, helpful kinds of relationships. Extroverts may do that as well, but they're more interested in. Sort of the ability to affiliate with people. They like that social dynamic. And so they may or may not be cultivating social relationships that are actually beneficial to them, when you think about needs that people might have. So the motivations that introverts and extroverts use in creating those relationships, I might argue introverts are actually better at it. I don't know if you have a different thought about that. No, I would definitely agree with that. And it's more of a challenge, I think, for the introvert to cultivate those relationships. And also that person may need to have more time alone just to recoup, because too much in actions may actually be stressful. But I. But I do think it's an, universal need for us to socialize and be in a setting, I think for the introvert where you can actually develop those deep relationships. So if you are volunteering for Meals on Wheels then you might have to spend more than two minutes each place and only have a shorter route. So you can take eight or 10 minutes with the business meth when you're delivering the food and then having fewer but deeper relationships. Yeah, the extrovert might have a much Yeah, more fulfilling lives with more people involved. Yeah, exactly. Unfortunately, I think we're out of time. I've very much enjoyed talking with you today and this was the last session in the series. So I want to thank everyone very much for attending. Thank you.