Episode 47: Navigating the Later Years with Dr. Iqbal Ahmed

Dr. Iqbal “Ike” Ahmed joins the Mind Dive podcast this week to explore the profound complexities of mental health as people age. The journey begins with Dr. Ahmed's early life in India and his extended family who served as the bedrock for his lifelong dedication to understanding and aiding the elderly mind.  

In this Mind Dive edition, Dr. Ahmed navigates the ever-shifting definition of the word 'geriatric,' as well as demonstrating how the perception of aging adapts with the passing of time and how life expectancy molds society’s categorization of the elderly. Dr. Ahmed brings a wealth of knowledge, peeling back layers of cultural variation in elder care, and engaging in a conversation that can help broaden appreciation for the depth and diversity of geriatric psychiatry. 

Embracing cultural diversity, the discussion explores how different societies and traditions imprint upon the process of growing older, and the role these variations play in the mental health of seniors. Dr. Ahmed provides insights from his upcoming book, promising to paint a vivid picture of aging minds across cultural divides. Dr. Ahmed’s invaluable insights into the curative powers of interpersonal relationships and social networks can help fortify aging seniors against the effects of mental and physical decline. Tune in for an enlightening discussion that not only informs but also inspires respect and empathy for the journey of elder generations. 

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Transcript

Dr. Bob Boland: 0:02

Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, Dr Bob Boland and Dr Kerry Hurrell Twice monthly.

Dr. Kerry Horrell: 0:14

We dive into mental health topics that fascinate us as clinical professionals and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in.

Dr. Bob Boland: 0:44

Another exciting day today. I'm so happy we have Dr Iqbal " Ahmed. We're going to call you Aik today, is that okay, dr?

Dr. Iqbal "Ike" Ahmed: 0:51

Ahmed, that's going to be perfect. You're fine.

Dr. Bob Boland: 0:53

Dr Ahmed is a clinical professor of psychiatry and geometric medicine University of Hawaii. He's also a clinical professor of psychiatry uniform services university and adjunct faculty at Trippler Army Medical Center, also in Hawaii. He's a past president of the American Association for Georetic Psychiatry. Received the APA Weinberg Award for contributions to geriatric psychiatry yeah, that's a big word. He has published in the areas of geriatric psychiatry and CL psychiatry, with a particular focus on cultural issues. Hopefully we can get a bit into that too. He's been recognized nationally for work on enhancing DEI within psychiatry and is a graduate of St John's Medical College in India. Welcome, it's so glad to finally get you on, dr Ahmed.

Dr. Iqbal "Ike" Ahmed: 1:38

Well, thank you. Thanks for inviting me, and it's a pleasure to be here.

Dr. Kerry Horrell: 1:43

We were just saying before, you two know each other through your geriatric geriatric and CL psychiatry overlapping.

Dr. Bob Boland: 1:53

Yeah, absolutely. We're going to focus on the geriatric part today, though maybe we can get a little feel from that. But let's just start with you. Tell us about your career, how you became interested in geriatric psychiatry.

Dr. Iqbal "Ike" Ahmed: 2:05

Well, it's interesting to think of my interest in geriatric psychiatry. To go back to my personal life, that's because I spent a lot of my formative years, all my endless years, with my grandparents, maternal grandparents, and we're doing extended family of about 20 of us, so we're talking about 20 of us. Yeah, so it was my grandparents, my uncle and aunt, my cousins, and all of that in India. So it's a lot of families and I was exposed to both my grandparents there and on the both sides of the family my maternal, my maternal grandparents and my maternal grandfather has been, I would say, my role model in my life. So it was a delightful experience. I spent my formative years there because my grandparents were traveling and work, so that's why I lived there, and so I think that really brought in great interest in being around older people, spending time with them, listening to their stories.

Dr. Iqbal "Ike" Ahmed: 3:10

And as I became interested in psychiatry, my coincidence actually appeared in geriatric psychiatry. I was a CL psychiatrist. I done a CL fellowship in Boston and they were just starting a new small unit for older patients and they didn't have anybody to help us for psychiatric care, so I was asked to help out. So then that was how my career started in early 1980s in geriatric psychiatry, and so my career has been in both console areas on the geriatric psychiatry. So basically we're roughly half time in each of these older years, and so it's been a terrific experience being a geriatric psychiatry and I think I brought back all that I learned from my own grandparents in my life.

Dr. Kerry Horrell: 3:58

One thing on my mind. Surely most people know what the word geriatric means. It means folks who are older, but are there cutoffs for this?

Dr. Bob Boland: 4:08

Like a huge geriatric, I keep pushing back the dates. If you'd asked me 20 years ago, I'd probably say yes.

Dr. Kerry Horrell: 4:15

Why are you thinking about this? For two reasons. One, and I'm sure there's another podcast, but I'm in my 30s and I would like to have a child at some point if possible, and I'm pretty sure I'll be a geriatric mother if I get pregnant past 35. But then I was thinking about this with my own mom. I was like my mom and my dad are both around 70. And I was like they're legit geriatric now, right. Well, that didn't feel right. You're listening, mom and dad. I don't feel this. So where's the cutoff? What becomes geriatric?

Dr. Bob Boland: 4:49

Can you fill us in?

Dr. Kerry Horrell: 4:49

What does that word mean?

Dr. Iqbal "Ike" Ahmed: 4:51

It's interesting, geriatric psychiatry traditionally, at least in the US, was defined both by Medicare and retirement age, so around 65 is what we used to say. But we realized that there's no uniformity in aging and there are many aspects to aging, and geriatric psychiatry is a term used in the US. For example, I did part of my training in England and then they don't call it geriatric psychiatry, they call it old age psychiatry, and so the terminology is there's a straight to it.

Dr. Bob Boland: 5:22

Yeah, no, no, no euphemism or nothing.

Dr. Iqbal "Ike" Ahmed: 5:25

So typically the talk was 65 was the cutoff, but we know that there's a lot of variability and even terms within old age. We talk about young old, middle old and old old. So like 65 to 70, old, be like young old, 74, 75 to 84, middle old and 85 plus would be in the old old. And this has to do with because really a lot of the changes of old age are really experienced much to a greater extent after it's 75. So a lot of people now between 64 and 75, are like people who were maybe about 30, 40 years ago in the 50s. So aging is of course, an evolving process. So it's no good gel cutoff and people are some places in developing cutoff, that is, 60, where the lifespan is shorter. So again, so it depends on where you are and how you look at it.

Dr. Bob Boland: 6:24

Makes sense. I mean, we had the Houston marathon just last week and I knew a few more than a few people my age group who did pretty well with it.

Dr. Iqbal "Ike" Ahmed: 6:33

So it's just I myself, 72 years old, so when I start to patients, I still suffer. I'm a geriatric, geriatric, psychiatrist.

Dr. Kerry Horrell: 6:44

The best kind, they would say yes exactly.

Dr. Iqbal "Ike" Ahmed: 6:48

At least my patients don't tell me you're just a young guy, what do you know about us older people? So at least I don't have to deal with that anymore.

Dr. Kerry Horrell: 6:55

But there is okay. So geriatric psychiatry could it be broadly defined as the study of aging and in particular in regard to psychiatry?

Dr. Iqbal "Ike" Ahmed: 7:08

Yeah, I would say definitely. I would agree with that. I think that's basically psychiatric care of older adults. By the way, we have moved away from the term elderly within the past few years.

Dr. Bob Boland: 7:18

Right.

Dr. Iqbal "Ike" Ahmed: 7:19

And we no longer use the term elderly in a talk on older adults. So, and so you can see it's got a more fluid or aging adults, but older adults, accepted term now in the literature and sort of that kind of elder.

Dr. Kerry Horrell: 7:32

So that makes sense to me. I feel like I don't love, I don't feel comfortable saying elderly.

Dr. Bob Boland: 7:37

My spell checker fixes that for me. It doesn't like to work.

Dr. Kerry Horrell: 7:41

It's a very elderly thing.

Dr. Bob Boland: 7:45

It's spell checkers. Okay, we're going to move on from that and. But really we're talking here about psychiatry and like in basically some of the challenges of getting older and you know, because there's some, I mean it must. It's such a large subject and we have sort of touched on it a bit before. Like Dr Chon talked something, some about Alzheimer's dementia, some of the problems like that but Dr Jassi talked about sort of like about growing well, about kind of like wisdom is and things.

Dr. Bob Boland: 8:13

So we've touched on this a bit, but I mean, so we're kind of leaving you with like a large subject to talk about. But do you see any general problems that you think are particularly important that people encounter as they get older that they may not have had to worry about when they were younger?

Dr. Iqbal "Ike" Ahmed: 8:27

So I think as people age, you know, I mean again they're going to have to bring in some terminology in here, you know and that how we age to logics and depends, at least to do, logics in genetics. But that's not the entire story, you know. So we talk about the concept of primary age, which is based on for genetic vulnerabilities and different people based on the genes and the family background and, you know, might age differently. But there's a time called secondary age, which is what, how we add to our genetic aging profile. So all that you do in a lifestyle how we live, as far, how we eat, we drink, exercise, you know, smoke and all kinds of stuff is shortens the lifespan based on the lifestyle. So the secondary ageing, as part of aging, one of the some of the common things we see is obviously increased medical morbidity. So people as you get older are more likely to have medical problem and for some of the most common ones, like osteoarthritis and hypertension. So as far as medical issues and cardiac issues, heart disease right.

Dr. Iqbal "Ike" Ahmed: 9:37

Yeah, and so along with that is integers of medications and things like that. So one thing we know with those people ages, psychiatrically, older adults is that we have to do things when medical comorbidity is one of the big factors in care of mental health disorders and older adults. So we have to factor it that the other one is in, obviously, because neurological changes that the brain might issue become much more important as far as when, if you have a first onset of a psychiatric disorder and then older adults, you have to make sure that the underlying factor may not be a medical or medication related or neurological related. So I think that's one of the key distinctions as far as in geriatric psychiatry is a greater awareness of focus on the medical issues and medications and in neurological issues. So people more vulnerable, much more vulnerable because of what is biological issues.

Dr. Iqbal "Ike" Ahmed: 10:35

Other thing, of course, is things would go with aging. Sometimes is that the stigma was aging to some extent, especially, we should say, in Western societies, but now we notice that it's also in the Eastern societies too that we do see increasing stigma, and so other things would come with age are obviously changing. Roles within the families of people may not be working anymore, the role of parents, of changes. So you go from, if you are fortunate enough, go from being a parent or a grandparent, but people might be retiring. So you deal with what? Biological and psychosocial issues? So sociological factor there's a concept called social sociological agent, so that biological, aging and sociological, so sociological, has to do with how society is, older people and the roles with the society, and so I think that's another factor which has to be taken into account.

Dr. Kerry Horrell: 11:33

Can I ask something that to the both of you probably will sound kind of silly?

Dr. Bob Boland: 11:37

I just can't wait.

Dr. Kerry Horrell: 11:38

Well, it's because I'm not an MD, I'm not a psychiatrist, but I think the more that I'm in this field, the more I'm recognizing. Again, this might sound silly but I feel like psychiatric medications, they interact so much with like the heart and with like blood pressure at times and with, you know, some of these other things that I could imagine are also changing as people get older. Like again, I feel like I hear a lot of names and medications and the work that I do and I have a good sense of some of them, but, like a lot of them have an impact, especially for anxiety, for example, would impact like blood pressure, like that, something that might be changing as people get older. Right, like so is it more challenging to kind?

Dr. Bob Boland: 12:18

of navigate. That doesn't seem like a silly question, right, but you spend a lot of time thinking about that. Yeah, is it harder?

Dr. Kerry Horrell: 12:24

to navigate, like psychiatric medications as people get older or even things like and this is probably too big of a question but aren't some psychiatric medications for older people put them at more risk of like dementia and memory problems, and so I imagine it's a lot more to navigate.

Dr. Iqbal "Ike" Ahmed: 12:39

But definitely it is a psychophonical because more complex, or rather you're perfectly quite right on that. The one is because of the medical vulnerabilities. So not just medical vulnerabilities but just the biological changes in the body, right, how the kidneys function, how the heart functions, how the liver functions. So just from that standpoint and talk with that, if you have medical disorders with the heart or kidneys and all of that, so that makes a person more vulnerable to medication side effects. All psychotropic drugs I think you know psychotrics have some sort of medical effects and normally it may not be a big challenge in younger adults but as people become older it gets more challenging. Well, one is because it changes in metabolism but also the vulnerability of side effects in different organ systems in the body. So that's definitely a problem.

Dr. Iqbal "Ike" Ahmed: 13:32

Another thing is, of course, that older adults are much, many more medications.

Dr. Iqbal "Ike" Ahmed: 13:36

We say an average and older person who is an outpatient and an outpatient clinic has done four different medications and inpatient was about 10 different medications. So there are a lot of drug-drug interactions you have to worry about. So from that standpoint, prescribing medications psychiatric medications and older adults is much more complex and just from the physiological standpoint we have a mantra. We call it, I call it the mantra and it's like a pharmacology with older adults. So just start low, go slow, stay the course. So a person older person over age 65, as an average we would say it should be about half in what is in older person or age 85, I'd say maybe a third to a quarter of the dose in my tears and older. So I think this is a common mistake. That often happens is that that's not factored in and a lot of the studies where medications for that one didn't have older populations in the clinical trials, so the data was not very good as far as we don't know much about what the drugs do anyway.

Dr. Iqbal "Ike" Ahmed: 14:39

Yeah, right, absolutely yeah.

Dr. Bob Boland: 14:42

I mean, what typical problems do you encounter, like what sort of mental health problems do you typically see in older people?

Dr. Iqbal "Ike" Ahmed: 14:49

So as far as older, I don't think we have problems. I think you already mentioned the issue of dementia, right? So dementia is just what now they call an major neurocognitive disorder, that's what one called a neurological element. But definitely a lot of them are psychiatric symptomatology and often they might present to psychiatrists. So I would say that's probably one of the more common ones, you see. But the other one is depression and they usually want to depression anxiety. But you tend to see that.

Dr. Iqbal "Ike" Ahmed: 15:22

So I think the big ones, of course, I think the dementia, the depression, maybe increased suicide risk, maybe some anxiety disorders and what they call secondary psychiatric disorder. Secondary numerical problems is another thing. Other thing I would say is just some issues related to grieving, because as people get older they're more likely to have people in their life who die, right yeah. So I think it's a lot of people start with parents and their peers and siblings, friends, all of that. So lots of that is part and parcel of life. Other thing is lots of, from a standpoint of medical problems and functional impairments you may not be able to do all the things you did before, just as over what you did, so coming to terms with that. So I think Ericsson had something valuable when he said, as far as an aging and developmental standpoint, ego integration was a despair, and some people do a great job in coming to terms with the losses Do you want to say a little bit more about what that means.

Dr. Bob Boland: 16:28

Ego integration versus despair.

Dr. Iqbal "Ike" Ahmed: 16:30

Yeah, so definitely. So it has to do with coming to terms with your life. So as we all age right, we're in this very at your age too, right, and you think about what you think your life is going to be like, right, and and the relationship. But when you come closer to you know in the 60s, 70s, 80s, you're looking back more than looking forward to looking back at your life and including your relationship to regrets and your ideals and goals you thought you'd achieve in life. And then some sense, you have to come to terms with that.

Dr. Iqbal "Ike" Ahmed: 17:07

And if you come to terms and make peace with your life, you know, I mean it can be very satisfying. You've gained a lot of wisdom within care and that's adjusted out to that. But on the other hand, if you struggle with that and you don't make peace in your relationship to what has happened in your life, you can end up feeling despair and so experience depression. So in part of working with older adults with depression and therapy is helping them look at that, right. So there is a therapy called interpersonal psychotherapy, right, and it has to do with looking at relationship, changing relationship with your own children, for example, in a relationship with a role reversal, things like that. So yeah, so the other thing to talk about more about is talking about the final stage, and some people argue that it's not the final stage, but is looking back at their life and coming to terms with it.

Dr. Bob Boland: 18:02

I was just going to say. There is that sense of like. I mean, when you think of youth, you think of that sense of endless possibility and it slowly closes you get older, like when I first got married we bought the entire edition of the Harvard classics.

Dr. Bob Boland: 18:17

We're going to read all these great works of, like you know, western civilization. Well, we haven't read many of them. I look at those, I still look them in the bookcase and like, well, I'm never going to read these. Even if I started today, I probably would not be able to finish them.

Dr. Kerry Horrell: 18:30

This is where my mind is going, so Terry is totally uninterested in that point. It's going to relate even to what you're saying.

Dr. Bob Boland: 18:37

Okay.

Dr. Kerry Horrell: 18:38

So I thought, though I give that I. You know I work mostly with young adults and adolescents. That's the primary population I work with. But even in this population, the young adult population, I talk about grief all the time and I think, like one of if any of my patients are listening, they're probably rolling their eyes because they're like good Lord, there she goes again on grief All this woman likes to talk about. But I do, because I think grief is so a part of life. I think grief is so a part of psychotherapy quite frankly, very active doing psychotherapy. Anyways, the point I'm trying to make is that something I often say is like you got to make room for grief at the table of your life, like that's part of life and I could imagine, especially as you get older, like part of part of the being able to integrate and move through these things, would be able to grieve like ah, I probably won't read the whole- article yeah, grieving putar Right yeah.

Dr. Kerry Horrell: 19:26

Collection, no-transcript, as you come to terms with like there's there's limited time and, yeah, like there's things I maybe would have wanted to have. Plus, like you're saying, like there's losses that I'm having to face and tolerate, and I think my sense is because one question I think we want to talk about too is how do we think about aging? Well, even I think starting young in life, like my sense is one part, would be getting comfortable with grief, getting you know, making room for it at the table of your life. So this is going to be a part of life, can you?

Dr. Iqbal "Ike" Ahmed: 19:57

yeah, absolutely is. I think separation and loss is part of life and you know, and relationships are such an important part of life, an important part of lives of older and students. You know that relationships have both positive and negative impact on our life is in a social support, for example, is an important part of helping older and with loneliness, especially as you have to run through the pandemic, and loneliness is not at epidemic proportions and an older lives that became more of an issue during the pandemic. So we know that protective effects of social support and social relationships and so many different ways, not just in mental health but also physical health, including things such as the rates of dementia service factor, for example, and so we can contribute to depression and dementia.

Dr. Iqbal "Ike" Ahmed: 20:49

And the positive side of relationships can be very protective in many different ways. Relationship appears, but within the family, including a relationship within other generations, what they call the intergenerational relationships, like the children and the grandchildren, all of them. So, but, yeah, as part of life, as I said, especially as the age, you know the losses are different kinds, so the losses among you know you have to work with, which might be different than in losses in an older level, for example, nobody like people are talking about love, relationship between, like, having a boyfriend, girlfriend, whatever it is, and then, and their own sense of identity and what you think it's going to be in.

Dr. Bob Boland: 21:34

So yeah, but the losses, as you said, the part of life, they just vary in different stages of life given that you know all these different things loss, you know, you know, loss of other people, loss of your health and stuff I mean, a lot of people assume that mental disorders are much more common in the elderly. Obviously, dementia is more common because it doesn't really occur in younger people. But what about other things? Are they really? Um, are mental disorders more common in elderly people? I'm sorry, I can't say elderly, older, older people than others?

Dr. Iqbal "Ike" Ahmed: 22:06

yeah, I would say that the big thing is the dementia. It's just enough. When you look at depression, if you look at at least the gsm5 kind of criteria for depression, they're lower in older adults. Okay, it's lower.

Dr. Iqbal "Ike" Ahmed: 22:19

Yeah, I think surprises a lot of people yeah, surprises, and now there's a debate about what that really means and whether is it the criteria or it's kind of different.

Dr. Iqbal "Ike" Ahmed: 22:28

So you may not see major depression but you might see greater amount of depressive symptoms and they may not meet criteria for major and they may present a little bit differently. For example, depression in older adults might present more with physical complaints, might present with pain, might come of, they're present with even cognitive complaints like memory loss and all of that. So it might not be as air cut, as straightforward and obviously the causes of depression are as medical causes can be there and just dealing with these losses. So it might be a somewhat lower but it might also might be different symptomatology as far as depression and older so and I think anxiety disorders might be lower. I think personality disorders may not present in the same way. So and you don't see that at the older adults. So I think that's definitely there's greater to your life satisfaction, studies of life satisfaction in older adults, so that the greater life satisfaction as a whole than younger adults.

Dr. Kerry Horrell: 23:32

And I think Dr. Deshita talks a lot about positive aging and wisdom and all that is what we was protected fact that the nice segue into also how different cultures or people of different ethnic groups might also have differences in aging, and that does seem to be one of your areas of expertise. I wonder if you could say a little bit more about that, about, like, how to be culturally aware and sensitive around culture, ethnicity in this population, which is a huge question.

Dr. Iqbal "Ike" Ahmed: 24:00

I think that's a huge concern that has to do with the I wanted to call it a sociological part of the issue. I think one of the things. When I talked about my trainees, residents of the years, about geriatric psychiatry, they said geriatric psychiatry is sort of depressing, you know they don't people all, all people, all their life and they all die and all get dementia and all of that.

Dr. Bob Boland: 24:20

I said no, I hope you didn't pass that person. I think it's getting old.

Dr. Iqbal "Ike" Ahmed: 24:25

I always buy you know part of life and I remind people that even in this hour we spent together, we are one hour older than we were. So aging is a continuous process, right, and when people children are born, genetically the children all over the world are very similar, but older adults across the world are very different. Why? Because our life experiences are different depending on where you're born and you grow up and every older. That's what made me geriatric psychiatry interesting is that people life trajectories are so different depending on what has happened in their life and older adults, each one is very different than other ones. Yes, in some ways, biologic and all that they might be similar, but if you talk about life experiences and how people think could be quite different. And I think an older person in India who is over 65 is very different than the one in the US. I would even mention to say that the older person is a 65, houston is very different than in Hawaii, because life is very different here than you know what, just in a physical environment, also social environment.

Dr. Iqbal "Ike" Ahmed: 25:33

We grew up right and for culture. So one of the big factors of this is culture right and as far as culture goes, this attitude was aging. So, whether how positive it is or not, but certain ethnic groups, depending on where you live, are greater vulnerability due to both biological and social factors. If you are a minority person or person who might be discriminated against, for example, you know older people are more vulnerable to the effects of that than even a younger person. So the ability to access healthcare, for example, it might be a challenging for an older person who comes from a disadvantaged background. You know it might be. It is social.

Dr. Iqbal "Ike" Ahmed: 26:17

We talk about the concept of social determinants, of health right when they access to healthcare environments where they've been growing. What we're exposed to. We know that in the US, the minority groups, for example blacks, have a shorter lifespan than whites and Asians have a longer lifespan. It has to do with lifestyle factors, which is also has to do with things such as socioeconomic factors, effects of discrimination, access to healthcare, biases in healthcare, you know, as far as how early things get diagnosed or not, and attitude to mental health care, trust issues between certain minority groups and, you know, provide healthcare providers. So all those have an impact. So, from a cultural and ethnic group which we belong to, how you age, both physically but also psychologically, and so including things that's a race or dimension.

Dr. Kerry Horrell: 27:13

One place my mind goes to as well is how much the role of societal value of older adults plays a role. But I think one of the things that I feel aware of and feel somewhat frustrated by is that it does seem like in a lot of the states, for example, there's like a there's there's a lack of valuing in older adults. My sense is that feels different in other places in the world or that there's again more of a value on intergenerational connection.

Dr. Bob Boland: 27:44

On respect for elder ways.

Dr. Kerry Horrell: 27:46

Yeah and I could imagine that could turn into the SSI or the determinants of health.

Dr. Bob Boland: 27:54

Social determinants of health, social and economic.

Dr. Iqbal "Ike" Ahmed: 27:58

So you know it's a particular interest in this and as part of this, I have to say, we actually work in a book on the mental health of older adults across cultures, so looking at it in different parts of the world, when might the book be coming out?

Dr. Iqbal "Ike" Ahmed: 28:12

Well, we're hoping maybe later this year or in the early part of next year. So we always do the tail end of it. So we have authors from different parts of the world writing about aging in those areas. So not only culturally, but social structures, health care systems, all of those and lived environments are different in different parts of the world. You mentioned about the role of attitudes of older adults. There's a term which is often used, at least in the East. It's called filial piety, Respect to elders.

Dr. Bob Boland: 28:42

You say that term again. I'm sorry.

Dr. Iqbal "Ike" Ahmed: 28:47

Filial piety. Yeah. So respect to the elders so there are, you know so, as an attitude of obligation to older adults in the family, respect towards them, and you know all of the intergenerational compact equality. Whatever the younger generation, also the older adults are taking care of them, all of them. But you know the world is changing and of course it's. People move across continents all the time. Societies are becoming more and more similar in many ways and the example would be and I was, I did the chance to work with on a panel with psychiatrists from China and Japan, and you know there for a good example, japan has changed so much.

Dr. Iqbal "Ike" Ahmed: 29:29

There were high rate of older adults, but older adults and the relationship between them and the children has changed and people have moved more to cities and this is the biggest issue in China. Apparently People are moving more from the small towns and villages into cities for jobs and other things. Big structures are coming to play a slot Also of older adults and cities have been destroyed and building up new structures. A lot of older adults live in villages but there are very few young people. That people have moved on. So even attitudes of older adults are changing in traditional societies, with respect. So maybe the United States might have been the same thing many years ago, but some of the eastern countries are just having a little bit later. So it's definitely, as I said, social factors impact where you live and what culture you belong to. But you know, it's very fluid, it's not as clear-cut as the boundaries are not as clear-cut as ones we thought they were.

Dr. Bob Boland: 30:33

Wow, wow, that's too bad. It's just moving to a modern society, sounds like has a downside for older adults. Yeah, last thoughts, I mean any advice for aging? Well, yeah, I think a great question.

Dr. Iqbal "Ike" Ahmed: 30:47

I think this is one of the more common. Sometimes I go to talk to groups of older adults in the community, including nursing homes. It's one of the most common questions comes to me like hey, what advice do you have about how do we age well?

Dr. Bob Boland: 31:01

I don't think it's a compliment. You seem to have done it pretty well so far.

Dr. Iqbal "Ike" Ahmed: 31:05

Yeah, but I think what I would say, not just from a personal experience, but what we know about this subject, is that I think one is, of course we can change the genes, the abundance for the rehab, but we can do certain things. I talk about secondary age, right, that's where we solve the problem and how we live our life. So, as far as both from a physical and but I was also saying from a mental standpoint and a degree of dementia, what people can do is how we, for example, eat right and nutritional factors about and people talk a lot now about Mediterranean diet, but basically it is about avoiding diet which can cause metabolic syndrome, and so eating maybe more vegetables, fruit, you know, and grains, and maybe less red meat and maybe small seafood, olive oil and so on. To some extent, maybe even drinking something like wine might make a difference, but again, it depends on how much you try.

Dr. Bob Boland: 32:10

I'm hoping for that one. Yeah, I know the research mixed. I imagine this being the US. It's not what we eat is important, but also how much we eat Right, absolutely so.

Dr. Iqbal "Ike" Ahmed: 32:22

it is anything about how much you eat is in moderation so, but also how much we exercise right and how active they are, physically active, always a balance, but it's a matter of being physically healthy as possible. So taking care of what helps and if you have a healthy issue like blood pressure, then taking care of early intervention. And this is again how to do with minority issues. We know that African Americans and Latinos have a high risk of cardiovascular morbidity, mortality and so an often not diagnosed early enough interventions that not have good access to good nutrition. So those factors make, and so diet, nutrition.

Dr. Iqbal "Ike" Ahmed: 33:05

But psychological well-being is important. Positive mood is helpful. Depression can be a risk factor for increased morbidity and mortality in great sedimentary. Good amount of sleep as another factor. So an avoidance of trauma and things that, just as far as dementia goes, taking care of it. But the bottom line, if I were to tell people if I can use one sentence to remember from what I tell I said what's good for your heart is good for your brain. So if the people take care of all the cardiovascular is factors such as the talk about nutrition, exercise, kid eating, cancer, blood pressure, it also protects your brain. So what's?

Dr. Bob Boland: 33:45

good for your heart is good for your brain. I like that.

Dr. Kerry Horrell: 33:48

And I think, if we take it even to a figurative level, what's good for your heart. I think we should more early intervention on grief, for example. I'll tell you I love, like one of the most pillar books that I've read in my experience as a psychologist is Tuesdays with Maury, and I love Tuesdays with Maury for a number of reasons, but I think the part, the experience of meaning making in the face of suffering, vulnerability, dealing with and coping with our need for other people and dependence, anyways, I think it's just an incredible book and I recommended a lot to my young adults and again, I'm like, I think like getting inoculated to grief and suffering and loss and change earlier on what's good for the heart.

Dr. Bob Boland: 34:33

I like that. Yeah, good for the brain.

Dr. Iqbal "Ike" Ahmed: 34:35

Well, certainly social connections and stuff in that sense too, yeah, and I think, of course we have to remember, I think activity carry absolutely. I think grief, for example, has biological effects on the heart as well, right, the depression and all of that it's not just a matter of so as far as grieving and all of that from a psychological standpoint, but even from a biological standpoint on the heart and brain. That has an impact, right, that's why we talk about depression and so, but yeah, so the importance of addressing grief early and prevention of depression is a very critical factor and the management is trust. Again, trauma is a big factor, right, and we know it was. Childhood events have a long-term effect on including an older adults. So issue of a trauma, in addition to the issues of grief and loss in our factors. So earlier we started on life and how we start aging. So, and I tell my student, I said you are an age where you can take care of the aging now.

Dr. Kerry Horrell: 35:38

Yeah.

Dr. Iqbal "Ike" Ahmed: 35:39

But what you do now makes a difference At my age and I should continue to do things that should, whatever I can. But you guys can take care of yourself now, but you have a much better health to age in, so it has to start early.

Dr. Bob Boland: 35:51

I think he's talking to you, carrie Nice, too away from me.

Dr. Kerry Horrell: 35:55

No, I remember when I took my neuropsychology courses. I don't love cardio, if I'm being honest. I really don't like a lot of exercise, if I'm being honest, but I remember hearing about just the relationship between cardio and the brain and I was like, look, that sucks, because that's really compelling to me. I care a lot about my brain and that was like dang, I really I got it.

Dr. Bob Boland: 36:16

My guess is there are things you do that are physical, mostly like my brain.

Dr. Kerry Horrell: 36:20

Yeah, I traveled there because at some point I was saying something about trauma and pain and you went. Great, there's a lot of wisdom in what you're sharing, dr Ahmed. Thank you for sharing with us.

Dr. Bob Boland: 36:35

Thanks so much for meeting with us today.

Dr. Iqbal "Ike" Ahmed: 36:37

It's been a pleasure. So thanks for all your wonderful questions that made my job easier to share.

Dr. Bob Boland: 36:43

whatever Sure, we've been trying so hard to get them out here. So I'm glad we it was worth the wait. I'm so glad you got, I'm so glad we were able to get you. So once again, we've been listening to Dr Ike Ahmed, who's been telling us about geriatric psychiatry.

Dr. Kerry Horrell: 36:57

And living and aging healthly.

Dr. Bob Boland: 36:59

Yeah, and I'm your host. I'm Dr. Bob Boland

Dr. Kerry Horrell: 37:02

I'm Dr Kerry Horrell.

Dr. Bob Boland: 37:03

And thanks for that.

Dr. Kerry Horrell: 37:06

The Mind Dive podcast is presented by the Menager Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.

Dr. Bob Boland: 37:15

For more episodes like this, visit wwwmenagerclinicorg.

Dr. Kerry Horrell: 37:20

To submit a topic for discussion, send us an email at podcastatmenageredu.