A New Prescription: Giving Thanks

Recently, we discussed current efforts to eliminate stigma against mental health, including the potential effects of the Affordable Care Act on mental healthcare in the United States. This week, we will see how gratitude, a deeply humanistic emotion, can improve your mental and physical health.

gratefulheartOn March 3, 2008, my father experienced a minor heart attack. My family rushed to the ICU and crowded around his bed. We feared that he would sustain lasting damage to his heart. Surprisingly, he was in great spirits, and thanked us for coming to visit him! As soon as he left the hospital, my dad started to perform daily ‘gratitude meditations,’ in which he reflected upon the things in his life for which he was grateful. This simple act helped to relieve him of the stress associated with recovery.

Physiological Effects of Gratitude
My father’s story illustrates that feeling grateful can influence not only our psychology, but also our physiology. In fact, just 2 minutes of intensive gratitude meditation can reduce heart rate and negate stress. Higher gratitude levels can also lead to:

  • Increased quality of life, even in patients with debilitating neuromuscular diseases
  • Improved immune function
  • Higher energy levels
  • Better quality and duration of sleep
  • Higher levels of happiness and optimism, which in turn have powerful effects on the chemical regulation of our brains. Happiness and optimism have been linked with a lower lifetime burden of disease and improved familial relationships.

Our emotions can pass on to our children
Increased gratitude levels may even carry over to our children. Recent research has focused on how epigenetic modification of DNA resulting from long term depression may be inherited. In essence, our emotions and grat checkexperiences, if strong enough, may be passed down to the next generation in the form of DNA modification. This offers a powerful explanation for why depression seems to run in some families, but happiness in others. Taken as a whole, these studies demonstrate the holistic effect of positive thinking on the human body and bring a new meaning to Descartes’ famous conclusion, “I think; therefore, I am.”

It is difficult to imagine how one can feel grateful in the face of adversity. However, as Dr. Robert Emmons, a positive psychology researcher at the UC Davis explains, “in the face of demoralization, gratitude has the power to energize. In the face of brokenness, gratitude has the power to heal. In the face of despair, gratitude has the power to bring hope.” Though it may not be easy to feel grateful during trying circumstances, focusing on the positive aspects of one’s life can help us through the worst of situations. See our Weekly Gratitude Activities Checklist for ideas on how to bring gratitude into your lifestyle.

Expressing one’s gratitude has been enumerated by the world’s major religions for thousands of years. Not only does it improve interpersonal relationships and bring out the best in others, it also provides us with numerous health benefits. There is never a better time than now to start reaping the benefits of thanking those who are important in our lives.

So, in the spirit of gratitude, the staff at Aarris Homecare thanks you for choosing our services!

Works Cited
Dunavold, P. “Happiness, Hope, and Optimism.” CSU Northridge, 1997 (http://www.csun.edu/~vcpsy00h/students/happy.html)

Emmons, R. “How Gratitude Can Help You Through Hard Times.” Greater Good: The Science of a Meaningful Life, UC Berkeley, 2013 (http://greatergood.berkeley.edu/article/item/how_gratitude_can_help_you_through_hard_times)

Emmons, R & McCullough, ME. “Counting Blessings Versus Burdens: An Experimental Investigation of Gratitude and Subjective Well-Being in Daily Life.” Journal of Personality and Social Psychology, 2003, Vol. 84, No. 2, 377–389

Emmons, R & Stern, R. “Gratitude as a Psychotherapeutic Intervention.” J. Clin. Psychol: In Session, 2013 Vol. 69, pg. 846–855

Braunstein, D. “Pass the Gratitude: Recipe for a Happy Thanksgiving.” Huffington Post (http://www.huffingtonpost.com/glenn-d-braunstein-md/gratitude-health_b_2131450.html)

Levinson, DF & Nichols, WE. “Major Depression and Genetics.” Stanford School of Medicine 2014 (http://depressiongenetics.stanford.edu/mddandgenes.html)

Nestler, EJ. “Epigenetic Inheritance: Fact or Fiction?” Fishberg Department of Neuroscience and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, 2013

(https://www.dana.org/Publications/ReportOnProgress/Epigenetic_Inheritance_Fact_or_Fiction/)
Rimer, S & Drexler, M. “Happiness & Health.” Harvard School of Public Health, Winter 2011

(http://www.hsph.harvard.edu/news/magazine/happiness-stress-heart-disease/)

Scott, E. “Family Connection and Happiness—Fostering A Closer Relationship With Your Family.” Stress.about.com, 2007 (http://stress.about.com/od/familystress/qt/family.htm)

Heartmath Institute: http://www.heartmath.org/templates/ihm/e-newsletter/publication/2013/spring/appreciation-is-good-for-you.php
WebMD: http://www.webmd.com/women/features/gratitute-health-boost

Products of Prejudice

Last week we examined the causes of commonly-held stigmas against geriatric mental illness, including self-stigma, social stigma, and institutional stigma.

How do these stigmas affect the ability of elders to seek care for mental illnesses?

1. Fewer doctors train in geriatric healthcare, which makes it difficult for seniors to find specialized medical doctorattention. Seniors must travel further distances to see doctors with a detailed understanding of mental illness in the elderly.

a. Many doctors believe that they can have a more meaningful impact as pediatric psychiatrists, rather than as geriatric psychiatrists because they can change a child’s future as opposed to alleviating just a few years of suffering in mentally ill seniors.While pediatric psychiatrists provide immeasurable services to mentally ill youths, this mindset devalues the mind of the senior with respect to other age groups.

b. Historically, major healthcare plans have not provided enough incentive for hospital to provide mental health services. This is changing as a result of the Affordable Care Act, which we will discuss more in detail next week.

2. Doctors without training in geriatric care often misdiagnose or directly discriminate and stigmatize patients with mental illnesses. This can have a profoundly negative effect on patients by reducing treatment efficacy. Discrimination from healthcare workers can even worsen treatment outcomes. While many doctors are not directly prejudiced against the elderly, they are just as susceptible to prevailing stereotypes as the next person.

3. Because of social and self-stigmas, patients may distrust the medical establishment’s ability to treat their illness or fear institutionalization in a psychiatric ward. As a result, patients would be less likely to seek treatment for psychiatric disorders.

Education is the best strategy to overcoming stigma

Education and Empowerment of the Mentally Ill
ageismIn order to effect long-lasting change of public sentiment, people afflicted by psychiatric diseases must dispel their own stereotypes against mental illness. These include the incorrect assumptions that:
• Mental illness is incurable
• Mental illness is a normal part of aging
• Elders with mental illnesses are not worth being treated

 

Education and Empowerment of the Public

The public must also be educated about mental health and aging. Today’s mass media often disseminates misleading and derogatory images concerning mental health and the aging process. Seniors are often portrayed as out of touch with reality, childish, and useless. Few films depict old age in a positive light, and many films focus on the dangerous aspects of mental illness, though only a small percentage of mentally ill patients are violent.

bedsideEducation of the next generation of doctors and medical professionals must be a priority for the future. A study conducted at the University of Calgary, Canada, showed that basic psychiatry education in a group of medical students helped to reduce common stigmas and misconceptions about mentally ill patients and improved student confidence when working with patients with psychiatric diseases. Geriatric healthcare must also become an integral part of medical education as America’s senior population (65+) is projected to double by the year 2030. Many of these efforts are currently underway.

Tune in next week to learn about current efforts to eliminate mental illness stigmas.

References

  • CDC.gov. “Depression is Not a Normal Part of Growing Older.” http://www.cdc.gov/aging/mentalhealth/depression.html
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Neelgard, L. “Report: Too little mental health care for seniors.” Associated Press. http://usatoday30.usatoday.com/news/health/story/2012-07-10/aging-mental-health/56132426/1
  • Papish et al. “Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial.” BMC Medical Education 2013, 13:141
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Thornicroft, G et al. “Discrimination against people with mental illness: what can psychiatrists do?” Advances in Psychiatric Treatment, 2010, 16: 53-59

 

Mentally Ill Seniors—America’s Black Sheep

Depression affects over 6.5 million of the 35 million Americans aged 65 and older, and yet only 10% of them are receiving treatment for the condition. This indicates a deep failure on the part of our healthcare system to recognize and treat mental health problems in older adults. While numerous problems contribute to this failure, underlying assumptions about elderly people cause social, self-, and institutionalized stigmas that complicate the ability of older people with mental illnesses to seek treatment for psychiatric diseases.
Let’s briefly discuss some of the different types of stigmas based around mental illness in the elderly:

Social Stigma
• Social stigma against mental illness in the elderly is closely related to ageism, or the idea that older people are not stigmaas able to contribute to society as younger people.
Oftentimes, depression and related mental illnesses are seen as normal aspects of the aging process. Events such as retirement, the death of loved ones, medical problems, and increased isolation can evince feelings of sadness and grief, but do not directly cause depression. With strong support from one’s family or therapist, these distressing events may be successfully overcome. However, dismissing depression as an unavoidable side effect of aging drastically reduces the chances obtaining treatment for depression and related mental illnesses and can exacerbate the severity of the illness.
The media commonly portrays elderly people with mental illnesses as childish, stubborn, and resistant to change. While this representation may stem from the self-stigma (discussed below), this portrayal only reinforces existing stereotypes of mental illnesses by imposing judgments on afflicted individuals rather than highlighting the need for change. In this sense, the media contributes to the problem.

Self-Stigma
cycle• Self-stigma occurs for a variety of reasons, including fear of financial repercussions, embarrassment, isolation, and/or distrust of mental health services. At worst, elderly patients fear being institutionalized in psychiatric wards or old-age homes and where they will be cut off from their families and friends.
• The baby boomers’ emphasis on self-reliance in the face of difficulty also contributes to self-stigma. As such, self-stigma is directly caused by and contributes to social stigma.

Institutional Stigma
• Assumptions about older people based on the above stigmas can lead to misguided policy that in effect punishes the mentally ill. For example, Medicaid does not cover services for those suffering from mental illnesses, which means that patients are often forced to find more expensive healthcare plans. To complicate the issue further, many states are cutting funding for mental health services in an effort to balance the budget even while 1 in 6 Americans suffer from some sort of mental illness.

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Each stigma is engendered by and reinforces the others.

Next week, we will discuss existing barriers to eliminating these stigmas and current efforts to bring awareness to the state of mental health services in America.

Sources

  • Depression in Older Adults & the Elderly—http://www.helpguide.org/mental/depression_elderly.htm
  • Goodell et al. “Health Policy Brief—Mental Health Parity.” Health Affairs, April 3, 2014. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_112.pdf
  • Mentally Healthy Aging: A Report on Overcoming Stigma for Older Americans. DHHS Pub. No. (SMA) 05-3988. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, 2005.
  • Persky, T. “Overlooked and Underserved: Elders in Need of Mental Health Care.” http://www.mhaging.org/info/olus.html
  • Tomasky, M. “The Great GOP Mental Health Hypocrisy.” The Daily Beast, Politics, 9/20/2013. http://www.thedailybeast.com/articles/2013/09/20/the-great-gop-mental-health-hypocrisy.html

Survivors: Life After Stroke

stroke2As the treatment technology progresses, more than 7 million Americans have survived strokes today. If you are or have a stroke survivor in your family, please be positive, because the hope of getting better is never gone. Please be patient, since the recovery is a life long process. Please be informed, since there are a lot of changes brought by the stroke you should acknowledge. Today we talk about life after stroke. The information is crucial because it matters to the survivors’ recovery, rehabilitation, and next stroke attack prevention.

Be Prepared: Changes by stroke
Surviving a stroke, we first should admit that stroke changes life, both physically and emotionally. Stroke causes brain injury that may affect how people move, communicate, think and act. Here are some common general changes survivors might experience after a stroke:

  • Weakness or paralysis on one side of the body
  • Difficulty speaking or swallowing
  • Tire easily
  • Change in personality, performing improper language or behaviors
  • Difficulty with memory, judgment, and problem solving
  • Difficulty with peripheral vision and problems with visual cognition

Other changes are dependent on whether it is left- or right-brain injury. Generally, one side of the brain controls the opposite side of the body. For example, right-brain injury may result in weakness or paralysis on left side of the body. The survivor also tends to lack awareness of the left side.
At the same time, stroke survivors also go through a series of changes emotionally. Many of them experience frequent emotional instability. Other changes include:

  • Depression
  • Lack of motivation and indifferent
  • Unexpected feeling of anger, anxiety and frustration

The above are common changes that stroke survivors would go through during the recovery process. It’s best for family members and patients to be prepared and recognize these changes in time.

Returning Home
When the patient is medically stabilized, the physician may recommend returning home. Some stroke patients are afraid of this process for the fear of having another stroke attack. There are a lot of other fears due to this change of setting that we also need to understand. For instance, some may feel that their friends and family will abandon them. Or they fear that their loved ones are not competent in proper caretaking. Being surrounded by other people at home may also make them realize their disability, which can be hard to accept. Therefore, family members and hospital staff need to work together to prepare for the transition.stroke1

When is the right time?
There are four major factors to consider when assessing whether getting back to home is a good decision. Stroke survivors at home need to have ability of self-care, meaning one should be able to accomplish some basic daily activities. Also since the medical care still continues, the patient needs to have the ability to follow medical advice as well. It is also highly recommended that a caregiver, either family member or hired professional staff, assist the patient when needed. In addition, the survivor needs to have the ability to move around and communicate, so that they can ask for help in an emergency.

Adapt your home
Before welcoming your loved one home, family members should work with professional staff to change the home setting, making it safe, accessible, and comfortable for the stroke survivor to live.
First, you need to check every corner of your home and be diligent about hidden hazards that may cause falls and other accidents. Measures like taking up the throw rugs, having more lighting, using a non-skid mat, and fixing your floor or staircase are highly recommended. Further action, like installing a raised toilet seat, safety grab bars or handrails can also be helpful. You may also want to build a ramp so that patient can move around as much as possible.

Caregiver
Caregivers are often the spouse, adult child, or parent who provide most of the care for stroke patient at home. Since the recovery process is a challenge for both patient and caregiver, we suggest the two sides to share decision-making and feelings as much as possible. The caregiver’s responsibilities range from providing physical assistance, taking care of the survivor’s everyday life, to managing financial affairs, and providing emotional support. In other words, the caregiver needs to cover almost every part of the stroke survivor’s life.
However, we should not neglect that caregivers also need care themselves. Try to encourage the survivor to be as independent as possible. This will not only relieve your pressure but also help the survivor’s recovery progress. While you encourage your loved one to participate in leisure activities, you can also try to have fun. It’s totally fine to take a break, which would be beneficial for both you and your patient. A paid professional caregiver is also a choice many people turn to. While you try to take good care of people in you life, remember to take care yourself as well.

Resources
http://www.stroke.org/site/PageServer?pagename=surv
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309716.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309720.pdf
http://www.strokeassociation.org/idc/groups/stroke-public/@wcm/@hcm/documents/downloadable/ucm_309723.pdf

Sound Body, Sound Mind

As our body goes, so goes our mind.
You know how you feel after a long car trip, when you finally get out of the car and stand up, you’re stiff and sore, right? Imagine years of not getting up. One day you’ll realize your body aches are chronic and your memory isn’t as sharp as it used to be. Most just complain and brush it off as old age.

Senior-doing-neck-stretches-350x234
You don’t have to live this way! Make yourself get up and do something aerobic at least 3 times per week. You could go on a walk, run, take a bike ride, invest in cardio equipment, or join a gym. Start slow and steady. Try to get your heart rate up for at least 20 minutes each time. Add in weight bearing exercise, flexibility and balance exercises, and notice your aches and pains diminish.

Find a Buddy
I recommend finding an exercise buddy to keep yourself on track. Those who exercise with a partner are much more likely to continue their routine. Motivating each other and holding each other accountable to your exercise schedule goes a long way in your success.penguinbuds

What’s good for your heart is also good for your mind
Each year that we don’t get the exercise our body needs, we age prematurely. Not only does your body start to deteriorate, so does your mind. Studies have shown that exercise can actually ward off dementia, Alzheimer’s, diabetes, and high blood pressure. According to Dr. Stephan Bamberger, PhD, Lac, “The connection between Alzheimer’s disease and blood supply to the brain, has recently been confirmed by researchers at the University of Leiden in Holland.” As your blood flow decreases, due to clogged arteries or blood clots, your body and mind will feel the difference.

3menAvoid Crippling Effects and Future Medication
• Exercise has been proven to:
• Improve your immunity
• Improve your cardiovascular function
• Improve your digestive system
• Protect against loss of bone mass with weight bearing exercises
• Improve your functional reach
• Improve your balance and flexibility
• Reduce pain from rheumatoid arthritis
• Reverse muscle atrophy

As a former fitness club owner, I witnessed the positive effects on the elderly, who happened to make up the majority of our membership. Two personal stories are testimonies to the need to begin or continue an exercise routine.

Virginia
The oldest member of our club was sharp as a tack, with memory better than most our younger members. She was (and still is) friendly and loved by all our members who came in to work out the same hours as she. Virginia drove herself and a friend to our club 3 x’s per week. She walked laps in our pool, stretched out in the hot tub, took a shower and afterwards, usually rushed out to meet some friends for dinner. We celebrated her 100th Birthday Party at our gym with her family and friends.

muscle_brain
Texas
Waiting in the dark in his car 3 mornings per week, Texas would wait until an employee arrived to open the door at 5:15 a.m. Texas proved to his doctor that he had what it takes to ward off the diseases that can come with old age. I met Texas when he was a young 75 year old gentleman. The previous year, Texas was told by his Dr. that he was going to die in 6 months if he didn’t start changing his ways. He was diagnosed with Type II diabetes and high blood
pressure. The very next day he joined a fitness center and started walking on a treadmill for and hour 3 x’s per week and started watching what he ate. In 6 months, his diabetes had disappeared and he was taken off his heart medication. Now 78 years of age, he continues his routine religiously each week, always with a smile on his face.
Allow Virginia and Texas to be your inspiration. Kick some of those painful signs of old age by making some lifestyle changes to improve your quality of life.
Always consult your doctor before beginning an exercise program.

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