Click here to listen to Optimizing the Life of Seniors

Hello, everyone. I’m Dr. Trish Murray – physician, best-selling author, and the Health Catalyst Speaker. You’re listening to Discover Health Podcast, and today the title of our podcast is “Optimizing the Life of Seniors.” I am so excited to have a colleague that’s been such a wonderful person in our local community here of the Mount Washington Valley, Marianne Jackson who was a medical doctor her for many years and now she’s very busy doing some other things past retirement. So, Marianne, thank you so much for coming on the show!

It’s a treat! I really appreciate the opportunity.

Oh, absolutely! So, folks, Marianne’s lived an amazing life. I’m going to read this bio that she has provided to us to just give you a glimpse of what she’s been involved in. Marianne Jackson served the New Hampshire North Country as an obstetrics and gynecologist for twenty-five years before leaving to complete a master’s degree in public health at the University of North Carolina. There, she worked in patient safety and quality until happily returning to the Mount Washington Valley in January of 2015.

Now retired and living in Madison, New Hampshire, she is devoting much of her energy toward being the Vice President of the Board of the Gibson Center. In this role, she co-coordinated the eleven-town Mount Washington Valley Age-Friendly Community Initiative and has launched HomeShare MWV Gibson which is an effort to pair homeowners with safe and compatible renters in their homes. She’s also dedicated to making conversations about end-of-life decision making a natural and comfortable topic for families. In that capacity, she serves on the End-of-Life Healthcare Decisions Coalition, which is part of the Foundation for Healthy Communities in Concord. She is a member of two task forces of the governor’s commission on aging. For fun, Marianne sits on the Tin Mountain Energy Team that promotes renewable energy and reduction of energy waste.

Her recent awards include The Joseph A. Vaughan Award given by the governor to a person from each county in recognition of exemplary volunteer efforts on behalf of New Hampshire’s older adults. The MWV Age-Friendly Community Action Plan that she drafted with the other Gibson Center leaders won the New Hampshire Plan of the Year Award in May, and most recently it won the Northern New England Planner’s Association Award for Plan of the Year. Last spring, she was awarded the Tin Mountain Conservation Center Distinguished Service Award for efforts on behalf of renewable and clean energy efficiency.

Wow! I hope I’m still going as strong as you are when I retire!

Eclectic!

So, Marianne, the first question I love to ask every single guest because I think it’s so insightful and opening for people to hear is – how has you come to be of service the way you are presently?

I come by it by birth. My mother, she only died two years ago at ninety-nine, she was a woman of exceptional character and service of that greatest generation that are the women who volunteered, who made communities function during all those years of the fifties. Let’s just say had she been born when I was, she would have been the president of a bank or she would have been the senator from Massachusetts. She was a remarkable woman. And so, the idea of serving the community, being a person who is a leader and who brings people together was what I…I just grew up with that in my family as what you do. Then I was very, very lucky as a high school student to be asked to be work for an internist in town. I was fourteen years old, but the nurses in that office treated me like I actually knew something, and I could take care of my part of the responsibilities in the office which then led to a career that took me to nursing school which then led to physical therapy school. I graduated with a MS in physical therapy but then went directly into medicine from there. I have never looked back. I have been thrilled, very, very pleased with what my career path. It sometimes was extremely hard, and, in some ways, I think as you know being in rural medicine has a little bit of a missionary sort of field to it because you’re so alone and isolated, but at the same time totally supported by your community.

Totally.

I wouldn’t trade it for anything. That’s why when I say, “happily moved back to the Mount Washington Valley,” it’s because this is where it happens. This is where we make a difference, and it’s been really fulfilling.

Ah!

Does that answer your question?

Yeah! It’s wonderful, and that’s why I always ask it. It’s so amazing to hear everyone’s story to how they’ve come to where they are. So, a question I have to ask though before we move on is how did you go from PT to OB/GYN?

In a circuitous kind of way, but I recognized when I was in physical therapy that there was more I could learn, more I really wanted to know. Quite honestly, I was at that cusp in the lives of women that I began to…it was only after I had been through the physical therapy school that I realized I could as a woman be accepted and go on to medical school because having grown up in the fifties, that would not have been something that would have been an option.

Right.

It was then in medical school that I became that much more aware of what we do in OB/GYN and the role I could play in the lives of women. I cared deeply about women’s reproductive health and I was either going to go the route I did or go to the CDC and work internationally in reproductive health. I don’t know what that life would have been. I did this one!

Well, I could tell you that the Mount Washington Valley is very glad you made the choice you did! I know that you’ve retired, I’m still in practice, but I’ll tell you when I first came to this community it was like if you needed to see an OB/GYN you wanted to see you!

Thank you.

Dr. Marianne Jackson.

Thank you. It’s because I really enjoyed the work together in partnership with the patients whose lives I always wanted to just see them reach their greatest potential. That was my mantra.

Exactly as you’ve said, they know that, and they feel it and that’s what they give back to us. The love and the connection of the relationship of getting each other and working together to optimize someone’s health.

Right.

That’s so awesome! Let’s get into talking about how we optimize the life of seniors.

Okay.

First of all, what is an AARP age-friendly community? How does it have an impact on the lives of older folks?

Wonderful. AARP is an affiliate, if you will, of the World Health Organization’s age-friendly initiative, which starting in 2005 looked at the world and said, “Our demographics are that we are aging and we have the opportunity to look at our communities internationally – all across the world – at what are the domains of health in our communities that create the best life for seniors? AARP then developed a model for examining our communities using what they use, and the World Health Organization uses eight domains. How do I find my eight fingers? We in our work boiled it down to five, but it’s a way of bringing together the municipal leaders in towns and cities with the non-profits and other agencies who also work on issues related to aging, partner with them, cooperate, collaborate, all those wonderful C-words that bring us to joining forces to look through the lens of aging to make our communities stronger. That’s not at a sacrifice of other generations because when you start to really examine it, what’s good for seniors is good for toddlers, is good for young families.

So, let me just say that our local effort brought our work focused on five domains which are health, housing, transportation, outdoor spaces (recreation and parks and roads and streets), and community connections.Click To TweetWhen you look at those domains and find all the people in your region who are working in those areas and begin to connect them to each other, the possible benefits, the projects, the collaborative efforts just multiply rapidly. All of these people are mission driven and have the same big goals in mind, but what the age-friendly community initiative does is brings them together convened in a way that they’re really talking to each other. What we see are people, then we’ll hear from one agency of what they’re trying to do and the other says, “We’ve got some of those! Why don’t we partner with you on that?” Or one town has got a terrific outreach program for transportation, and the next town says, “We’ve been trying to crack that nut. Can we borrow what you’ve done?” Of course. You learn from each other, you borrow, you steal ideas from each other, and you can obviously see that many things then can start to happen.

Absolutely. Collaboration and interaction are so beneficial. We’ve had a health collaborative in the valley before and I’ve sat on that committee. The same thing was happening. One agency or office would talk to another and exactly what you described. The more people come together and talk about what the needs are and what’s happening and what one’s doing and the other one says, “Oh. We have stuff that would help you, and you have things that could help us. Let’s get together and…”

Join forces!

The ages of competition are gone. The idea of let’s collaborate and come together is such a beneficial thing.Click To Tweet

Right.

We all benefit.

Let me give you a very quick example that I think demonstrates it. Because we are now well known for having come together, we obtained a grant from the Tufts Health Momentum Fund to “equip, train, and connect seniors to the internet.” What we have are donated computers from all over the place, the Waldorf School, Northway Bank, individuals, and those computers are getting refurbished and cleaned up. They are being donated to seniors who need laptops and desktops. The donation came through the Conway Library which is also providing a tutor who will train seniors on how to use internet capability for things like simple email, Zoom conferences, tele-health. We are partnering with the Gibson Center, the library, the visiting nurses to identify – who are the people who would benefit from that training? A couple other local businesspeople who are donating their time to do the tutoring and the computer refurbishing. That’s what can happen when you bring all these different people together. The Gibson Center, the Conway Library couldn’t do it alone.

Right.

But with everybody saying, “I can contribute some of that.” It’s like stone soup. Everybody brings a little piece of it together, and it makes it possible to train twenty-five to fifty seniors on how to be on the internet.

Which is amazing during this time, of course, with the COVID-19 pandemic. Wow! So many people of every generation but particularly seniors, if they don’t have the technical skills…the way we connect now is so much more online like this. You and I are on Zoom. So, what has the COVID pandemic highlighted also about the health and well-being of our seniors besides this one example you’ve already pointed out?

COVID obviously has devastated the senior community disproportionately more than younger people. One of the things it has pointed out and has made worse is

ageism which is a way of stigmatizing elders and making them feel disposable, dispensable, as if their contribution or lives are less important than someone else.Click To Tweet

It has pointed out one more reason why trying to maximize aging at home, aging in place is so much more meaningful and purposeful and safe. We had already been working hard to help more and more people age in place and now we understand how much more important having everything in place to help that whether that’s more caregivers, more home health aides, paying our health whether it’s nursing assistants or NAs, the people that make that possible for the most elder seniors. COVID has created more divides in the way it has anyway. There are digital divides; there are income divisions; there are racial divisions that COVID has highlighted in the most horrible way. Seniors are suffering from that as well.

Yeah. Absolutely. I mean, we’ve done live movement programs, and I’ve also done a community [event] before where people come together in the evening and we even share meals and things like that. It’s so difficult when you can’t do those things, especially for the folks…even the podcasts and the webinars I do. For a long time, people would come if they couldn’t do the technology piece or they didn’t have the technology piece, they would come to our office and they would listen from the other room. We’d set it all up for them. We have done some of that still where people just wear masks, but my point is that for those that aren’t technically, as you brought up earlier, trained and need that training. That program you alluded to is fantastic and they can still stay in contact, but COVID has definitely caused such a difficult time for so many people and especially as you say the seniors and their health and overall well-being which also has brought up more knowledge of loneliness or separation and what it can do for our overall health. What does the research tell us about loneliness and separation on seniors and overall health and wellness?

The research existed before COVID. COVID has provided us…unfortunately there will be many more PhDs written based on information that will come out of this year, year and a half, whatever it turns out to be. The research is stunning in its conclusions that loneliness…let me back up. Maybe some of your listeners are aware of the initiatives in Great Britain to combat loneliness because they have determined it is one of the most significant risk factors for death. So, anyone who really wants to dive into this, I want to encourage you to look at some of the literature coming out of Great Britain and why is it that they have said, “this is one of our number one health risks and we’re going after it.” But in a broad brush,

loneliness and isolation increase some of the obvious things - depression, suicide - but also diminish appetite so thereby nutrition suffers, inflammatory diseases then are thereby increased.Click To TweetI shouldn’t say, “thereby.” I don’t know that we know, maybe you know much better the data on how these things interact, but the correlation is undeniable.

Actually, there is some research that shows that people that are dealing with loneliness on a regular basis have a higher CRP or hs-CRP.

Right.

Either of those markers are a marker of generalized inflammation.

Thank you.

They have been shown to have higher levels of these two particular inflammation markers. In the functional medicine world, we know that inflammation is such a brewer’s yeast, if you will, of causing chronic disease. If we have increased inflammation, we’re going to develop more and more chronic diseases such as high blood pressure or heart disease or lung disease or other diseases of the systems of the body because the body is chronically inflamed. Yeah, that research does exist in that marker.

Thank you for that. This is for your listeners. We’re now really having a conversation. This is informing me of the specific marker and that just as you’re suggesting it worsens some of the dementias that are also already in play because of the isolation you now have a lack of stimulation, you have an increase in anxiety which is leading to increased sleep disorders or disrupted sleep. This cascade of inflammatory markers, the mental health disorders, as well as the physical disorders. If someone’s arthritis gets worse and they are now isolated and unable to get out and walk and move because they’re usual companions can’t come over and get folks out to walk. The normal things that you do, there’s a lot of suffering and I know that our folks who have been working at the adult day center have seen a marked decline in the functionality of many of their clients who had to be turned away as the adult day center closed. Despite they’re working very hard to stay in touch by phone and Zoom when they can, you can’t underestimate the power of voice and touch and the nuance of a smile and those sorts of interactions.

Absolutely.

You really see people go downhill.

Yeah. And particularly in between generations, meaning there’s research that has been done in nursing homes or senior homes, let’s say, where they bring in children to interact with the older folks, the seniors. The seniors’ cognition gets better, their ability to move improves, their depression and anxiety get better. The fact that you, again, combat loneliness by bringing not only people of the same generation together but particularly if you bring people of different generations, particularly the young and old, it’s so amazing because of course it makes us all smile to interact with little ones on a regular basis.

That actually…I want your listeners to know about a program that’s been replicated and there are some others that are similar called Music and Memory. I don’t know if you’re familiar, but it’s a beautiful mechanism by which certainly the professional care providers in a nursing home but even more wonderfully is when teenagers come in interview the senior about their music preferences and put a playlist together that has all that wonderful Gershwin or Sinatra or jazz or what did you play at your wedding? What did you listen to when…? And puts that together. So, there’s the interview, there’s the playing the music together, and then the elder has that playlist back either at home or whenever they want to listen to it. Music, choirs, singing, dance, we know that all of these arts are stimulating very important parts of the brain. We can get down to hormones and oxytocin and prolactin and all these things, but they’re engendered by those multigenerational relationships and then the arts. So, these are things that we look forward to being able to get back to on a person-to-person basis when the COVID is over or we’ve got it under control. We’re really looking hard at ways to do the best we can whether that’s Zoom, FaceTime, getting kids and these elders together.

Right. Yeah. It’s so important, it’s just amazing the different things that it sounds like you’re working on and trying to help people with. It’s amazing. Didn’t also, Conway from the AARP get some sort of recognition as far as our area?

Well, the plan did…this was so outrageous because I’m not a city planner. I’m a doctor! We followed the roadmap that AARP puts together. We did it a little more creatively and we did say we are not one town. We’re a region. We’re the Mount Washington Valley with one regional high school, one regional hospital, regional newspaper, chamber of commerce, etc. We’re much better when we all band together just the way we started the show.

Cool.

So, we are unique amongst the AARP age-friendly communities that we have this regional approach, but we include Fryeburg for a good reason. Now we’re two states. Fryeburg, Maine has joined with the Mount Washington Valley of New Hampshire and it meant that we have resources from both the Maine AARP and New Hampshire. We have wonderful coaches and mentors in both states helping us.

That’s great!

Yeah!

That’s awesome.

One of the real huge benefits with this AARP network is that their networks of webinars and calls for us particularly with what’s called the rural health collaborative. We are on phone calls with people in Idaho and Iowa and Texas with people who are also rural who have the same issues trying to figure out how do we deal with the transportation issues of people who are fifty miles from the nearest whatever, who don’t have close family units or public transportation. We feel very lucky to be connected to people who are looking at housing and transportation and community connections in many, many different ways and solving the problems.

Again, to get back to the beginning of the collaboration and the idea that we don’t just collaborate with people here in our own community because our community has its own paradigms and its own history.

Right.

What we’ve always focused on. If you start talking to someone like you say from Idaho or Texas or somewhere else, it’s like maybe their paradigm is different and they get us to look at things differently.

Yeah.

We do the same for them. That’s amazing!

Marianne let’s talk about end-of-life care planning. Of course, none of us get out alive and we’re aging and if you want to optimize your senior life, one of the things you don’t want to avoid is the fact that none of us get out alive. It’s very helpful to not focus on it but at least have the conversations so your family know what you want or what you don’t want and things like that. So, what is important for seniors to know about end-of-life care planning? Why is this topic so difficult when it relieves so much anxiety if you do open the door and start having the conversation?

Thanks for this chance to talk about this. It’s such a great topic. I think to answer the second question first. One of the reasons it’s so hard is that our options and the choices have changed so dramatically over the last twenty years that we don’t have the model of our parents’ parents having had any discussions at all. Because if you look at lifespan and you look at what did people die of before about the 1950s, it was diseases and conditions that caused rapid death. If you look at

in the early 1900s, the average length of time between the onset of symptoms and death was fourteen days. Days. Now, we live with chronic illness for years and years.Click To TweetWe have many, many, many more interventions and choices that were not available.

My mother never would have had a conversation with her parents about end-of-life decision making. There was nothing to decide because it just happened. My mother fortunately was so progressive. The reason I care about and I’ve been in this is that she started billing out her advance directives back in the late 1970s, early 80s. Revised them over the decades and sent them out to all of us. It meant that as our four siblings, we knew who she was, what she wanted, what she didn’t want, and we did not have to question it and we didn’t have any arguments amongst each other about what to do about Mom because we knew very clearly.

What I want everyone to understand about what is important is taking the opportunity to have the control over expressing your values to the generations so that there doesn’t have to be the kind of angst, guilt, confusion, conflict, at a time when families are already suffering because somebody’s ill. Those do not need to be compounded by a lack of knowing when we can early on have facilitated conversations. There are many professionals trained to help people understand what filling out an advance directive can mean. To a person, when they have completed the conversations, they all look at each other going, “Wow, wasn’t that the best? Wow! To think we weren’t going to have this conversation.” Because we learn about each other, about what matters, what we have striven for, what we want people to remember us for. It’s a relief to families.

I want people to know that they can go to the websites to download in their state advance directives. They don’t need a lawyer; they don’t need any other heavy duty help unless they want it. Most medical offices have people who can council them through the language of an advance directive. It needs to be something that everybody in the family knows that it exists and there are copies dispensed everywhere. I’ve even got to where I travel with mine. As it has happened, my most serious issues have been when I was traveling. Lo and behold, I’m in some other state and they say, “Do you have an advance directive?” Yeah, now I have it in my suitcase. It’s such a gift.

We like in our generation to have control. We’ve always wanted control. If you ask people, that is what they want more than anything else. So, to take time to say, “I want everything done. I want to live as long as I possibly can.” That’s your choice if you make it clear. If your choice is, “At this time in my life, if I can’t return to X, Y, Z function then I don’t to keep living because that isn’t living to me.” I want my family to understand what that means. What’s that look like. And let them without guilt say, “No. Let her have a natural death.” As an aside, do not resuscitate is allow natural death. Let’s look at the language. Allow natural death is a kind way of saying, “I’ve got to go somehow.” My mother used to say, “Do not take my ticket out of here. I have some tickets and they may be that heart attack. Do not take my ticket.” She did not want to live as a person with major disabilities, and she didn’t.

Yeah.

I think it is people have the choice and the most important choice is to exercise that choice. Don’t leave it to the medical community that otherwise doesn’t know. It’s not fair to them.

Right.

It’s not fair to the families. I really want people to approach it. I wish it was something that we talked about openly, readily, really comfortably with each other.

I would totally applaud and echo everything you said. My personal experience with my folks was not as wonderful. Your mom living as long as she did, my mom ended up with Alzheimer’s for many, many years. I did open the conversation with my father around, “Well, what do you think Mom would want?” Then I’ve had, obviously, prior to my dad’s passing, the open conversation with him. I totally understand the idea of opening that door and having that conversation. Being in the medical field though, I’m comfortable with that because I’ve had those conversations with many families along the way in my training and so forth.

Right.

For us, we sort of do it because it’s something we do on a regular basis with the patients we work with, but folks out there I would reiterate – open the door and have the conversation. It reduces anxiety, it makes you feel closer to your loved ones because you respect each other and understand what each other feels and what each other wants. You may want something different than your parent or vice versa but have the conversation and have each person have the right to make their own decision about end-of-life thoughts and what their options are.

Thank you, Marianne, so much for coming on the show! It’s been great to share and hear your ideas about everything that’s going on here in the Mount Washington Valley to help optimize the life of our seniors and then across and how you’re collaborating with towns and communities all over the country! That’s amazing.

We’re having a great time, and I really appreciate being able to talk. If any of your audience has questions about things we’ve talked about or wants resources, links to things, I’d be more than happy to communicate with them about where they can turn.

Where can they turn? What’s one place you would recommend anyone go to learn more about some of the topics we’ve talked about today?

This is not an advertisement, but the AARP website does have significant material. Compassionate…I’m going to get my compassionate caring and caring compassionately mixed up…I will let you know, and your listeners can then get the link from you in terms of where they can download their state-by-state advance directives.

Okay. We always transcribe these podcasts, so below we could absolutely put whatever you send to me that people could read below and be able to get that.

As a single book, Atul Gawande’s Being Mortal is just outstanding. I’ve never had anybody who said they didn’t get something wonderful out of it.

That’s Being Mortal?

Being Mortal, yeah.

That’s great! Marianne, I always love to end with asking, again, every single guest and I can’t wait to hear your answer – what is your number one secret for living a healthy life?

Balance. Balance. A little bit of everything. A whole lot of different things, whether that’s music, play, absolutely exercise, reading (I read everything eclectically), staying socially connected. Obviously, I thrive on that. I couldn’t do without any one of those elements.

Yeah, and it’s so important to balance them all.

Right.

Right now in my life, business is so busy that it’s starting to lose a little balance. It’s like, wait a minute! What can I pull back so that I can maintain my balance of my personal life and my business life? For example. We all do that. We get off balance, we all get off balance. We fall off the wagon, this and that. That’s what we may want to do, once a month and ask yourself, “What’s out of balance, and what needs to come back into balance to view?” The idea of trying to keep yourself as optimally happy and in balance as you possibly can.

It’s not a perfect day every day, but you get it over the course of the month and the year. The balance is there.

Yeah! And that’s what we work for. The idea of once you start focusing on it and looking at it, then you are in control just like the end-of-life decisions. You get to be in control, maintaining your balance.

Great.

Thank you so much for coming on the show, Marianne. Everybody make sure you check out the AARP as well as we’ll put the other link and Being Mortal. Check out that book. Thanks so much for listening to the show. Thanks so much for being on the show, Marianne. We’ll see you on the next episode of Discover Health.

 

Resources from Dr. Marianne Jackson

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