Episode 78: Steps to Aging Gracefully

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Welcome to Supplementing Health, a podcast presented by Advanced Orthomolecular Research. We are all about applying evidence based and effective dietary lifestyle and natural health product strategies for your optimal health. In each episode, we will feature very engaging clinicians and experts from the world of functional and naturopathic medicine to help achieve our mission to empower people to lead their best lives naturally.

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[01:10] Cassy Price: Welcome to Supplementing Health. With all of the advancements in preventative medicine that we have seen over the last decade or so, sixty could easily be considered the new twenty. However, to optimise your golden years you need to manage and optimise your health in all aspects. So, joining me today is Amy Cameron O’Rourke, a nationally known elder care specialist in the United States. She has been a professional care manager for more than forty years with twenty of those years at the helm of the Cameron Group which she founded as well as O’Rourke Associates in Orlando, Florida. Amy is the author of The Fragile Years, and we are so excited to have her here today. Welcome Amy, thanks for chatting with me today.

[01:46] Amy Cameron O’Rourke: Thank you for having me, Cassy.

[01:49] Cassy Price: So, I’d love to know what initially sparked your interest in elder care and why you are so passionate about improving quality of life through the aging process.

[01:57] Amy Cameron O’Rourke: I volunteered at a girl’s club when I was in high school and part of our volunteer work was bringing girls to the nursing home down the street and entertaining and being with the folks in the nursing home. I fell in love with the work and with the residents. They were cracking me up, they were honest, they were funny, they were grateful. They had all of the inside qualities that I love in human beings in general and I made a decision then that I was going to work with older adults. I was fortunate to have been exposed at a young age to something that struck me emotionally.

[02:39] Cassy Price: That’s awesome. Most people don’t find that well into their career, right?

[02:46] Amy Cameron O’Rourke:  Right. I considered myself very lucky.

[02:50] Cassy Price: So, what are some of the tips for caring for an aging family member that you have learned over the years and how can we provide assistance and quality of life as we age?

[03:01] Amy Cameron O’Rourke: The first quality to me in having an aging family member is to really hone your listening skills. Try to get a sense of where they are and try to be with them, you know that old phrase be with people where they are, that really holds true when you have an older relative. There is a lot of emotional baggage, if you will, or grief that hits people when they are watching their parent or their aunt or their grandmother diminish. It is painful. Sometimes in response to that pain they do things like try to control them or make them do things that are unrealistic for them to do. So, one, be with them where they are and two, try to resolve any grief or unresolved issues with your parents before you start trying to help them get the care they need so that it becomes less emotionally complicated.

[04:16] Cassy Price: That is great advice. I think we always think there is more time, right, so we don’t want to dive into some of those more difficult emotions.

[04:25] Amy Cameron O’Rourke:  I know and then if you find yourself, it happens to all of us, it happened to me with my father and my mother, if you find yourself getting easily irritated and frustrated and trying to hurry them along it is a sign that you should step back a bit, find out what is going on with you before you then begin trying to help your parent. It always happens, I don’t have any judgement about it, I just think it is a pain that people don’t talk as openly about. We talk about death and the pain of losing somebody but the pain of watching somebody diminish is a grief that is unique to the situation.  

[05:09] Cassy Price: So, one of the aspects that tends to dimmish with age is bone and joint health which leads to slower movements, more pain, more challenges that we don’t generally experience in younger years. So, what are some of the most common habits that you see that can impact bone and joint health both positively and negatively?

[05:32] Amy Cameron O’Rourke: I watch people that age and everybody gets aches and pains and so keeping yourself not active in terms of going to a gym and those kinds of things but getting up and walking to the mailbox and not trying to get your neighbour to bring your mail in. If you go to temple or church, sitting somewhere where you have to walk a little bit. Park your car away from the inside of the church or the temple. Incorporating movement throughout your day instead of trying to get yourself to walk thirty minutes outside. That is kind of daunting if you have a bad hip, for example. Keeping yourself moving in regular activities of the day is one piece of advice. The other is that there is a lot to be said for social engagement in whatever form you can get it. Whether it is stopping and talking to the baggage person at the grocery store or waving to the recycle pick guy that picks up your recyclables. Keeping yourself engaged in the outside world can boost your energy so maybe you have more energy to take a walk that might take ten minutes.

[06:56] Cassy Price: I would say that is definitely something that has gone by the wayside for all generations, not entirely but definitely. I remember when I was younger, and we would go to the grocery store and it felt like it took hours because Mum would be visiting with everyone and their dog but now it feels like there is not that same community engagement generally speaking.

[07:14] Amy Cameron O’Rourke:  I know. It is funny you said that because I had the same experience with my dad. I would take him to the grocery store, and he talked to everybody. We stopped at the deli counter. We talked to the fish guy. We talked to the bakery women. He was known in the store, and I watched him and I thought he was doing this naturally or organically what all of us really would benefit from doing everyday ourselves.

[07:38] Cassy Price: Absolutely. I think technology has gotten in the way as well and of course with everything that has gone on with the pandemic, I am sure that didn’t help things much either. So, jumping back a little bit to the physical activity, beyond making more natural movement in your life and building that into your daily activities, are there specific physical activities like sports or games that you would recommend for older individuals? Do those recommendations change with different age groups or different conditions?

[08:13] Amy Cameron O’Rourke:  Well, I like to think of incorporating the movement into the daily life but to give you some specifics if an older adult was sitting in a chair with arms, taking the time in the morning to stand up and sit down as many times as they can in the minute in the mornings and doing it again at lunch time and doing it again at the end of the day. Maybe it is with support and somebody that you have to sit next to you, doing some standing up and balancing exercises like lifting one knee up and holding it, doing it with the other knee and holding it. All older adults are afraid of falling and it is a legitimate fear but doing some of the balancing exercises are helping in that there are a lot of programs around Thai-chi and chair yoga and classes that are available online. I really support the notion of doing those kinds of programs. I watched my dad and it is kind of shocking that he did this but he practiced falling. He said, “if I’m going to fall I want to know how to fall.” I watched somebody do that with a physical therapist and practice it. My dad after that fell and he got good at it and didn’t break a bone. I am not saying that everybody should do that but try to think outside of the box. The other tip that I watched older adults used is that they have a tendency to look down when they are walking, and I think that it hampers their fear. I think it makes it more difficult. Looking straight ahead once you have the joint strength and the bone strength, looking straight ahead is helpful in walking. The last tip I will throw out there is that one barrier to staying well is putting your pride down and accepting help. So, if you are afraid of walking but you can walk with a cane, use the cane. If you walk better with a walker, use the walker. If you have somebody that will come by and accompany you to do something, take advantage of it. People with a lot of pride ending up having accidents that are preventable because they wouldn’t accept help when they needed it.   

[11:03] Cassy Price: That makes sense. I think it a challenge for people, right? They remember what they were able to do before and they don’t want to admit that maybe they are not there anymore.

[11:13] Amy Cameron O’Rourke:  Exactly. You are exactly right. Your head is saying one thing and your body is saying another. I saw a guy jump in a pool and I had to jump in the pool after him and save him because his body had forgotten how to swim. That is a dramatic example but if I hadn’t had been there, I don’t know what would have happened to him. So, I said “what were you thinking?” he said, “I used to know how to swim, and I got in and I just forgot how to swim.”

[11:44] Cassy Price: Wow. I can’t imagine how challenging that is for people as well coming to terms with those things. So, talking about falling and obviously breaking bones becomes more common as we age from falls and trips and slips that previously might not have done any damage. So, do you use bone mineral density testing in your practice to help determine the likelihood of those fractures and injuries?

[12:14] Amy Cameron O’Rourke: I have clients that do, keep in my mind I am not a physician, all of the people that I work with have physicians and I like the physicians to guide those kinds of tests. I think there is a lot of value in them. What we try to do is make sure that we are following the physicians’ guidelines to maintain current bone density or do the programs that they are recommending like using physical therapy and helping with physical therapy programs to maintain or increase bone density. We let the physicians guide it with our following their guidance.

[12:55] Cassy Price: How frequently do you find you get new guidance or new testing done with your clients that you can then adjust their programs?

[13:04] Amy Cameron O’Rourke:  We try to have that done annually. I think everybody gets an annual wellness visit and gets screened for all of the appropriate tests at that time. Then if they are wavering physically the every ninety day check is the next measure that we would use to see how they are doing and what tests would be appropriate.

[13:33] Cassy Price: So, do find there is a specific age that you see significant bone breakdown occurring in the clients that you work with?

[13:42] Amy Cameron O’Rourke:  I don’t know that I would throw out a number here as much as I would frame; the new retiree at sixty-five, they call them first-generation retiree, at seventy-five you are a second-generation retiree. At seventy-five I want there to be a real big support mechanism to keep moving and keep yourself as well as possible because it becomes harder and harder from seventy-five forward to keep the energy level to keep that current activity up. Then the third stage is the fragile years which is why I wrote the book which usually is accompanied by some support whether it is a person or a walker or some device to help eat and it is at that point it is not too late certainly but it is harder to build on your health. The focus becomes maintaining your health rather than building it. So, it is probably a long answer to say it is never too early to start. If you become a first generation retiree, take advantage of that surge of energy you get when you are first retired and stay with it.   

[15:14] Cassy Price: For retirees that have maybe experienced some situation where they have had to be bed bound for some time, what are some of the things that they can do to avoid atrophy and maintain that health so that they can reach those later years and still have a solid quality of life?

[15:34] Amy Cameron O’Rourke: There is a lot of things you can do in a bed. I have watched people do it and you want your system circulating, you want to sit up, you want to get out of the bed whenever possible on a regular basis, you want to minimise being in one position for more that an hour. There are wonderful yoga stretches and range of motion exercises. There are leg lifts, knee lifts, knee stretches, ankle rolls, arm rolls. There is a lot of movement that can be accomplished in bed to avoid atrophy. I had one gentleman that was in bed, and we encouraged staff to help him get out of bed and he was so mad and frustrated and uncomfortable but we encouraged him to stick with it because there was a period of time that it was going to be more uncomfortable than less but then he got used to it. It is like anything that we do that is difficult, there is always a period of “I can’t do it. Don’t make me do it. This is really hard.” Just stick through that. He is actually doing better, and he has experienced no atrophy. We let him yell and be frustrated and kept encouraging him to move. So, with some support and movement you can prevent atrophy.

[16:59] Cassy Price: Okay, cool. So, in your book The Fragile Years, do you include any of those stretches and movements in there as part of the strategies that you talk about?

[17:09] Amy Cameron O’Rourke: The goal of The Fragile Years is not directed so much at specific exercises as much as it is for families with elder relatives and teaching them how to keep their loved one…to minimise acute episodes. If they do have an acute episode to know how to navigate the difficult systems that they begin to interface with like the hospital or the nursing home or the assisted living. So, it is more of an inside intelligence book to help family members. I certainly promote movement in the fragile years but not specifically in the book.

[17:56] Cassy Price: Okay. So, one of the other conditions that obviously comes up with age is Dementia. I think that adds extra challenges. Like we were saying people don’t want to come to terms with the things that they can’t do anymore, and they don’t want to let their pride go and when you add in that layer of losing touch with reality and sometimes lapsing into the past or completely fabricated realities. Can you adjust to manage those sorts of episodes and make sure that they are still feeling welcome and in a calm and positive environment?

[18:45] Amy Cameron O’Rourke:  I love that question because I will tell you what happens with a lot of folks with memory impairment or dementia is that they are physically really fit, they move a lot, they have a lot of energy, not everybody and I certainly wouldn’t want to generalise people with memory impairment but generally memory impairment is their only chronic diagnosis. So, they can be in really good shape. In communities I would highly recommend looking at the local programs that include brain fitness and day programs to keep them moving if they are not moving already. One advantage to having a memory impairment is that they might not remember that they didn’t exercise and getting them to move around can be accomplished by communicating a story and keeping them distracted as you are moving around. It is almost easier to work with someone with a memory impairment because you can enter their realty and help them move in a story or a place that they think they are. I hope I am not offended anyone in the interview, but I have had folks that will take long walks looking for someone who is not looking for someone in the town they are in. if it gets them moving and gives them hope, use what you have to keep them going. Look locally at programs that can help them specifically interact with those that are like them. By that I mean that you can have an older adult with a memory impairment but put them in an exercise class where people are well and alert and know what they are doing, that person with a memory impairment can feel that they are not like them but if you have them in a program with others with memory impairments they feel accepted and they know that they are not the only one with a cognitive deficit and they thrive. Not always, I am talking in a bell curve, not always and sometimes there are stages that they go through that are more difficult and challenging but I would say use what the person has to help them move in whatever world they are living on in a given day.

[21:23] Cassy Price: You mentioned the stages that they go through, do you find there are certain stages where you need to focus more on the nutrition that they are eating to help support bone mineral density and muscle growth and all of that to ensure that they can keep that strength as they go through the rest of your years regardless of the mental capacity that they are in?

[21:46] Amy Cameron O’Rourke: I think the moderate stage…I use three stages. There are lot of different sophisticated stages. I use early, middle, and late or mild, moderate, and severe if you will. I think if they are not able to use, for example, a utensil like a fork or a knife in the moderate stage, that can happen, looking a finger food that are healthy and appealing is definitely the way to go. You want to make it easy. If they lose their attention span, instead of having three meals a day for instance, maybe you have them eat every two hours when they have the attention span. I have had clients that I have worked with where we gave them food on the run because they were burning up a lot of energy and moving a lot and we would put a sandwich in their hand and they would eat while they were walking around. So, adjusting their food intake to what their attention span can tolerate and if and when they lose the ability to swallow, working with a speech therapist is helpful also. Incorporating those in the severe stage, when they are on their way out, that is the time that you want to help them leave the world in a healthy way. Probably the mild cognitive impairment stage would be the easier stage to work with. The moderate stage, when they lose attention span and the ability to work with utensils becomes the time when you want to use healthy finger food and food that is easier to chew to maintain their bone density health.

[23:39] Cassy Price: Okay. That all makes sense for sure. Earlier, I guess right at the beginning of our conversation, you mentioned that listening to people is obviously a really big part of helping them cope with the changes that come with aging. Do you have any other strategies that you can share that will help or ways that people can help their older loved ones cope with the emotional and mental aspects of the reduced mobility and physical changes that they are going through?

[24:09] Amy Cameron O’Rourke: I think if you’re working with an older relative, starting early is wise. Say for instance you have a parent that is sixty and there is no problem yet, nothing has happened, beginning the conversation then like asking open ended questions like; ‘What is your vision as you grow older? What is your vision for retirement?’ Watching and observing them so that when they do need your intervention, you know their history, you know their pattern, you’ve had them verbalise what is important to them. If you live at a distance there is a book called My Mother, Your Mother and Dr. Dennis McCollough who wrote that book recommends the seventy-two hour visit where your only purpose is to be with your parent or be with your elder relative and that is to observe how things are going. I have had clients say this that when their child comes to visit, they haven’t been visiting, they say “I think my child thinks I am going to die because they are out here visiting.” If you can, not everybody can, but if you can, visiting on a regular basis or on an annual basis so just being with them with no agenda is also something very helpful. Then finding something that they like to do and doing it with them, whether it is golf, or bridge, or a card game or watching a movie together and watching a show so that you have a bond that you can build on when you start having to help them.

[26:00] Cassy Price: Awesome. So, if listeners want to get a hold of your book, they can get it at your website agingexpert.com, correct?

[26:08] Amy Cameron O’Rourke:  That’s correct. You can get it on agingexpert.com. You can also get it on Amazon. Either place is a great place to look to buy the book and get prepared for what I call a lifestyle change, which is a lifestyle change for your parent and a lifestyle change for you as the adult child.

[26:30] Cassy Price: Fantastic. Well, thank you so much for joining me today and sharing your knowledge. I think there is so much that we don’t necessarily want to prepare for but realistically we do need to as our loved ones start to age. I think this is a great place for people to start even thinking about and considering their next steps.

[26:49] Amy Cameron O’Rourke: Well, I appreciate the opportunity to talk to you Cassy. I hope the listeners out there have gotten some help for themselves.

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Thank you for listening to Supplementing Health. For more information about our guests, past shows, and future topics, please visit AOR.ca/podcasts or AOR.us/podcasts. Do you have a topic you want us to cover? We invite you to engage with us on social media to request a future topic or email us at marketing@aor.ca. We hope you tune in again next week to learn more about supplementing your health.

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