members nor pbs el paso shall be responsible for the views opinions or facts expressed by the panelists on this television program please consult your doctor [Music] good evening with the

advancements in medicine and simply taking care of ourselves better and better we are all living a little bit longer and isn't that great news but there are physical complications with

aging we all know that sometimes there are mental complications and that can be very emotional and difficult to talk about in this next hour we're going to be talking about mental

health and our aging family members who might be in the first stages of dementia and there's all kinds of reasons why that will be happening we are specifically going to talk about

providing the medical student who is here today to answer our phones today we have madeline morris with us and she has wonderful handwriting because she sends the text to me on my phone so

it looks like i'm playing with my phone during the show it means i'm trying to get the questions from you all so thank you very much for calling madeline who you just saw there on

the air a huge thank you also to the el paso county medical society who brings this program to you each and every month i'm catherine berg and you're watching the el paso physician

[Music] good evening we're here this evening to talk about geriatric behavioral health and we also want to uh talk about not just behavioral health but through our mental issues that

we can speak about this evening we have a returning individual so you are officially a veteran and i like that you have an 18-word name we have dr angelo mauricio rodriguez chevrolet's

here and he is our panel and our psychiatrist may i correct you oh dear god yes angel marcelo rodriguez rodriguez thank you marcelo can i just call you marcelo marcelo's great

that's how my friends call me so feel free to well i'll be your friend this evening okay jacob can i be your friend too yes ma'am because we also have jacob butler with us and

he is a mental health nurse practitioner in the geriatric behavioral health unit at the hospitals of providence and you are at the memorial campus yes so thank you so much for being here

and marcelo i can't call you marcella because you know you worked hard for that doctorate degree so i'm going to call you dr rodriguez chevrolet wow you did that well i'm

trying um as a psychiatrist what do you do all day every day because there are some practitioners that take people in their office you know medications this and that and the other so when

people are thinking about asking questions to this program give them an overview of what you do every day wow might take us the hour yeah it might take us the entire time i'll give you

the short birthday i'll give you the short version okay all right so because of the pandemia obviously there's a lot of remote work so i'm doing quite a bit of clinics from

there including emergency health network we we also uh provide services for the jails okay so i do that i do our clinic on the west side clinic i supervise all our nurse practitioners and

peas uh attend all kinds of meetings having to do more with the administration clinically of those providers as well as strategic planning and that sort of thing and i obviously round and

supervise as well the nurse practitioners over at the general behavior unit at providence okay and so the geriatric behavioral unit we're going to talk about that too because i know

jacob is involved with much of that but jacob on and it's it's easy for me to ask you what you do all day every day and it's very difficult to put that in a small package um

but take a couple of minutes to explain to the audience what what you get to do every single day i get to work my butt off for doctor williams so basically uh in the mornings i do round uh

usually mon uh tuesday wednesday thursday at the geriatric behavioral unit and then i go uh tuesdays no wednesdays i don't even know you see yeah anyhow uh tuesdays and thursdays um i

do see uh id the idd population here in el paso which is the intellectual developmental disabilities for a couple facilities here in in el paso also in uh on on wednesdays i do do the

partial hospitalization program for dr rodriguez like i said i work and then partial hospitalization is that you said yes it's for emergency health network okay alternatives program

where they do half day of uh hospital or therapy and i do a lot of the medication management that's usually monday wednesday friday um in the afternoons um i do go see the the patients

in the annex uh here in the jail system monday through friday and you're everywhere yes i'm pretty he's young enough to do this look at this very solemn face he has i

don't know if you can see it yes i am everywhere yes thank you for reminding me yes and then on the weekends i have to go work with him sometimes oh gosh does he ever invite you over

for barbecue i've i've been in his house twice right twice yes i've been to history all right just checking just checking out everyone um we are we are focusing tonight so

both of you all do mental health issues for all ages but tonight we really want to focus on the the population of 65 and plus because there are you know 14 hours of shows that we can do on

mental health issues and i like that we take some of these pockets sometimes and really do a deep dive in some of this so when we're looking at 65 and older and people just think of

mental health or dementia automatically the alzheimer's word comes up and oh it must be alzheimer's and that's not necessarily the case so i would love for you uh dr rodriguez

chaverus if you can describe the declining of just mental health in general and when when dementia sets in what can be some of those causes and i know sometimes we don't know but just

the idea of what some of those causes could be well let's start with we don't know okay because actually you mentioned dementias and oftentimes the alzheimer's comes to mind

which is actually a diagnosis of exclusion meaning that if the signs and symptoms that fit criteria for dementia are not found elsewhere you basically call it alzheimer's and it is the

most common because most commonly we don't know we suspect that's why in the diagnosis category which by the way uh now is is more related to neurocognitive type of that's the

actual term okay uh that's where they all would fall fall in so if you don't find somebody had i don't know a vascular dementia for instance related to multi infarcts uh

strokes and so forth we call it vascular damage right if somebody abuse alcohol or their all their life and actually develop those signs and symptoms of dementia we've referred to

alcoholism at the cost it's a parkinson huntington's korea those are more rare but really it's good to clarify because i get that question or i see the patients families and

significant others kind of puzzle what they told me was dementia and then somebody else said it was alzheimer's and so forth and it's kind of neat to put it in in that context in

reference that alzheimer's is the most common type of dementia but we don't really know because to really diagnose it it's a little bit too late it's an autopsy right you

could actually find those neurofibrillary tangles and so forth we don't want to get too technical that dr alzheimer's described exactly and let's talk about dr hall's

alzheimer's for a second but when um and i am going to get technical for just a minute because again and you're spot on and this is what i've heard from from many friends of

ours that when the autopsy what do you see in the brain with the autopsy that shows okay yes this patient did indeed have alzheimer's versus a brain that may have been someone who had

dementia from whatever abuse say drug abuse alcohol abuse etc what is it that you see with alzheimer's versus other conditions well obviously i'm not a pathologist right or sorry

but you have to play one on two tonight well i will all right i appreciate it i think i have a good explanation okay right but but basically it relates precisely to how these tissues in the

brain brain cells and so forth because atrophy could be everywhere you know atrophy is normal in the process of aging but then that tends to grow you know in any kind of dementia you you

will see that but these neurofibrillary tangles that the doctors exactly describe are pretty peculiar in form and location and shape and so forth and the other point to actually make clear

is that unless you're doing research you're not clinically you're not going to get a lot of families asking for autopsy exactly because of the age and the multiple conditions

they might have had uh pretty much and the emotion that goes wrong why yeah exactly you know i mean if you had a mysterious type of death whatever you really need to find out it's a

different matter but we're clinicians right so we obviously don't don't do that side of it nor do we get that request it would be pretty rare for somebody to die after being

diagnosed and treated for any kind of dementia and then ask for an autopsy exactly except if you're conducting research right and jacob this may be an unfair question to ask you is it

might be something that i would ask dr rodriguez chavis but in the idea i think of you as is the guy in the field you're the one seeing everybody and when you and let's just say

with the annex when you're talking about the jail so when we have we have inmates that are in there they're like in their late 60s in their 70s and so you get to see people are

there times when you have a suspicion that they should and this is where the hard part is that how do i diagnose someone with a dementia and how do you treat it and that's it's a

big question and i don't even know exactly how to go around saying that but when are the suspicions there because i totally have been the girl that have put her car keys in the

refrigerator i put the dog bowl in the shelf in the bathroom and so all of us kind of have our moments of am i going nuts or am i really losing it am i just not remembering things so

there's that i'm kind of making fun of it but i shouldn't um because we all kind of have that that stage of i'm really starting to forget things when do people start

worrying about that when you're 65 not only uh no um you know what i i just we a matter of fact the annex just asked me to assess a patient who's 80 years old uh and they're

they're they're trying to figure out if he has dementia so what i did on the gbu unit today was ask social services anayansi hello and i nc but anyhow and i asked her for the moca

screen which is a montreal cognitive assessment okay that gives us a scoring of anywhere from 1 to 30 but it gives us an idea of of their state of dementia the severity of the dementia i

should have brought it um and then also we have the intellectual functioning that we also do upon psychiatric evaluation where we ask them for questions related to the recent memory remote

memory such as what's the president's or what's today's date or what elementary school did you go to and um unfortunately like dr rodriguez said we can't really

it's i mean i guess dementia is i mean if it's asked on a daily basis and if it's not if all the medical causes have been ruled out then then there's a strong likelihood

that that there's probably some dementia going on okay uh as dr rodriguez said we can't diagnose alzheimer's we can't get a true diagnosis of alzheimer's unless we

do not autopsy right so you're looking at at this point kind of clinically what the answers are and you talked a little bit about the mocha scale is that the scale that you were talking

about cognitive assessment okay so is that this the questions that you're asking just now where you went to school who the president is or no that's something different

they'll ask you to to to do a little crossword puzzle and then they'll ask you to draw a clock 10 past 11. they'll ask you to name some pictures um they'll ask you to

repeat some words five specific words like velvet face uh in about five minutes after uh and then you score it all together and then um just based on the number of questions that they got

right then you get an idea of how bad their cognitive state is so if they get 30 out of 30 well or you're good to go right or even i think what 27 right doctor so 27 and up is

you're you're you're good so so in assessment processes would it be for example and again i like talking about case studies without names but it it helps because in your head

there's a story and it also helps the audience see this person's story so you're asking you're talking about this 80 year old individual who you're asking to assess

so you are doing both the mocha scale and other questions too is he assessed several times within a certain amount of time frame for example asking these same questions within four or five

weeks of one another or is it just like a one-time thing because i know there's there's bad days and there are good days yeah exactly how does that work yeah i mean we always

schedule follow-up appointments and then we always ask them we always check their memory um it's uh it's usually pretty consistent every time you talk to them of their cognitive

state and it's it and especially in the in the criminal system it's very hard to um to help people with dementia a lot of the medications that are available on the population

aren't readily available in the criminal justice system so we have to work with what we got and um but also it's a placement issue i mean it's hard to it's hard to um

place somebody that's in jail um and get them the proper help when they're in the in jail so um so that's i don't know if i answered your question but no you did and

that's actually it's a perfect follow-up for dr rodriguez chevrolet's because now we're looking at treatment so let's say jacob has been with some people and

let's just say that there is now somewhat of a diagnosis just diagnosis of dementia not knowing what kind of dementia but there's definitely some issues with dementia and so and

maybe we can take the annex out of the equation now but let's talk about any 80 year old who is having these issues and definitely they've been scoring lower say they're in

the 15s out of 30 or something like this where and how does the process of treatment come in and and i and i say this also in the caveat because many older people and thank goodness because

they're hopefully their babies and their grandbabies love them but have care systems around them have people that are their support systems treatment for medication and then also if we

can talk about treatment of what you talk with the families of the person with dementia about because that that's a big game changer right there if you've got people around well it

also going to depend on symptom formation you know what what are they depressed are they crying are they aggressive are they are they psychotic do they think the family is against them kind

of paranoia type of thing which is relatively common uh they've been persecuted they're taking their properties their monies their et cetera et cetera and this could be a change

in behavior that could be acute but more more um like all of the sudden but more frequently it actually takes time some changes and a lot of people focus more on the memory thing you know

and you're right just like you sometimes i wonder about myself but no you know there's particular changes over time that would seem like this is out of character or this is getting

worse or or confusion right in general you know you know going to the bathroom thinking it's the kitchen or you know obviously that might be a little bit more longer down the road so

if there's aggression agitation and so forth you have no option but to use medications we like not to and unfortunately because of that age group there's not a lot of medications

that are actually researched for that population and what else that puts us in as clinician is that we need to consider of label of label not because you cannot use it right because it was

not research right so there's no data to back it up right so and traditionally those studies unless you really go into the pediatric population and so forth but traditionally for adults

it's about 18 to 60 60 to 65. so it's you got a patient that's 88 right 90 right there's no research to say exactly a particular a one that that concerns us is

antipsychotics because oftentimes you have to give them because they're psychotic right but they're off label right we shouldn't really be given them so when you say off label

it means it's it's something that has been given but it's not technically and we're not when i say off-label not name-brand not approved by the fda okay not approved by

the fda so i just want to make that clear that it wasn't that it's not a name brand so and this is where it's hard too and it's and these are hard questions so i'm

gonna throw a pretend case study out there so now we have someone who's 83 and in great physical condition great mental condition but then all of a sudden they just start doing what the

family would say just weird things you know they're they're locking themselves out of the house or they're you know like you said walking into the closet thinking it's

the bathroom etc so when that starts happening what does a family member do and so i'm thinking about people in the audience right now that that might be sitting there watching

it's like well my mom's starting to do this my dad's starting to do this do i call someone who is it that i call and what do i tell them because you also have that idea of

mom's going to be very prideful mom's not going to want to think that anything's wrong so there's that dilemma that the family members have and i and and jacob you could

probably answer this too and both of you i'd love you to jump in because i'm trying to figure out because the person usually who has dementia they're not the ones that realize

that they're having an issue it's usually family members so what might be some advice that we can give to the family members if they notice these types of behaviors and and not

just forgetting things you're absolutely right when there's uh mood changes or all of a sudden they're just mad all the time or crying all the time etc what could you tell the

the family members who are they calling are they calling you are they going to say hey jacob tell me what's going on this is jacob butler here well i mean the the hospitals of

providence the gbu unit does uh a matter of fact uh we we just we've had patients call the unit and ask them for help and they have very good nursing staff very good nursing assistants

they got the units very very well run um they attend to medical needs they attend to behavioral health needs um and basically we just got to rule out all the underlying causes for example

eti can cause cause delirium uh uti can cause diseases oh yeah yes okay that's new to me that's a yes tough connection okay so i mean we we encourage them to go to the emergency

room once they're medically cleared then they go up to the unit uh the geriatric behavioral unit the hospitals the province and then we address the the the mental health needs of the

patient um after the medical clearance occurs uh medical always comes first first because there's a lot of the thyroid the thyroid can give you manic symptoms of bipolar that's a

whole yes so we got a lot of we got a lot of conditions medical conditions that could cause mental health issues and so we got to roll all that out before we accept somebody to the unit and

um and it could just be something simple like a uti okay we give you antibiotics and you leave and your hallucinations go away and your delirium goes away and and that's it and then if

if all that subsides then and it's still something mental then then we me and dr rodriguez and and also uh there's also another nurse practitioner george medina we look into the

behavioral health needs of the patient and the great thing about the hospitals of providence is that we attend to the medical needs of the patient and also the behavioral health needs of the

patient so if something comes up while they're on the unit [Music] they have registered nurses that are uh both working on the on the mental health aspect of the patient and the

medical aspect of the patient and they're there um i know i've worked at other mental health facilities and for example if you have a medical problem with somebody short of breath

or somebody's tachycardic which is increased pulse rate at a 150 the nurses catch it right away they don't have to call the emergency uh department or the ems services which

medical emergency medical services and then transfer them out if there's something wrong with the patient we transfer them out right away okay to address their transfer amount to the

medical to the medical floor same place yeah okay same place um we've had those situations also the the beauty of um the geriatric behavioral unit is that a lot of these medications and

that's it's even harder with the adult the jerry uh geriatric population it's harder because their organs don't work as fast yes and the kidneys don't filter as

fast the liver doesn't work as good so we got to be careful with the meds a lot of these meds can cause low sodium levels right and we're drawing labs to monitor those levels some

medications require a therapeutic level we're able to draw those labs and get results within hours oh that's quick okay yeah so we're able to provide iv fluids we're able

to insert foley catheters we're able to do all this medical stuff along with addressing their mental health needs so and that's that's a full gamut too and dr rodriguez

chevrolet if i can take it to you with what type of so is great jacob mentioned thyroid he mentioned utis what other seemingly benign in the world of mental health or in the mild world of uh

mental issues what seemingly benign things could also trigger some issues sure so thyroid is one that we can talk about there's so many people that have you know i'm hypothyroid

for example so i'm synthroid girl have been since i was pregnant had no idea i was hypothyroid so you know my ears are broken up right now too well one of the most common things would

be dehydration for instance and some of these patients might not be ingesting enough liquids water in particular but any uh and not only that with our weather exposed to the weather the sun

some medications actually make them more sensitive uh it might be even a matter of nutrition as well so and jacob is completely right we are all trained whether you're a nurse

practitioner whether you're a doctor or whatever you will train you you think organic first right you have to rule out that you don't want to assume all is this mental condition

and then neglect to look at all these other parameters you need to follow to have that comfort zone clinically that you're moving in the right direction okay i mean even with behavioral

changes for all we know it could be a tumor right you know good point so you know or people have been in some kind of a trauma as well you know it's something that affects the brain

gradually it could be even mild bleeding along the way and you don't know if the person is behaving quite different and and especially if they already have a psychiatric history and by

the way one does not exclude the other we call that comorbid and that's from orbit so one because you have one it doesn't mean you cannot have the other exactly if and in fact my

dissertation in my residency i did it precisely on an unfortunate death of a psychiatric patient schizophrenic long term showed up to the same er they put him over there and took for the

resident for the psych resident to come in the guy was having a heart attack oh my goodness oh goodness is this you don't want to assume that obviously because right people that have

mental conditions are human beings right they can have all the conditions you know and let's let's let's face it to have something wrong with your brain and that's where

the problem is right you know a lot of people think it's more behavioral or whatever no the data and the research is quite clear that these are changes neurochemically that that

they're so fine and i want to call them even mysterious right that they cannot be measured exactly so you when you can put something on the table and measure it i should have been an

orthopedic sometimes i feel because you know you you mess with your weight mechanical that makes sense you know it's like the thesis you put together with orthopedics but they

don't like it when i say that no no of course not but but but in the case of psychiatry or behavior of emotions and so forth but think about in terms of what the brain represents you

know you could call it the boss if you want yeah although every part of the body every organ of the body obviously has its role and its importance and so forth but all of those signals are

coming from from up there you know whether heart beats or not or whether your lungs are expanding or not so you know when people ask me well how much of it is in my head but 100 of the brain

is there well you hit on something that fascinates me because neurochemical neurochemical is is what is happening in the brain and when there are medications and treatments and i'm

just thinking about this day and age and i'm i'm looking at young people but also old people uh old people seniors behave i'm one of them so don't get mad at me um when

you're looking at antidepressants for example and then anti-anxiety uh and these are medication because there's a whole gamut of antidepressants a whole gamut of anti-anxiety

sometimes they're somewhat linked together sometimes they're not then there's the adhd medications that are out there so all of these are are when i think you said

neurochemical so when i'm thinking of that what are some of the most common medications that are being given and again mental health with seniors doesn't necessarily just mean

dementia what other types of of issues are there i know there's a lot of depression in our population so maybe we can skew a little bit that way and and talk about that and what the

medications there are and then what cognitive behavioral help they can have as well and just some of the services you all can well well it's a great question because really anxiety

disorders are the most common disorders if you look at i don't know adolescent meditation or whatever you know but when you go into 65 or over the group we're talking about it

depression actually takes that role and it's depression and dementia actually the most common ones when i talk about neuro chem chemicals in the brain it's basically that all this

body all our reactions emotionally physically whatever are actually guided by neurotransmission in the brain it's all about chemistry right so and electricity see and those are the two

hardest things that's it yeah so so so so the signals come into our brain so we can operate in one way or the other are electrical but the transmission of that information from one cell

to the other one requires chemicals right exactly it's complicated so and i'm not going to make it complicated it's basically well nobody here's this part of it so

i'm so glad we're talking about it it's the chemical and the in the energy so to speak brain cells brain cells cannot touch each other right this is it's called a synapse

there's a little space in between so what you have in there chemicals where are those chemicals presynaptically that means before they meet the other cell they have vesicles when the

signal carry comes through it actually changes the permeability of the brain cell and opens it up and you have the serotonin epinephrine dopamine right so this is oh and then it's

it's ions and it's electrolytes i mean it's complicated but to make it simple okay basically these chemicals are poured and you have to have the right code to give the right

information to the next one that's why we call it a neurochemical imbalance because you might not have enough on the outside of the cell you might have plenty in the inside but that

doesn't do you any good because you need it out there or you might have too much yes exactly all right so then there's a mechanism we call re-uptake and that's why a lot of

these medications you ask for are reoptic inhibitors what does that mean is it like a gatekeeper i'm not going to i'm going to close the gate so we can have more available for the

brain exactly there's too much i'm going to open the gate and put it back in the cell so when the next signal comes around and it's like a pump you keep this rolling so a lot

of these medications are designed around that and if you look at antidepressants and you're right that's a whole bunch of classes a whole bunch of them okay and it's not to

say that one is better than the other you know which one is the better the one that works what and that's something too and jacob i'm going to throw it to you because you were

talking about medication management so that's part of what you do when you have all these site visits um and that's a great question too because when you are state you know taking

and let you i'm just going to throw the number 10. there's 10 antidepressants out there and two of them may work really well but one's going to work the best so when you are

managing patients medication maybe we can talk about the first one that they're trying and then also someone that you've been seeing for several years um and we're looking at

changing their medication how do you cue in on what it is that you need to do with changing medication or at least just starting someone on medication well it also depends on the behaviors

that the patient is exhibiting if the patient's psychotic then we have to look into maybe some type of antipsychotic just based on experience i've seen i've seen an

antisecondary called respiral work best for for the senior population and more the geriatric population we usually don't try to get too aggressive with the medications because like i

said before the organs aren't working as fast the liver is not working as fast and most of these medications go through the liver so we have to keep an eye on that if the patients are

aggressive i mean we usually start with something we don't attack the patient with meds but if they're coming in for depression and anxiety and they're having some behavioral

issues then we just uh we we start them on an ssri which is a selective serotonin reuptake inhibitor which is what dr rodriguez was just talking about it helps keep more serotonin the brain

and then it first for unknown reasons um the the keeping serotonin and norepinephrine in the brain which are the main neurotransmitters involved with depression um was what helps with

depression right um and it kind of keeps a level certain to where there's not that yeah the drought yeah or they're transmitting the serotonin in the brain and the norepinephrine

also is is part of the depression so so let's just say let's just say somebody's really depressed and and we treat them on ssri and we don't see results or they're

lethargic or then we can maybe try an uh serotonin norepinephrine reuptake inhibitor which is an snri which will sometimes you don't hear about snris very often yeah there's not

there's not as many as ssis okay yeah okay so norepinephrine gives you there's got some stimulating properties and norepinephrine um and that'll help wake you up the only

problem is you prescribe an snri which is a serotonin or it might decrease your appetite and in the elderly population that's not a good thing appetite might be an issue right so

we've got to be very careful wellbutrin is a norepinephrine reuptake inhibitor and it also increases the dopamine in your brain okay and then that can cause hallucinations so it's

like a catch-22 for everything what do we do we got to think about it we always go for the simple option if the simple option works then some a simple ssri and um and if they're

aggressive or psychotic uh a small dose of an uh of uh antipsychotic or which is dopamine receptor antagonist so they're all neurotransmitters and and then um we go from there i mean we

can't get too aggressive with the elderly population but but it's uh we have to be careful right and then we have to we're going to look at medications you know i think

we've we've hit that pretty well and if we're in a combination i always think with mental health there's a combination of medications and also cognitive behavioral talk

therapy so to speak um is that something that again with your site visits and i'm going to kind of ask you the same question also in a moment uh with your site visits are there also

therapists that you work with or just individuals in you know the annex or just different places that you the different sites that you go to that also provide help with talk therapy and and

how again with the senior population i completely respect that the organs aren't taking medications as well so if you're able to do some kind of talk therapy and i know that's

the small way of saying it cognitive behavioral therapy um where do you go with that and who provides that is that like who in the system is responsible for that no i mean i i tell every

patient look medications aren't going to solve your problems right you got to make an effort and therapy therapy cardio behavioral therapy or any type of therapy if i always tell

patients medication might be 40 of treating you uh the other 40 in therapy and then 20 you got to do your part right you got to take your meds you got to go to therapy and and that's

the great thing about the hospitals of providence the gpu unit they have activity therapists they have social services available on the unit rehabilitation counselors they have if we need

speech therapy they're having trouble swallowing right we get speech therapy involved we have we have um i don't know what else to do if a lot of physical therapy everything's

available on that unit so it's it's a team approach uh me and dr rodriguez will be the first ones to tell you that we don't we can't do everything right and it's a

team approach and and me and dr rodriguez kind of makes sure the meds are going right we get input from the nurses the rns even though the the nursing assistants i mean they're the eyes

and ears they're on the front yeah they're they're our eyes and ears having a conversation with someone today the people on the front lines are the people that really see

what's happening all day every day and jacob neglected to make sure mention occupational therapy i'm an occupation that's my undergraduate well that makes sense because

it's it's a repetitive movement it's impediment thoughts it's repetitive everything and i want to bring this up too prior to the show starting um and this is a large

percentage you know one of the questions is what percentage of older adults deal with behavioral issues and you know and when we say older adults it's 65 and above so you guys what one

of the two of you were given a percentage of well actually if you look at the adult population it's more like a 26 type of thing okay we're looking at this population is is

it's right around 20. and that's that's a big percentage that is quite two out of every 10 people that is quite up there right and and uh you would think well what why younger

people might have more basically because oftentimes when you get to that point you actually in general terms might have had a constructive life and whatever when you actually get in there

is when you're dealing with a lot of these barriers struggles not to mention that perhaps the most common vulnerability is neurogenetic neurogenesis play a big role in this you know so

we cannot it's a risk factor and a lot of people think that we inherit conditions oh i got my diabetes from mommy or papi or whoever you know what i got was the risk of developing the

condition whether i do or not it's a different matter it might do with lifestyle my diet alcohol drugs i mean all these other things and and to piggyback with what uh jacob was saying

you know all stories to this day show that when you do therapy and you do medicine you always get a better outcome there's not a single study that shows differently right you know it

doesn't mean everyone needs therapy it doesn't mean anyone needs medicine but when you actually can justify and use both you get a better a better outcome and it makes a lot of

sense of course it does you know because the medicine takes their care of the neurobiological genetically predisposed thing right but the therapy takes care of the behavioral psychological

component right and there's skin in the game because they have to participate in therapy that is correct well you learn skills right you should anyway you know tools coping skills

setting boundaries uh issues of self-esteem uh issues related to past trauma whatever the medicine is not just gonna take that away yeah make you sleep better it perhaps not feel depressed

to the point that you have death wishes or even suicidal thoughts which is the major risk we have in on our field and that we have to be so astute about right and we you mentioned uh past

stress so ptsd and i know that's a whole different show in and of itself but let's schedule it yeah we should schedule it seriously because there are we think just like with

dementia people think the word alzheimer's so just like with ptsd ptsd people think automatically something has to do with the military but there's a lot of patients who experience

something in their childhood something really really bad that either they're trying to block or just trying to live through it but things manifest later and sometimes they don't

manifest until they're in their senior years so i i think that's so interesting that you said that i want to go back to what you mentioned earlier with jeans running in the family

and i say kudos to everyone who's working in the field of alzheimer's right now there's a lot of research out there um and just like in the world of oncology of what your

genes are going to tell you for your risk and good for you for saying if you have alzheimer's in your family or if you have breast cancer in your family doesn't mean that

you're going to get it it means that yes you have a slightly higher risk and i wanted to just bring that up because i'd like you to go into that a little bit for people who maybe

have done the autopsy on past relatives who have passed and they have had alzheimer's i know that there is now correlation genetically with alzheimer's but how i guess what

i'm asking what are the questions that you get from patients when they know that they have alzheimer's running in their family if there's anything that they can do do they

wait do they just kind of look for certain things they come to gbu which is a geriatric behavioral unit at hospitals of providence it's hard to get it all together sometime um but what

do patients ask you in that in that realm well specifically with memory going back to most people kind of go there right you know doctor you think because we all have those issues so

it's not only right many reasons why you can have memory problems other than being easily destructible maybe a little atd on the side or it might be anxiety can cause cognitive issues

depression can cause psychosis can do it so you know aging just normal natural aging we could be looking at and but but you're right a lot of people go to the extremists especially they

know about history yes because you know grandma exactly you know and they might be young enough that you say well not really i mean even when people have pre-senile type of changes which

does exist right especially when there's other factors to consider why cognitively there you see that some impairment but it's usually gradual enough like i said earlier that

people might say you know this is not going in the right direction kind of thing you know right it's it's a lot more than those kinds of lapses we have at times or we mis we missed

the right exit right like i did today oh well there you go that makes me feel so much better that's good uh jacob a question for you so there are specific requirements for a patient to

actually be admitted to the geriatric behavioral unit what is it i know it kind of goes back to the question we were talking about earlier about assessing someone but what is it that a

person has to check off so to speak on these tests to be eligible to either check themselves in or have a family member check them in are there certain specifics the criteria that

you're looking at to be admitted well first of all they got to get medically cleared so if anybody calls a unit it's like you can call and say something wrong with my mom okay well

then why don't you get her checked out in the emergency room first make sure she doesn't have she's fine make sure she doesn't have kidney disease um of course now with

the pandemic kovid they do covet testing for the senior especially because it affected that population uh we checked the kidney function a lot of times the kidney function isn't uh up

to par then we gotta we gotta figure out what's gonna it might just be like we said back to urine um but 65 for the hospitals of providence um we were trying to get that that number

lower but um it didn't go through as of yet but 65 central line central lines are lines that go from a major artery into your into your heart and then also ruling out infection just

ruling out the medical issues that are involved uh with with um what could be causing behavioral issues and once they're cleared uh then then they're they they're pretty much

cleared to go up to the unit they just have to be over 65. i mean is there anything else doctor well overall just looking at it uh from a more thorough point of view as we do those

assessments obviously some kind of criteria brought them in it cannot just be the diagnosis yes and that tends to happen at times well i have to mention can we get into the dementia unit

right well we're not the dementia unit to begin with as many things going on right but you know danger to suffer others paranoias psychosis that sort of thing inability to actually take

care of their own needs or they don't drink or there's no water and obviously they're going to be dehydrated and then all of those medical components need to be taken care of

as well some of it might not be solved completely in an emergency room obviously exactly you know you may initiate the antibiotic for that uti or whatever but the behavior might still be

there so you're not going to send them back home because you don't know how soon they're going to clear or not we might need them in the unit to do that and then send them

home and that sort of thing so and that's where some teamwork comes in as well because you have the you know the people who are running the unit but then whoever their primary physician

is i'm assuming that there is some kind of a teamwork going in there it's like medically they're okay mentally they're being managed uh with medication or not so how how

then is just the same question but an opposite how then is someone able to be discharged what are those boxes to be checked off and that again huge question i know please give me the smile

like this again here she goes she's asking the questions um and i know it's different with every person i absolutely get respect that uh because i'm assuming that the with gbu

the geriatric uh behavioral unit you don't want to be up there like forever you want to be up there for a time to manage whatever it is you need to manage create the tools give them

like you said ways to to deal with whatever is it they're dealing with and so now it's time to bid discharge or they would like to be discharged what what is it that they have to

do to make that well let's start with the average length of state it's usually about nine days that doesn't mean some people might be there a couple of weeks or two months

okay or we've had i i guess the record i'm gonna call this about three months or so and there were other issues legally you know right that kind of but we are assessing those

people daily obviously we're staffing those people treatment team you know where everyone involved is there now that the family could not come in we have them on the phone or in the

video or whatever so they can participate as well because obviously they're the best source right exactly when they come in you don't know those people so you don't know what

the level of functioning was before we got them so we have to assess on an ongoing basis that progress and sometimes you have to accept how far you can go with that progress because

oftentimes it's a matter of expectations not only the family sometimes ours as well you know and under the law basically you have the right to be ill even from your mind right right you

have the right to refuse truth i like that we have the right and at the end of the day we do so that's patient savings you represent attention to self or others or even property you

know somebody's breaking the trying to break the unit apart and throwing chairs at the nurse's station or whatever it might be you know that represents the danger to several others

and all the property that can be destroyed in the process right so you don't really want to send somebody like that to a lesser restrictive level of care to an outpatient setting or a

foster home or home or whatever it might be so following up that progress and to what point these people would be at a point where they're functional yes that's going to be you

know that's something i should have brought up very early on because um i remember and i believe was the last time that we were together once the mental health issues are interfering

with their everyday normal lives their everyday function is when um the assessments kind of come in and i remember that you know all these notes that i take you know and then sometimes i

leave and you're like that's what it's called disorder otherwise exactly if you don't meet the question that you're not able to do what you have done all of your

life just normally that's time to think okay i need to get something to say yeah so we are about at the you know nine-ish minute mark before we go this goes by really really fast this

program so what i'd like to do is stop these questions for a little bit and uh jacob if i can ask you if there was anything that you had in your mind that you really wanted to talk

about tonight and maybe we haven't touched face on yet or if there's something you'd like to reiterate what is it that you like to tell the audience or just get that

information out it'll be quick with me the the basic uh the basis of why we work and what we do we work is to improve your quality of life not your quantity so you can live to 105 and

be miserable or you can live to 90 and be happy right and the other thing is that wasn't brought up is cultural awareness for example if you grow up in juarez mexico across the border

and you see dead people on the street i mean to them depression and anxiety is normal and i've had a lot of i've had a lot of experience with that especially in the in the in the

jails with with undocumented uh individuals that are there at the jails i ask them to are you depressed well what's depression are you asking for them different than somebody else right

what's anxiety i don't know what anxiety is because they grew up with it right and so we have to take everybody's culture into and that's that's the importance of

having a team like they do at the hospitals of providence because we we get different perspectives from different people and we work as a team as dr rodriguez mentioned there's a

treatment team we all get social services is there rehab is there activities are there the patient's there we also have the family members there because family is very important in

somebody's care so it's it's a it's a teamwork effort for everybody there's a lot of stuff that goes into mental health and for example latino might think well not

eating or sleeping too much or just signs of depression are normal that's just their part of life and and um and it's just it's just we got to be very aware of that so you

know that's such an excellent point of what what is the asterisk of normal yes what is the definition of that in any given especially when you're talking about mental health when

it's when it's clinical and it's medical you know that the you know kidneys should function between this and this area but with mental health that's such a good point and

we're also looking at generations and again we're looking at the senior population they have lived through things especially someone in their 80s and 90s they have lived through

things that i as a 54 year old have not lived through and spot on on that point i would love for you to expand on that if you could so again perspective looking at cultural differences

looking at generational differences because what i have a 24 year old and 18 year old and i think you guys have it so easy but in so many ways they don't because we didn't deal

with social media social media is a parasite you know so that's a whole different layer that we don't understand and that's a perspective i don't get it might be a

perspective that their 85 year old grandmother doesn't get i would love you to expand on that in any way that you'd like to to add sure and it's one of the reasons we are so

proud to actually work in that unit because we do that we are looking at all those factors rather than saying okay well psychosis and psychotic and see you later and so forth no you need to

look at the person as a whole and what are those needs whether it is those cultural differences that we see all the time especially being in in a border city uh you have to take that into

consideration or maybe they moved here from the northeast i don't know you know and and whether there's some changes really in adapting or because we do see those as well where

people might live here but they bring their elderly parents over and their elderly parents might have some issues especially if they were quite independent over there and now here they

cannot even drive on their own not because they cannot drive but perhaps because they don't know where to go right exactly they don't know where you know and they don't do the

social gps type of things and so forth so looking at all these factors is so critical you cannot just say well this is it and you know i have the answers and let's move on and that

kind of thing and that's why i feel the our unit at providence is is so different because it's dedicated to this population it you know it's a unit within a hospital and most

general behavior units that have worked in the past and so forth it was a mix right it wasn't dedicated for that population you didn't have a staff that was trained for that

population and that's what makes a difference when you can really look at the person as a whole and what their needs are you know whether social whether it's it might be a

placement issue so we stabilize that person you asked me about but now they don't have a place to go back to bingo where do they go because keep this in mind another issue that we

haven't mentioned in this population is a lot of them have lost everyone else a lot of them have no family right they might be i mean like that 99 year old lady remember i mean she had

no one everyone else had died and she would she was cognitively with it enough to tell you oh my goodness right no one in my life left everyone so that's another question and i know

we're counting down but jacob you brought some things to mind too i'm thinking about the relationship that you establish with these patients and with other care caregivers so and

i'm thinking about the receptiveness of care how often is it that people will think well i don't need help i don't want help do you have and you can just throw a percentage

out there in the top of your head what you think of but are most people receptive to receiving help or or you know some people who think that they don't have any issues but you see the

issues and the family members see the issues how in general does that work because i feel like that's a whole other ball game too i mean usually the people that that go to the unit are

are hopefully there voluntarily every once in a while we have the emergency detention orders where we have to the el paso the police department has to get involved because they're

aggressive or but most people are receptive they're on that unit because they need help and they realize that they have help and that happens with all age groups if they're if

they're asking you for help uh that means they've come to the acceptance that they probably can't do it without medication or probably can't do it without therapy and

i'm gonna tell you everybody has some form of mental health issues whether it's depression or anxiety absolutely for yourself yes yeah i have i i'll speak for myself

you're absolutely right dr rodriguez has mentioned adjustment disorders i mean somebody dies in the family it's an adjustment disorder absolutely it's it's we we go

through depression we go through anxiety it's just some people just need a little bit more help and so they are very receptive um unfortunately the stigma attached to mental health is

still there but i'm seeing a lot more people um accepting it yes there's a great book that i love and one of the quotes in there one of the questions is what is the bravest thing

you've ever done and the answer is ask for help and i think that's how we'll kind of stop with with some of these questions here and i want to let everybody know that once um

we're off the air i know this goes by super fast and you can watch this show again and other shows that we've been running uh for years and years and years but you can go to

kcostv.org give them a day or two and then this uh show will be posted on that on that website and just look for watch and programs and you'll find the el paso physician also the el

paso county medical society carries it on their website so once it's posted on case us tv and or pbs el paso sorry i should say that too it was kcos tv when you're on last because

i was looking at our last time here but pbselpaso.org would be the website and then also epcms if you think of el paso county medical society and that one's a.com youtube too everyone

in the world loves youtube so you can also find this on youtube look for the el paso position or pbs el paso but i think you can specifically look for it at the el paso position and i know

last week we had a program about people 12 to 17 getting their coveted vaccinations and for free and very easy and conveniently for you you can go to the civic center monday through friday

from 8 a.m to 4 p.m or saturdays from 8 a.m to 1 and you can just drive through and you just need a parent with you or a legal guardian and you can get your covid vaccine and that will help

everybody and that will kind of get this world somewhat back to normal i want to say thank you so much to tenet hospitals of providence for underwriting this program and i also want to say

thank you to madeline and thank you for watching this program i'm catherine berg and this is the el paso physician good night [Music] [Music] [Music] this is masterpiece i need to say

something i think our marriage might be over so trial separation except not to trial honey