Aging Gracefully: Reset Your Nervous System and Boost Longevity

I'd like to welcome everybody to today's presentation on addressing age related changes in the nervous system. I'm your host, Dr. Donnelly Snipes. Today we are going to explore how aging increases sympathetic dominance or stress response and irritability. We'll review the impact of sympathetic dominance and identify strategies to rebalance the nervous system. So sympathetic, nervous. Sympathetic dominance is something that develops in people who have a history of chronic stress and just in people who are older. And one of the reasons it develops as we get older is aging is stressful. And there are a lot of things we can do to mitigate that stress. But it's important to understand that a lot of adults that we are working with will be experiencing some level of sympathetic dominance. Now, the good news is we can help them balance that out. Your autonomic nervous system is comprised of your sympathetic nervous system or your fight and flight and your parasympathetic nervous system or your rest, digest and repair. And they're supposed to balance each other out. But when one is used too often, usually the sympathetic nervous system, because of chronic stress, it becomes too strong, it becomes dominant, and that parasympathetic nervous system, the rest and digest, becomes unable to balance it out. Think about it. When you were younger, we called them teeter totters. Where I was from, some people call them seesaws. But if you are on a teeter totter with somebody who was much bigger than you. I remember trying to be on the teeter totter with my son when he was a toddler and he was all of £40 and I was a whole lot more and he just didn't have the weight to bring it back down to balance me out. So obviously I would have to assist him. But what we are talking about with older adults is helping them strengthen their parasympathetic nervous system so it can balance out and turn down, not use that sympathetic nervous system as much, not be as stressed out as often. So that starts to actually weaken a little bit. And so we get back into a some sort of balance. Stress in and of itself is not bad. Stress, fight or flight is designed to help us survive, but it's what we do with that stress or leaving stress unattended that's a problem. Stress is our body's way of saying, hey, something ain't right. And we're supposed to address that, not just go, you know, whatever. Think of the nervous system like a bucket and stress like water. Every stressor adds water to that bucket. Sometimes it's a big stressor. So it Adds a gallon of stress, a gallon of water. Other times it's a little stressor and it's more like a tablespoon, but it adds up. And the parasympathetic nervous system comes in and dumps the water out of the bucket. Well, if that parasympathetic nervous system isn't ever emptying the bucket, then the water builds up. And it doesn't take much on any given day to have that water overflow. Which is why we see in older adults sometimes they tend to just kind of go off about seemingly nothing. It's that straw that broke the camel's back, as we used to say. So we need to help them empty some of the water out of their stress bucket. That way they've got more room to manage stress as it happens. Aging, as I said earlier, is stressful. Both aging and stress cause changes in the body that actually add more stress and, and inflammation, make it harder to relax and speed up the aging process. Now you're going to hear me say probably 50 times today, maybe more, that what we are really needing to do to help adults, especially older adults, balance their nervous system, manage their blood sugar, reduce their inflammation, address their mood, lability and improve cognitive functioning. All of those, all of those are negatively impacted by inflammation. And most of that inflammation is caused by uncontrolled stress. So anything that's a stressor is going to kick off that stress response. Which, you know, I could. Long story short, when that stress response is chronically kicked off, then we start to see chronic systemic inflammation and systemic means throughout the whole body, including the brain, including neuroinflammation. And when our brain starts experiencing that, we start having cognitive decline. We start seeing neuronal death when stressed. And this is another thing, and it makes sense. If you're walking through the forest and you see a cottonmouth, it's a poisonous snake, you're going to be stressed. And then for the next part of that walk, you know, we're going to assume the cottonmouth goes on from the next part of that walk or that hike. You are going to be hyper vigilant to the threats. You're going to be looking for other cottonmouths. You're going to be less attentive to the bunny rabbits and, and the neat plants and the sound of the trees. You're going to be waiting to find another cottonmouth. The same thing is true anytime our nervous system is set. So when we are, when our sympathetic nervous system is activated, when we feel unsafe for some reason, we pay more attention to the threats that are in the environment than we do the, the non threats. So while that's good, it helps us survive. If we are consistently, chronically paying attention only to the threats, then the world starts seeming a lot more stressful, a lot more unsafe than maybe it really is. And that chronic attention to the threats keeps us in fight or flight, keeps that sympathetic nervous system geared up, keeps inflammation going and we need to help people notice the whole picture. I'm not eliminating the, the threats. You know, there, there are crappy things out there, there are stressors and we don't want to negate those because that makes people feel even more unsafe when they're invalidated. We want to acknowledge those there are stressors and there are good things in terms of age related causes of sympathetic dominance. Now in younger people, some of the things that we see that cause sympathetic dominance or an overly strong fight or flight reaction is trauma. And ultimately people who've experienced adverse childhood experiences or trauma of some sort tend to have more sympathetic dominance, especially if they never regained a sense or never gained a sense in the case of some kids, never gained a sense of safety and empowerment. Resolving trauma means regaining that sense that I am safe and I am empowered to keep myself safe. If we don't have that, then our stress response is always going to be on just a little bit, kind of like a soldier in a foxhole. And that's going to contribute to that systemic inflammation that's going to keep that bucket somewhat full. As people age we also see physiological changes. And when there's changes in the body factory, it's stressful again. Think about at work when you've been working at the same place forever and everything's been the same for forever. Then all of a sudden a new CEO takes over and eliminates a department and everybody has to adjust. It's freaking stressful. Well, the same thing is true as we age. Some of our departments go offline, like our gonadal hormones when we go into menopause or andropause, that actually throws that stressful on the system. Is it natural? Well yeah. However we do know that as people go into andropause or menopause and there's a reduction in their gonadal hormones, there is more inflammation because testosterone in men and estrogen in women are highly neuroprotective. They help regulate the stress response, the sympathetic nervous system and they have some anti inflammatory properties. And when those go away, you know, it's er, how's the body supposed to take care of all those tasks? Possible reduction in oxytocin in older people. Oxytocin is, some people call it the love hormone or the bonding hormone and that's actually a misnomer. It's actually our survival hormone. Because when we are with our children, for example, or our grandchildren and there's a threat, our oxytocin actually goes up and mama bear or grandmama bear comes out to protect our youngins. So oxytocin actually comes out in order to protect the people and, and creatures that are important to us. Oxytocin also comes out when we are socializing, when we're making friends, when we're doing nice things for other people, even people we don't know. You do something nice, oxytocin increases. It's a fabulous system. Oxytocin, oh my gosh. And we're going to talk a lot about it because it is one of those hormones that can actually help replace, if you will, the estrogen or the testosterone. Because oxytocin is a very strong modulator of the nervous system and it's extremely anti inflammatory. Oxytocin is a wonderful neurochemical and we can kind of hack the system with oxytocin by encouraging people to do nice things for others, by encouraging laughter, by encouraging even socialization or touch. It doesn't have to be something huge. Maybe if you're working in a assisted living facility or a nursing home, having the residents help each other out, having a buddy system, just having a buddy system increases oxytocin in those people. If you are in home care, you know, increasing oxytocin, when you go in and see that individual and they are happy to see you, they automatically have an increase. Assuming they're happy to see you, they automatically have an increase in oxytocin and that can help stabilize their mood and it can help them manage some of their inflammation. Now again, if they see you as a threat, yeah, their oxytocin is going to go up, but they're also going to get more irritable. So it is situationally dependent. We need to make sure that when people, that people have experiences throughout the day that help them feel safe and empowered and hopefully connected to others. Even watching videos on YouTube. A lot of older adults are turning to YouTube now and that's fine, that's great. As they watch some of these videos where they can relate to the people that are, that they're watching, that can help increase oxytocin a little bit. Now we ideally don't want them watching videos that are going to get Them stressed out and fired up because that's going to increase stress and stress related oxytocin. But there are a lot of other things. Watching cat videos, dog videos, baby videos, funny videos, laughter increases oxytocin. As we get older, we experience an alteration. A lot of people experience an alteration in your thyroid hormones. Our body is a fine tuned system. I've tried to make the analogy of spaghetti sauce before because there's a lot of spices in spaghetti sauce and when you put too much of one, you know, it throws the taste of the spaghetti sauce out off a little bit. And you need to adjust all of the others. Our nervous system and our body is the same way. When serotonin is altered, then all of your neurotransmitters are altered, some of your hormones are altered. When we start losing or reducing estrogen and testosterone, we start to see a significant increase in hypothyroid in older adults. Now what? Why do we care? Hypothyroid is feeling depressed, feeling stressed out, feeling hopeless and helpless, feeling fatigued all the time. And you're like, well, how does that increase sympathetic dominance? Because it ticks people off. They're like, I am so freaking tired of being sick and tired all the time. Okay. We do see alterations in the entire system, which is why it's so important to make sure that your older adult is going to the doctor getting blood panels. I am a strong advocate for having not only T3, free T3 and free T4 checked, but also TSH and reverse T3 to identify whether the system is working well. I have other videos on the thyroid hormone, but the basic fact is the standard test that doctors run to identify if your thyroid is working well misses a lot of people who are hypothyroid because it's not looking at those other parts. The part that they're testing is working fine, but the body's ability to convert T4 to T3 and use that T3 effectively, not so much. So encouraging older adults who seem depressed, who seem fatigued, and it's not related to grief, encouraging them to make sure that in their annual physical they have their thyroid checked. Chronic pain causes stress. When you have difficulty sleeping, when you're in pain a lot, it's irritating. It's not maybe a gallon stressor, maybe it's only a half cup stressor, but it's still adding water to that bucket every single day, every single time you hurt. And that it can cause people to keep their muscles more tense to guard against that pain area, which is also exhausting. And stressful. And health conditions like diabetes, hypertension, congestive heart failure, all of those are dysfunctions in the system. And dysfunctions in the system cause the stress response to be activated. The body says, hey, something ain't right here. More causes. I know. And, and this is why I thought this presentation was so important, because too often we think that older adult stress is all cognitive or grief. And yeah, there's a, a bunch of that, that happens and we'll get there. But there are a bunch of things that are happening in the body, in nutritionally with them and physiologically with them, that are triggering their stress response. They may not even recognize it as stress because it doesn't feel quite the same way. But it is triggering the body to try to protect itself, to try to right what has gone a little bit wrong. So nutrient deficiencies. We've got an entire presentation on that later. And it's not just about not eating. Older adults don't absorb certain nutrients nearly as effectively anymore. So we need to make sure that their nutrients are balanced. Why? Because the nutrients we eat, what we eat is broken down into its component parts and it's used to make hormones, neurotransmitters to repair our body, to keep us, to keep us going, to clear out the junk. We call them reactive oxygen species to clear out that oxidative stress that develops as a byproduct, byproduct of living. Every time we do something, we breathe, we eat, we think whatever, it creates waste products. There's leftovers, if you will. And those leftovers are called reactive oxygen species or oxidative stress. So think about a factory. Every time they make something, they've got boxes and wrapping and other stuff that. From the parts and they put it into the, into the garbage. Garbage can. Well, if they don't clear out the garbage after two or three days, it's going to be almost impossible to do their work because there's just too much crap piled up around them. So it's really important that the body is able to clear out the oxidative stress. And that's cleared out in two ways. Normally the body clears it out when we, when we sleep. And older adults don't tend to get good sleep and don't get enough sleep. That's a different presentation today. But it's also important to recognize that as that garbage builds up, the body normally clears it out. It has a process for clearing it out. But when we have too much stress, then we are increasing the rate that we're producing garbage for lack of A better term. And our body can't clear it out quick enough. That's when eating an anti inflammatory diet is helpful. Think of the anti inflammatory diet, kind of like garbage compactors and it's squishing it all down so our body is more able to get rid of it. Slower repair of nerves, our body breaks down or cells die, neurons die, whatever, and they get repaired. And that's wonderful. But as we get older, especially if we're nutrient deficient, especially if our hormones are out of balance, especially if we've got chronic information inflammation, then we're going to have slower repair of our nerves and pretty much everything else. We're going to have slower wound healing, etc. There's a sense of unsafeness due to sensory changes, which keeps the stress response on. As people age, we lose peripheral vision. So it's harder, especially in high activity environment. If you got a lot of grandkids running around, it's harder to know where people are, which is, can be stressful. As hearing goes. And more than 50% of people over 50 have some level of hearing loss. As hearing goes, it can start to feel more stressful. Not only to understand conversations, but it can also keep, make us feel unsafe because we can't hear people walking up behind us and then they tap us on the shoulder and we like jump out of our skin and sensory processing changes. So we have a difficult time as we age integrating what's going on, it slows down. What we hear, we receive and then we understand. When we're younger, we, we hear it, we receive it, understand it. But as we get older, the process, the pathway from the stimulation to the brain to understanding what's going on, it slows down. That's normal, that's not dementia, that's normal cognitive slowing, normal sensory slowing. But it's important to recognize because too often when we're talking to older adults, they have that slower processing and we say something to them and it takes them a minute to register what we said and we either repeat ourselves, we start to think that they're developing dementia, which they're not. But either way, if they feel like we're thinking that they're losing their mind, or if we're constantly repeating ourselves and not giving them a minute to process what we've said, it's stressful. Grief and trauma issues are often more frequent, contributing to stress and sympathetic dominance. The grief of losing friends, whether you're losing them to death, to moving to an assisted living facility, to dementia. You know, when people lose loved ones and, and Friends to any of these things. It can be very stressful. Older adults, a lot of older adults have pets that they love dearly. And we all know that pets pass on. We need to recognize there are a lot of different things that older adults grief. I have an entire video on the YouTube channel called the. I think it was the trauma of aging. And I go into all of the different direct and indirect losses that older adults are dealing with. But all of these things when we're grieving or experiencing losses, that's something we couldn't control. We couldn't prevent Susie from, we couldn't prevent her dementia from advancing. And then we start to get stressed out and think, oh well, what if that happens to me? Then we start developing anticipatory anxiety and if we have dementia, maybe we're in an earlier stage. Anticipatory grief. We see what, what's happening to our friends, to our cohort, and we know it's coming. So there's a lot of stuff that's stressful. Our goal is to reduce stress which will reduce inflammation and the repercussions of inflammation on each piece of life. And I'm going to use this mnemonic throughout today. It stands for physical, interpersonal, emotional, cognitive and environmental. Because stress and inflammation impact all of those practical interventions to help balance the nervous system. And again, we're going to go in depth in, into most of these today, throughout the rest of the workshop. But nutrition, encouraging older adults to consume anti inflammatory foods. Those are colorful foods. You don't need to get too hung up on the science of all of it. We know that the richer the color, the more anti antioxidants and anti inflammatory compounds it probably has. And each color of food has different benefits, different anti inflammatory compounds in it. You have red, yellow, green, purple, blue, black, white and brown and orange. Yeah, I think I've got them all now. But you want to try to encourage them to eat three colors at every meal. As adults get older, it can be more difficult to consume some of these foods, especially the ones like apples that are crunchier, that are high in fiber. It may upset their gut some. So looking at smoothies, superfoods, there are a lot of really yummy superfood powders out there that can help the older adult get a little bit of protein and their and a really hefty dose of antioxidants. As always, I'm not a medical doctor. Have them talk with their physician before they change their nutrition. But that is one way that we have found effective in some of the Assisted living facilities that I work in to get older adults to get their antioxidants, increase omega 3 fatty acids. If you are working in a nursing home or assisted living facility, make sure There are omega 3s used in cooking and used in, you know, provided in the foods. Avocados, great food, very soft food that can be eaten. Very high in omega 3s. Not everybody likes them. But increasing that omega 3 level so there's a better omega 3 to 6 balance is helpful. Work with your dietitian to try to do that so you're reducing the inflammatory compounds. Too many, too much Omega 6 can be inflammatory. We need some, but too much can be inflammatory. We want to increase all of these because they help reduce oxidative stress. Remember I said that these anti inflammatory and anti inflammatory foods are kind of like trash compactors. They grab all of those reactive oxidation, reactive oxidant species and squish them together. They grab all the garbage, the byproducts of living, and squish them together so they take less room and our body can more effectively excrete them. So, and obviously that is a metaphor for what's happening. That's not exactly what happens, but that's what we're dealing with. As we reduce inflammation, we're going to see a reduction in brain fog and sympathetic overactivity. When we have inflammation, our brain is going, that's stressful. We're not supposed to have that much inflammation going on. So the stress response is kicked off, which actually paradoxically increases inflammation. So let's help the body clear out some of that junk. Hydration also helps reduce inflammation. You got the junk. But unless there's a good way to get it out, if it's sticky junk, it's hard to get it out. So we want to make sure that we're keeping that path smooth and fluid. So hydration, not over hydration, but adequate hydration helps reduce inflammation, which can reduce behavioral and emotional issues related to neuroinflammation, dehydration and constipation. Lots of Asians there. And adequate hydration also reduces urinary tract infections, which by the way, for adults that go to the emergency room, seniors that go to the emergency room, more than 30% of the ones that present for delirium actually have a urinary tract infection. It's not cognitive at all. It is a UTI that is causing inflammation that that's contributing to their delirium. You can. And again, not a doctor, but one of the things that is very helpful, especially if you're taking Care of an older adult, a family member. Get the. There are test strips that you can get, UTI test strips that you can get for home use. Now, they are not diagnostic, they're just screening. But if you have an older adult that you're caring for and you suspect a uti, or let's have them screen for a UTI at home and then we can make better decisions about what to do next. In some cases, Teladoc and some of the telephone doctors may prescribe a antibiotic just based on symptoms and the results of that test. I'm not saying they will, but I've had experiences where some of them have. So that would save you a trip to the emergency room. Circadian rhythm destabilization throws the whole system out of whack. That's like in your body factory, not having a schedule, just telling the workers, hey, come in whenever you want, do your job. You know, whenever you want, you can come in at 2 in the morning, doesn't matter. Well, nothing's going to work effectively or efficiently if you don't have people doing their jobs a lot of times at the proper time. Especially in an environment like a factory where department A has to get their job done before department B can do their job, et cetera. Circadian rhythm stabilization helps rebalance the sympathetic and parasympathetic nervous system because the circadian rhythms control virtually everything I learned doing this presentation. Circadian rhythms actually even control your saliva secretion. Who knew? So we'll talk about that in the, in the section on oral health. But by keeping consistent routines, cyclical light and cyclical temperature, you can help the adult set their circadian rhythms. Now, we all know about light. You're supposed to reduce blue light before bed. Well, that's wonderful. But it's also important to have bright light during the day. Our bodies take it, take their cues from the sunlight, so bright, brighter light during the day and then dimmer light as we go into the evening. And as dark as possible when you're trying to sleep, we want to make sure that people's routines are consistent because our body takes its cues from our social environment as well. If you are up playing cribbage or something with everybody in the facility at 10 o' clock at night, you're stimulating your awake hormones, if you will. So it's important to recognize that what you're doing before bed also tells your body, is it time for bed? With our little kids, we used to bring them home from school. They play for a while, they'd eat dinner, take A bath, read a story, go to bed. Those activities actually cue your body in. I have a game that I play on my phone before I go to bed and it's kind of funny. I notice that if I try to play that game during other times of the day, I start getting sleepy. It's like, oh, we're playing Scrabble. It means it's about time to go to bed. So consistent routines are very helpful, making sure the older adults try to go to sleep about the same time. And we'll talk about sundowning and stuff in the video on circadian rhythm and sleep stabilization and cyclical temperature. Our bodies are supposed to sleep or hibernate, if you will, when it's cool outside. And we're supposed to be awake when it's warm. And we want to do that in our homes and our facilities as well. During the day it's warmer, so people are up moving around, their body temperature's warmer. And during the night body temperature cools. And one of the ways to assist in that is to cool the ambient temperature. All of those things are important to helping set the person's circadian rhythms. Believe it or not, for whatever reason, our natural circadian rhythms are actually not exactly 24 hours. So by doing this we are forcing, if you will, forcing our body to be on a 24 hour schedule. We want to improve sleep. Just because our circadian rhythms are stabilized doesn't mean we're getting good sleep. If the person's getting up to pee 15 times a night or has chronic pain and can't get comfortable, or has sleep apnea and is waking up gasping for breath, we do need to focus on that. Activities that promote oxytocin, such as social bonding, touch, positive interactions, laughter can also promote calmness. It can promote a feeling of ah, relaxation. And we want to encourage people to figure out what helps them feel that sense of calm and relaxation. Oxytocin release also can help reduce loneliness because it helps people feel connected since a lot of times it is released when they are interacting with others in real life in some level or interacting with pets. And pets are huge for increasing oxytocin, reducing blood pressure, reducing stress in older adults. As we see our stress hormones go down, as we see people feel safer, more empowered, we also see a reduction in agitation and improved sleep. Pain management is important to help people reduce stress. We if you've got chronic pain, it doesn't matter what age you are, it's a chronic stressor and we want to help people learn how to live with pain they may not be able to get rid of all of their pain and an acceptance and commitment therapy. One of the things Hayes talks about is living in the and I can have a rich and meaningful life and have chronic pain. Encouraging people to embrace the good days, the days when their pain is a 2 instead of an 8 score. Today's gonna be a good day. I'm feeling okay. Encouraging them to talk with their physician about medications. You know, I'm not a huge fan of medications, but sometimes, especially in short courses, it can be helpful. Physical therapy. Movement with approval of the doctor and or physical therapist. When you sit, your body pretty much literally locks up, which is why it's so important to move. And when you sit in one position for too long, you start getting achy, your muscles start getting fatigued, and they can actually adapt to that particular position, which may not be ergonomically correct, which increase chronic pain. So movement, it. I'm not talking go on a power walk. I'm just talking about getting up, walking around a little bit. If somebody is chair bound, moving their arms, if they still have movement in their legs, if they're not paraplegic, sitting in their chair and moving their legs, wiggling their toes, wiggling their fingers, anything they can do to activate some of those muscles is going. Can be helpful at pain management. They've also found that people with arthritis, for example, do better if they consistently use their hands. If they've got arthritis in their hands. I have arthritis in my hands. That's why I use that example. And some days I think, oh, I don't really want to. And it's not doing intense exercises, but it's, you know, moving those hands, wiggling those fingers, maybe even putting them in a warm water bath and moving those hands around that can help reduce some pain. Guided imagery is super helpful. Imagining the pain as a dial that people can turn down or imagining it as a color. I see I've got pain in my hand, so I see a red aura around it, and I'm going to envision that red turning to a cool blue. That can be helpful for other people focusing their attention on something else. If they've got pain in their hands than wiggling their foot and focusing on what their foot feels like to wiggle, that can be helpful. Or just straight up guided imagery where they take, they mentally check out for a minute and they go to a happy place and they notice what it smells like, what it looks like, what it, what they hear in that place can be very helpful. Massage can be helpful for chronic Pain as well as heat. And again, clear it with your doctor and or your physical therapist ahead of time. We don't want to recommend any of these treatments for people to do. We want to recommend that they talk with their. We want to educate them and recommend that they talk with their physician or physical therapist about what might help. And then we can help them implement whatever their treatment plan is. Aerobic exercise and gentle movement enhance parasympathetic function. Believe it or not, gentle exercise, not, you know, really rocking out, but gentle walking, like walking around the mall or just kind of strolling through the park, reduces cortisol. It reduces one of our main stress hormones, which helps trigger that parasympathetic function. We're increasing oxygen, but we're reducing cortisol. It helps decrease stress, improve mood, and support cognitive health. Anything we do to reduce inflammation, especially neuroinflammation, is going to support cognitive health. Vagal toning is another thing we can do to help balance the nervous system. Your vagus nerve is your main parasympathetic or main rest, digest and repair nerve. And it winds and connects to just about every organ. But the interesting thing is it also has a branch called the trigeminal nerve that comes out onto the face. So there's a lot of stuff we do with our face that can either trigger or turn down the vagus nerve. When we smile, it triggers the trigeminal nerve. It goes, oh, we're happy. That's a good thing. Calm. When we chew, that triggers the trigeminal nerve to tell the vagus nerve, hey, we're fixing to rest and digest, so get ready. Again, turning down that nervous system. And I am not saying that we want to constantly feed people to get them to relax. No, that's definitely not what I'm saying. That brings on a whole other set of issues. But what I am saying is there are some activities that we do. Chewing. If your. If your older adult can still chew gum, that's helpful because chewing does trigger that trigeminal nerve and the vagus nerve. If they can't, no worries. You can put your middle finger on the tragus, which is the little flap on your ear, and your index finger behind the ear, and gently massage. Not hard enough to push the tragus down, just enough to move that skin, and that actually triggers the vagus nerve. Blowing bubbles, bubble stuff like we used to use when we were a kid is helpful. Singing loudly and I know there are some people in a couple of the alfs I work with that there's one lady who plays the piano and she doesn't sing much, but there are a few other people that will belt it out and that increases oxytocin when they're doing it together, as well as increases the parasympathetic tone. Singing is wonderful. There are a lot of other things that you can do. But when we increase the activity of the vagus nerve, what we're doing is telling the body to slow the heart rate and slow our breathing so we can divert energy to something else. Or maybe nothing at all. Maybe just repairing and noticing that. So slowing your breathing, even doing what we call box breathing, where you breathe in for four, hold for four, exhale for four, hold for four, and repeat. Not everybody likes box breathing because it feels too weird, which is why I usually give the suggestions for singing, blowing bubbles, etc. The ABCDs of vagal toning makes it easier to remember. The first one is acceptance. When you start to get stressed, accept what's going on. It is what it is. I. I woke up this morning, I'm feeling pain, all right? Sucks. But if I get upset about it, it's going to do nothing more but increase my pain, and it's not going to help at all. So I'm going to accept it is what it is. It's where I am today, all right? I'm going to do something to slow my breathing. Box breathing is fine. Blow bubbles, doesn't matter. I sing. I sing really loudly in the shower. My husband can attest to that. C stands for compassion. Having compassion for yourself and others is super important. But when you wake up and you're in pain or you wake up and it just grief hits you like a ton of bricks, all right? Accepting this is where I am today. Breathing to slow that stress response. Having compassion for yourself, especially if, you know, if your heart is hurting emotionally, having compassion and saying, you know what, it's okay, you are allowed to grieve instead of fighting with it, because fighting with it is stressful. Distraction is another thing that can help with vagal toning because it turns our attention away from what's stressing us out. You know, like when you start to get a shot. Especially for little kids, when the doctor's getting ready to give them a shot, they try to get you to. To distract them somewhere else so the kid's not paying as much attention. Well, that one doesn't usually work very well. But when you pay attention to your distress, when you're focusing on your distress all day, it keeps your stress response up. Now, that doesn't mean you're supposed to ignore it forever and always. Sometimes we've got to deal with things, but we also need a break. That's why therapy isn't eight hours a day, seven days a week, because people need a break dealing with their. Their stuff, dealing with their grief, their anger, whatever. It's exhausting and it's stressful and they need time to rest and relax. So we help them. Distract and support seeking. That's the s. Because the more we seek support, the more we trigger that oxytocin in a positive way and can help reduce inflammation and balance the nervous system. So ABCDs, acceptance, breathing, compassion, distraction, and support seeking. That's something that you can put on a poster, post in your person's room, or post in the living room or wherever, depending on whether you're a facility or a home caregiver. And finally unhook from the stress. And this is another acceptance and commitment therapy thing. Our feelings are our way, our body's way of saying, hey, something may not be right here, but it doesn't mean it's necessarily fact or it doesn't mean there's necessarily something we have to do about it. I wake up in the morning, I've got pain, my hands hurt, I'm frustrated. I am feeling angry that I have pain right now. Okay, well, that feeling is there. That feeling is valid. Now, what am I going to do with it? Am I going to stew in that anger and just, you know, dunk myself in it? Or am I going to choose to let it go? Am I going to choose to distract myself or do something else? Distraction doesn't have to be doing something superfluous. Distraction can mean I'm getting up, my hands hurt. All right, I'm going to massage them a little bit, and then I'm going to take my happy butt to work. Because when I'm focused on writing presentations and teaching, I don't notice the pain as much. If I sit around the house all day, I'm going to tend to focus more on the pain. So unhooking from the stress merely means instead of saying, I, I have this pain and it's part of me and I'm not letting go, I'm taking that feeling, I'm taking that thought, I'm unhooking from it, and I'm deciding, am I going to carry it with me or am I going to let it go? Interpersonal strategies encouraging adults, older adults, to develop autonomy and mastery. Okay, some of the things you used to do, maybe you can't do anymore, but what can you do? My stepfather, as he got older, he used to be an avid golf golfer, but as he got older, his balance got poor and his back got really bad. So playing 18 holes of golf in a day just wasn't in the cards anymore. And he's really got very depressed about that. Focusing on what he could do, he was able, for most of the rest of his life, he was able to play nine holes at a time. So, okay. It's not uncommon for people to just go out and play the front nine or the back nine. That's pretty common. He could also putt. He had no problems with putting. So if he wanted to get that nature therapy, he would go out and go, go to one of the putting greens and just practice putting. So that's what he could do. He loved golf. He didn't want to give up golf and he got quite good at putting, but he couldn't do 18 holes like he used to when he was younger. Instead of being angry about that and giving up golf completely, he figured out what he could do. He also changed from walking the golf course to using a, using a golf cart, which really dug into his self esteem a little bit. But he accepted it and he said, you know what? I want to play golf. It's worth it to me and I'm going to do what I need to do so I can get out here. Increase social support by building and maintaining supportive networks which will help reduce loneliness and stress and improve mood and reduce agitation. In assisted living facilities. Help people connect on similar interests, whether it's reading or crocheting or cooking or woodworking or cars or I don't know what they liked. Sometimes you can help them connect around their era, if you will. So people who were born in the 40s may all connect around stuff from the 50s. People with dementia, their, their golden window, as they call it, is from the age of 15 to 30. That's the part of their life that they tend to remember the clearest for the longest. So thinking about what was going on when this person was 15 to 30, and that's the era that you, of people that you want to connect them with. People that were born, you know, within five years or so of them because they will connect on music, they'll connect on events. You know, my mom, you could, she could talk about Woodstock all day long. I didn't go to Woodstock. I have no idea. It was way before my time. But that was something that she could connect on. Encouraging people to do that is so Helpful. Even having trivia, trivia days where they are, you know, trying to remember who sang this song from 1953. You can break them into groups and remember it's going to be a little bit slower paced, but break them into groups and whichever group gets the most questions. Right. Is the winner. Yeah. You know, in the assisted living facilities I work in, you don't even need to have prizes. They just kind of enjoy that friendly competition and they look forward to it. They really enjoy. There's a game that's a lot like Wheel of Fortune, but it's not Wheel of Fortune that they play, and they just love that. And bingo, who knew? Bingo is a big thing. And it gets people together, which increases oxytocin, even if they're not talking much. So talk with older adults. Talk with them about what they love and maybe what they love that they can't do as well or don't think they can do at all anymore. And then figure out, are there ways we can help you continue to do this, and if not, what are some other things you might like doing? My grandfather had Parkinson's, and he used to make some of the most gorgeous miniature dollhouse furniture. But obviously making these little teeny tiny miniature furniture things didn't work really well once his Parkinson's really kicked in full bore. So he had to find alternate things that he could do once he couldn't do that anymore. If, if he would have had somebody who wanted to learn that, he may have been able to teach them and mentor them even though he couldn't do it himself. So getting creative, thinking about what could you do that is an easier version or a, you know, assisted version or something that is tangentially related that you will still enjoy. Improve communication when older adults can't understand you. It's stressful. I know I have a hard time hearing sometimes when my husband's talking in the other room and he's basically talking into the wall and I'm in another room and I can't. It just sounds like Charlie Brown's teacher. And it frustrates me. I'm like, I can't understand what you're saying. And okay, you know, so I can get upset about it, or I can walk in there and go, what did you say again? But it is stressful when we can't hear, when we can't understand. Even if somebody's right in front of us and we can't hear and understand, we want to use clear, respectful communication, Speak to the person as clearly as possible, make eye contact, because Even though we don't lip read, we most of us know that if we're watching a television show or something and the, the voice and the lips are out of sync, it just makes our brain go. There is a certain amount of lip reading that every single person does. So if you're working with somebody who has hearing impairment, making sure that they are looking at you and there's proper lighting, if they're looking at you and it's super dark and they can't see your face anyway, it ain't going to help. But if the lighting is adequate, and that also means there's no huge glare coming in from behind you, so they're going, it can really help improve communication. Reduce conflict in communication by using the CARES mnemonic. Be increasing consistency in relationships with themselves and with others. Being attentive to their own needs as well as to the needs of others. Being responsive to their own needs as well as the needs of others. Encouraging themselves as well as others and making sure that they feel safe and loved and others feel accepted and loved for who they are. You create a safe environment. I'm not going to reject you if you screw up, I may help you figure fix it. But I love you even if you make mistakes, I love you even if you can't do this anymore. So creating an environment of safety and, and acceptance of people reduces a lot of conflict. And it can be really helpful to have people, especially if you're in a group setting, to have people talk about what responsiveness looks like. When I get upset, if you're going to be responsive to me, this is what's most helpful and this is what's not helpful. Don't come up and give me a hug. Don't tell me to calm down. You know, those are the two things you do. I'm going to get more stressed. But it's helpful if people communicate ahead of time. This is what helps. If you're going. If you want to try to help comfort me or respond, this is what's useful. We want to recognize emotions as signals rather than threats. If somebody gets angry, that means their stress response has totally kicked off. They're in fight or flight. Well, what was the threat that triggered their sense of vulnerability, that triggered their fear and their anger. So anger is a method of communication. That's the brain's way of saying, I feel vulnerable and I need to protect myself. Fleeing, you get away from the threat. Fighting, obviously you try to defeat the threat. But a lot of older adults, as they lose some of their functioning, maybe they can't hold things as well anymore. And they drop something and they get really angry and you're like, okay, you dropped it. What's the big deal? You know, we'll clean it up. No big deal. But their, their anger is a 10, when you know, it was probably only deserving of a 2 or 3. Well, why is their anger a 10? Because that represents to, to them their personal decline. That makes them feel vulnerable because they're losing some of the abilities and potentially some of the independence that they used to have. So they're angry about a whole bunch of other stuff. The, the fact that they dropped the glass of milk, that's just the precipitating event. But what are they really angry about? So we need to recognize emotions as communications. For adults who tend to be irritable, they tend to get triggered in a heartbeat. Self soothing statements can help, like I can handle this, or this isn't worth my energy. I, um, whatever. Finding a phrase that works for that adult that they can use when they start to feel themselves getting irritable, you know, live and let God let go, whatever. Gratitude journaling can helpful be helpful. And that's not all the time. But journaling their gratitude once a day. What happened that went well today? I have a gratitude plant, or I did at one of my facilities. We went out and we got some dead branches off of one of the trees and we got the little package tags that hung on a string and each person each day would fill out a, one of those tags and hang it on the branches like a, like a tree. So we ended up having a gratitude tree by the end of 30 days. And talk about practicing forgiveness. Now that's easier said than done, but forgiveness is saying, I'm going to learn from this. I'm choosing not to let you have energy, this energy anymore, and I'm taking my energy back. You are not deserving of my energy to stay angry. I'm going to use that energy to learn how to protect myself from you and protect myself from that happening again. But it's not worth me steeping in that anger. Build resilience by spending 20 minutes a day, usually at a meal, focusing on what's going right. And this can be in the morning, where people are focusing on what they're excited about for the day, or it can be in the evening where they focus on what went well that day. The other 23 hours and 40 minutes, if they want to be grumpy, you know, that's fine. But for this, 20 minutes and they've actually found that the benefits of that persist throughout the day. If peop we encourage people to spend 20 minutes looking at that other stuff. Remember I said at the beginning, when we're feeling threatened, when we're feeling vulnerable, we tend to focus on almost exclusively the threats. So if we spend 20 minutes a day focusing on that other stuff, it helps balance out our nervous system. Address anticipatory grief. You know, I know this is coming and I'm starting to grieve the loss of my fill in the blank and jealousy. We see as people get older and they start losing functioning or losing loved ones, they may be very jealous of others who haven't experienced those losses. So helping them manage that anger and a lot of times with older adults, the jealousy is grief related. And remember, grief is denial, anger, bargaining, depression and acceptance. Well, jealousy is a form of anger and we definitely want to help them address that. And if again, if you're in a community environment, then if you've got some people who still have their significant others that they're living with and others who don't, there may be some jealousy. If you have some people who still have certain types of functioning and others who don't, there may be some jealousy. We want to help them grieve. Grief is a loss of any type, whether it's functioning, independence, dreams, housing, significant others, etc. We want to help them process guilt, grief, resentment and depression using mindfulness and psychotherapeutic interventions in order to help them reduce chronic emotional stress. That fuels sympathetic overactivity. That fuels that stress response. We want to help them turn down the volume. We're not saying it doesn't. We're not saying don't grieve. We're not invalidating your feelings, but we're helping people manage them a little bit better so the feelings are not deafening, the feelings are not oppressive and help people past process past traumas to reduce anger, grief and anxiety. If people have past traumas that they never resolved, then they never started feeling safe and empowered again, which as I mentioned earlier, means that their stress response always stayed on just a little bit. We want to help them process those so they're emptying their bucket. So they are starting with as much room in their stress bucket as possible. Cognitively. We want to help them engage in cognitive restructuring for managing stress related thoughts and improving their sense of safety and empowerment. One of my favorite mnemonics is FitCat, helping them notice the facts in this context at this time, getting away from emotional reasoning, I think feel scared, therefore this must be threatening. No, I feel scared. But in this context at this time, is this threatening? If somebody came from a history of domestic violence and they're in a situation now that they're not in that situation anymore, they're in a situation now where they're safe, but they're in an environment, maybe in. In the day room, and somebody starts raising their voice and yelling and getting angry, it's going to trigger those memories from that DV experience. But in this context at this time, what are the facts? Are they safe? And in general, I would probably say yes, that's just Sam over there popping off about something. But Sam's not a threat to you. Facts in this context at this time, back then, yeah, that was definitely a threat. But now you are safe and you are able to keep yourself safe. Dialectics means embracing the goods with the bad. I always use the example of cat hair and dog hair. I don't like cat hair and dog hair everywhere. But I would not give up my animals for the world. So I have to embrace the good with the bad. I have to embrace the fact that my floors are never going to be completely clean for more than five minutes. But I accept that because the love of my animals is more important to me. Embracing hardiness and their rich and meaningful life. Hardiness is commitment, control and challenge. Identify all the things in your rich and meaningful life right now. Whatever, however you define your rich and meaningful life, all the things that you're committed to, all the things that are deserving of your energy, identify of what's going on right now, what aspects of that that you can control and what you can't, and for the things that are not going well. Because generally, when we look at the whole piece that includes all parts of our rich and meaningful life, all aspects of it aren't going to hell in a hand basket. Generally, it's only a few things. Okay, so of those things that aren't going well, what can I control? Of those things that are going well, how can I use my energy to nurture those? How can I control those and make them grow? And viewing this as a challenge, I viewing intentionally using my energy to move toward my rich and meaningful life as a challenge. Commitment, control and challenge. And as I mentioned before, living in the and accepting I can have a diagnosis of dementia and have a rich and meaningful life right now. I can have a diagnosis of cancer and have a rich and meaningful life right now. Maybe I can't do everything that I wanted. And yes, there are things that I'll need to grieve If I know that I've got dementia and eventually it may progress to the point where I don't remember things, okay, I need to grieve that. I need to grieve the loss of my dream, that I am going to be sharp as a tack until the day I die. All right, let's grieve that. Let's integrate that issue, but also get to the point where we can accept that this is. And there are things I can do to live my best life as long as I can. In terms of brain fog and problem solving difficulties, encourage people to write things down. If they have trouble remembering what's going on in a conversation, encourage them to keep a notepad with them. Or if they think of something and it's not time to speak yet, encourage them to write it down. So when it's their turn to speak, they don't go, oh, well, crap, I forgot they have it written down. That works really well for older adults. Encourage them to use push notifications to remind them to take their medicine, to brush their teeth, et cetera. Address triggers for brain fog like poor sleep or irritability or, you know, anything that happens in that adult's life that makes their brain fog worse. Let's figure out what we can do to address it. Chunk things into smaller tasks. Because older adults fatigue faster. It's just the way things are. So chunk it. Instead of working or doing something for three hours, let's do it for 30 minutes and then take a break and then do another 30 minutes. And encourage them to work during their best times. If they are at their best from 6am to 11am Great. Let's have our visitation. Then let's have the grandkids come over. Then let's have Thanksgiving dinner early because that's when grandma's at her best. And avoid that sundowning time. Encourage them to engage in cognitive stimulation exercises. Thinking using their brain. Whether it's crossword puzzles or Trivial Pursuit or Wheel of Fortune, anything that gets them to think. Playing cards, bingo. Actually stimulates the brain. Talking with other people, all of those things stimulate different parts of the brain. Painting, you know, whatever. Make sure they're using structured routines that helps eliminate some confusion and some stress. And provide scaffolding. If they can do something up to a point, let them do it to the point that they can't remember what to do next. And then provide some prompts instead of doing it for them. Use scaffolding to help them build their skills environmentally, increase safety and empowerment. That means talking to the person and saying, hey, what's going to help you feel safer and more empowered? And you can use different words, obviously, but some people will be able to tell you, you know, I feel unsafe at night when I'm here by myself. Okay, well, what can we do to address that? Create predictable, calm environments, eliminate stress triggers. Involve the older adult in decision making to reduce perceived threats. When older adults feel like you're making decisions for them, you're controlling their life, they are going to rebel just like teenagers do because you're taking their power they've been independent from for 50 plus years, thank you very much. And now you're treating them like a child. Oh, so we want to involve them in the decision making process instead of doing things for them. And nature exposure. Ah, nature exposure is so wonderful. They found that just being in nature because of the smells from the plants and a variety of other things, it actually reduces stress and inflammation, improves mood and cognitive functioning. They don't have to be strolling through the woods and getting exercise. Just being in nature, being outside and smelling the plants and the trees can be super beneficial. I encourage you to identify behaviors and issues with older adults that you're working with that are associated with sympathetic dominance, which means they're associated with stress. What things are going on that indicate that the older adult feels unsafe, disempowered, vulnerable, and create a list of tools and strategies that can be implemented to help them feel safer and address some of the physiological issues that may be contributing to their stress. Sympathetic dominance contributes to inflammation, faster aging, reduced immunity, poor regulated, poorly regulated blood sugar, sleep and circadian rhythms, irritability, brain fog, and worsening of chronic conditions. Too much stress is no bueno for the whole body factory. Many older adults are motivated to reduce inflammation, pain and disease, all of which are going to help promote improve mood. Most older adults that I that I work with still have a big stigma about counseling and addressing mental health. But if you help them develop tools that'll help them reduce stress, inflammation and pain, they're all about that. Help older adults recognize they aren't crazy or helpless. They just need new strategies to deal with the consequences of aging.