 Hello everyone my name is Jane Katten and I'm the CEO at Agewell. I want to welcome you to our show tonight called Aging Matters brought to you by our special sponsor MVP Healthcare. We'd like to thank them very much for their sponsorship. Before we jump into our show I'd like to tell you a little bit more about Agewell. Agewell is the largest area agency on aging in the state of Vermont and we serve clients in four counties in Franklin, Grand Isle, Chittenden and Addison. Last year we served over 15,500 clients and let me tell you a little bit more about the programs that we offer. You may have heard of Meals on Wheels or Home Delivered Meals. This is a tremendous program where we bring nutritious food, therapeutic diets to our clients straight to their homes. We have congregate meals. We also have wonderful events that include food, activities, music all around the state. The other wonderful part of our programming is the wellness portion of our programs and that includes evidence-based programs that are related to activity. So wellness, exercise, you may have heard of Tai Chi or Tai Chi for arthritis. So these are activities that our clients can take part in anytime. We also have a wonderful group of social workers who are out in the field and they are providing a little bit more wraparound support for clients who may need more help so that they can stay independent at home. All of our clients are over the age of 60 years or under the age of 60 with a disability on long-term care Medicaid. The last program that is so important to us is our volunteer program. It is over 1,100 people strong and our volunteers really are the backbone of our home-delivered meals program. But not only that, they offer friendly visitation. They might do some transportation to doctor's visits or any other thing that our client may need help with. So as we've learned a little bit about age well, our show Aging Matters will be sharing interesting topics that we think are important to help people age well. So every month I'll be hosting different guests and we'll be exploring topics of interest. And today I'm delighted to have a wonderful guest with us here today, Dr. Alan Ramsey. Welcome. And he's here to discuss two very interesting topics. The first one is called the social determinants of health. And the second is called food as medicine. So welcome, Dr. Ramsey. Again, nice to see you. Thank you. And before we jump in to some questions specifically about our topics, maybe you can tell us a little bit about your background and what interests you about what we're going to speak about tonight. I'd be happy to. And Jane, thank you for inviting me to participate in this first program on how important aging is to all of us, all of our Vermonters. So I've been a family doctor in Vermont for over 40 years. Most of that was spent at Colchester Family Practice in the Department of Family Medicine. And then in 2012, I was appointed to the Green Mountain Care Board for five years. And so I moved my practice to the People's Health and Wellness Clinic in Berry, Vermont, which is a free clinic. So as you might expect, when you practice this long, your patients age with you. And so aging becomes more how you age healthy in a healthy way becomes more and more important. So that's where my interest in the Age Well Board of Directors evolved. You know, I've been on the board now for five years. And I've found that being involved in a community organization that can make things better for my patients as they age is a really important service. And so that's what happened. Well, thank you. That's that is a tremendous background and we're very lucky to have you here this evening. So as I mentioned, Dr. Ramsey, our show today will focus on the social determinants of health and a concept called food is medicine. So let's jump right in. And I've got a few questions to start us off. Tell us what exactly are the social determinants of health? We've heard this term in health care and in the social services. What are they? Okay, well, let me start by saying healthier organizations, insurance companies divide social determinants of health into a set of domains. But let me tell you what happens in the real world. So when I see a new patient at the People's Health and Wellness Clinic, I always ask them five or six important questions. The first question goes without saying, do they have access to the health care system? Typically no. That's why they're being seen in our free clinic. Number two, do they have housing? Number three, do they have transportation? Number four, what's their educational status or are they employed? In other words, what's the economic social determinant that they have to face? Are they lonely? Do they have family in the area? Do they have social contacts that prevent them from declining into a sense of loneliness? And lastly, and also very importantly, do they have food security? So in the real perspective of an office clinic, that's what happens. Now, I'm asking those questions, knowing that there's very little I can do in my clinic session to really reconcile some of those important issues. So what I have to do is to look for community agencies that can provide services that I can't provide in the office. Now, are they important? It has been studied and looked at over and over again that people who suffer for any one of these important social determinants of the health have poorer health outcomes. They cost more in the health care system. They generate more problems in the system. So addressing social determinants of health and not only identifying them in primary care, but seeking out organizations like Agewell that can really participate in lessening the environmental effect of those things. Dr. Ramsey, you touched on the concept of the five domains. And one of them I understand from my research is called social and community context. So as we think about the five domains, you talked also about social isolation, loneliness. Is one of the domains more important than the other to focus on? Are they all an issue together? What do we do about these? Well, that's a great question. In some people, typically not as we age in younger people employment, the economic issues. I think as we age and have fewer social interactions with, through work and family, loneliness can be a very critical issue around these social determinants. Loneliness means it contributes to depression, contributes to cognitive decline, contributes to worsening self care, contributes to acceleration of chronic disease processes. All of those things happen when a person becomes lonely and isolated and don't have the contacts that they need. Thank you. Those are, those are so impressive. I don't think we realize how impactful some of these social determinants are on people's lives. So let's take a moment, you know, and especially as you're talking about isolation and loneliness, that let's talk a moment about the pandemic and as we're emerging out of the pandemic. In your practice, did you see the effects of the pandemic or the isolation that your patients or even some of our clients may have felt during that time? How do we, how do we address that? Are there still effects going on from, from emerging out of the pandemic with regard to isolation or social involvement, social activities? I think there's still going to be a recovery period. I think we don't know what the oncoming winter brings us in terms of flu and COVID and now we worry about RSV. So I think there's going to be a slow, slower transition out of some of the consequences of the pandemic. And those consequences for me were more difficulty discussing other behaviors with my patients, talking about smoking cessation, talking about immunizations, you know, talking about substance alcohol use. All of those things became more difficult as people were more isolated. So we had, so the idea is to think about how to engage that person with agencies outside of the clinic that can deal with loneliness, can deal with some of these issues. And it's another reason I got involved in age well. So, but there's more than age well, you know, and I do make certain recommendations to my patients who I feel are getting more and more isolated, asking them to reach out a little more aggressively to their family and to their other social interactions, reach out to their church or synagogue or mosque or exercise classes. There are things that people can do as well as utilize services in the community. There's nothing probably more important than that. So staying healthy is another big part of avoiding loneliness. Stay healthy, eat well, stay physically fit. Wonderful. Well, thank you for those thoughts and those those strategies. I think they're very, very important to remind everybody. So as a community based agency, one of age well's main roles is to tackle food insecurity, among other things that you heard about earlier. So the idea of nutrition being a big part of managing the social determinants of health, is this also important? Yeah, you know, people realize that that if you really think about it, we almost have in this country and around the world, an epidemic of diet related chronic disease. Diet, we think diet related chronic disease. In the United States, it's manifest by obesity and rising significantly rising rates of diabetes. But there are many other things that are involved in that. I call it epidemic of dietary related chronic disease. And as a physician, I got very little training in nutrition. And so and I don't think that's changed much in the last 25 or 30 years of medical education. There's just so many complex issues that take take the place of learning about nutrition, learning about food as medicine. So let's let's shift gears a little bit then and talk more about the idea of food as medicine. We're hearing more about this term everywhere we go now. What does that mean? What is it food as medicine? Well, to different people, it means different things. And you know, in an office setting, it might mean nutritional education. Okay. In a community setting, it might be therapeutic design meals, or Trent trying to get people to transition to more fruits and vegetables, you know, so it can mean a lot of different things to different people. But remember, what we eat is the one thing that we can control that can have an at an advantageous effect on how we age and how we stay healthy, how we eat. That's a behavior. So and it may be more important than any medicine that I prescribe, you know, and there have been studies about this studies about the impact about transitioning to fruits and vegetables and the control of hypertension, the reduction of cardiovascular risk. There have been studies. I think they stopped doing studies because they were also positive. So we have a lot of information to support the fact that food is good medicine. It's just that, you know, and when you're isolated, when you're lonely, you do make poor choices. But I think in our program, and I know I hope you'll be able to talk a little bit about the therapeutically designed meal program. Definitely. Just just to take this a little bit further, it's interesting that the concept of good food and nourishment is being promoted more and more as good medicine. But hasn't this always been the case? I think you were alluding to this. We remember the old adage, an apple a day keeps the doctor away. We've all heard that when we were growing up, certainly. So what's changed to make this concept new? Well, I think the prevalence of chronic disease, you know, change. But you remind me about some of the history here. And the best quote that I found was from a little over 2,000 years ago. A man named Hippocrates said, let food be thy medicine and medicine be thy food. That is a very famous quote that turns up in the American Society of Nutrition uses that to really say that we've talked about this for 2,000 years. And the issues that we get into is that changing how we eat and changing our nutrition is something that is going to help us down the line. It's not going to help us tomorrow. And we seem to want quick fixes on everything. Now, how does that apply to the aging Vermonter? Okay, the aging Vermonter is going to benefit over a shorter period of time by having the right nutrition to assist in the control of chronic conditions as they evolve. Okay. So an 18 year old or a 20 year old or a 25 year old over 20 or 30 years changing them is going to have a big deal. A 60 or 65 or even 70 year old person who changes who makes that transition to more plant based nutrition is going to have a benefit fairly quickly. Okay, they're going to feel better. They're going to have better exercise tolerance. They have better energy. They're going to sleep better. Those things have all been studied and proven so wonderful. Thank you. So it sounds like there's many things each of us can do to manage our own health, which is the point you're making, definitely, like focusing on simple steps to eat healthy foods. I know that H well offers therapeutic meals. You mentioned this just a moment ago through our meals on wheels program. And from your perspective as a family physician, can these tailored meals talk a little bit more about how the tailored meals can help if a person's challenged to plan meals. They might have a chronic disease, diabetes, or even get the right kind of groceries from what you know about therapeutic meals. Well, again, take looking at the evidence. There have been some very specific studies that have shown, you know, short term and long term benefit, a proto prescription program. Some insurance companies, some payers are saying that we will provide fruits and vegetables through a prescription program. And have shown that that does things that reduces the blood sugars, reduces the weight. So what we what our therapeutic meals are designed to do is to take away some of that complicated decision making around changing from eating one way to changing to eating a new way when you get a meal delivered that's therapeutic, you don't have to worry anymore about Oh, you know, is this what's best for me. So I think that's an important aspect of a third of our program. We don't provide, you know, pharmaceutical orders or prescriptions for vegetables and fruits like something that we provide tailored therapeutic medication or meals. So so your your conversations or your thoughts remind me of a story about a client who is actually on a therapeutic diet with age well for diabetes control. And he has reported that the portion sizes, the the types of foods he has on his diabetic diet, and just the the frequency that he's learning how to eat he's taking advantage of some dietary counseling. He is losing weight. His diabetes is coming under better control. And his family physician is singing his praises, because he's thought about his his diet to help manage his diabetes. So I think you've hit on exactly the right concepts. I think we all have stories like that. Where we juggle medications and do the best we can. And then finally, we realize that a change in eating habits that therapeutic meals is going to be medicine, it's going to be food is medicine. So let's think take that one more step. This is this is you talk about fruits and vegetables, prescription for health, think about eating healthy. What do you think is holding back our health care system of providing more support? Maybe I think the insurers are starting to catch on. Certainly health systems all over are starting to catch on. But but what is really holding us back from investing in this kind of concept of food as medicine? Well, it's complicated. Again, some of it is short term outcomes versus long term gain. Some of it is how we pay for health care. You know, and everybody on the age well board is knows having spent five years in health care policy on the Green Mountain Care Board. It became very clear that the way you're going to control how the growth in health care costs in Vermont is to invest more in primary care mental health and community based services. That is how we achieve the holy grail of controlling the growth and health care costs in Vermont. Now, has that happened? Not to the degree where we see health care costs being controlled. Okay, so why does it is some of it is how we invest we invest in acute care, crisis care, hospital care, urgent care. But our investments in those three categories, primary care, mental health and community based services like age well, still lags behind the necessity that what in need where it needs to be. Well, let's hope that over time, more investment in population health will come our way. So I want to thank you, Dr. Ramsey for sharing some very interesting insights into the social determinants of health and food as medicine to wrap up some of our thoughts. If you could offer advice on what you think are the most important or maybe the most simple steps that older adults can take, especially if they're dealing with the challenges associated with the social determinants of health. What would that be? Well, stay connected to community based services to your primary care office. Make them aware of your needs. Let offices help coordinate services or refer you to an agency where we care management services like age well can be provided. The health care system, I think of it metaphorically as an ocean. And there are certain things like I think that the People's Health and Wellness Clinic is a safe haven in this ocean. It's like, you know, I think of age well is the same way. The health care system is complicated, difficult to navigate people, particularly as the age need all the help they can be, they can get. So I would ask I would suggest that I would suggest when things are getting worse emotionally, physically, think about ways to get into a counseling arrangement counseling situation, take advantage of volunteer programs, seek out community service programs that you can volunteer in that you're passionate about that you really believe in. So there are things that can be done. And it's just a matter of accepting the help that's out there. That's wonderful. Thank you for those thoughts. Dr. Ramsey, I'd like to thank you for taking the time today to join us on Aging Matters. And to all our viewers, I hope you enjoyed our show today. And please tune in next time as we dive into some new topics that will help us all to age well. And remember, as Dr. Ramsey so wisely suggested, if you or anyone you know needs help or assistance or any kinds of support to help you stay at home to remain independent, please think about age well, our helpline staff are available five days a week. And we have a helpline number that I'm going to share with you. Please call 1-800-642-5119. We're here to help. Take care. And thank you for joining us. I hope to see you next time.