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Bob Lewis (Host): Good afternoon and welcome once again. I'm Bob Lewis with our continuing series of experts talking to us about health from the Summa Health System here in Akron.

Today we're going to talk about, about getting older. The U. S. is facing a major demographic shift. The baby boom population, those born between 1946 and 1966, already halfway into it with the so called retirement age, golden years, senior years, whatever you want to call it. And this presents a significant challenge to our health care system.

It must kind of grow and meet the complex needs of this aging population. For example, we expect the number of Americans aged 65 and older to be about 80 million in less than 20 years, in 2040. And the number of adults ages 85 and older, that group most often in need with basic personal care and more could quadruple between the beginning of the century and the year of 2040.

Joining us today is Dr. Gabrielle Ruff, a Geriatric Specialist at Summa Health to talk about this issue and what they're doing at Summa Health to, uh, help us folks who are getting toward the, uh, the so called, uh, golden sunset years of our, of our existence. So, so Dr. Ruff, first of all, thank you very much for taking time out of your Sunday to be with us here on the program.

Gabrielle Ruff, MD: Oh, thank you so much for having me, Mr. Lewis. It's a pleasure.

Host: Now, this shift in population and the need to support these older Americans has had a big impact already on the health care system. Can you talk about this impact and more specifically talk about how Summa Health is adjusting to support our older population?

Gabrielle Ruff, MD: Absolutely, that's a great question. Um, I would actually like to say I think that Summa Health, for many, many years, has been, um, on the forefront of addressing, um, age friendly care. I had the privilege of doing my geriatric training at Summa, um, about a decade ago. And even then, they were very much on the forefront of addressing age friendly care, which they are continuing to do.

Um, one of the things we like to focus on when we are looking at age friendly care is something that we call the 4Ms. And we, uh, use those to designate money, meals, medication, and mobility. And those are four areas that we notice as seniors get older may need to need a little bit of help and assistance from family, depending on the senior.

Um, but those are areas that we talk to our patients about, making sure that they do have those areas shored up. They do have responsible, trustworthy family members involved in those areas to make sure that those areas are staying safe as they continue to progress, um, through life. We have a program here at Summa, uh, the Senior Health Program, which is in the Senior Health Center; where we do geriatric assessments, we also do memory testing, and we give caregiver support. We know that many of our patients have loved ones who are now providing care, whether it is spouses providing care for loved ones with memory loss. Or children providing care for loved ones with memory loss, or nieces, nephews.

So part of our program is designed to support caregivers and to help them understand the resources that they have available, as again, they help a loved one continue to age well.

Host: What about the new sensory room that you have in your senior health program? What is that?

Gabrielle Ruff, MD: Um, that is a new room that we share with our complex care clinic. Um, it has some unique features, um, that are helpful for patients who may be triggered by excess stimulus. Um, so it's a room that has, um lights that can be dimmed. It has a beautiful, relaxing ocean scene on one of our walls. Um, we have some different, uh, items that can be used for calming. There's a rocking chair. Again, it's a room that any of our providers can use if we know in advance that we have a patient interaction that may benefit from less stimulus.

Host: Do you use it often? Is it something that's used on a regular basis?

Gabrielle Ruff, MD: I believe our complex care clinic colleagues do use it on a regular basis. It's also available to myself and my geriatric colleagues. We have not, I should say, I have not personally used it yet, but I'm looking for the right opportunity, so we're glad to have it as a resource.

Host: So let's talk about some of those specific health conditions that tend to be unique to the older population.

Gabrielle Ruff, MD: Absolutely. Some of the things that we see as, as all of us age, um, that are oftentimes beyond our control, are changes in balance. Sometimes we'll see that there's more risk of falling. Sometimes that can be due to things like arthritis, changes in nerves and sensation in the lower extremities. Medications can also impact balance. And because we're aware of that, we make sure we try to address that when we interact with our patients.

We also have a unique relationship with our trauma service on the inpatient side at Summa, where anytime an older adult comes in after a fall and ends up admitted to the trauma service, geriatric medicine is automatically consulted. So we can come in and address some of those risks for falling that we know are unique to older adults.

Something else that we see, again, which is beyond the control of our patients as they get older is a diagnosis of dementia. Um, there are about a hundred different types of dementia, but our clinic, again, is uniquely situated to address, support, caregivers, diagnosed, many of those different types of dementia.

Um, one of the most common types of dementia, and we'll talk about this a little bit later, I think, Bob, is Alzheimer's. So, again, the biggest risk factor for Alzheimer's is getting older. So, our specialty is poised to help older adults who may be facing that diagnosis and their families as they, they deal with it and learn more about it.

Host: And also, support for the caregivers. This has to be an important part of a, of a treatment for somebody who's older who has the, other people taking care of them.

Gabrielle Ruff, MD: It is paramount. I often tell our families, um, that we interact with in the clinic, that the most important part of the discussion isn't so much me giving a diagnosis or even talking about medications.

It really is when we're pulling in our social work team to talk about the caregiver support. Um, until we find a cure for the various dementias that exist; living with a diagnosis of memory loss is very important. It can be challenging to our caregivers. So our role is to make sure that the caregivers don't feel alone and that, you know, they have a place to turn to if they have questions or they need resources to try to make sure that their loved one is as safe as possible.

Host: So, Dr. Ruff, let's talk more about Alzheimer's and dementia. You've indicated that dementia is the overall bubble from which Alzheimer's becomes a part of that. So, what are some of the common signs and symptoms of Alzheimer's in its earliest stages?

Gabrielle Ruff, MD: This is a really important question, and I'm glad that you brought it up. Uh, the reason is there, there's aging that is sometimes associated with getting older. I'm sorry, there's memory loss. I apologize. That's associated with getting older. And then there's memory loss that actually is associated with a diagnosis like Alzheimer's. So some of the things that a loved one or a healthcare provider may notice in someone who has Alzheimer's memory loss is a sign that someone may see, confusion, uh, trouble with language, maybe losing the ability to name items or objects that they previously could name. Um, oftentimes, mood and personality changes can also be seen. So, these are some of the earlier signs that someone may notice.

Host: And how would these symptoms differ, again, from just normal forgetfulness that we have when we get older?

Gabrielle Ruff, MD: And that's really important for families to understand. How we classify the difference between memory loss associated with normal aging and memory loss associated with a diagnosis like Alzheimer's dementia is primarily function.

Um, as we get older and we might have a little bit of decline in memory, function for normal aging memory loss should still be maintained. Um, someone may find that maybe they need to use to do lists a little bit more and they need to use calendars, but overall, they are still able to manage their life without any significant problems or without any significant safety issues.

Um, someone with a diagnosis like Alzheimer's dementia may find that even using those little cues and tips like a calendar or a to do list isn't helping. Uh, they may also find that there are some memory changes that are presenting safety issues, for instance, forgetting to turn off the stove or the oven after they make a meal or driving somewhere familiar and getting lost. Particularly, we live in a state where it snows, so that could be a safety issue, especially in winter.

Host: What is the difference, though, between Alzheimer's disease and dementia?

Gabrielle Ruff, MD: That is another question that I get very often in my clinic. Um, so I'm glad that we have the opportunity to say this on a bigger platform.

Um, as I mentioned before, there are about 100 different types of dementia. Alzheimer's is one of those types of dementia. So Alzheimer's dementia is due to the Alzheimer's pathology in the brain that is causing that memory loss that we're seeing. It is the most common type of dementia, but it is one of many types of dementia.

So I usually tell people, and many of my colleagues use this phrase, all dementia is not Alzheimer's because there are many different types, but all Alzheimer's is dementia.

Host: What are some of the other types of dementia and what kind of symptoms do they have?

Gabrielle Ruff, MD: Uh, some of the other types of dementia that we work with, uh, vascular dementia may present after someone has had a stroke, and sometimes what we notice is people have a stepwise decline in memory, kind of a plateau of functioning at a certain level, and then there may be a little bit of a drop, and then kind of a plateau.

That we can see with vascular, um, dementia. Patients who have Parkinson's have the risk of developing dementia. And that can sometimes present with hallucinations. People see things that aren't actually there. Another type of dementia that is characterized by seeing things that aren't there is something called Lewy body dementia.

So, those are just a few of the other types of dementia that we also diagnose and treat.

Host: Are there some specific risk factors that could indicate a higher likelihood of somebody developing Alzheimer's?

Gabrielle Ruff, MD: Absolutely. As we mentioned earlier, age is the biggest risk factor for developing Alzheimer's, but a family history also will increase your risk a little bit more above that of the general population.

There are certain genetics that are tied to having a higher risk of developing, um, Alzheimer's. We also know that trauma to the head, head injuries earlier in life, can sometimes accelerate, um, the presentation of dementia in some patients.

Host: Now, I notice da lot with celebrities of the recent years, and rather young in life in their 50s or 60s, developing Alzheimer's and dementia, and many of them had long histories of excessive drug use, uh, back in the 80s, for example, or excessive alcohol consumption. Can using drugs or alcohol at some point in life excessively, could that contribute to an early onset of some sort of a dementia or Alzheimer's?

Gabrielle Ruff, MD: 100 percent it can, yes. Um, I would say specifically more overarching dementia. Um, substance abuse can contribute to that. Uh, if you think about, for instance, alcohol, someone who is excessively using alcohol is continuing to expose their brain to a toxin, and over time, that does cause damage that presents as dementia.

Host: What about things like smoking, which we can kind of blame for almost everything in the world. Can smoking also do that?

Gabrielle Ruff, MD: We can still blame smoking for many things. Smoking is also problematic because smoking can impair vascular health and just like the heart, the brain has blood flow and it's important that that blood flow is maintained to keep the brain working at peak performance.

So, smoking can definitely contribute to the risk of dementia, specifically when we're looking at our patients with vascular dementia. Smoking increases the risk of having a stroke. Having a stroke can increase your risk of developing vascular dementia. I like to tell my patients the things that keep your heart healthy, keep your brain healthy.

Host: So like watching your weight, having a good diet, keeping your cholesterol levels normal, that can also not only contribute to good heart health, but good mental health too.

Gabrielle Ruff, MD: Absolutely.

Host: Let's talk some more about how people diagnose early stage dementia. As a medical professional, how do you officially diagnose that?

Gabrielle Ruff, MD: We use several methods in our clinic. One of them is cognitive testing, and these are standardized tests that are designed to look at how different areas of the brain are processing information. All of these tests have a normal range that is based on someone's age and education level. So when we're administering these to our patients, we're looking at how they perform and the range that they fall into to kind of give us the first peek into whether or not there may be something going on with memory, um, that is beyond what we would expect for normal aging.

And that's just one piece of the picture. It's rare for us to just use that test as its sole diagnostic feature. We also take into account what family members or other loved ones are telling us about the individual because we're looking at memory performance and function when we're attempting to make a diagnosis.

So, one of the earliest things that we'll do is some cognitive testing and getting a history of function from family when we have someone who's presenting with memory loss and we want to see if this is something like dementia.

Host: Does the person who actually is suffering from dementia or Alzheimer's, are they aware of it? Do they know there's something wrong? Or do they, it is a disease so such that they don't even know there's anything wrong with them directly?

Gabrielle Ruff, MD: That's another great question. I will say that I have seen both in my practice. I'd say probably more of my patients have less insight into the fact that they have dementia and that is, that's part of the disease process and it's typically hard on caregivers because being able to care for someone, a lot of times, is contingent on their cooperation.

So, if someone doesn't have the insight into the fact that they have a deficit, it makes it very hard on caregivers. There have been some patients in my practice, though, and this has been a unique gift to their families, that do have insight into their memory loss, the diagnosis of dementia, and actually have been able to help their loved ones plan for the future. But, I'd say, by and large, the majority of my patients have lack of insight into that process.

Host: So, Dr. Ruff, what would be some of the benefits of the early detection and diagnosis of dementia and related conditions?

Gabrielle Ruff, MD: I like to tell my patients and their families there's so little in life that we have control over when it comes to the future. This is one of the things that we can do to help give them some control over the future. Early detection allows the family to plan for support in those areas we talked about at the top of the 4Ms, Money, Meals, Medication, Mobility. It allows them to put things in place to make sure that someone is not at risk for being, um, exploited financially, um, and make sure that they put things in place to make sure that there's someone maybe going with a loved one with dementia to the doctor to ensure that all the important information that's being delivered is captured and acted on. Um, if someone needs to retire from driving; that's a process that we can start looking at if we have early detection of dementia, again, keeping that individual safe, as well as other people on the road. Um, making sure that someone is still eating well, maintaining their nutrition. All of these things are areas that we can act on if we do know early what's going on in a patient who has dementia.

Bob Lewis (Host): At this point, what kind of treatment options are available that could slow or eliminate the progression of Alzheimer's?

Gabrielle Ruff, MD: That is a big question that a lot of my patients and their families have. And I like to say that fortunately there are people much smarter than me that are continuing to work on this every day. And I hope that I see a cure in my lifetime.

Um, right now what we have are modalities and medications that can slow the progression. There's certain medications that work with chemicals in the brain, prevent those chemicals from being broken down quickly, which kind of allows them to stay around longer. And that can help with concentration.

Um, we have some newer medications that have actually come on the market and made a lot of news when they were introduced and these medications act specifically on some of the proteins that have been identified as problematic in specifically Alzheimer's dementia. So we do have medications that can slow the progression, but currently we have nothing that is curative.

Host: What is, biologically, what is the cause of the, of these, of Alzheimer's? What actually is happening in the brain that causes it to break down?

Gabrielle Ruff, MD: There are some, there are some, I should say, there are different kind of pathologies going on, but one of them is the presence of abnormal proteins that are problematic for the transmission of the signal across neurons, which is what one of those unique medications that came out, I want to say last year, actually looked at is those abnormal protein deposits in the brain.

Host: Now, is there any, any, uh, proof that, say, staying mentally active can stave off or to, or can, uh, uh, slow, again, the progress of any kind of dementia or Alzheimer's if you use your mind more, if you think more, if you, uh, uh, I guess, I guess you try to be more aware on your own, on cognizance, uh, cause that, could that, like, exercise the brain and keep these things at bay?

Gabrielle Ruff, MD: There's a huge benefit to staying cognitively active. Um, it improves your memory and improves reasoning and processing speed. So, yes, it is definitely helpful in slowing the progression of, of dementia. Absolutely. And we like to encourage our, um, our patients who do have a diagnosis of this to stay active, to do things that they enjoy, to stay social.

Interacting with other people does help continue to maximize the brain's ability to to process language. We noticed that many patients during the pandemic who were isolated had a progression of their, their symptoms of dementia because they weren't interacting with people. They weren't socializing. So socializing is a huge part of maintaining brain health for as long as possible.

Host: So what, what steps can an individual take if they suspect themselves or a loved one could be exhibiting these early signs of dementia?

Gabrielle Ruff, MD: The most important step is talk to your healthcare provider. That's first and foremost. It's easy sometimes to just brush off some of the signs of early dementia as, oh, this person's just getting older. Oh, this is just, you know, memory loss, that's normal for aging. But the truth is, we don't know until we assess it. So, first and foremost, I would say getting evaluated by a healthcare provider. And that can be your primary care doctor. Um, and if your primary care doctor is comfortable diagnosing and managing, that's fine.

Um, sometimes primary care doctors will refer to our clinic for a more in depth assessment, and that's also completely appropriate.

Host: Dr. Ruff, let's go back to one of the original things you talked about, a concern about the senior population falling, falling and losing their balance. Uh, this is again a major, major problem with people as they get older. What is it about getting older that makes them some unstable on their feet?

Gabrielle Ruff, MD: That's a great question. Um, as we get older, um, muscle mass can decrease. Um, also for patients with joint issues or inflammatory issues of the joints like arthritis, that can increase pain, decrease mobility. Um, some patients due to things like diabetes may have some nerve damage in their feet and legs that actually decreases the ability to feel the ground under their feet.

Um, that can pose a problem with falling if you can't actually feel where you're walking. Some patients also are on medications that can lower blood pressure. So if someone's on a medication that can lower blood pressure, they stand up too quickly, the body doesn't quite compensate, there's some dizziness and someone can take a step and fall.

Those are some of the things, um, as we age that can contribute to the risk of falling. Vision changes also can contribute to the risk of falling. If vision is worsening due to something like glaucoma or macular degeneration, that may make it hard, especially in areas of low light or areas where there's a contrast difference, um, like stepping off of a curb, that can also contribute to falls.

Host: And, uh, what about working with, uh, with the caregivers and also with social workers to, uh, for example, assess a, a senior's, uh, living conditions and maybe recommend that they could use a extra banister or railing here or there or, or, you know, again, a special kind of maybe chair or somewhere to help them out.

Is there anybody that helps people do that by actually going into their home and, and giving it, if you will, a safety check?

Gabrielle Ruff, MD: Absolutely, yes. Um, caregivers are welcome always to look in the home and look for things like rugs, um, sometimes step stools can be more problematic than they can be helpful. But also we have physical therapists, occupational therapists who can sometimes perform what's called a home safety evaluation where they can actually come into your home and look for the areas that need more support to prevent falls.

Again, areas where rugs may need to be moved. Areas where grab bars, um may need to be installed. Um, if there's safety issues in the bathroom, physical therapy and occupational therapy can help with that. And social work. Social workers are some of my favorite people in the world. They also can, again, help with resources for caregivers, just globally, who are looking for help when caring for a loved one with with dementia or a loved one who's just dealing with some of the sequelae of getting older.

Host: Now there's been a lot of emphasis, of course, that trying to get people to stay into their homes as long as possible before having to go to a nursing home or, again, because of their health conditions. This is a, but on the surface seemed to be a good thing, but on the other hand, you seem to raise some concerns that possibly somebody has to make the judgment that somebody really cannot live at home, by themselves, or in their old home, they have to have a change of scenery or even a, uh, going into an assisted care or more fully care facility. How can you work out that? How can you convince someone to do that?

Gabrielle Ruff, MD: Oh, you know, I still don't know that I've figured out how to convince people to leave their homes. Um, we do the best that we can, again, to get the buy in from our patients if we can.

Um, oftentimes, really, who we're convincing are the caregivers, though, who may be in a position to make that decision, even if their loved one does not have the insight or the capacity to make that decision. And a lot of times, what we do is we're weighing safety. Um, one of the hardest things that I think I have to do in my job is help people make that decision of when it's time to move to a higher level of care and primarily what we're looking at is safety.

As you mentioned, the goal is to keep people in their homes as long as possible because that's a familiar environment. It's a comfortable environment for many people. They own their homes and that's a source of pride and dignity and we want to support that as much as possible, but when safety becomes the overarching theme, that's usually when we have to share with caregivers that we may need to look at this next step.

Um, excuse me. Again, if someone is having trouble remembering to turn off the stove. Um, if someone is having trouble with falling because they live in a two level home and they just can't navigate stairs. We really try to support the caregivers in instilling as many things as possible in the home for safety, whether that be cameras so they can kind of see how someone is doing in the home and if they fall, they won't stay down, you know, for days until someone finds them, or using automated medication dispensers so someone doesn't have to try to remember to take their medications.

We try to do as many things as possible to ensure that someone can be safe at home, but when all of those measures have been put in place, and someone still is unable to stay safe at home; that's when we really have that conversation with the caregiver and the patient about looking at the next level of care.

Host: Now, Dr. Ruff, how can somebody find out more about senior care at Summa Health?

Gabrielle Ruff, MD: Um, you can visit, uh, summahealth.org/seniors. Um, the number to our clinic is also 330-375-4100. We take referrals from primary care doctors. We actually take referrals to our clinic from any doctor. So, if you have a loved one who you're concerned about, you can definitely reach out to their primary care doctor and see if they might be willing to make a referral.

If you're a patient and you are concerned about your memory personally, you can ask your doctor to make, um, a referral or you can call the number that I just mentioned and, um, make a, an appointment for yourself.

Host: Once again, to find out more about Senior Healthcare at Summa Health here in Akron, call 330-375-4100. The website summahealth.org/seniors, 330-375-4100, summahealth.org/seniors. Dr. Gabrielle Ruff, Geriatric Specialist at Summa Health. Thank you so much for being with us here on WNIR Kent Akron. A great discussion and I hope we, uh, reached a lot of people out there and, uh, hopefully gave some folks some really good advice about what they can do because getting older is, uh, inevitable. There is only one of their option, and we don't like that at all. Right?

Gabrielle Ruff, MD: Right. But we love what we do and we're happy to help.

Host: Thank you.

Gabrielle Ruff, MD: Thank you for having me, Bob

Host: Again, Dr. Gabrielle Ruff, geriatric specialist at Summa Health. I'm Bob Lewis.

The talk of Akron, WNIR!