And welcome back to "Family Health Matters" I'm Shelley Irwin.

With me today are those guests, Dr. George Kipa, Deputy Chief Medical Officer, of course, with Blue Cross Blue Shield of Michigan.

Dr. Kipa good day to you.

- I'm glad to be here.

- Renee Parham, Yes, Renee Parham, Life Enrichment and Dementia Services Manager at Clark Retirement Home, Franklin Campus.

Hi to you, Renee.

- Hello.

- Thank you to you as well.

Ana Ramos, Community Outreach Coordinator at the Alzheimer's Association, and Ana glad for your local angle as well.

Good morning to you.

- Good morning.

- Let me start with you Ana, tell me a little bit about you and the association.

- Yeah, so I work at the Alzheimer's Association, Michigan Chapter here in the Grand Rapids Office.

I am that community outreach coordinator, specifically for the Latino community.

So my work focuses on creating pro education programs that are accessible to the Latino community.

I also work to bring bilingual support groups to the community as well, both for caregivers and people living with Alzheimer's disease.

And then I also work to recruit volunteers to lead those programs as well.

- Thank you.

Renee, what is your role and your program with the Franklin Campus at Clark?

- Absolutely, so our Life Enrichment program at Clark for our memory care and just in general, really focuses on resident wellbeing and looking at overall wellness and wholeness.

So my job is to oversee those programs.

I also work a lot with our families whose loved one are experiencing dementia.

And I help families work through that and what that means and how to connect with them as the person progresses.

And just to make sure we have meaningful connections and relationships throughout their lives.

- Thank you for that.

Dr. Kipa, how are you spending your day in this niche?

- Well, it's been obviously an extraordinary time, but today, I interact with providers in my role at Blue Cross and deal with the various ways in which we can help improve health care in Michigan basically, that's what I do.

(Dr. Kipa chuckles) - Yes, thank you for doing that because I know this is World Alzheimer's Month.

My notes, tell me more than 50 million have an Alzheimer's disease or one form of dementia.

Let's start with some definitions, if I may, Dr. Kipa.

Kipa, we introduced this as Alzheimer's disease.

We talk about dementia.

Where are we here with our language?

- Sure, well, yes and as you said, it is Alzheimer's disease month and it's a good time to learn about it and then bring awareness to it.

But Alzheimer's is the most common form of dementia.

And even though it's common, there is some confusion in past misinformation.

So we start with the fact that dementia itself is kind of an umbrella term.

It's not a single condition, but it's a term that really includes many types of progressive brain disorders.

Those that impact our thinking, our cognition leading to problems with memory, communication, language, decision-making.

So it is the most common cause of dementia, which is the overall term.

- Yes, and this could be starting what, physiologically, even before symptoms do present?

- Well, we do call something preclinical dementia is when the patient realizes there's something not quite right, but generally speaking those around them and their physician may not recognize that that's the case.

But most commonly dementia really kicks in over age 65, but it can affect children up to 5% of the time.

So it's not really a sign of normal aging.

It's a medical condition that can be treated and a correct diagnosis is important.

So since there are types of dementia that are very treatable and even curable.

- Yes.

Renee, would we go into perhaps some early signs and symptoms that may need attention and ultimately your care?

- Absolutely, and so what you're looking for is a pattern.

You don't want to just have a one-off things here and there, but a pattern of things such as memory loss that disrupts a person's daily life.

If there's changes in their ability to do things that they've always done really well say there's a recipe or something that, or a game that they've always really known how to do well and enjoy.

And they start to struggle with that.

New problems, with words or speaking languages, very highly impacted by dementia and something that people don't always think about.

Short-term memory issues as a common thing to look for as well.

And trust your gut, if you know your person the best and you see something that's not quite right, it just kind of gives you pause, take advantage of that and take notice, and don't ignore it because like Dr. Kipa said, dementia is not a normal part of aging.

We all make it a little bit of memory loss as we age, but dementia is not a normal part of aging.

And so it needs to be evaluated.

- Ana, what is the role of the foundation in our early stages?

- So the Alzheimer's Association does a variety of, brings a variety of different services to the community from providing education around, Alzheimer's disease and dementia, talking about the 10 warning signs, which Renee mentioned, some of those that we teach about, knowing the difference between what's normal aging and what isn't, and then knowing what to do after that.

So we try to bring support both to, people who have just general concerns about potential dementia in either themselves or a loved one.

We provide support to those who have received a diagnosis.

So providing support groups to both people who are living with the disease and also people who are caring for them as well.

We have a 24/7 helpline that can address any questions that a person may have, regardless of where they're at in the process.

We also provide support to families who are caregiving.

So any behavioral issues that they might be facing with their loved one, we're available 24/7 to help out with anything.

- And you represent us here with your Alzheimer's Association here in West Michigan, don't you Ana?

- Yes.

- For reaching out nice.

Dr. Kipa, of course, we all know the answers.

I'll start with you, what point?

Obviously there has to be a diagnosis.

What is our first line of treatment?

- Well, the tricky part is making the diagnosis because as I said, there are many different causes of dementia.

And if you've got something that may be potentially treatable or curable, you wanna make sure you're on it.

And so in terms of considering what the differential is, you think about some of the common things that are out there.

If you think of Alzheimer's as being the most common cause of dementia, and let's say vascular issues being the second most common people may have had many strokes.

And I know in the past, when I've done just random CT scans on patients that are in their 70s or 80s, or you'll see signs of small mini strokes.

So that's another form that can lead to dementia.

But things that, for instance, depression is probably one of the most common things, you thinking about that might lead you to think you're experiencing problems with cognition and you have some form of dementia, but depression is very treatable.

So you wanna recognize that for sure.

Alcoholism can lead to problems with dementia.

You certainly wanna catch that early.

And so those are things you can prevent.

Also, sometimes medications may lead to dementia.

So in good history and physical exam, you take the history, you wanna make sure you're not missing, perhaps something that the patient is taking that might influence that.

And then of course, the rare hereditary things.

Well, that's a little more tricky with testing and laboratory testing, but those are some of the common things.

And of course, infections in the past, things like neurosyphilis where, they are something you'd wanna consider that of course is treatable.

So those are some of the things that come into play with the differential diagnosis.

But when a patient comes in for an exam, you wanna observe them and do a careful history and you check their short-term memory.

You find out what you can about their activity.

And as Renee referred to before, in terms of observation and activity, you also, you wanna make sure that you're not overreacting.

People forget their keys and do things like that.

That doesn't mean that they have early signs of dementia, but if they fail to recognize a family member or get lost in normal surroundings, things like that, you try to bring all these things out before you run into testing and things like that.

So it's a complex process.

It takes all those years of education as a physician in the various fields of expertise to make that diagnosis.

- Yes, heads are nodding.

Let me go back to you Ana, if you can expand on that and go into your niche for the Latino community.

- Yeah, so Dr. Kipa is very on track.

We, as the Alzheimer's Association, definitely encourage, as soon as some of those signs are noticed, you're at an education program, and you're starting to realize, like I see some of those signs in myself or in someone else, we definitely encourage everyone to visit their primary physician to talk about what medical evaluations can be done to get closer to a diagnosis.

And in terms of the Latino community, so not many people know that Latinos are at higher risk for developing Alzheimer's disease.

They're 1.5 times more likely to develop Alzheimer's disease than non-Hispanic whites.

And so we really try to expand our programs from, having programs that talk about just general education around Alzheimer's disease to risk reduction.

What can we do with our lifestyles to change, to reduce our risk?

What are things that are common in the Latino community that put us at higher risk for Alzheimer's disease?

So addressing a lot of those concerns, addressing the stigma around the disease as well.

It's something that's not really talked about in the community, or there might be also just a lack of knowledge around the disease.

And a lot of families will just think, "Hey, grandma and grandpa, just getting a little bit older, and this is normal."

So really, combating a lot of that, a lot of those myths that, "No, this isn't normal for healthy aging."

And there's things that we can do to, reduce our risk and also just make the caregiving process a lot easier on the whole family as well.

- Yes.

Renee, at what point do you welcome in those who need your services specifically your memory union, yes?

- Yeah, absolutely.

So we have people who have dementia at varying levels throughout our community, whether they're in independent living or assisted living skilled nursing.

And so what someone needs is, unique to them.

But when we really encourage someone to move into assisted living or memory care is when they are unable to safely be by themselves throughout the day.

And so if you're worried about cooking, if they are leaving the stove on, or if they're making statements about leaving that don't really make sense.

It's like, say their home, but they say, "Well, I have to go home today."

You're already home.

Or if they are not able to manage medication safely on their own.

They might forget to eat and they might not be able to take care of their own hygiene well anymore.

So those are all signs to look for that it's time for assisted living or some other level of care in the home.

- Dr. Kipa, would you talk more, some review about the support offered to those in their stages?

- Sure, well, I think it takes a village, as dementia progresses, the patient is less able to do things for themselves.

I think the first thing that Renee and I were talking about that a little bit before is increasing social interaction, engaging their minds, in ways that will keep them, lower the isolation.

These times of COVID days, isolation is terrible what it's doing.

So anything you can do to stimulate the mind, I think is provide support to the patient that may actually help in terms of the disease progression.

And the care team, I'm a primary care physician, so you need a good primary care provider involved, but you may need a neurologist.

You may need a psychiatrist, you may need the nursing aspects of it.

And you evaluate the home.

Is there a need for a home health aid or home nursing in terms of the various medications, let's say that are available.

There are medications that are available that may help with the symptoms.

So there's obviously a lot of research with newer medications and hopefully we'll do more so in the future.

But if someone gets to the point where they can't do their activities of daily living, they may need a specialized facility.

So those are all things that need to be evaluated.

And one of the things that we have done with Blue Cross is work with our value partnerships to help create that sort of team-based care concept.

So that the awareness of that concept, that it does take a group.

And sometimes you need some sort of high intensity team care to assist with that.

And of course, working with the family members, making sure that they're okay, because that takes a lot from them to support the patient.

And so making sure that this team provides support to everybody in that team.

So no one is overwhelmed and that the patient comes out doing as best as they can.

- Yes, let's put some time on the caregiver.

I'll go back to you Ana, regarding the association I trust there are support groups.

There are times to share the good, the bad, the ugly.

- Absolutely, yeah.

So I would say that's one of the most utilized services through the association are the caregiver support groups that are offered statewide.

You can find one in your area.

And the nice thing is that it's facilitated by someone who's had that experience before too.

So not only are you able to get that shared experience from the people participating in the group, but also from the person facilitating the group as well.

We also offer respite certificates that allow the caregivers, to take a break, which is really important when you're providing for a loved one.

And then we also offer education programs for caregivers as well, where they're able, to ask questions about behaviors or how to communicate effectively with a loved one.

We also have the helpline that a caregiver can utilize anytime of the day, if they have just, a small question or if they just wanna talk to someone and vent a little bit, that's another great resource for them as well.

We also have social engagement programs, both for the caregiver and also the person living with Alzheimer's disease or dementia.

And so those are really great in terms of, keeping your mind active and being socially engaged.

But I think also, having a time to just be with people who have just, that shared experience of going through this process.

- Yes, Renee, back to your program, I know the Franklin Campus at Clark Retirement, take me through perhaps activities that you do share when it comes to social, emotional, and more support for your residents.

- Absolutely, happy to.

So structure is very important for someone who has dementia.

Having those routines really helps them to feel comfortable and secure.

And so we keep our programs on the same time every day, but what we do changes, one of the best things that we do as we partner with Franciscan Life Process Center for their music therapy services.

And we have that at least two times a week where we have group programming and one on ones, we will do exercise because cardiovascular health is so important for one warding off dementia, but two just maintaining your good health as you age.

So we do lots of exercise.

We'll do cognitive programs that will help exercise the mind in a healthy way, because when you're reminiscing with someone who has dementia, we don't wanna say, "Well, don't you remember, so-and-so did this on that day.

What do you mean, you don't remember that?"

So we are looking at using the brain skills that they have that are strong, such as, "Remember, when did you like to go to the beach?"

You know, living in Michigan, we all have this long, wonderful tie with Lake Michigan.

So did you ever enjoy going to the beach growing up or a lot of our people from Grand Rapids, "So tell me what was like, living in Grand Rapids, growing up."

And really pulling on those long-term memory, strengths that they have.

And we will do just reminiscing and art therapy.

I'd mentioned music therapy, cardio drumming is another really popular one.

We've been doing lots of Zooms, especially over the last year.

We've been very happy that we're able to have families back in person, but utilizing technology more than we ever have the past year, especially with travel.

Since we can't go out places, We've partnered with the GRAM and done virtual tours at the GRAM, which have been really exciting.

- Wow, yes.

Dr. Kipa, I do wanna spend some time obviously talking about as much prevention as possible, but what about zoning in on the journey with exercise, with nutrition, basic part of the aging process in general, but will that help?

- Well, I believe it would, there's, it's a tricky business, but generally if you do all the good things that you can do for prevention, I believe that daily exercise and watching your nutrition all the way along.

For instance, in the vascular area, I think it is pretty well established that watching your diet, eating the right things and exercising helps you.

And so certainly in the vascular causes of dementia, that should help.

And in general, because of the complexities of the disease that we're still trying to understand from our research, anything that can build up our body's ability to stay strong and fight disease, I think is a good thing.

So yes, doing all the smart things in terms of prevention, keeping up with your regular physician visits and all the regular preventative care that's required, exercising well, watching your diet, sleeping well, that keeps your body in shape.

And I personally believe that that will be helpful in the long run.

Obviously, the disease spectrum is a complex interaction between genetics and environment.

And there are many variables in that interplay, but I think the smart bet is on those who do all the right things to stay healthy.

- Thank you for that.

Ana, does the association deal with research at all?

Any of our dollars go into your association?

Do you have a handle on this?

- Yeah, absolutely.

So one of our other strong pillars is research.

So, conducting research ourselves, but also supporting local research projects as well.

So anything from, risk reduction to treatments, just the disease in general and learning more about, how we can get closer to a cure and ending Alzheimer's and other dementia.

So we're definitely active in that.

I don't have any local examples right now of research.

I guess the most recent big thing is the medication at your home and the Alzheimer's Association support towards that.

But yes, we definitely are very active in the research realm and are always trying to fundraise to help, continue to support research.

- And I know you are very well known for your Alzheimer's Walks, not only locally, but throughout the state, yes.

- Yes, last weekend actually was the kickoff to our walks nationwide.

Our local Grand Rapids Walk will be taking place October 9 at Ah-Nab-Awen Park in downtown Grand Rapids.

And so that'll be taking place.

Then everybody's welcome to come and join.

What you do is you usually join a team of, family members who wanna honor someone, who's either living with the disease or lived with the disease.

You can honor just, the general public who are caregiving or, things like that.

Or maybe you just know someone who lives with it and you wanna support the cause.

So you can create a team.

And what we do is we do a 30 minute walk about a two mile walk around the park and we just, have different things to honor those who have lived with the disease or who are caregivers.

We have a big promise garden, we call it.

And there's different colors that represent different people's, roles and the disease and different things like that.

So that will be happening in October and you can visit www.alc.org/walk.

If you wanna get involved.

There's different fundraising goals that you can set and, when different things to help support research and also care and support here in the state of Michigan as well.

- Thank you, we'll share all of your contact information near the end.

Dr. Kipa, if a parent has the diagnosis, what should the lifestyle be of the next generation?

How familial is this?

- Well, it's again, variable.

A lot of variables come into play and the genetics part is still really in its early stages, but there are genetic markers out there that can, of course play a role in something very rare, like Huntington's disease.

Let's say that's a different story.

And then there can be testing that can help prevent perhaps that the next generation, so to speak.

But overall, as we learn more about the genetics of the disease, I think there will be more information about how that can impact the next generation.

But I would go back to what I said before, living according to the best approaches of preventive care, avoiding things like smoking and drinking excessively in terms of alcohol, exercising, all those things.

I think I would say that for everybody, but perhaps, especially for those that have some relatives, but one thing that you can always do is in your annual visit with the doctor, if you suspect that that's the case, that you have a relative with the disease, or that's something to discuss with your physician and as more information is available to the medical community, but that can become part of both preventive and therapeutic treatment plan.

- Yes.

Where do we find out more about your services at Blue Cross Blue Shield?

- Well, bcbsm.com, is a good place to start.

And there are many and much information there, miblueperspectives.com also is a good website.

And I think those would be good places to start.

- So along with my four mile run, do a crossword puzzle here and there.

- I would say exercising one's mind is always a good idea.

I would certainly exercise the mind in every possible way.

And I love Renee's music program.

So I think that's especially of interest to me.

- Yes.

Renee, what do you leave us with on behalf of your services at Clark?

- We believe that residents, when you have a dementia diagnosis, it is not the end of a life well lived.

There is still a lot of joy and love and happiness that can remain throughout the person's life.

And so that's something where I'd really like to focus on.

And I love how Ana keeps saying, living with dementia.

We're not suffering from dementia.

We're not mean not to downplay at all the terribleness of this disease 'cause it is awful to no extent.

But there is still joy and love and hope in all these things.

And so I would say focus on that, focus on remaining abilities, try not to focus on the things that are hard and the things that are sad and difficult, but focus on the good that what's remaining.

- So how do we find out more information about Clark?

- Yeah, we have our website, clarkretirement.org.

We also have our Facebook page.

You can search us Clark Retirement Community.

We have lots of fun videos and posts and educational articles as well that we keep very active on that.

So those are both great resources.

- Great and you are specifically on the Franklin Campus.

- Correct.

Yeah and Keller Lake Campus as well.

- Yes, great services you provide.

Ana Ramos, so what else do you have to share with us?

- I just wanna say, I feel like it's important, even if this disease doesn't impact you or your family still, feel welcome to come to our education programs, learn more about the disease so that you can better support just the community in general.

I liked what Dr. Kipa said about it does take a village.

And so the more of us that can be educated about the disease and how to support caregivers, how to support the person living with Alzheimer's or a form of dementia, the better off we'll all be.

And I think, it gives us time to be able to maximize the quality of life and for there to be, less anxiety around making decisions and more time to benefit from treatments and more time to plan for the future and be able to enjoy time together as a community.

So I would say even if you don't feel like you're impacted by this still, come to the programs, learn how you can get involved, become a volunteer and help support, these families.

Yeah.

- Yes, and again, what day is your walk here in West Michigan?

- October 9, it starts at 10:00.

- Good that you are doing, again exercise as a fundraiser for sure.

And one more time, how do we find out about the Alzheimer's Association?

- Yeah, so you can visit our website at alz.org/gmc.

That is specific information regarding the Michigan Chapter.

And then also I'll throw out the helpline number.

So that's a helpline that's open 24/7, year round.

And we also offer language services in more than 200 languages.

So it's really accessible to the whole community.

And that would be 800 272 3900.

- Great, thank you all for your expertise in this discussion about Alzheimer's disease.

Take care.

And thank you for watching our Family Health Matters.

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