Hello, listeners! I hope you’re taking care of yourselves and finding moments of joy. In today’s episode, we deep dive into a comprehensive question from one of our loyal listeners.

This listener shares their journey, from discovering our podcast through a Men’s Health article on mental health to now being engrossed in Dr. Becca Levy’s book “Breaking the Aging Code.” The core of their question revolves around the challenges the aging population faces, particularly concerning mental health. They highlight the troubling fact that the majority of mental health providers do not accept older patients on Medicare and express concerns about receiving appropriate care as they age, especially without having a family advocate by their side.

Our discussion touches upon the age bias prevalent in the medical community and the importance of proactive health measures, both mentally and physically. We delve into the effects of cardiovascular health on cognitive abilities, the significance of continuous learning and social interactions, and the role of stress in aging. Furthermore, we emphasize the importance of advocating for oneself, understanding the intricacies of Medicare, and the potential benefits of seeking younger medical practitioners who may have a fresh perspective on care.

Thank you for consistently sharing your thoughtful questions. They add depth and perspective to our conversations. If you have questions or topics you’d like us to address, please reach out to duffthepsych@gmail.com. Don’t forget to check out the detailed show notes for this episode at http://duffthepsych.com/episode367.

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Question:

I started listening to your podcast a few months ago after a Men’s Health article about mental health mentioned your podcast, so I thought I would give it a try. I have been a loyal listener ever since then. I am currently reading Dr. Becca Levy’s book “Breaking the Aging Code” again based on a summary of her work in Men’s Health magazine. At the time I am typing this, I am in the middle of chapter 5, where she the author describes the historic bias against helping older people with mental health problems. On page 82 “Doctors are quick to give older patients medications, which require less effort and time to administer, and tend to be cheaper in the short term than combining them with psychotherapy, although many patients would prefer also including meeting with a therapist in their treatment.” On page 83 “64 percent of mental health providers do not accept older patients who rely on Medicare.” I find this deeply troubling and discriminatory. As a man in my late 50s, I want to make sure that I get the appropriate care that I will need in the future. I never had children so I do have a family advocate that others have. I have two questions based on this: (1) what should I consider for my own well being as I get older. I do exercise which includes running twice per week, weight lifting twice per week and yoga once per week and running anywhere from one to three obstacle course races each year. Hopefully, this helps my mental health as well as my physical health. But is there anything beyond this and a healthy diet that I should be thinking of? (2) What can be done to help the medical community improve their practices for the aging population as a whole. I do not want to be dismissed as an old person to set in his ways, they way Levy talks about in her book. Thank you for your consideration of these questions.

Response:

Firstly, thank you for being such a loyal listener and for bringing forth such pertinent questions. I’d like to contextualize for our newer listeners. By profession, I am a neuropsychologist, primarily assessing cognitive functioning, often for older adults who may be grappling with potential dementia. I see a myriad of challenges that older adults face in the healthcare system, and I resonate deeply with Dr. Levy’s observations. Age bias in medicine is a real issue. For instance, many older patients, post-stroke, are often overlooked and don’t receive adequate follow-up care. The lack of effort in the care of older adults is, quite frankly, infuriating.

Dementia, to clarify, is a cognitive impairment severe enough to disrupt daily functional abilities. While there are progressive degenerative conditions like Alzheimer’s, sudden onset symptoms, as described in one of my cases, often indicate an underlying condition and shouldn’t be brushed off. This lack of thorough investigation and care is a disservice to the patient.

On the topic of psychiatric medication over therapy, there are multifaceted reasons. Age discrimination is one. However, in some cases, like severe dementia involving memory loss, medication might be a more suitable route. But the key is not to assume and instead engage patients in their treatment decisions.

Medicare, for those unfamiliar, is a US government-funded health insurance program, primarily for those over 65. Being a Medicare provider myself, I can attest that while the process might be smoother, the reimbursement is paltry. It’s a complicated issue where systemic flaws and personal choices intersect. But the onus remains on the provider to offer the best standard of care, regardless of reimbursement concerns.

Now, addressing your questions directly. For health and longevity, you’re on the right path. Cardiovascular health is crucial for cognitive function as we age. Maintaining vascular health is paramount, and your active lifestyle supports this. Brain stimulation is equally vital. Activities like learning new skills, be it a language, an instrument, or even ballroom dancing, are beneficial. Social interaction is another essential aspect, as is managing stress levels.

In navigating the healthcare system, self-advocacy is crucial. Research, question your providers if necessary, and don’t hesitate to seek second opinions. It’s also beneficial to get feedback from loved ones, as they might offer a different perspective on your care. If you ever feel discriminated against based on age, stand up for yourself, whether that means addressing the doctor directly or escalating the concern.

In conclusion, you’re on an excellent trajectory. While being proactive about aging, ensure you’re also enjoying the journey, not just preparing for the destination. If you’re passionate about these issues, consider getting involved at the grassroots level to make a difference. Thank you for such a valuable question, and I hope this response offers some guidance and reassurance.