 Good morning, Dr. Rebecca Starr. Thank you so much for joining us at the Amherst Senior Center. Oh, sure. Thank you. Thank you for having me. I'm excited to be able to have this time to talk. Yeah, great. Well, welcome to the community. I had the opportunity to meet you when you first arrived to Cooley Dickinson Hospital, and you have been a really wonderful community partner and a source of wisdom and advice, certainly for me and my position as director of services throughout the pandemic. I'd like people to know that you phoned me, you contacted me, emailed me, just asking, do we need support? Do we have questions? So first of all, I just want to thank you for your presence in the community. My prior practice was around the field, the intersection of medicine and law around geriatrics. And so the fact that we have a geriatrician at Cooley Dickinson Hospital, I just want to say, like, hooray, we are so very lucky to have you. So with that said, I thought it would be helpful for people to kind of get to know you a bit. And if you could just tell us a little bit about your professional background, your education, and sort of what brought you to this position. Sure. So I'm a geriatrician and most people know, but in case that means I take care of people who are older than 65. And I always say, you know, that is your age, but not by how you feel inside. And I always joke that I will always feel 29. So people shouldn't get, you know, scared of that. It just is what it is. And I've had known that I want to be a geriatrician from the moment I thought about going to medical school. So this has always been something I wanted to do. And I feel so lucky to be able to practice geriatrics. And actually, I feel tremendously lucky to be able to practice geriatrics in this community, in this area. I started off at Downstate, SUNY Downstate in Brooklyn, and spent a summer at Mount Sinai. They had a great geriatric program, and I had a great mentor there who brought a tremendous amount of enthusiasm in. I then went to Brown, and there was a very strong geriatric practice and a gerontology, and we'll talk about the difference there. Also a strong research program there. With that work, then I went to Cambridge Health Alliance, that's in Cambridge, Mass. There, the goal was to take care of the underserved, if you will. And I worked at a PEACE program, which stands for Program for All-Inclusive Care of the Elderly. And that's a program for 55 and up who are duly eligible on Medicare and Mass Health. And who have a good amount of chronic conditions or mental health conditions that they could actually be in the nursing home, but the goal is to keep them living in the community with a really lovely wrap-around care supports. So I did that for some time, and then sort of felt the pull to this area, and went to work at Bay State. And there I had some amazing opportunities. I did geriatric consultations, primary care, and actually started the ACE unit at Bay State. It's acute care for elderly, where we made a designated floor in the hospital, and we showed that providing really great care, basic care, and I think fancy, we were able to really reduce what we call hazards of hospitalization. So more people on this unit went back home, there was less complications, and people really seemed to like that. From there, I've now been at Cooley Dickinson now for a year. July 22nd was my first year anniversary, and have really been welcomed here. Again, I think there was a strong need for this, working the Cooley Dickinson Health System. I've really been supported and able to build a great geriatric practice in the outpatient setting. I also see some inpatients and have started a program within the community as well that I can talk about later. Great. So you mentioned that there is a difference between geriatrics and gerontology. Could you explain what that is? Because I'm not sure I even understand that. Gerontology has been talked about even as far back in the age of Aristotle, where he called, used this word, Eugiria, and I'm just looking at my notes, but he meant successful aging, a long and happy life in which independence was maintained and there was no pain or suffering. So that continued on for a while. Dr. Mechnikov coined the word gerontology, and that was over 100 years ago, and that's the study of the biological, behavioral, and social sciences of old age. So gerontology is the study of aging. In 1909, Dr. Nasher first used the word geriatrics to describe the medicine, and they called it of old age. So geriatrics is the medicine of taking care of older adults. And gerontology is the study of that. And there's a lot of intersection as well. Yeah, yeah. Fascinating. So what drew you to this specialty in terms of treating older adults medically? I just think that that's always so interesting among the fields. I know that there's a dearth of practitioners. You know, they have some things that I think pull people's attention. This may not necessarily be among those, particularly for young people who are training as a physician. So I'm always curious why this field for you. Sure. And I think to your point, there's maybe 6,500 geriatricians when there's the need for over 30,000. So I always try to encourage everybody to go into the practice. And as geriatricians, I think we're some of the happiest, you know, physicians in the field of medicine. I was blessed to have four amazing grandparents. And I think many geriatricians go in have had grandparents that were these great role models. So I was able to grow up with four grandparents, each one tremendously different from the other. I had a grandfather that loved to go dancing. And his wife, my grandmother wore leather pants into her 90s. She did shrink a little bit and just made sure that they were always hemmed perfectly. But they, you know, there's a stereotype and they live their lives. Who they were in their 20s and 30s and 40s was that same person in their 60s, 70s, 80s and 90s and 100s. And they changed along with it. But they kept that spirit. They had a real zest for life and continually learning. My grandmother would read the New York Times, for example, from cover to cover every single morning, and stayed up on all the politics and everything going on in the world. So they showed me how important it was to have that continual desire to know what's going on. My other grandparents, my dad's parents were also equally amazing. My grandfather was a lawyer and hated it and went back to work in his 40s, which was unheard of at that time, went back to school, became a patent lawyer. He worked in New York City on the 27th floor and he walked up and down the flights of stairs twice a day. I don't know how he did it, but I really think that that contributed to his overall well-being. My grandmother was an opera singer and then an interior designer, and they remained very active going into to classes all the time. They traveled the country back and forth throughout their years, and they really tried to travel internationally. They were lucky that they had the health and the financial resources to do that, but again, this great curiosity. As they got older, I was able to see again how they adapted to that, their resilience, their struggles, and their losses as well, too. I thought if I can help other people, having them as my role models in mind, then I feel really blessed to be able to do that. What an amazing imprint and role model for that term of a successful aging, right? Yes, very much so. You are the medical director of geriatrics at Cooley Dickinson Hospital, and so you have this imprint or role model around successful aging times four, which is like, and those stories are so rich and dynamic. What do you see in your practice around aging and how sort of people in the valley are aging? How would you contrast that to what you grew up seeing? Sure. I think there's, you know, everybody's different, right? So I'm gonna, but I do see a tremendous amount of that as well, too, that need for learning and to continually be interested in what's going on in the world around them, to really, many people are very into both mental and physical exercise, and they read a lot, and they know what they can do to help them. So in those ways, there is that similarity. And in terms of the practice for your field, how or why would somebody come to see a geriatrician? In other words, if I was one of those robust, physically active, I'm 65, I'm doing crossword puzzles and, you know, going for walks and I feel fine. Would I see a specialist such as yourself? So sort of the question of like, when and why would somebody seek a consultation with a geriatrician and get that sort of input? Great, great question. And I'm gonna back up what I see myself doing is really focusing on someone's overall well-being, right? And I don't think of geriatrics as just the medical management of disease, but again, focusing on sort of the full frame, the full picture of somebody and seeing the whole person. So generally, I think if somebody is very robust and active and everything is going fine, they generally don't need to see me at that point. But if they have questions on what I can do to what do you know that can help with successful aging, then that might be worth a visit to talk about those things. And then they've sort of established themselves with me. And then we can check in whenever needed. And that could be every year or every couple of years. But you have a sense of, All right, this is working really well. These are some things you might want to change. And then let's check in. That's for the healthy, robust person. Yeah. Some people start to have concerns about their memory, perhaps, or they they've had some chronic conditions and they they're wondering if a geriatrician can look at it from a geriatric point of view. Are the medications that worked beautifully in their 40s and 50s and 60s? Are those the medications that they should still be on now? Or are there any changes that we can make to make sure that they again continue to successfully age? And with that term, I think it's an important term, but I don't want anybody to ever think that they found if there's any. So so some people come in, people come in for a variety of reasons. I'm always happy to see everybody. I think there's people that want to check in and make sure that they're feeling great and want to continue to do so. Some people come in because they want to start planning for what could happen in the future. And they want to make sure that they have those plans in place. And I think that's important in a similar way to estate planning or, you know, advanced care planning. I'm certainly happy to help with that. And then other people again, want to, you know, feel like their function isn't what it used to be. They're having more pains from arthritis. They're having more trouble with things like perhaps urinary incontinence, or they can't do what they wanted to do. And we try to look at the whole picture and come up with creative and out of the box ways to think, how can we help improve this? What would be a creative or out of the box way? So I just, I'm fascinated by this concept of sort of a holistic assessment and not just looking at a condition or a particular problem, but really looking at, can we enhance other things even as you have that chronic condition. That's really fascinating. Well, I think that there's so much that we can think of that can help somebody in small ways. Some of the basic things is sometimes it's hard to do laundry. Maybe the laundry is downstairs in the basement and the stairs might be a little treacherous. And knowing what places in the area will pick up your laundry and bring it back all washed and folded in a not expensive way. And so it's something that you don't even have to worry about anymore. So what are the concerns and what are the possible options? Knowing the community resources is huge. Our community centers are such a great resource. And knowing what they offer, knowing what Amherst Senior Center offers, for example, knowing what's available, I think is really important. And I think working to say, you know what, this doesn't exist. Have you guys thought about doing this? So it could even be help walking a dog on a hot day. You know, anything that we think of, if somebody is having difficulty sleeping because of arthritis, what can we come up with that can help with that pain? Is it special mattresses? Is it working with occupational therapy? So really thinking, what's the problem? How can we find a solution to it and make it so that you can get the best quality? Does that help answer that a little bit? Yeah, no, that's so and it's very interesting. And I think probably unusual in the practice of medicine overall, to be so global in your sort of outreach and the way that you conceive of problems and sort of troubleshoot beyond just here's a pain, here's a pill. And that's all that you're looking at. Yeah, one of the other things that's important that we I have here at Cooley Dickinson is time. So our visits are a little bit longer. Some people aren't always quite prepared for that. But we really want to get to know the whole person, and they can really think through the solutions. So because we have more time, that's really helpful. And then we work closely with their primary care provider to, to make sure that our notes are sent and understood. And we really try to think of that as a partnership. Yeah, so that actually was one of the questions. So before we had this presentation, an opportunity to talk, folks did send me some questions that they had. And that was, I think that there was a lot of questions around, do you replace a primary care physician? Do you work with that primary care physician? And, and sort of like walking through, what is it like if I came to see you? What is an appointment like? And how is that different from the PCP visit where it tends to be limited in time and, and then availability? Yeah. So in this role, some geriatricians are primary care providers, some are consultants. In this role, I'm a consultant. And so that gives me the opportunity to see, you know, more people and really work with them through things. So people can either get a referral from their PCP or self refer. That depends on insurance, what their insurance allows. But we welcome that or referrals from the community as well, if there's concerns. Again, we do our best to partner with PCPs. And really try not to take over, but perhaps suggest or try to highlight things that again, can help with aging in a way that that keeps people as vibrant and healthy as possible. So I think that answered part of your question remind me of the other part. What would a first visit be like? You mentioned that more time that you can spend with a patient when they first come in. So what would, what would it be like? What would somebody expect? Sure. So we send out a packet of information prior that asks a good deal of questions. And they're really important questions. And so it's not just asking what are your chronic conditions? What are your medications? But you know, how do you take your medications? How do you get them? How do you use pillboxes? Really understanding how that happens. We act to ask about activities of daily living. Those are what we take for granted, but it's important. It's if you think about everything you do from when you're in bed, to getting up to having breakfast. It's, you know, are you able to transfer out of bed? Can you get to the bathroom? Okay. Can you get yourself in the shower? Can you get yourself dressed? Can you eat? These are basic things. But again, we don't ever want to assume that anybody can do these. We want to be aware of difficulties. We look at IADL, so independent activities of daily living, or there's sort of a higher level. Who does your finances? Do you do your finances? Food shopping, driving? So we really want to know what areas are going well, and what areas might be a little more difficult. And again, try to work with that. We ask about people's sleep, because we know that sleeping is so important to how you feel during the day, how your brain functions. Some people get concerned that their memory, they're having concerns about their memory, when really, it's actually that they're not sleeping well, or maybe there's some undiagnosed sleep apnea. So we'll ask questions. What is your exercise tolerance? How far can you walk? Can you walk upstairs? Again, we want to know everything and not take anything for granted. Try to figure out what might be something holding you back from continuing to live independently. We ask about advanced care planning. We really want to know what are your thoughts about this? What do you have completed? Do you have a health care proxy? Make sure everybody has a health care proxy. And if somebody doesn't, we, we work to make sure that that happens. And by we I want to call out I have the great fortune to work with an amazing nurse, Sharon Asher. She's a huge piece of this. It's a partnership. I think it always takes a team or a village. And she innately understand so much about a person and their family caregivers. And I think add such a strength and robustness to the geriatric practice as well. Yeah, yeah. So that that was a really wonderful explanation of really what that visit was like. One of the questions I had been sent was, you know, how would you help with everyday living? And I think that you covered that so remarkably well, because it is the struggle of the everyday tasks. And if there are some small modifications that perhaps an older adult can't think of, it's fantastic that in that medical model, you take into account all of that about quality of life. I just, that's really wonderful. You are indeed lucky to have you. Well, thank you. Yeah. One of the things that you just talked about really reflected to me that this concept that we talk about, and I hear about often in senior centers about the importance of being able to age in place. And I have certainly seen that during the time of COVID, the ability to age in place in your own home has really taken on a new urgency. People not wanting to go to long term care facilities or other congregate settings and really doing an all out muscular effort to keep people with robust services in their home for helping them for those things around toileting, or whether it's, you know, getting groceries or navigating areas where there might be a stair and how can we modify your house with some, you know, quick either installation of stairs, the elevator thing, and also ramp. So we've been involved in a lot of requests around that to help people to age in place. And I'm wondering if you could speak to from your perspective, what's your opinion about aging in place, you know, the impact on a person's mental, emotional, spiritual and physical being? And do you have an opinion about the importance of that and the appropriateness of it? Absolutely. I think everybody's different in everybody's case is different. But that being said, I think many people want to age in place, right? But it's important to really think about what does that mean? What are the things that enable you to age in place? Is it being able to drive? Is it being able to drive to go get your groceries? In the age of COVID, if you can't get groceries, who could get you those groceries? If you have an animal, who's going to help if the animal needs to get to the vet in a in a timeframe, navigating your house, you might live in a beautiful three story house. But if it's hard for you to navigate those stairs, that's really something to think about. Thinking about bathrooms. Again, some people say, Well, I'll move my bedroom downstairs to the main floor. But you also want to make sure you have a bathroom on that floor that's accessible and set up to help you wash your baby. So these are all things to really think about. Think about what you do every day that keeps you this way, handling your finances. Many people are moving to electronic finances, you know, doing it online. My mother is still going to the bank. So thinking about what that can look like, what help you might need. Using a computer and having internet. Those can be complicated things to set up, but can really be, especially now, a window into telemedicine visits, a window into zoom meetings with family and friends. And so thinking about what you might need there, and who can help you with that. Do you have family or friends that can help you? There's great movements that are starting. Amherst Neighbors is starting in North Hampton Neighbors. And before COVID, they were able to get into the house. Now, I'm not sure where that stands, but we've been partnering with Cooley Dickinson V&A. And they've been amazing partners. And they're going into homes now using all the protective equipment. They have appropriate PPE. And they're doing it in a safe way to say, doing home safety evaluations, recommending modifications, physical therapy to make sure you have exercises to do, and occupational therapy to make sure, for example, your stove is accessible. And whatever you're doing, you're able to do. And are there any modifications that can be made? So thinking through all those things really helps. We know that people have these beautiful family homes that are on many acres. I hear this. And that can be really something to think about. And it might be a place where you need to think, who's going to manage all of this? And what are you getting from it? And does it still make sense, I think, to stay there? Or might it make sense to think of alternative places? Even in this age of COVID, I think we know that assisted livings, independent livings are doing tremendous things to stay as safe as possible. And I think there's still very good options as well. And so if you had advice based on what you see about older adults, planning and foresight, what would be your message to our community around planning as we look at aging? Great question. We all have our wishes. We want to stay in our homes, right? We want to maintain the level of independence that we have had all of our lives. But we also have to face the fact that unfortunately things happen and it might not continue. And just as we have life insurance and hope that we never have to use it, it's equally important to have plans in place for what happens if or when I can't drive. What's going to happen then? What are my resources around? What do I have family or friends that are around and that can help me if I need to get some urgent medical care, for example? Or if I have to go somewhere, who can help take care of my pets? I think it's really important to plan out these, I always say you hope for the best, you plan for the worst and then you're always prepared. And one of the things that I see, unfortunately, is that people haven't really planned it out. They have their wish, I'm going to stay in my home. But that's a wish and it's important to separate that out from a plan. I want to stay in my home and here's how I'm going to make it happen. Right? Here are the things that I'm going to do. This is how I'm going to get groceries if I can't drive. If I can't cook, this is how I'm going to get meals made. If I can't bathe on my own, this is how I'm going to get help. And I think it's important to think about, do you have the resources to be able to do that? What are alternative options are out there and really think about this? If I have a big yard, who's going to take care of this if I can't take care of it? These are things that I see that haven't been done. In many ways, not to blame anybody, it's just not how we're set up as a society to think about. And so I think those are important things to really think through. Sit down with your family if they're there. Sit down with your friends or community. Many people have a church or a place that they can talk with and really think these things through. I'm certainly open to your suggestions on it as well. You have a wealth of experience that way too. Well I think we both, well I know from our perspective at the Senior Center, we are often called in as a resource but often at the tail end. So something has already happened or there's an emergency need that needs to be resolved or quickly handled without that kind of foresight. So when do you think people should begin this conversation? Because I think that when we talk about planning the more concrete for anybody who might be listening to this, we can share with them when they should begin this discussion. And are there any tools that you would recommend or that you are aware of that might help someone to sort of triage and think ahead about all of these kinds of details other than seeing you where we know that those conversations will happen and then they can see us at the Amherst Senior Center and we have resources and we can talk to people about that. But are there any other resources or tools and then the timing of it? What would you suggest? I think you're so right. Often we see people in a time of crisis and unfortunately when you're in crisis you don't have those same choices and options and things are being done in often in ways that down the line you wish hadn't been done if you don't think things through. I would say you know while you're still in good health is the time to start maybe putting it in even on the age of retirement whatever that is. What is it going to look like now right? What is it going to look like if my partner or I become ill? How are we going to manage that? What are the options? And then really visiting that as time goes on. But I still I and you asked about tools I'm honestly not aware we're actually trying to build them now as we speak to say what happens if you can't drive? What are you know your resources? Can you still realistically live in your house if you can't drive? What what will that look like? What what family is around we know nowadays everybody moves so far and I told my kids they can't. And I don't think I'll have luck with that but the reality is that people live in many places families too now we know you know with divorce and remarriages things can become more complicated and so I think it's really important to start having these conversations early on before there's any changes in mobility or there's changes in your cognitive function if somebody starts forgetting things and then there's concerns that there there's memory issues I think it's important to have these conversations really starting and I could say say say it is at 65 it's just an age but it's important to start to plan that way along with that planning it's important to do advanced care planning as well too. And what do you mean by advanced care planning because that's a term a lot of people have different ideas around what what do you mean by that? Sure so again I always say it's um you wear your planning for the worst uh you know I'm hoping for the best but everybody over the age of 18 should have a healthcare proxy and I this is my biggest thing you know I'll I'll have parents I'll see a patient and there's their their kids will come in the kids don't have a healthcare proxy so we actually have healthcare proxies and we hand them out to everybody and they can even fill them in in the office and get them witness just so you start with something. People will say well it's at my lawyers and I say well that's I'm glad it's there but you need it in the hands of your healthcare proxy you need it in the hands of your PCP or anybody that's caring for you and if you're traveling or you know depends where you're going but it's good to have that as well too. Yeah so healthcare proxies again everybody over the age of 18 should have one you can go to Massachusetts has a website on it it's sometimes it can be difficult to come up with these honoring choices is a great website started by a lawyer and that's in Massachusetts and it's really great about running you through questions so that's the start and then talking about what can be hard but what we might say is end of life care and it's really thinking about but at every age and stage in your life you want to think about the care you want the care you don't want and really having these conversations with your families so that they're aware of your wishes having these conversations with your PCPs so they're aware of your wishes and completing a most form if it's getting to a point where you're developing a good amount of chronic conditions and but always having this conversation it can be scary for some people some people don't want to talk about it my mom will say not this again but I think it's really important so that I know what her wishes are so that I can honor her if it comes to that and I think it helps everybody be prepared so that there is no crisis that's such an important piece of it yeah and the most one just to to distinguish the health care proxy from the most form for people who are listening so the health care proxy designates a person to make medical decisions if you are you lack capacity to do that most form is a medical order form that you complete with a doctor is that correct so I just want to make sure people think oh i'm going to sign a most myself that would be a conversation that somebody would have with someone like yourself or another provider is that right that's right exactly thank you for making that clarification a health care proxy designate someone to make decisions that you would make for yourself if you couldn't make it and I always make that distinction it's not the health care proxies uh decisions or wishes it's your wishes and that's why it's so important to have that conversation with your health care proxy and say these are is what I want this is what I don't want so that they're aware of that we find that some people appoint health care proxies and have never had that conversation with them that's the health care proxy the most is in order for life sustaining treatment and it really talks about things like if my heart was to stop beating what I want to have artificial resuscitation chest compressions in what I want to have a breathing tube or be intubated and then it actually on that's on one side it's a pink form on the other side it talks about what I want dialysis or what I want to feeding to or IV fluids different different options and you're absolutely right it is a medical order that should be signed by your doctor or advanced practitioner can do that the other thing that I that's important to say is these are not set in stone once you sign them they're not engraved somewhere they can be changed as you go through life and if you sign it one way in one situation you can change it always to another you know another time you don't want to be changing it every month but you want to think it through and take a look at it at least once a year if something changes does that help answer that question yes yes yes yes and I think particularly around the most in the healthcare proxy because we do receive I receive a lot of calls and people are confused they think they only need a most and they're not asking about the healthcare proxy so in that conversation for the reason I went so emphatic over your suggestion that everyone should have it is we are really going to be rolling out some more programming around the healthcare proxy in the most next week we're going to do a caring conversation on Zoom specifically about healthcare proxies and most so this is this is really apropos of that and sets the stage for that and and I really appreciate that from your perspective too it's really important that your patients have that conversation and and sort of leap over the cultural barriers to talking about end of life which which I think are so significant from my perspective even as an attorney I often had to deal with those situations where if somebody didn't have a healthcare proxy the hospital would hire me to appoint a guardian and then a stranger is trying to extract information about you to discern what would be your choice around end of life care and a judge another complete stranger is the person who's ultimately making that decision whether to intubate you or not or to pull life sustaining care and so to the extent that that we can have control in one of our themes of the senior center is empowerment and control and I think having a good end of life is as important as the whole stream that that aging and dying is also living so so I really I really appreciate your on that I completely agree I think we we want and should have as much control in all aspects of our life as possible and being prepared with this is important so I just want you because we only have probably a few more minutes and I want to get to a few more questions that have come in so because our topic was healthy aging healthy living and so folks were asking at a variety of different ways but what healthy habits would you recommend other than than living the lives of your four grandparents I think you give some great role models about how to live but are there any other health habits that you would recommend so that we can age in a way that is as healthy for us physically mentally and emotionally as possible and many people ask those questions and what can I do to maintain my memory in mind and we know that there's three things that have actually been shown to help one is physical activity so physical activity helps your body and your mind and by that we mean 30 minutes three to five times a week it doesn't have to be all at once don't go from zero to 100 if you haven't been working out but really any any type of exercise one point I want to make especially in and I don't want to talk much about but in the age of COVID if people have really been inside it's really thinking all right what can I do inside to get some exercise and I tell people stationary bikes it doesn't need to be the peloton but really anything even just getting up from your chair five times an hour with not trying not to use your arms as I'm trying not to use the arms of your chairs as long as you feel safe but standing up five times sitting down carefully making sure it's safe to do so but that can really strengthen your your quads and your buttocks and help maintain just so much so physical exercise and it's not just cardio it's also strength-based training always talk to your PCP first but our cardiologist here recommends strength-based training in addition to cardiovascular exercise I think those those two things are very important and we really know that they help they also give you serotonin that's that the neurotransmitter that makes you feel better inside so it can help your mood as well too so that's physical exercise mental exercise really important one of the things that I always tell my patients is we really have limits on how much television children should watch right and they recommend really not more than two hours a day but I find that many people as they get older maybe that you know it's a lack of things to do or a lack of company but the TV is on for long periods of time and we really know their studies show that that can actually decrease longevity wow really turning off the television putting on music whatever you like classical music we know can enhance your mind some people love music to dance to if you grew up in the you know dancing in the 50s turn it on and I think it can also lift your mood and help you exercise so limiting television so as part of the mental exercise there's some great classes that can be done online now I'm blanking on the site I can think about it and send it to you that people you can take classes like history in Spain and it can be as obscure or as interesting as you want it to be but something new we know creates that neuroplasticity that sort of the brain's an amazing organ and it actually can really grow so if you learn a new language or new instrument that can really do amazing things for your mind I'll hear people say well I'm not gonna be good at it and that what I tell them is it's not at all about being good at it don't worry about that maybe people around you might suffer from hearing the music but it's an act of learning something new that makes all the difference so even trying to learn a new language for just a short period of time a couple days a week can do amazing things making sure you're reading staying involved asking questions the what we've seen so far is that people that take a real active role in there what's going on around them reading their community generally have better physical and mental health than those that don't so that's physical mental activity meditation actually has been shown to actually help the mind and body and it can also decrease anxiety and depression and I know that sometimes there's that barrier that sort of poo poo I don't do that kind of stuff you know or I it never works for me I can't stay focused well that's the whole point of it right is that you shouldn't feel bad about it it's all about just trying to be present and bringing your mind back and they've actually done studies that shows that it can improve your sleep and so we recommend that for for helping the sleep improve your mood and really improve your mind so those three things are probably the biggest things that we look at we do also know that sleep is hugely important we know that sleep changes as you get older for a variety of reasons you might have arthritis and it might be more painful at night you might have urinary frequency you have to get up to go to the bathroom multiple times a night the quality of your sleep might not be good you might have undiagnosed sleep apnea so we ask a lot of questions around sleep and don't be afraid to talk about it with your doctors or your PCPs you know I'm getting up at night a lot to go to the bathroom there's things that we can suggest that can help with that so those are some of the big areas that I think can really help your whole, your mind, your body and just how you're going through the world those are tremendous thank you so much and I know that there's there's a lot of information about loneliness and depression in the community have you seen any sort of positive gains as a result of this time period for seniors are there any things that you're seeing that people are cultivating or doing that that is really working or successful it's a great question because it is a hard time for many one thing that I think helps is really trying to structure your day we know this works for anybody you know if you were tired you might have floated along a drift but having a structured day makes all the difference in the world so from eight to nine okay I can watch TV and drink my coffee whatever time you get up all right I'm going to get dressed and showered that's really important making you you don't want to stay in your pajamas all day long get yourself dressed and ready for the day it just can really change the mindset schedule out some exercise and then schedule some time that you're going to connect with somebody via phone via zoom I think everybody's feeling this way and would benefit from a call one of the things that that people have done is sometimes it can be hard to know what to talk about but sometimes you can do an activity together some people will um play games and they just move their other partners or components they can you can be really creative you can do a craft together I even have people who are fishing together they can set it up and so try to think about activities that you can do with somebody even though it's you know socially distanced that can make the difference so I think having a schedule making sure you've scheduled some activity in there and then thinking about things that maybe you didn't have time for going through those old photos that you wanted to go through organizing areas well this is a perfect time to get that stuff done make sure make a list of okay I need photo albums if I'm going to do this this is I need a table to do it what time of day we'll all do it and schedule that out so really scheduling that out thinking about your meals still trying to schedule and making sure you're getting outside for some fresh air in some sense you know while it's 95 be careful you don't want to go out in the hot part of the day but thinking about the earlier the later day and thinking about how you can see your family via zoom or maybe it's socially distanced outside you know in ways that can be done in a safe manner mm-hmm so I think people that have really stuck to a schedule have been able to get through this and and even thrive and you know depends what type of person you are if you're an extrovert or an introvert too that that makes yeah I have to say I feel better even hearing that that day that you just laid out than I think of the days I'm stuck around in pajamas yeah there is a noticeable difference just sort of in mood and attitude so I think I probably have time for one more question and I and looking at what we receive for for questions I think it there were a number around telehealth meetings with their positions and so do you have any tips for individuals who are accessing telehealth medical visits for the first time from your perspective as a caretaker to someone who's probably I imagine you're doing some telehealth visits yourself yes do you have any words of advice sure so it is a different form many people I think are used to what a visit means what a medical visit is you go in your weight room you wait there for a little bit you go get your vitals checked then you go in the exam room and you wait and this is a different forum and so just thinking that all right it is different but I do recommend if people can you know safely get on a scale have your weight ready if you have a blood pressure cuff and you're talking to your doctor advanced practitioner about blood pressure have a blood pressure ready having some of those basic things can really help give them the needed information write down your concerns again because you might not be used to this it might get you a little flustered so if you know your visit's coming in two weeks start writing down what your questions are or if you know what you talked about you know write down what you last did at Cooley Dickinson you can get on to my chart and look at your notes and so it might help to look at your prior note with all your newly learned technology skills or those that have had them kudos you know you're doing better than I am and then not getting flustered if things go wrong we're used to that as you know as we're learning and doing this too and things just aren't going to work you might not have the sound but I do think trying to practice ahead of time if possible is important we try to be as flexible as possible the zoom we know is HIPAA secure so we try to work with that but and the phone is also HIPAA secure so we try to make sure that those things are done but just knowing it's a different time you can always schedule another visit or ask a question if you forgot and I still think we can do a lot as far as the exam goes so I try to do as much of an exam as I possibly can I can't listen to the harder lungs yet that might change but not to be afraid of it just know that in some ways it's been great for me I get to see what people's houses look like that might scare others but I can see how they're walking and what they have to navigate in the house right yeah they can even pull out you know have your medication bottles that they're or whatever you're using it's a great way to do a medication reconciliation we can really see what you're taking so I actually think there's just some advantages to it as well yeah yeah well thank you so much because that that is helpful I think there's so much as you alluded to new space that we're all trying to broker and and I think not getting flustered and going with the flow generally serves all of us so and just to just sort of wrap it up I just wanted people to know who we're listening a couple of pieces of information so one when we're talking about telehealth visits or connecting with individuals the senior center we received a grant recently so we are purchasing and creating a technology loan library so any seniors out there who don't have the ability to access Zoom we will have nine tablets coming in soon and then I am doing fundraising to create a larger library so so that senior digital divide we're looking at and you know particularly people in terms of the loan we have some criteria and those who need it for medical visits is definitely a high priority for us to be able to help people to facilitate this even as a public health issue so one we will have that available so call us at 259-3060 secondly a follow-up that we will be doing a presentation on healthcare proxies and most forms next week so you can stay tuned to both the ads on our website and on our Facebook page so myself and another attorney Anita Sorrow who was in risk management as an attorney for base day are going to be doing that presentation and we'll have some more forms to follow up on your great recommendations for planning and then we're going to also have another conversation I believe it's August 20th with a palliative care physician around some more conversation for that advanced care conversations and how do you broker that space so we will we're going to follow many of the things that you raised and then I wanted people to know that certainly one hour is not enough to extract all of your wisdom and so we're really grateful for you sharing time but that we worked with the Amherst neighbors to to divide your time and attention for two different topics and I wanted folks to be aware that you will be speaking with and doing a presentation to the Amherst neighbors and that would be one that is focused we decided to have them they're going to do topics around COVID so we did receive a number of questions about COVID and we're going to save those for that conversation so if you want to share with folks that information the date and the time I can tell anybody that Amherst neighbors is a 501c3 if you're not familiar with them they're here in the community and it's a community-based and inspired group they're trying to serve neighbors simply helping neighbors there's no fee to join at this point in time and they have a website so if you just google Amherst neighbors it will come up I believe it's AmherstNeighbors.org and you can register so you do have to become a member and then they are doing programming for free so you are one of their highlights and if you could just do a little teaser about what you'll be discussing and when that would be that would be delightful sure thank you the talk is going to be August 6th from 4 to 5 p.m. again I'll talk a little bit about what I do and what it looks like in the age of COVID many people have questions about what they should or should not be taking or what are fair risks to take or not to take how to manage how to help with social isolation and how to maintain your the best possible successful aging and health during this time so those are some of the topics that I'll cover again it will be a question and answer so we'll see what other questions come in if there's anything that you're thinking about feel free to to bring those questions forward as well too that's fantastic and could you just share with people and closing if somebody watching this says geez I really would love to have an appointment with Dr. Rebecca Starr with two Rs at the hospital or from the medical the geriatric medical director how would they locate you and find you sure so on the Cooley Dickinson website we actually have a geriatric page with some resources are the name is called Cooley Dickinson medical group geriatrics if you have any questions or want to schedule a consultation you can call us at 585-0755 if you're interested in the consult you can also ask your PCP for a referral and again we have the web page on the Cooley Dickinson site that will give more information to great well thank you so much thank you for your time and your talent and thank you to Cooley Dickinson for bringing in someone who is so expert in the field of aging and aging well and in a way that comports with our values and with the community and you really are inspiring about what medical care can look like for older adults so thank you so much it was a pleasure always every time I interact with you it's a joy so thank you Dr. Starr and have a beautiful day thank you and the same to you as well okay bye bye