Home and Heart: The Importance of Aging in Place

Geriatric Care and the Significance of Aging in Place

In this episode of Open Forum in the Villages, Mike Roth interviews Dr. Seetha Bhagavatula, a geriatrician, discussing her experiences and expertise in caring for people with Alzheimer's disease or dementia. Dr. Bhagavatula shares her personal background, the importance of aging in place, and challenges associated with dementia care. The conversation also highlights misconceptions about dementia and the holistic approach required for optimal patient care. The episode concludes with an introduction to Remo Health, a virtual platform dedicated to supporting individuals with cognitive impairment, and strategies for handling dementia with family members.

00:00 Introduction to Open Forum Season Seven

00:30 Meet Dr. Seetha Bhagavatula

01:09 Personal Story: Caring for Grandparents

02:27 The Importance of Aging in Place

03:49 Music and Dementia

04:21 Stigma and Dementia in The Villages

06:39 Challenges of Dementia Care

07:44 Understanding Self-Identity in Dementia

12:04 What Matters Most in Dementia Care

14:21 Introducing Remo Health

16:05 Medications and Telemedicine

16:51 Improving Dementia Care in the U.S.

17:45 Early Signs and Family Conversations

19:47 Diagnosing Alzheimer's vs. Other Dementias

21:18 Conclusion and Contact Information

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Transcript

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Home and Heart: The Importance of Aging in Place

Dr Seetha Bhagavatula 

[00:00:09] Nancy: Welcome to Season seven of Open Forum in the villages of Florida. In this show, we talk to leaders of clubs and interesting folks who live in and around The Villages. We also talk to people who have information vital to seniors. You will get perspectives of what is happening in The Villages, Florida area.

[00:00:27] Mike: This is Mike Roth on Open Forum in The Villages, Florida. 

I am here today with Dr. Seetha 

 Bhagavatula.

[00:00:35] Mike: Thanks for joining me. Seetha. 

[00:00:37] Seetha: Nice to be here.

[00:00:38] Mike: Good. today we're going to be talking about one of my favorite subjects care for people who have symptoms of Alzheimer's disease or dementia. And in your bio, they say you're a geriatrician working with our older citizens. How long have you been doing that? 

[00:00:58] Seetha: I've been a geriatrician since 2020 . 

[00:01:02] Mike: Why don't you tell our listeners about your background and how you first became interested in medicine, and why you wanted to work with older people. 

[00:01:09] Seetha: I, was born in Vancouver, Canada. We were a nuclear family. We brought both of my grandparents on my father's side from India to Canada to take care of them. we didn't have a dining room. We took out the tables in the dining room, and they slept there. So they were front and center in the house.

We got to interact with them every single day. My grandfather had Alzheimer's dementia. My grandmother had multiple strokes. We were blessed to have people come into the house and take care of them while my father worked and my mother stayed at home. I got to see what it was like for people to grow old with their family in their home environment.

And that was wonderful to see. when I was younger, I didn't know any different. We had a situation where we had to put one of them into a nursing home briefly while we were traveling. My grandmother lost 20 pounds in two weeks, and she was, 

[00:02:08] Mike: in two weeks. 

[00:02:09] Seetha: She didn't eat at all. And my grandmother loved pizza. She's from a rural part of India, but when she came to Canada, she was like, give me the pizza. So we made sure that she got pizza every week, but she actually refused to eat and she was more lethargic, she was more confused. it made me realize the value of aging in place, aging with your family, and when they passed away, it left a grandparent shape hole in my heart. And so I really wanted to take care of older individuals, which to this day, whenever I have anybody in front of me, I see my grandparents. it allows me to work from their perspective, what they want with that kind of empathy.

 ? My grandfather, started falling off buses in India, so that was the first thought when we brought him here. my uncle brought him in the plane here and had to take care of him. He was already incontinent and having trouble with words. When I was born, about six months later, he used to call me the little boy because he forgot girl versus boy.

by the time I was five or six he wouldn't talk. he could still get out of bed and sit in chairs and interact. By the time I was 10, he was completely bedridden and incontinent. even when he wasn't speaking, at some point my mother was cooking in the kitchen and singing a romantic song she stopped singing and all of a sudden my grandfather, who hadn't spoken for years, completed the song.

my mother felt two things. One, flabbergasted that her father-in-law had just sang a romantic song to her, and two, that shock that she hadn't heard his voice in so long. So that is also a way that I realized that music is something that retains in the brain for a very long time, even after changes with dementia, 

[00:03:59] Mike: Because you're not the first person that's mentioned this that people in a state of dementia really enjoy music and it is a way to reach them and they can reach back out that doesn't work with. regular spoken word language, 

[00:04:18] Seetha: Ready.

[00:04:18] Mike: Different part of the brain must be involved. 

[00:04:21] Seetha: Exactly.

[00:04:21] Mike: Do you think there's a certain amount of stigma associated with decline in dementia 

[00:04:27] Seetha: mean 

[00:04:28] Mike: I'm here in The Villages, Florida, the largest retirement community in America. We have probably 160,000 people here. I've been here for seven years I have noticed that there are people that have various stages of dementia still living at home in single family homes as well as we have various levels of care facilities here in the area. Why do you think it's important these people who are in some kind of cognitive to be living in their own home?

[00:04:59] Seetha: I think that people do better when they are in their own homes. Having dementia is such a loss of independence in so many different ways. What defines you as a person? What defines me as a person, right? It's our job . It's what makes us tick. It's our hobbies, it's our family, it's our surroundings.

What's the first thing we do when we get up in the morning? What's the last thing we do when we go to sleep? And I find that people with cognitive impairment and anyone in general does better with the routines that they're used to and the surroundings that they're used to. it also allows autonomy and a certain amount of self-expression to continue that oftentimes is lost in different settings, especially in medical systems like nursing homes and hospitals I have found that People's cognitions tend to do better when they're in their home environment and decline slower than in a new environment with people they don't know and surroundings that don't look familiar.

Those kinds of things tend to make people's memories. Decline faster, and there's something to being at home for sure, with your loved ones who know you and see you.

[00:06:13] Mike: And you had a different environment with your grandparents, here in The Villages. Most people are either married or living together with a significant other, and the children in another state. And it expensive to bring help into the house to deal with the dementia patient. Is that a significant factor why so many people wind up in memory care units?

[00:06:39] Seetha: I have found that a lot of people end up in memory care units when. Their cognitions have gotten so difficult that there's a safety issue. Oftentimes, in the evening, for example, when we have sundowning, people get up and wander, and there's a safety issue with that. 

Having to do with, getting up and going to the bathroom, maybe forgetting you've gone to the bathroom and getting up again the person who's with you, like a spouse or a child, cannot be there consistently for those things.

These are memory units in the community. If we're talking about nursing home settings. You are correct. Unfortunately, having the ability to have somebody there when they need what they need, which oftentimes ends up being 24 7 is hard.

It's expensive, we're all working. It's very challenging to find somebody who's able to do that consistently and who you may trust. that transition is also very challenging.

[00:07:34] Mike: What's the big misconception that the public has about dementia how does that negatively impact care for people who have the condition? 

[00:07:44] Seetha: I think the biggest misconception I hear is that person is no longer there or that person is being lost within the disease. There's a lot of data that's come out in the past five to 10 years that has to do with self-identity and dementia, which I'm very passionate about. what has been found is that a lot of individuals, even in moderate to severe stages of dementia, retain their definition of self.

We see this through their ability to personify things. I feel this. I want this. Their ability to show certain amounts of preference in their day-to-day life, Self definition is challenging because a lot of us define ourselves by our job. I'm a physician, I like to go to the gym, things that get lost.

My best friend is this person, My family is from here. The first definition that is supposedly lost. Is, vocational definitions, people tend to lose rapidly the definition of what they do for a living. That definition tends to go, but the self definition that lasts, 

[00:08:45] Mike: I'm just thinking about the application here to our listening audience, most people in The Villages have retired. They don't have that vocation. But what you might mean is I was a pickleball player. Or I was a member of the shooter's club, a member of one of the acting clubs, or a quilter and they no longer can go to those weekly meetings.

[00:09:12] Seetha: Even after retiring, people still have a definition of, I was a physician, I was a professor of physics. I was a marathon runner, which tends to be a challenging one when people's functional abilities decline. people tend to accept, even if they were still working and then got this disease versus when they're retired and let go of their definition of self from, whatever they did as a job the more important thing is that the one that retains for the longest is their self definition based on family and their relationships.

So even when people get moderate to severe dementia, they still have a definition in relation to others. They see themselves as mothers sisters. Brothers, friends, colleagues, they still see those things. And I think the biggest misconception people have is that once you get this diagnosis, you're a different person.

[00:10:04] Mike: And the diagnosis may mean they have a lifespan of five to 10 years beyond the diagnosis. Am I correct? 

[00:10:14] Seetha: Could be.

[00:10:15] Mike: If they're otherwise in good health, I why do you think dementia particularly a challenging disease for most families in America to deal with.?

[00:10:25] Seetha: That is a great question. Dementia is one of those diseases that. Once you get a diagnosis, the future is actually ambiguous and very scary. getting the diagnosis in the healthcare system we're in is very challenging you go to your primary care physician, they might spend 15 to 20 minutes with you, they may not be able to get into the nitty gritty, and then they will refer you to a neurologist, a geriatrician, et cetera, Referrals can take a long time and people are struggling with maybe manageable symptoms at that point. or you're seeing your loved one doing things that you don't recognize or you yourself are seeing things recognizing that there's something wrong and you don't have any guidance for that.

And then ultimately, once the diagnosis is made, I find that there's very little support and very little guidance of what can happen after that. really having those discussions, and that's why we'll talk about what matters most you really have to get to know the person and what matters to them and how they want to live their life.

I feel that falls to the wayside Medically necessary conversations that physicians want to get done, so that as the person declines, they have all their boxes checked. the challenge with navigating dementia, we're still trying to figure out a lot about what it is and how it works and how we can help.

There's very little to help it. That really, creates any benefit for them. very little support for that person, for who they are and what they care about. 

[00:11:55] Mike: Now what matters most in the treatment of a family member, given a new diagnosis of dementia? 

[00:12:04] Seetha: What matters most is a part of the five M of geriatrics. Geriatricians, talk a lot about the five ms and one of them, which is the most important, is what matters most. amongst other things, mobility, meditation, medication, multimorbidity, and then what matters most. As an individual who may be diagnosed with dementia versus you as an individual who may be diagnosed with dementia, live different lives, have different values, have different ways of looking at what's important in our life, I think what matters most is that conversation about what are the things that are most important to you.

So how would you want to live your life? What are some important moments, experiences that you want to continue that we can do the best we can to continue those things? Because let's be real, this is going to be a disease that is going to cause decline one way or another. And if I can know you to the best of my ability from what makes you tick, I will try to make changes aligned with that. Some people are like, I really don't want to take a lot of medications. Then it becomes a conversation of, here's the risk versus benefit of all these medications, or, I don't want to take any, and I have told you the risks of what it is to not take these medications and you accept those risks.

I want to be as functional as I can for my granddaughter's graduation in six months. Then it turns to what is your functional status? What is your limitations? What do we have to look out for? There are people, like you had mentioned, quilters, for example. Crocheters, professionalists, who find that those things are not actually as they're not as able to do that.

So we try to find ways to modify. There are different types of contraptions that exist to continue that What matters most is living, I can have life, but I want someone to be able to live as well. So I think in general it's very important, but when people are diagnosed with dementia, that loss, it's really important to know that person while they're still able to communicate it, and so that everyone is aligned.

[00:14:10] Mike: Can you tell our listeners about how Remo Health puts some of these concepts into practice for their patients. 

[00:14:21] Seetha: First I'll just say what Remo Health actually is. Remo Health is a virtual platform created for the love of one human being's, love for his father, and for his grandfather, both of which who had different types of cognitive impairment, and seeing and navigating that created a desire to support, these individuals. We are a group passionate about giving dementia care, dementia support, everything I spoke about as soon as possible, trying to help get diagnoses earlier and trying to have those conversations as quickly as possible, being there for people as often or as frequently as they need.

A lot of people with dementia will have issues with being confused especially in the evening, who am I, where am I? And feeling very concerned about that. And that can lead to hospitalizations, right? Instead of going to the hospital, you can pick up the phone and call and say, Hey, this is what's happening with my loved one.

Of course, if it is a safety issue, we have to do what's best for their safety. But there are strategies. Pharmacological or otherwise that you can do to calm somebody down, put them in the right space of mind so you can avoid that kind of hospitalization which, comes with its own, challenges, especially with people who have memory issues, 

[00:15:41] Mike: If someone wanted to contact Remo Health, what states do you operate in?

[00:15:48] Seetha: We are currently in Ohio. 

.

[00:15:50] Mike: Is Florida on the list? 

[00:15:52] Seetha: Florida's on the list. 

[00:15:54] Mike: Because we have a lot of people from Florida listen to the podcast.

I lived in Cincinnati 

[00:15:58] Seetha: yeah. 

[00:15:59] Mike: Before I came here, 

[00:16:00] Seetha: yeah. 

[00:16:01] Mike: Now you brought up an interesting question about medications. in your telemedicine visits, are you able to prescribe medications that you think the patient needs?

[00:16:12] Seetha: I can prescribe, I tend to not do anything without collaborating with the primary care physician.

[00:16:18] Mike: And what kind of medicines are 

[00:16:20] Seetha: There's quite a few that are going around.

It's a great question. Me for medications is a geriatrician 'cause I'm more of the holistic. Looking at the whole human mainly has to do with what medications are you on what problems can they cause and do they actually serve a purpose in how to manage what it's trying to manage. 

[00:16:39] Mike: If you had the power to change one thing about the United States Healthcare System, to get better support for people with dementia their caregivers, what would that be? And why? 

[00:16:51] Seetha: I think that when it comes to the care of dementia, I would want. The whole healthcare system to recognize and treat dementia patients as who they are on the inside. It has to do with each individual in the system and how they are taking care of the individual.

One of the challenges of having dementia, is people seeing you differently, treating you differently, not looking at you as the person who still knows who you are. And there's many examples of The person is right in front of you, but you're talking to the family member or the spouse and not looking directly at them.

I want everybody to recognize that the person you are on the inside and the person they are on the inside are more similar, than you think.

 and you're speaking to a story of people who know, what is best for them in the moment they're in. What's the safest thing for them? At times, the memory care unit serves a purpose and is absolutely there. . 

[00:17:45] Mike: How do you think a family should deal with, a family member who they think may be showing early signs of dementia? 

[00:17:53] Seetha: I think it's very important to express these things. First of all, coming to terms with any sort of cognitive impairment, each individual comes to terms with it differently, You don't want to. Overstep in a situation and say, Hey, you have this, I have to tell your doctor.

Because that person still has capacity to a certain extent. it's really, expressing your concerns with that individual, having a seat with them and saying, sometimes not speaking from the perspective of, I know your memories not doing well, it's more, Hey, we seem to be having trouble.

Or, you seem to be having trouble with putting your clothes on in the morning and you've been needing a little more help with that. Or it seems like you've been asking me the same question multiple times. Having that conversation candidly with them and saying, what's up?

What do you think is going on? even from a physician standpoint, we may not get buy-in that someone has dementia a lot of people may not see it in themselves and they may find, Hey, who are you to tell me that? So we work from the perspective of.

What is hard for you in the day and how can I help you with that? broaching the subject of, I really want you to be able to maintain your independence and your autonomy for what you do, and these things are becoming challenging. How do you feel about maybe trying to, talk to your doctor about this or maybe trying to find a way to mitigate these things rather than, throwing words around I think you have dementia. Now that being said, lots of people will be okay with that, the interaction with your loved one better than I do, I know if I said that to my dad, he might throw something at me.

My mother on the other hand would be more interested in having that conversation with me. 

[00:19:30] Mike: Okay. 

[00:19:31] Seetha: Each individual is different.

[00:19:39] Mike: We will return to the interview in a moment.

This is Mike Roth and Dr. Greg Curtis. We're talking about Alzheimer's disease. What is the diagnostic process to split the difference between someone who has Alzheimer's and someone who has a different form of dementia? 

[00:19:57] Dr. Craig Curtis: That's a great question, Mike. So Alzheimer's disease in the past was a clinical diagnosis.

And we would talk to the patient and the family and they would tell us about this progressive memory loss and maybe other symptoms that have been occurring over the past three to five years and we would simply test their memory and maybe wait another nowadays. It's completely different. As a matter of fact, now our diagnostic process involves actually looking for amyloid in the brain, which we now know causes Alzheimer's disease. How do you see amyloid in the brain? We can see amyloid in the brain using PET scans. Which is the most common way.

And now we're working on using blood tests, which are going to be coming out in the next few years. In fact, there's already one blood test that is FDA cleared to detect amyloid in the blood, which is reflecting amyloid in the brain. 

[00:20:52] Mike: And that would be the differential between another type of dementia and.

Alzheimer's. Yes, 

[00:20:58]  Warren: sir. With over 20 years of experience studying brain health, Dr. Curtis's goal is to educate the village's community on how to live a longer, healthier life. To learn more, visit his website, craig curtis md.com, or call 3 5 2 5 0 0 5 2 5 2 to attend a free seminar.

[00:21:18] Mike: Sheha, I want to thank you for being on the show with us today. Is there anything else that you'd like to add our listeners or way.

for them to contact Remo to find out if they can be helped by the services that you folks provide? 

[00:21:32] Seetha: Thank you. I had a lot of fun being here. The best way to get a Remo is to go to the website. There's a community that can answer questions if anybody has any concerns. And there's a lot of articles that are written and peer reviewed to give data and support for people who have questions.

There is a button you can click if you want to get more help and chat together.

[00:21:52] Mike: The website is remo.health.

Thanks for being with us today. 

[00:21:59] Seetha: Thank you.

[00:22:00] Mike: This is Mike Roth. Listeners, I'm thrilled to share with you this podcast, which is my passion project, to bring knowledge, inspiration, and things you need to know about the villages and the people living here. Be sure to hit the follow button to get the newest episode each week, or you can hit the purple supporter box.

Even a small donation of three to $10 a month makes a big difference. And you can cancel your subscription at any time. Your support means the world to us. Stay curious, stay inspired, and keep those headphones on.

[00:22:39] Nancy: Remember, our next episode will be released next Friday at 9:00 AM Should you wanna become a major supporter of the show or have questions, please contact us at mike@rothvoice.com. This is a shout out for supporters, Tweet Coleman, Ed Williams, Duane Roemmich, and Dr. Craig Curtis at K 2 in The Villages. We will be hearing more from Dr. Curtis with short Alzheimer's tips each week. If you know someone who should be on the show, contact us at mike@rothvoice.com. The way our show grows is with your help. Text your friends about this show if you enjoyed listening or just tell your friends about the show. We thank everyone for listening.

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