Feeling Anxious

With so many concerning things going on in the world today–not to mention the upcoming US elections–a lot of people are feeling anxious. Older adults–although we may have wisdom and perspective–are not immune to anxiety. In fact, it is the #1 mental health disorder among adults over the age of 65, and only about 1 in 3 who suffer actually get treatment.

The Cedars-Sinai Blog, lays out some of the main points of anxiety and older adults. Everybody lives with some level of anxiety, but it becomes problematic when it begins to interfere with our regular activities. According to the American Psychiatic Association, “Anxiety is an emotion characterized by feelings of tension, worried thoughts, and physical changes like increased blood pressure.” As we age, there are many things that make us anxious: health challenges, loss of loved ones, changes in lifestyle (like after retirement), and concerns about family. Anxiety can be treated; when left untreated, though, it can raise the likelihood of disability, stroke, heart failure, autoimmune and heart diseases, and memory disorders (dementia).

According to Cedars-Sinai, anxiety manifests itself in many ways such as avoiding socializing, loss of appetite, insomnia, restlessness, and intrusive thoughts. In severe cases, anxiety can devolve into a panic attack which can lead to shortness of breath, feeling like choking, chest pains, heart palpitations, lightheadedness, numbness, and chills.

If you or a loved one may be suffering from anxiety, it is best to discuss it with a trusted medical professional. There are many treatment options available–and not all of them involve medications. Talk therapy is very helpful. A support system of family and friends can also aid in recovery. There is no need to suffer in silence; in fact, that will usually only make it worse.

The world provides an endless source of anxiety-inducing stimuli. All of us are equipped to face them differently. If you need help, there is no shame in seeking it. Not only is your mental well-being at stake, so is your physical health.

Older Adults and Grieving

Yesterday was a difficult day in the Jewish world. It marked one year since the terrorist attack in Israel by Hamas in which over 1200 inhabitants of Israel were murdered, hundreds kidnapped, and others abused and injured. Jews (and many others) around the world gathered yesterday to remember and reflect. There is little comfort as war rages on many fronts in Israel and Jew-hatred runs rampant across the globe. We are all grieving while trying to make sense of the aftermath.

Each of us grieves differently. There really is no right or wrong way. Forty years ago, I used to lead youth group educational trips to Poland and Israel to study about the Holocaust; after visiting the death camps, some of the teens were devastated and distraught, others were more resilient and stoic. Over more than 30 years as a rabbi, I have seen the full range of emotions in my many meetings with families after the death of a loved one.

Grieving is especially pertinent to older adults. The longer we live the more likely we are to lose loved ones. My personal fitness business, At Home Senior Fitness, works with individuals over the age of 55; I have experienced the loss of at least four clients in the last few years.

As older adults, we should understand that the grieving process is unique to each person. There is no timeline. There is no checklist of what mourning will look like–even if there are religious or cultural rituals to follow. There are ways, however, that we can make the process more meaningful and less debilitating. Spend time with friends and family; even if it is just a walk or a coffee, being with others helps to ease the loneliness. Understand that it may take longer than expected (or desired) to work through feelings or complete tasks involved with closing out an estate. Share with others what you are feeling; talking helps to sort things through. Sharing memories helps us to grieve and can also inspire and enlighten the person with whom you are speaking. Get help if you need it; if you are feeling overwhelmed, reach out to others who may be able to help with errands, meals, rides to doctors’ appointments, etc. Most people are more than happy to help. Finally, if you find that you are depressed or “stuck” and cannot do the daily activities of life, get in touch with a clergy person, therapist and/or a grief counseling group; they can help give meaning to your grief and share resources.

Death is a part of life. We hope and pray that those we care about will live long, happy, and health lives. We know, though, that the time will come when we will have to say goodbye–and we have no control over when or how that will happen. When the time comes, we must surround ourselves with people and resources that will help us to honor our departed loved ones while facilitating our moving on to life without them.

May there be peace, justice, comfort, and love in our world soon.

Real Behavior Change

This Wednesday evening begins the new Jewish Year, 5785. Rosh Hashanah and the days through Yom Kippur (the Day of Atonement) are a time of reflection for Jews. We look back on the past year: what did we do well, upon what could we have improved? The holidays are all about change.

As a Rabbi and a Personal Trainer, change is a key part of my professions. As a trainer, I work with clients to get them to make changes in their health and fitness habits. As a rabbi, I work with others to change the world for the better, and also to make changes within ourselves that help facilitate it.

Can we really change, though? Is it possible to break out of our habits?

Recently, I took a continuing education course taught by Julia DiGangi. Dr. DiGangi is an expert in the connection between our brains, emotions and relationships. In the course, she discussed habit formation; habits are actions triggered automatically in response to contextual cues that have been associated with their performance. About 43% of our conscious experience is engaged in habitual behaviors! Most of the time this a good thing (like hygiene), but other times they can be negative (like smoking). Many of us–in both the spiritual and fitness realms–want to take the habits that do not help us and turn them into something positive. It is quite an effort, and unfortunately many of us give up before we can allow the new, better habit to be formed.

DiGangi explained how our brains are key in this process. The brain is like a “predictor machine;” it is not perfect, but it works well enough to keep us alive. Habits are simply fast predictions of how things should go; they can be overlearned patterns that are carried out without attention. There is a part of the brain called the Basal Ganglia; it controls addiction, emotion, thinking, and voluntary movement. It is a hugely important part of the brain and it is where habits rest…and where they can be broken.

The Basal Ganglia is also where attention lives. If we want to make real change, it will require a lot of attention. We must figure out how attentive we are, whether our attention is out of whack (ie, we are paying attention to the wrong things), and how we can improve our focus. Too often we focus on our problems and save little of our prectious time and energy on solutions. We need to refocus and pay attention. We should ask ourselves what are we REALLY trying to change–what is the root cause that needs fixing? How many times have we addressed it before and what did we do–and why was it not successful? Once we have done this, we must determine what is the TRUEST solution to the problem–not the easy one or the seemingly obvious one, but the one that will truly be successful. Then we need to be judicious with our time and resources to put that solution into effect.

This requires a tremendous amount of attention. Research shows that it takes 66 days to build a new habit. How many of us have the patience to work on a habit for that long? Does knowing it takes that long make a difference? Will it give us perspective and patience?

Again, whether we are looking at spiritual or health matters, attention is at the core of making real change. It is a difficult process, but it is possible to accomplish our goals and create positive habits that lead to positive character.

Best wishes to all who celebrate for a happy, healthy New Year. To all of us, pay attention. It is the foundation for change.

News About Arthritis and our Knees

CNN.com recently shared an article about new research on Osteoarthritis of the knee. It caught my attention because, as a personal trainer for older adults, one of the key complaints I hear about is knee pain. I also work with clients who have had knee replacements or other knee surgeries. This is not surprising since nearly 800,000 knee replacements are performed each year in the USA.

Osteoarthritis is a chronic disease that causes the cartilage of a joint to deteriorate; this leads to pain and stiffness and is especially seen in the hips, hands, lower back and knees. As we age, osteoarthritis can have a negative effect on our quality of life; depending on where it is found it can even influence our ability to remain independent.

The new research was published in the Journal of the American Medical Association and based on data from studies conducted in the Netherlands. The key finding is that the effects of the disease can be lessened or even eliminated by strengthening leg muscles. The research indicates that there is no link between a person’s total physical activity and the odds of their developing the disease. The subjects were then divided into two groups: those whose activity was non-weight bearing (like swimming and bicycling) and those who activity was weight bearing (like walking or running). The latter group was at greater risk for knee osteoarthritis–but only if they lacked sufficient lower limb strength. It has long been thought that one of the best ways to protect the knees is to build mass in the muscle groups around the knee. This research bears this out; the more muscle mass around the knee, the more it is “cushioned” from the forces that affect it through weight bearing movement.

This research reinforces the work of doctors and physical therapists who work with patients to strengthen the muscles around arthritic joints. While those who participate in non-weight bearing exercise have less cause for concern, it is important to know that runners and walkers have a strategy that can help ease pain, increase movement, and even prevent the need for joint replacement.

The Most Important Meal of the Day?

Did you know that it September is National Breakfast Month? We have been told for a long time that breakfast is the most important meal of the day; the reality is that every meal is important.

For the last few years, I have eaten the same breakfast almost every day: a half-cup (uncooked) of 1-Minute Oats with a tablespoon of brown sugar and a bit of cinammon. It takes little time to prepare and the calorie count is relatively low, and it has many nutritional benefits for older adults: it is high in fiber, iron, and magnesium, and is a good regulator of gut health. I also find it quite filling when it is all prepared.

Not everyone is a fan of oatmeal, though, so what are some other good options for breakfast? [Hint: it is not sugary cereals!] According to the National Institute on Aging (NIA), every meal should contain 25-30 grams of protein; good sources are eggs, nuts, greek yogurt, cottage cheese, and peanut butter. Breakfast should be lower in carbohydrates as this is thought to prevent or delay cognitive decline. Whole grains are also important and are easy to find in breads, oatmeal, and some cereals–just make sure they are not also loaded with lots of added sugar. Another part of a healthy diet for older adults is nutrient rich vegetables and fruits–berries are especially recommended.

The NIA suggests the following options as healthy breakfasts as we age: smoothie made with spinach, fruit, and yogurt; vegetable omelet with whole-grain toast; avocado breakfast bruschetta; banana split oatmeal; and eggs over kale and sweet potato grits.

Of course, there are many other options that can help us get our day off to a great start. Most importantly, put some thought into breakfast so that it is healthy and filling…and whatever you do, avoid skipping this meal altogether! Good morning and good breakfast!

Is Going Backward Ever OK?

Time Magazine recently featured an article that was brought to my attention by one of my alert clients. Angela Haupt discusses the benefits of walking backwards. You have probably seen some folks doing this on a treadmill and wondered whether it is effective or just plain silly. It might even remind you of an old Monty Python sketch. Does it really help? According to the article there are at least five distinct benefits.

People of any age and fitness level can try it. It is especially effective for older adults because it helps to improve balance and coordination, which can in turn prevent falls.
It works different muscles than the ones we typically use or works the ones we do use in a different way. Studies have shown that walking backwards can increase muscle strength.
It has been shown to help those with injuries or pain. Walking backwards has long been a part of PT and OT strategies. Research has shown that it can reduce pain for those with arthritis in the knees, as well as alleviating the symptoms of plantar fasciitis and lower back pain.
Backward walking can increase flexibility. We know that sitting all day (being sedentary) is an epidemic and can cause muscles to tighten up. Walking backward can stretch muscles and lead to greater flexibility and reduce the risk of injuries.
It can improve gait. Physical therapists use this technique to help patients improve their gait patterns. It can assist with slight limps or range-of-motion issues. As mentioned above, it can help with balance control by forcing us to really focus on the way our muscles and joints are moving, as well as being aware of what is around us.

It is imperative to ensure safety when trying backward walking. Start slowly in an area that is free of hazards. Begin with just a few minutes a day and work toward more time and greater speed.

Typically, going backward is not seen as a positive. In this case, however, it can help us–especially older adults–to improve our health and fitness.

Super Agers: What Are They and How Can We Become One?

It is no secret that Americans are living longer and longer. Just because the quantity of our years is going up does not necessarily mean that the quality of those years (especially closer to the end of our lives) is going up as well. In fact, one of the greatest fears of older adults is remaining physically sound while losing cognitive and mental capacity.

There are, however, those who manage to live well into their 80s and beyond while remaining “sharp as a tack.” Those who reach the age of 80 with the cognitive capabilities of someone decades younger is referred to as a Super Ager. Who would not want to be a Super Ager? It is the best of all worlds! The good news is that researchers have found six “habits” that Super Agers have in common that can guide us as we hope to achieve this status.

Super Agers maintain a healthier diet. 2 servings of vegetables/day, 2 servings of berries/week, and one serving of fish/week have a positive effect on brain health. Other foods to include for better brain health include nuts, whole grains, olive oil, beans, and poultry.
They have connected social lives. Studies show that more loneliness leads to greater chances of memory loss. Super Agers seek out social networks and meet new people.
They are better at managing stress. Older adults who find ways to manage stress (through exercise, meditation, etc.) have better health outcomes. (More about this below.)
Super Agers are intentional about getting enough rest. The more sleep-deprived we are, the lower our cognitive ability, the worse our mood, the weaker our immune system, and the more difficult it is to manage blood sugar. 7-8 hours of sleep per night is recommended.
They engage in a variety of brain-stimulating activities. Aging can cause declines in our cognitive abilities due to increased dysfunction in the pre-frontal cortex of the brain. Activities like crossword puzzles, Sudoku, reading, listening to lectures and music, as well as some word games can actually improve brain function, problem-solving skills, and the ability to think nimbly.
They exercise regularly. This very much related to #3 since exercise can be a stress-reducer. Regular exercise (both aerobic and non-aerobic) increases the production of Brain-Derived Neurotrophic Factor (BDNF), a protein in the brain and spinal cord that helps nerve cells survive and grow. Aerobic (or “cardio”) specifically reduces cognitive impairment and the risk of dementia.

The trend seems to be toward continued rising life expectancies. Medical science has focused on the quantity of years; our personal behavior, energy, and priorities should be focused on the quality of those years. Following the steps above are no guarantee that we will become Super Agers, but it is noteworthy that Super Agers share these commonalities.

For some of us, this will require a lot of adjustment (especially in our diet). Even modest changes can have an impact. The effort certainly seems to be worth the payoff.

Help! I Need Somebody….

Many of us are familiar with the Beatles’ song “Help!” Not only is it a great tune, but the lyrics connect with so many of us. We have all been “down” and felt like we needed someone (not just anyone) to be ’round for us and help us get our feet back on the ground.

Since that song was released, however, there has been a societal shift in attitude. We are supposed to be strong and handle things on our own. Reaching out for assistance can be seen as a sign of weakness. Only more recently has the pendulum begun to swing back; we are once again being taught (in most, but not all, settings) that it is OK to need help. We can be vulnerable. It is a normal part of being a human.

In my interactions with many older adults, the question of when to seek help is ever-present. It is not just a matter of physical health, but mental well-being too. Older adults wonder when it is appropriate to seek medical attention, housekeeping services, psychological care, grief counseling, etc. How do you know when you need help?

For everyone this is highly personal. Some people are much more resilient…or stubborn. Here are some guidelines:

Most importantly, if your ability to function in a regular way is impaired, it is time to seek help. Everyone has aches and pains. We also experience emotional ups and downs. If, though, they prevent us from carrying out the activities of daily living (getting dressed, eating, working, exercisings, etc.), it is time to reach out for help.
If your mood has changed significantly and it lasts for two weeks, this is also a sign that something is going on. We all have days when we are bummed out. If we are depressed, down, or inconsolable for an extended period, it is time to seek assistance.
If your sleep patterns change significantly–sleeping too much or unable to sleep–this can be a sign of a problem. On a related note, inability to concentrate or enjoy the things you usually do (hobbies, being with friends, work) is noteworthy and should be discussed with a professional.
If you are engaging in behaviors that are risky, this is also a time to get assistance. If your behavior is affecting your work, studies, friendships, or if it could put you in legal trouble or physical danger, this an indication that you need help.

So where should you reach out for help? Friends and family that you trust are always a good first line of action. The people who love and care about you can help you see things more clearly and recommend strategies for improving the situation. Those strategies may include talking to a clergy-person, a primary care physician, or a therapist.

At one time or another, we all need some kind of help. It is nothing to be ashamed of. It does not show weakness. Rather, it shows that we are human. I hope this helps….

Is Hospice just “Giving Up?”

Working with older adults means that every once in a while a client of mine will become either too ill or frail to continue to work out with me. I have even had a few clients who have passed away; I blogged about this the first time it happened. The truth is that none of us will live forever; sometimes, however, we are fortunate to be able to “orchestrate” what the end will look like.

As a relatively young rabbi in Toledo, OH, I was invited by the local hospice to learn about what hospice is. In Judaism, it is taught that one of the greatest kindnesses that we can bestow upon a loved one is to choose for them a “beautiful death” (in Hebrew mitah yafah). What exactly does this mean? It means to provide someone with a death experience that is as dignified, peaceful, and pain-free as possible. At the workshop provided by the hospice in Toledo, I found that the hospice movement (intentionally or unintentionally) helps to fulfill the idea of a beautiful death.

What exactly is hospice care? Hospice care is a program that provides care, comfort, and quality of life for people who are near the end of their life and have stopped treatement to cure or control their disease. Hospice care focuses on treating the patient’s “total pain” which includes physical, emotional, social, and spiritual concerns. It also supports the patient’s family as they cope with the end of life and during bereavement. Years after that workshop, both of my parents were able to receive hospice care–my mother for Mesothelioma and my father for Parkinson’s Disease. In both cases, nine-and-a-half years apart, there were no further treatments that could make a difference; we focused instead on creating a quality of life rather than a quantity of life. What good, we reasoned, was it to stay alive longer if only in misery? For my mother, her passing was a meaningful experience over seven days with loved ones surrounding her. My father’s passing was different; none of his children was there, but he died before the situation got to a point that could have been much worse had it dragged on. None of us in the family–including my parents–really felt like we were giving up. We were making the best out of a situation that was clearly no longer in our control.

If you are looking for more information about hospice, a simple on-line search can tell you about organizations in your area. If you are part of a religious community, they may have their own hospice as well. Librarians can also be a great source of guidance.

The work that I do as a personal trainer for older adults is aimed at helping to improve the quality of life for my clients. As I said above, none of us lives forever. When the end is near (and sometimes not so near) there are still ways to help improve our quality of life. Hospice is not “giving up,” but rather continuing on the same path of living the best life possible for as long as we have. It is a way of choosing a “beautiful death.”

You Say “OT,” I Say “PT,” Let’s Call the Whole Thing Off?

Over ten years ago, I was diagnosed with Tennis Elbow (lateral epicondylitis) even though I have never played a game of tennis in my life; it turns out that there are other causes. A few months ago, I began developing symptoms that reminded me of my Tennis Elbow; I saw a doctor in my primary care physician’s practice who suggest icing, wearing a brace, and treating the pain with acetamenophin (Tylenol). It did not improve much and then I took a tumble while traveling earlier this month; I landed on my knees, as well as (you guessed it) my elbow. The bruises were quite impressive.

After consultation with my PCP, I was able to get an appointment with a Physical Therapist (PT) for an evaluation. Imagine my surprise when she informed that she could only deal with my knee, since my elbow was considered to be in the realm of Occupational Therapy (OT)–at least that is how it works at the Cleveland Clinic. Instead of being able to have it all cared for at one time with one therapist, I now have two therapists and twice the number of appointments!

What is the difference between physcial therapy and occupational therapy? There is a lot of overlap, but some important distinctions as well.

Physical therapy focuses on improving a patient’s physical function, mobility, and strength. PTs treat patients of all ages with many different diagnoses, including neurological, cardiovascular, respiratory, and musculoskeletal conditions. They treat the whole body from head to toe (unless, apparently, it is your elbow!), and may focus on restoring range of motion.

Occupational therapy focuses on improving a patient’s ability to perform meaningful activities as independently as possible. OTs treat patients who have experienced birth injuries or defects, sensory processing disorders, traumatic brain or spinal cord injuries, autism, and other developmental disorders, or mental or behavioral health problems. OTs may work on the upper extremity, or the whole body, to help patients develop, recover, improve, and maintain the skills needed for day-to-day living. This could include helping a child with autism participate in classroom activities, a young adult with down syndrome develop job-related skills, or an older adult who had a stroke learn self-care tasks. OTs may adapt, modify, or change daily activities by altering the activity, the environment, or the patient’s skills. For example, they may teach stretches or exercises.

In my case, PT is dealing with my knee to improve my function, mobility, and strength. My OT is dealing with my elbow because the problems I am having interfere with my ability to carry out certain task with my arm and hand that I need to do on a daily basis.

In the final analyis, I wish I could get one therapist who could do both of those things…but that is not the way it played out here. At the very least, it has helped me to understand the different roles that each kind of therapy plays. I am confident that my therapist will both work in concert to get me back to 100%. After all, I have to learn to play tennis before it is too late!