Dr. Ethan Levine

Hi, this is Dr. Ethan Levine. Welcome to the latest edition of the Mental Wealth Podcast. Today’s guest is Dr. Sura Gourmay, author of Mindful Aging. And Dr. Gourmay, if you can introduce yourself to our listeners, I would appreciate it.

Dr. Surah Grumet

Hi, nice to be here. I’m Dr. Sara Gremay. I currently reside in North Carolina, and I have been practicing family medicine, particularly geriatrics. I also have a specialty in hospice and palliative medicine. I currently work at a company called Eventus, Whole Health. We practice in what we call the post-acute long-term care. So that is a fancy way of saying we take care of people who live in either independent living facilities, assisted living facilities, or skilled nursing facilities. So these tend to be older people who are frail. Some may be a little bit younger, but have advanced illnesses. So we take care of quite sick population.

Dr. Ethan Levine

I’m curious, what inspired you to work on this book?

Dr. Surah Grumet

So mindful aging has, I feel like it’s something that’s always been in the back of my mind. It’s almost like if you have something that you do and you’re doing well and you love doing it, but you find that you’re saying the same thing again, maybe time and again. Doing, taking care of older people, especially in America, we have a certain setup where as we age, there are certain things that we can do or not do. And so I ended up saying the same things to friends, to family, to patients, to their family members. And it felt like it was a great time to kind of put together things that I wish I had known before I started this practice or things that I wish my family and friends knew along the way, maybe earlier in their lives so that they could prepare for what it means to age in America.

Dr. Ethan Levine

So what you’re saying is the book’s written not so much for the older population that you serve, but for really the rest of us?

Dr. Surah Grumet

So that’s a really good question. Right now, it’s about 10 chapters. And I would say a lot of it is for older people as well. But I do wish it were read by people who were younger. I think I have young adult children, they may not be as interested or ready to read it. I wish they would. I wish that everybody kind of had it as a companion for them throughout their lives, because there are things that can help us age well. I do look at it for what I have come to think of the term as the sandwich generation. So those folks who are maybe taking care of younger children, but also their parents are aging, a lot does fall on our shoulders during that time. And I do especially think This book is probably particularly for that group of people. However, I think it would be helpful for kind of anybody who’s going to age in America.

Dr. Ethan Levine

So what things really have stood out for you over your career along the lines of mindful aging?

Dr. Surah Grumet

One thing is for sure for every person that I meet and take care of and their families is dignity. I think that everyone wants to have their goals and values listened to. And I think that’s not something that medicine today kind of takes into account, which is why I feel very grateful to practice in an organization that has an integrated group where we have mental health providers, psychiatrists and nurse practitioners, as well as talk therapists taking care of or working with anybody in their health. You really have to look at the whole person. You’re really not going to be able to cure someone’s diabetes or heart failure without knowing who they are, knowing what their values are. You know, they just can’t not eat that favorite Chinese food, even though each individual is going to be a little different. I think in general, I’ve learned that humans are very similar. We all want respect. We all want dignity. And if our providers and people who are trying to help us or are on the same page with getting to know who we are, what our values are and what our goals are, that definitely helps along the journey of health.

Dr. Ethan Levine

If I’m reading into this, it would sound like you’re saying that whether we’re medical practitioners or not, that same kind of approach is important.

Dr. Surah Grumet

Absolutely. We go see our doctors maybe once a year, maybe as we’re older, a little bit more. I know a lot of older people who are retired spend a lot of time going to specialists and others, but think about it, like day-to-day, who do you interact with? That’s really what brings us health and to me that’s wealth, having those relationships and maintaining security and health and happiness.

Dr. Ethan Levine

So as a practitioner… What does this look like?

Dr. Surah Grumet

I think greeting somebody, getting to know them, building rapport as a provider, I think that goes a long way. Physicians have been over the years and over the decades. Things have changed for the better. I think there was a study done some years ago showing that a doctor will ask you, how are you? Or what’s going on? And they interrupt within 10 seconds. I think that was the timing was done to see When asked like, Hey, how are you? You know, what brings you to the office? You’ll come in and say something and they’ll interrupt you. So I’m hoping that that trend is changing because if we can’t listen, then we can’t work together.

Dr. Ethan Levine

So give me an example of somebody that you’ve worked with that you learned from them rather than the other way.

Dr. Surah Grumet

Oh yeah, I have so many. One of the things I did put into my book is I anchored my chapters with patient stories. I cannot tell you how grateful I fell into geriatrics. Family medicine, I did deliveries, I did newborn well care. I took care of people mid-age and elderly. But of course, in the office, you know, it’s all mixed up. But as I’ve concentrated more in geriatrics, so taking care of really people towards the end of their lives, I’ve learned so much. I mean, the wisdom that people have towards the end of their life is huge. Really, most people just want to be listened to. It doesn’t take that long to feel listened to, and I have had the opportunity to learn so much from my patients and their families, and I feel blessed and lucky that I’ve been able to have these kinds of interactions. I don’t know that I could say one particular person, but I think in general, being in this field, you really have to be patient, and once you have that patience and can listen, you can learn so much, and I think that’s really the anchor of these chapters is what my patients have been through, what experiences they had, the problems they’ve had, how we’ve all come together to solve those problems.

Dr. Ethan Levine

I’m curious, with this kind of attention to listening and learning, how’s that affected your relationship with your kids?

Dr. Surah Grumet

One of the other wonderful things about my practice is I’ve been able to have a wonderful family life balance, which I think is pretty unusual and so important for not burning out, as they say. The kids go through stages, right? They have the fun things of youth, of being infants and growing, and now especially having them be adult children. I do think they’ve heard me have these conversations with families and patients. And even when I dictate my charts, my daughter would kind of make fun of me about some of the things that I would say when I’m dictating. But, you know, they’re listening, you don’t realize that they hear the things that you’re doing, which I think is wonderful.

Dr. Ethan Levine

The things that you’re saying resonate for me with the word mindful. I’m wondering how, you know, what caused you to use that specific term.

Dr. Surah Grumet

That’s a good question. I do feel like it’s gotten a little bit, how do you say, overused in our society. And I had to kind of really think about what that meant and why I chose it. So thank you for asking. I really meant it as the comparison to a lot of books about aging, which are like how to be younger, how to beat aging, your telomeres and your, this serum and drink and all these things that we, we try to do to beat aging, right? So I chose that word to tell everyone this is not about fighting aging. This is about what I’ve seen and observed as a practitioner and human with my own family and parents and just some guidance, I guess, and a companion about some common things that happen as we age and die.

Dr. Ethan Levine

So when you think about that balance, this population, a lot of people are looking for the pill or the shot or something. How do you steer that conversation towards the other side of the fence? Or what do you recommend on the physical side?

Dr. Surah Grumet

That’s such a good question. And it’s so timely. I’ve had family members and friends and patients ask about tests for dementia, there was a hopeful medication that really hasn’t turned out to be as good as we had hoped. It’s about the same or equal to the current medicines that we have, which, you know, it’s not to say it’s not going to do anything, but getting to the value and goal about what is the fear. There is a fear for all of us about aging. I think in our society, we don’t really talk about death. We don’t talk about aging much. We don’t have many movies about it. I’ve been impressed with the New York Times. They have had actually frequent articles about aging, which I’m like, yay, finally, somebody is paying attention to our aging population. We have aging boom in America. In the next 20, 30, 40 years, we’re going to have a lot more older people, a lot fewer younger people. So kind of getting on board with that, I think is really important.

Dr. Ethan Levine

So what advice do you give to the sandwich generation people about how to manage that relationship and the mindful aging piece for their parents?

Dr. Surah Grumet

Right. I’m just going to be honest. There’s no pill. There’s no magic word. I think just starting as if you are the care partner or child, son, daughter, best friend, or whoever the caregiver is, just knowing that you can’t do it all, I think that is a really good place to start. because we want to be good people mostly, right? That’s generally, we want to do the right thing. And sometimes I have seen family members who feel like they have to do it all. Maybe there are a group of siblings, you’re the only one who lives near the parent or the family member or loved one. Maybe that person has no other family, so you’re kind of, you’re it, right? And definitely that is a uniqueness of America, I think. Maybe not only America, but it is a uniqueness of America. Independence is our Our Cree, right? We talk about our independence. That’s a foundation of America. So not a lot of us live together with families, multi-generational families. So we end up being more alone. And that is hard when you’re aging because it’s hard to age alone. It’s hard to be an infant alone. It’s hard to age alone. So we need our community. We need people. So knowing that you’re going to need help is really key, otherwise you’re going to get stressed out and you’re not going to be able to do it. Knowing what resources there are, knowing who can help, knowing where to look depending on the problem. I think that’s another reason I wrote the book, so that people know what resources we have. So yeah, I think that was another reason I really wanted this book out there, because there are resources for people, for the aging person, that if the child or caregiver doesn’t know about them, they wouldn’t know to ask. It’s not really advertised. So again, these are things I learned slowly over the years to look into and be able to offer people.

Dr. Ethan Levine

Let me ask you about one of the situations that I know a lot of people go through, and I’m interested in your perspective. There’s a couple of aspects to it. You see your parent beginning to show signs of dementia, and how do you handle that conversation, or do you have a conversation?

Dr. Surah Grumet

Well, I think that really depends on, let’s just say, your loved one, because who knows if it’s a parent, an aunt, an uncle, a best friend. It depends why you want to have the conversation. I mean, you’re observing what you’re observing. You see what you see. But is there a reason you have to have the conversation? I think that’s the question you need to ask. Is it, are you worried about their safety? Are you concerned about them being able to eat, stay healthy, hygiene, dry? So I think it’s important to understand what you observe and then decide what battles you want to choose, because that’s where I see a lot of conflicts arise. You could even start by just saying, Hey, mom, have you noticed some changes in your memory recently? And I will bet most of the time, most people, if you ask it in that way, they’ll probably share with you. If you come up to them and you’re like, Mom, I’m really worried about you because… You’re probably going to shut the door a little bit. that conversation. So I think just going in with curiosity without judgment and genuine curiosity helps kind of lay out what might be happening. Now, if you know it’s true and your parent is like, I’m fine, that’s a very different conversation than if they’re like, yeah, I’ve noticed so and so, you know, so I think knowing the person, their personality, and really, again, coming back to what are you worried about? People do age and they forget names sometimes and they, you know, so there is some of that, not everybody, but lots of people have that. They notice those changes and that’s okay. So I think knowing why, why are you asking?

Dr. Ethan Levine

Well, let’s take the easy one. Assume it’s a safety risk, you know, it gets into the area of being able to drive. How do you handle a conversation?

Dr. Surah Grumet

Yeah, I have to say doctors can be fired, right? It’s, you usually by the patient. And I would say in my 20 years of doing what I do, I have been fired two times. And both of those times are when I brought up driving safety. And they were true driving safety issues. One was an accident that was obvious. because of limited neck movement, vision, I was left to that conversation ’cause the family didn’t want to address, and I had to because it was dangerous. The other was memory. So somebody got lost and ended up two states away. And both times the person got very angry and just requested another doctor. So, you know, you have to be careful because you can push people away. It doesn’t mean what you observe and what you see, even though it may be true. even as a loved one or a family member. And I’m sure that’s why people often come to me to share the news, right? Because they don’t want to be the ones. And that’s fine. I’d much rather a family maintain a relationship. They can find another doctor. I want them to maintain their unit of family. So it’s a challenge for sure. That’s extreme. But I would say, again, knowing there are resources and the tool that I learned to answer your question, I think in a helpful way, like occupational therapists have driving schools. Some university settings have like an official driving school. So in North Carolina, there’s a Duke driving school, and it’s run by occupational therapists who use mock wheels and they monitor all the important things for driving. And they will let the person, sometimes they do that automatically after someone’s had a stroke or other debilitating accidents. So there are resources. If you don’t have an official driving school, you can get a referral for an occupational therapist to make a recommendation. There’s obvious tests and results that is not a personal affront, right? Because people feel you’re taking away their independence. That’s how they get out of their home. That’s how they go shopping. That’s how they get to see their family, right? Their transportation is key. Also, I would say starting with another idea, something like finding an app, like an Uber app, having an alternative available and not just being like, we’re taking your car and you can’t go anywhere, right? So I think just thinking about the whole picture and starting before there’s an accident or before the person gets lost. And sometimes people will agree, and I’ve had good luck with like family members or patients agreeing to, I’ll just go to the store, like I’m not going to go more than five or 10 blocks. And a lot of times that solves the problem. So I think thinking outside the box a little bit, having honest conversations, listening to what are anger points or flashpoints where that person is really just not going to do what you’re recommending. And you don’t want to break that relationship because of that. And people are allowed to make bad choices, right? That’s the other thing. It’s like, you’re allowed to get in an accident. If you hurt somebody else, then, you know, And sometimes that’s another thing. I think another thing I’ve learned from patients over the years is, changing it being about them and more like, hey, maybe your car, grandma, wouldn’t be great if you could give it to your grand. son or granddaughter. So kind of making it into a volunteer opportunity where they’re helping somebody else. It takes away the attention of the why and it makes it into something good that they can do that benefits the whole family. So I think someone’s much more likely to do that in a positive way than taking away your driver’s license.

Dr. Ethan Levine

I’m interested if you have any guidance for people on how to handle the situation where the spouse is hiding or protecting or won’t let you in. They’re protecting that.

Dr. Surah Grumet

I see what you’re saying. Yeah. So that is such a fascinating thing. I have definitely, I’ve taken care of lots of partners, whether they’re husband and wife or friends that have lived together for 20 years, just partners. And it’s so interesting. You definitely see how in a couple of whatever kind it is, people take over certain jobs or roles. Maybe one person does the banking, one person does the shopping. So you have a unit and what happens I’ve also seen is that perhaps one person, their cognition is limited, but one, their vision is poor. So one is kind of using the eyes of the other, but the cognition of the other. So people develop when they’ve been together a long time, they don’t even know it. They don’t realize it. So when you’re showing somebody there’s a problem with your husband or wife, that also puts that person in some ways at risk, possibly for maybe they have severe arthritis or they have Ms. or they can’t get out of the house, they’ve counted on or needed their Their partner to do a lot of that for them So they may be masking or hiding for a real reason and I’m lucky to usually take care of both partners And so taking care of one is often also involving taking care of the other and so one of the chapters I talk a little bit about dementia Happening and how this couple kind of worked out a very beautiful way to manage that. So it’s hard.

Dr. Ethan Levine

So you’re saying looking at the bigger picture too, not just the hiding, but the why?

Dr. Surah Grumet

There’s probably a reason they’re hiding it, yeah, and finding out and digging a little. Being patient again, and maybe not that first time. But if you start noticing it, a lot of times family members, so kids or loved ones will know the story behind it. I love having that family medicine background where it really is a family and you can get hints and ideas from those. If the patient allows you to talk to family, it can be really helpful.

Dr. Ethan Levine

So at what point should people be thinking about mindful aging? When should we think that we are aging?

Dr. Surah Grumet

From the day we’re born, we’re aging, right? We’re going through stages. Each stage of life has its challenges, right? In adolescence, it’s our independence or getting to know who we are and young. adulthood, we’re being productive, we’re having careers or getting married and, you know, starting a family. I think people start to realize it probably in their forties or late thirties, depending on that each person is a little different, but you start to notice you’re not functioning the way that you did before. I mean, to me, that’s a great time to start thinking. And also if you’re aging at that time, your parents are also aging. So perfect time to start thinking about retirement plans. That is something kind of unique to American society where we have a little bit of a safety net, but not a big one. So thinking and planning for retirement earlier, right? I was so thankful my daughter’s economic class, they actually spent time talking about like what it really was, what is banking and like what is retirement? I was like, that’s the best, you know, high school economics class I’ve ever heard. You know, so thinking about these things early, getting plans in place, I think as early as you can, it’s great. Some people didn’t grow up with a lot. And so it depends on where you’re starting and what resources might be available to you. And I do talk about that a little bit in my book as well. America is not like a unified society, right? There are definitely those who are poor, middle class, rich, ultra rich. We had our first, what is it, billionaire or trillionaire, right? So there’s a stark difference in resources. So it really depends on what your resources are and That does play a part. If you have Medicare, Medicaid, all of that does play a part in planning for the future. So it’s important to know these things early.

Dr. Ethan Levine

During the writing of the book, you talked to some experts in different areas, and I wondered if there was something that you learned that surprised you. And then overall, in this process of creating this book, what have you learned about yourself?

Dr. Surah Grumet

I think one thing, I’ve known this, but it kind of came into sharper contrast when I interviewed Lynn. She’s a lawyer who does elder care and estate planning. And I don’t think I really understood the difference between a power of attorney and a durable power of attorney. And I think that’s really important because if you select someone to be your durable power of attorney, you don’t have to wait and get a letter that you have a cognitive impairment or some problem where your power of attorney comes into play. So I think everyone should have a power of attorney. Again, I think that’s like a high school or a college thing where all Americans should be able to appoint someone to help them. We do have next of kin laws, which is great, but having that is really important. And I think knowing the difference between a power of attorney and a durable power of attorney is something I didn’t really realize the importance of that.

Dr. Ethan Levine

So how do people go about that?

Dr. Surah Grumet

So a durable power of attorney generally I believe there is a way, most of the time it’s done by a family lawyer. I do believe that there are ways, like some community centers will set up free services for folks. So it depends if you can afford it, a family lawyer. If not, a lot of community centers do set up ways to get these done that are either cheaper or free.

Dr. Ethan Levine

Do you feel like everybody ought to establish that? Why?

Dr. Surah Grumet

Think about it. At some point, the possibility of you needing help in the future is large. At some point, we all need help, right? Whether it’s a younger person who unfortunately just was taking care of somebody who was in a horrible car accident and they were unconscious for some time. And you know what? That person, even though they’re in their 30s, they need someone to speak for them. So a lot of times, even a bad illness, whether it’s a pneumonia or a bad COVID infection, there are times when we want We need somebody who’s going to be taking care of us. And while, as I mentioned, most states do allow next of kin to do it, it’s helpful to have that in place.

Dr. Ethan Levine

What have you learned about you?

Dr. Surah Grumet

I personally went through a really hard time with my dad, who had early, kind of a young onset dementia. He did pretty well for some time. I was in a different state from him, although I visit frequently, so it really felt a lot of it on my mom for the caregiving. We have a loving family, but you know, still it’s it’s a big challenge. So I think trying when I when I was writing the book, I definitely thought a lot about my own experiences and what helped me, what challenges I had. I felt guilty when my dad fell, had nothing to do with me. But we all go through these. It’s it’s part of being human and being a loving person. And it also helped me kind of put into one place and things that I’ve been thinking about for years, and that was very satisfying. So I think I got a lot of satisfaction of writing it and being in the editing phase now. It’s really fun.

Dr. Ethan Levine

Do you feel like you’ve changed as a person in some ways?

Dr. Surah Grumet

Yeah, I do, because when I started the book a year ago, I never would have thought of myself as someone who would have or could have written a book. And I think that it is something that is very joyful. And I’m so glad that I did it, and I’m so glad I have a family husband who’s supportive of me writing away for hours when I could be doing other things with them. And so I think just I’ve learned that being able to talk about it and share it with people who might be interested, and it’s okay to share. I’m kind of a private person. I’m not great about talking about myself. That’s not one of my personality traits. So it’s okay to have it talked about and share it with people. So that’s something I’ve learned for myself.

Mukund

How does culture impact caring for aged people? Have you come across cultures, differences?

Dr. Surah Grumet

It’s incredible how different cultures around the world have kind of included, solved, maintained elder of their community. And if you think of like A lot of Europeans came to America long ago. And I do think that in those times, like when I think family was also kind of a lot of people lived together or maybe even a compound. I do think that those who have come more recently from other places have maintained those. closer family ties, I’ve noticed that doesn’t matter where they are in the world. They definitely come with more of that like expectation of caring. I’ve also had other American families who have decided to have the person move back in. Maybe they lived apart and moved back in. So there definitely are cultural differences. There are definitely cultural differences about death and dying. That is huge thoughts of the afterlife and how to care for somebody as they’re dying. So there are many cultural differences. The nice thing about America is it is the melting pot. There’s so many people from different places. I’ve actually learned so much about that. So that’s been something I’ve had the opportunity to learn about.

Mukund

When people come to you, what are the main reason they talk to you? For example, is it anxiety or is there any reason that it’s associated with aging specifically?

Dr. Surah Grumet

That’s a really good question. It really varies. I mean, if you were to go into an urgent care, the most frequent reason for visits is like low back pain. So for sure, I get a lot of pain, anxiety, and… depression. Maybe they don’t call it depression, but signs and symptoms of mental health distress are huge. Questions about memory loss is another big one. A lot of people come to me. I take care of people at the older range. They come to me with 20 medications, and that’s a whole chapter in my book is to talk about, do you still need to be on all pills each specialist gave you 5, 10, 15, 20 years ago? So that’s definitely a big part of my practice. They come to me with a symptom, and a lot of times it ends up being what call polypharmacy. So interactions with medications that, you know, maybe shouldn’t still be on board or need to be rethought. So that’s a huge one too.

Rob

I was really interested in your, the idea of dignity, aging and aging and dignancy. I think that’s a big topic. I’m just wondering whether you have any suggestions for people that are speaking with their parent now that is, as you suggested, they’re either struggling with a cognitive decline or some sort of behavioral issues, what steps they should take for themselves, the end of it to caregiver, what they should take for themselves, both to sort of alleviate some of that tension between the relationship and also how they should communicate with their parent as they’re aging and accepting that change in their parent.

Dr. Surah Grumet

I think you answered your own question. It is from the children who I interact with, which is many and caregivers in general. This is probably one of the most common problems is how do you handle the stress? I’m assuming that the question that you have is around you’re worrying about a parent, a loved one, or people, you know, worrying about someone who’s aging, maybe with cognitive decline. It ends up being called behavioral problems. So along with cognitive decline, people get confused, they get angry. They get paranoid. They get all the things that people, you know, can happen to people. I think along with dementia, those things are very, very common. And they can be scary as a loved one, as a partner, husband or wife of someone who’s having those symptoms. Now, again, are these symptoms that are hurtful to someone? Are they harmful? Or are they just confusing as the partner or, you know, caregiver. So I think having someone to educate you or having a support group can be really helpful because if you’re just coming to this and your husband, wife, mother, whoever, uncle, is suddenly acting paranoid or, you know, getting angry, losing their temper, screaming, a lot of times you see people who have certain kinds of dementia behaving in ways that they never would have before. I went through that with my own dad and that was horrifying to see him fight with people. Like we used to call him the cheerleader because he would just always be complimentary and cheerful. And when the dementia kicked in for him, he would get angry when he would get either hungry or confused. And it took a while for us to educate, even as a physician. So I would recommend as an observer, somebody who’s a caregiver to educating yourself about what are some things that can happen to a person as they decline or have cognitive impairment. So these are usually mechanisms that we’re using. Let’s say I’m the person with a cognitive decline. I’m saying someone stole something because I can’t find something, right? So that’s a protective mechanism. I’m protecting my own dignity, right? By saying someone stole my rings or someone took my money, right? Or I’m confused that maybe my husband is still working or going out shopping. And so I’m saying they’re cheating on me because they’re not here with me all the time and I want them here. So I think just educating ourselves about what can happen, what is kind of a typical response to dementia can really help us handle that. There are tools, and this is, again, I talk a lot about occupational therapists. I interview a wonderful OT who her whole focus is on dementia and how like really amazing tips and tricks that you can do, whether it’s modifying the environment or modifying your approach or being a just listening or, you know, coming to somebody sort of at their level. Maybe they can’t see or hear as well, but they also have cognitive decline. So it can be very like scary, right? So thinking about these things is really important. Knowing, getting this information, I think is why I want this book out there so people can know these things are very common and there are some simple things we can do to help.

Dr. Ethan Levine

I know one of the situations you and I have seen is where a loved one is in the facility holding hands or sitting very close with someone else and their spouse comes in. What do you say to them?

Dr. Surah Grumet

It’s so important that you say that because when somebody, especially in a memory care unit, the most common reason people end up having to leave their home for memory is sleep disturbance and behavioral disturbances. So if they’re in a memory care unit, it’s usually because of those things. Unless it’s just there really is no one else to take care of them. But let’s say they have a husband or wife or spouse or partner. They’re usually there for those reasons. So I think as the partner without the cognitive problems, knowing that their loved one, it’s not an insult. They don’t remember you. A lot of times people with dementia will think of you, they’ll recognize you, but they won’t know your relationship anymore. So they may call you their mother. They may call you their sister. So they go back to like their early age. So it’s not personal. It’s not something that you did wrong as the partner. So they’re really in a different stage of life. They are not trying to be hurtful. It doesn’t make it easier as a partner, but it does help know where you are to where that person is.

Dr. Ethan Levine

So if there’s one piece of advice that you’d give to our listeners, what would it be?

Dr. Surah Grumet

I think just knowing that you’re not going to know everything and knowing that there are resources available, whether it’s mental health support or PT, physical therapy, occupational therapy, speech therapy, mental health therapy, all these things are available. They are typically done by people who know they’re caring for older people or people with disabilities. They have self-selected. So these are people who want to be there helping. And so knowing when to ask for resources is, I think, the one thing I would like people to know.

Dr. Ethan Levine

Very much appreciate you taking the time with us today and hope we get to see you on another podcast in the future.

Dr. Surah Grumet

Thank you for inviting me.

Dr. Ethan Levine

The.

Mukund

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