Dr. Paula Hartman-Stein 0:00
So people whose window looked out into a courtyard with greenery versus whose window in the hospital looked to the parking lot or to another wall, and found amazingly enough that people who were able to look at the greenery were discharged one day, on average, sooner, complained less. And the nurses notes reflected, they were not as grouchy and required less pain medication. So that was really one of the very first studies. And 15 years ago, there were only literally a handful of research studies looking at the effect on mood, blood pressure, something called cortisol levels. Cortisol mean is a chemical that gets goes up whenever we're stressed. Okay. So 15 years ago, handful of studies since then over 1000. So this is not, whoo, this is weak, we can demonstrate this in many, many, many, many ways. So that's what I've been learning over time, and then trying to bring it to my own patients into my own life. And it's, it's, it's an amazing free modality of helping ourselves, it really is considered by many a part of integrative medicine, a part of free thing. And of course, because there's no money behind it, you're not going to see ads on television, like we do for all the drugs, we're not going to see ads and say, hey, go out in nature and you're going to lower your cortisol level, you're gonna lower your blood pressure, you're never gonna see that because there's no money behind it. So that's why I want to be a messenger to as many people as possible.

Dr. Regina Koepp 1:53
I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and families. I created the psychology of aging podcast to answer some of the most common questions I get about aging, questions about mental health and wellness, changes in the brain like with dementia, relationships, and sex, caregiving, and even end of life. Like I say, in my therapy group, no topic is off topic. We just have to have a healthy way of talking about it. So if you're an older adult, or caring for one, you're in the right place. Let's get started.

Dr. Regina Koepp 2:37
Paula Hartman-Stein, thank you so much for joining me on the psychology of aging podcast. I'm curious if you'll start by sharing a little bit about who you are and what you do.

About Paula Hartman-Stein

Dr. Paula Hartman-Stein 2:47
Okay. Well, thank you very much, Regina, for having me as a guest today. I really appreciate it and appreciate all the work you're doing to to explain to the public more about the psychology of aging, a topic that obviously is important to me, too. I'm from Western Pennsylvania, originally, and started out my career as a medical psychologist worked in hospitals. And back in the day, going way back now into the 80s. There was an opportunity in the hospital where I was working in Akron, Ohio, they were starting the very first geriatric Assessment Center in the city, there were two large hospitals, they're teaching hospitals, and Dr. Schlemmer, a family practice doctor started the first center and asked me to be their psychologist. And I thought, well, this would be a great opportunity, having worked with people with a lot of chronic medical conditions. Well, I started working there, and within a few months, I realized how little I knew about the field. So what I did those days, there were very, very few opportunities for postdoctoral fellowships. There Were None in the region. And I was I was married and didn't really couldn't travel to another city. So fortunately, case, Western Reserve and Cleveland had an opportunity. They called it a geriatric clinician development program. It was primarily for primary care doctors, but they allowed me and I was the first psychologist. And this, you're not going to believe how long this took. But it was one day a week I traveled to Cleveland from Akron, which is about an hour drive, one day a week for seven years. And yes, seven years to get the certificate. And so I I shadowed people in the geriatric field. And then at the end, I had to develop a capstone experience was to develop a course on the pragmatics of a practice of psychology practice of working with older adults, and I did that for Cleveland State University. So um, so I'm one of the you know, in this area from the 80s, one of the pioneers, I guess, at least in Northeast Ohio, to work In the field that you and I both share of gero psychology. So I worked in hospitals, I've worked in every setting with older adults except for one and that would be prisons and never worked in a prison wouldn't want to. And then eventually I left the hospital started my own practice called the Center for healthy aging in Akron, and then in Kent, Ohio, where can stay is, and I did geropsychological cognitive evaluations for people who were worried about their memory, I worked with a lot of caregivers. And then I started a lot of group work, I really like group work. And so I developed the thing called the memo Club, which stood for memory and mood, and did a whole series there. And then I've worked in academia part time as well taught some courses, online courses, courses at Kent State courses at Arizona State University. So did that for many years. And then finally, in 2015, I decided to close the private practice. And because we were event, my husband and I were eventually going to move to where we live now, which is in North Carolina. And so I started doing more training. So I did training primarily of professionals in the field, nurses, social workers, psychologists, etc. So I've been doing that since 2015. And, and I write, I'm a regular writer and contributor to a newspaper called the National psychologist, I've written over over 150 articles all on the aging topic. So I do that. And then I had an opportunity to put together a book called enhancing cognitive fitness and adults. So this was quite a project 37 chapters, 66 contributors. So after I put this book together, that's when I thought, well, what can I as one person, one person, what can I do to contribute to the field. And that's when I started a lot of these blue programs, putting together people who they, the people that were there were either had depression, or had just very mild cognitive impairment. And they, they wanted, they didn't need to be in, they all lived at home, they didn't need to be in assisted living at that time. They didn't need adult daycare, but they were they were not confident to take classes, let's say at the university that were open to people free of charge. They didn't want to do that. So I and so I ran this program for over 10 years, and really learned a lot from it. So anyway, that's that's my story. And I'm, I'm a Coal Miner's Daughter, I come from a very practical working class family and had great opportunities for advanced education. But I think because of my coal mining, that that's why I'm as practical as as I I am throughout my my life.

What is Vitamin N?

Dr. Regina Koepp 8:16
And now 10 years ago to now you've started some another concept or another sort of helpful program, or way of understanding brain health called vitamin in. Can you share a little bit about vitamin in what is it and tell us about it?

Dr. Paula Hartman-Stein 8:36
I'd love to talk about it because it's, it's something that not enough people know about. Vitamin N is a term for nature. And it was coined by an educator and journalist named Richard Louv and I'm a big fan of his work. I follow his work. He has a number of books and he wrote a book, actually, in 2011, it came out called the Nature Principle. And I heard about this, but I also want to tell you how I asked also at the same time was around the same year. There was a conference that Andrew Weil put together in in Arizona and I was fortunate enough to attend and I heard a lecture that changed my life. I heard I heard a program by a research scientist named Esther Sternberg and Dr. Sternberg worked for the NIH she was she is a rheumatologist studying various problems with arthritis and those kinds of conditions. And she gave this remarkable talk about how the effect of place affects our mood and our health and well being. And there's a PBS special that she produced or was part of the production about this topic, okay? The site, it's called the science of healing. And so I looked at this, I was reading Richard Louv, and my son who was in college at the time, was interested in something called Green Exercise, in green exercise is doing exercise outside. And so all these things came together. And so as my son worked on his capstone project for his senior project, of course, mother had read all the articles too. So I did. And it was an amazing up, opening for me. I think, Regina, that those of us in the mental health area, we tend to be in our own silos where we, you know, have certain journals that we read articles and learn things from, and we don't always know, open ourselves to other fields. And I think this I know, I don't think I know this is true, in terms of in terms of vitamin in, or the health benefits of nature. Richard Louv also coined a phrase which I love to use, it's called nature Deficit Disorder. We've all heard of attention deficit disorder. Yes. Well, ndd nature deficit disorder is not a medical category in the DSM in our in our book that categorizes and mental conditions. But it It describes the disconnect, and what happens to people when they are not in nature enough, and in fact, live it or not in January of 2021, just this year, when we're doing our podcast right now. The the EPA Environmental Protection Agency came out with an incredible statistic, that the average American spends 93% of their time, in a building, or in a car. So it's about 87%, in a building and success 7% in a car. So 93%, we're not outside. And there's a problem with that. And of course, now technology is marvelous, and what we would we do without a during this pandemic time, but too much of this is not good for our brains. Now, one might say, Oh, that's just because you know, people think, you know, it's pretty to look outside. And you know, I'm looking to my side here, a window with rain coming down today, but it's a lot more, it's a lot more than just beauty. And there's the, well, first of all, the ancients knew about this intuitively. 1000s of years ago, the the Chinese daoists made temples to nature. The ancient Greeks also did part of their health and healing was was in nature. But the research, there's research, there's always research, but it's just that we don't always know about this published research. Now you may have heard of this study. It's a it's a seminal or very important original study in the 80s 84 came up by Richard Alrik, in Texas, where he looked at people who were hospitalized for gallbladder surgery, and looked at people who just by happenstance, this was not done purpose. This was a an observational study. And he looked at how many days were they those days, probably today, you're not even in the hospital. But in the 80s, you were hospitalized for gallbladder removal. So people whose window looked out into a courtyard with greenery versus whose window in the hospital looked to the parking lot or to another wall, and found amazingly enough that people who were able to look at the greenery were discharged one day, on average sooner, complained less and the nurses notes reflected they were not as grouchy and required less pain medication. So that was really one of the very first studies and back. Let's see 15 years ago, there were only literally a handful of research studies looking at the effect on mood, blood pressure. Something called cortisol levels cortisol mean is a chemical that gets those up whenever we're stressed. Okay. So 15 years ago, handful of studies since then over 1000. So this is not Whoo, this is weak, we can demonstrate this in many, many, many, many ways. So that's what I've been learning over time, and then trying to bring it to my own patients into my own life. And it's, it's, it's an amazing free modality of helping ourselves, it really is considered by many a part of integrative medicine, a part of free thing. And of course, because there's no money behind it, you're not going to see ads on television, like we do for all the drugs, we're not going to see ads and say, hey, go out in nature, and you're going to lower your cortisol levels are gonna lower your blood pressure, you're never gonna see that because there's no money behind it. So that's why I want to be a messenger to as many people as possible because I've been able to learn this through happenstance.

Dr. Regina Koepp 16:08
Well and learn it through science, and lived experience. So you're, you're sharing with us being in nature or even observing nature in its natural habitat. So if it's a courtyard, there's benefit, if you can look out the window and see trees or life. And that's one way of engaging with nature. So if you're in a hospital room, are you able to see nature? And the other is being in nature? Can you talk a little bit about that? What are the benefits of being in nature? How does that help our brain health?

What are the benefits of being in nature? How does that help our brain health?

Dr. Paula Hartman-Stein 16:49
One of the one of the researchers is named Strayer from the west Utah with and one of one of his research findings is that if you are walking, you know, we're not talking about you know, real vigorating running, just walking in nature, he found an improvement in working memory, in also in creativity. But there's a caveat, you can't have your cell phone. And we'll you know, doing that or have your earbuds in ixnay on that your buds. Okay, so,

Dr. Regina Koepp 17:32
...So you can't be listening to this podcast.

Dr. Paula Hartman-Stein 17:35
Right. now, you're not going to get the same benefits, okay? Maybe, but not not the same. So you need to be mindful you need when when you walk outside. And really the core research, I should say the main research really has come from Japan. Professor miyasaki is the main researcher who has studied, what is called in the term is forest bathing in English, or Shinrin-yokuu, and I'm probably mispronouncing it, but that means wandering around for about 30 minutes or longer. And taking in the vision, the sight, the sounds, the smells, the feeling on the body of the breeze, etc. So, and he has been Misaki his work is pretty amazing. Looking at reduction in again, in in blood pressure. Also skin conductance. In other words, showing that you're less stressed. And, and this I like the because my work has been in the cognitive area for many, many years. And I'm interested in how it improves our, our thinking and our attention, just as mindfulness meditation does.

The power of human-animal interactions

Dr. Paula Hartman-Stein 18:57
So that the really, to me the really powerful thing also is that, you know, many many people of course live in cold climates during Of course during the winter. And you know, and there's rain in bad weather. So and and maybe people have trouble walking. So what can we do about that? Last week, I was on a on a call with a number of people who work in long term care and these these are across the United States and Canada. And I asked the question to these administrators. What if anything they were doing during the pandemic for nature exposure for their residents, and one woman who was from Waterloo. Candidates in Canada said their her program was very aware of this of this research literature. They make a point of bringing in plants to people's rooms. They make a point this is this was interesting too. They have the UK and I guess Canada referred to we call them parakeets. They call them budgies, birds. And lo and behold, I found an article very, very recently about the effect of looking at big birds or parakeets and reading to them, okay, they're in cages. And this was a randomized control trial, where they had some people looking at artificial birds, you know, that that actually move and have sounds who look like birds. And then the real birds, and the third group, were just talking to cages that were empty. Well, we wouldn't expect they do much. But, but the interesting findings, I think it's pretty fascinating. And this administrator didn't know the study, but I don't know intuitively, their group came up with this idea of these buddies. And, and what they what the researchers found in the randomized control trials, what they found is that people reading aloud to the real birds had a drop, also, same kind of drop in blood pressure, reported feeling better, less anxious. So who knew?

Dr. Paula Hartman-Stein 21:38
So there's, there's a whole group of articles about what is called human animal interaction, and some really good studies about it. And you know, all of us know about service dogs, and it's seen and seen that, and dogs are used, actually in courtrooms today to help children who have to testify to calm down. So dogs we know about dogs, and then then there's equine assisted treatments, that the horses so that's, that's a whole other area, but having cats and dogs around, also, there's a bonding chemical that gets released oc tosun oxytocin. So animals and but the really amazing thing, at least to me, is some very, very new research articles about having eye contact with wild animals, not ones, they're going to, you know, kill you. But um, but birds out in the wild. Also, the one study that I read was done in the UK, and it was with lemurs, these little critters and creatures, were not going to harm you. And then there's long tails, you know, so they had people go out into enclosures with the lemurs, I mean, they're right there with you, because they're not going to hurt you. And just watching them and maybe making eye contact with them. With I think it was a 20 minute walk was a short walk also had the same kinds of effects. So the, you know, however you want to call it the universe, God, however, one, you know, looks at these things. We have this right there.

Dr. Paula Hartman-Stein 23:30
And I also... just let me say this, I also discovered some of the power of being in nature in terms of problem solving. How did I find that? Well, when I, again, 10 years ago, when I started into this area of intervention with my clientele, I started to do writing workshops in parks. And, you know, during during reasonably good weather, although we could do it in the rain, too, because I would I would rent out you know, a place where there was a roof over your head pavilion or some Yeah, pavilion, that's word and, and so I, I've done this enough for almost 10 years, and I've done it in different parts of the country. I've done it with professional groups, and I've done it with with the community groups and intergenerational and what I've This is not a randomized control trial, this is not something like that. This is by a my own observation and anecdote. I have found that that people well, I would give a certain trigger something a prompt, and the prompt would be and I have to give again, credit where credit is due.

Dr. Paula Hartman-Stein 24:53
And I attended a workshop by a well known Catholic priest for Richard Rohr from his from Albuquerque. And he did a workshop that I attended called spirituality and nature. And that's when I was a big skeptic about this. And I thought, What is he talking about? But he had us go out on the grounds, beautiful grounds. Pick an object that attracted us a tree, a branch of squirrel, the pond, a flower, whatever. And be mindful of it, study it carefully. I picked up pine trees and pine tree and study it in great deal of care. I mean, most of us, you know, we look at things, but don't really process it. But so this was to look carefully and ask the object a question, see if it could teach us anything. So one could say that that was the trigger that the information is in our own brain, and that the nature object was just the way to get it out. And it may be that we don't know. Exactly, but I, it was an amazing experience for me personally. So I thought, well, I'll try this with my my clientele. And it was incredibly amazing. And if I may just tell you this anecdote. Normally, the the size of these writing groups, there tend to be small, they tend to be anywhere from eight to 12 people. And that's, that's an easy group to manage.

Dr. Paula Hartman-Stein 26:37
Well, I had an opportunity to go to Australia a number of years ago, and to do a workshop about healthy aging, and to do something experiential. While I was just into this, this writing and nature idea. So I had 80 people. And these were age from 25 to 75. Wow, what am I going to do with this crowd. So I was able to figure it out. And had everybody go out into this was a beautiful setting, it's a subtropical setting there in Brisbane, Australia, do the same thing come back together. And then I divided them into groups who picked something that was related to animals who picked something related to trees and grass and flowers and who picked something related to clouds or wind. And I had everybody you know, 80 people, you can't read your whole piece. But I had everybody read to two or three sentences. And it was just a tapestry. It was because there were different accents. Anyway, it was a beautiful thing. I wish I had a recording. But here's my point. At the very end, a woman came up to me who was a retired psychologist in Australia in her late 60s, early 70s. And, you know, I never met her before. And she said to me, I'll never forget it. She said, You know, I don't know what you did in there. But I've been in therapy myself for about two years. And this writing experience in nature? I have, I have the answer. Now. I know what to do to solve my problem. And so you know, we weren't going into what our problem I have no, I have no idea what your problem was. But But she said it was just a way to, you know, I look at it as clearing one's mind. Being mindful, stopping the clutter and the monkey mind as we call it. And then being able to focus and lo and behold, your relaxed nature relaxes you, we know this for a fact. And then things come out of your own consciousness. So it's, it's it's great medicine, nature is medicine. And we can you know, have the plant in our room. If you can't go outside, you can sit on your porch and do chair yoga, you know, as long as you look around, and don't have your earbuds in and working on your devices.

Dr. Regina Koepp 29:17
Now, if if nature is medicine, yes. How would you dose it? How often should people be going outside? What would your prescription be?

Dr. Paula Hartman-Stein 29:27
Well, that's a good question. No one's asked me that one before. I don't think there is a specific amount. But this is more of off the top of my head. I would say if you can do it at least three times a week. But if you have if you're fortunate enough as as as I am in this in this home that we have in the western North Carolina mountains. I mean, I don't go outside every day, okay. I'm one of these average Americans who spend Too much time in a in a box in a house. But I do look outside every day every day. And the first thing I do in in my bathroom, I have a great, I have a great window, and I put the blinds down. And I just take a look at the weather, look at the trees, I've big pine trees and actually can see a lake too. So that starts my day and makes me feel happy. Can I just tell you one other little anecdote?

Dr. Paula Hartman-Stein 30:31
Once upon a time, it was actually around the same time as about 10 years ago, 10, 11 years ago. My husband and I were living in Ohio and we were vacationing, we actually went to a pre retirement conference in Asheville, North Carolina had never been to Nashville didn't know anything about it. And during our free time, we went to these grounds at the Biltmore Estate, these grounds were were put together were designed by Frederick Law, Olmstead, the great landscaper who did Central Park, these are exquisite grounds. And this was the springtime and the azaleas were all in bloom. And, and I said to my husband, I feel so happy here. And he looked at me and we tend not to be impulsive people. But he said, maybe we can move here, I said, move here, I never thought we'd move out of Ohio.

Dr. Paula Hartman-Stein 31:34
And that was the start now, here is a must tell you this interesting fact, which I did not know at the time. And that is that there have been some neurobiological studies by a group in California, where they, they put people in the scanner, okay, is your PET scans, I believe, PET scans. And they were able to show them different visual images while they're in the scanner. And the people when they saw images, beautiful images of nature, versus, you know, cars or buildings, different parts of their brain lit up. And so here's the idea that we have, we have some nerves from our visual cortex to the hippocampus, which is an area as you know, has to do with memory. And along this, this neural pathway are little, little, little sites, little areas that pop out, shall we say, little bits of, of opiates, the feel-good chemicals that people get, okay. And so I really do believe this, that when I was in that beautiful Azalea garden that I was like on a little mini natural high, from my brain, because I cannot tell you how happy I felt. And so what that tells us, research wise and then feeling wise is that you don't, okay? You don't even have to be totally aware of of your surroundings, because things are happening sort of unconsciously, in terms of your brain. So there's all these things going on. We can be mindful, you know, really paying attention. But even if we're not, and I don't want to say bring out your device, and you can still get the good benefits. That's not quite right. But you even if you are listening to a podcast when you're walking, because you just want the exercise, all right, you're still going to get some benefits that you didn't even know about. I just found this research just to be absolutely fascinating.

Is there any link between being in nature and reducing the risk of dementia?

Dr. Regina Koepp 34:07
And now Is there any research that talks about nature and prevention of or delay of dementia?

Dr. Paula Hartman-Stein 34:18
I have not seen anything that talks truly about the delay of dementia, what they what I've seen and read over and over and over is that there is an enhancement of creativity. There is also an enhancement of working memory, how it can prevent or delay that is not known. And I can say that with pretty good certainty because in the last four months, I had a an opportunity and and took it to I was asked to write a chapter for an academic book on what's preventable So I spent four to five months with with a couple colleagues, but I was the the I did the heavy lifting. I did, I was the lead lead author in this. And and so what I have done is found all of the published research, I think, at least as of least as of December of 2020. And 2020, as we all know, is a is a year for the ages, right in many, many ways. One good thing about it in terms of the in terms of the brain health areas, this two separate groups of researchers, international researchers, very separate groups published in 2020, I think I like a month or two apart interesting. The their findings for what factors can you can we modify in our lives that helped to prevent or delay dementia? Wow. So I was lucky to, to find all these articles.

What are some ways to reduce the risk of dementia?

And and so I there are 12 to 19, modifiable risk factors. And so I put them together in a way that that people can understand without reading all these articles that I took me five months to read anyway.

Dr. Paula Hartman-Stein 36:26
So certainly, moving more is one of them. But the it's interesting, they don't specify the dose of it, that is truly not known. But the fact that we do have to move more, both aerobic as well as strength training, that's one.

Dr. Paula Hartman-Stein 36:47
Nutrition's a biggie big, big, big. And there are all sorts of, quote, dietary patterns. We've heard of the Mediterranean diet, there's the mind diet, there's the DASH diet, there's the Nordic diet, there's the Esselstyn diet. And there's the Ornish Diet. Okay, the main, I would say, of these different diets that have been looked at, we can say the research does show an interplay of them, that the more whole foods you eat, in other words, try to stay away, this has really changed my life too, because I certainly like sweets. And I'm not saying I'm going to give them all up, I doubt I can do that, or will do that. But the less less sugar less added sugar. The more that we eat. Together back, the less processed foods we eat. So soda pop ixnay on the soda pop. You know, things like hotdogs, actually red meat, all of these diets. They have very, very little, if any, some have absolutely no meat, no more of a vegan diet. At least two of them are the very low fat diet. But But the more whole foods, the more greens, the more berries, the more. So I snack regularly now on on nuts and seeds. And that's a much better snack. What are you saying?

Dr. Paula Hartman-Stein 38:20
So there's nutrition, there's the alcohol. This is interesting. In these meta analyses, this is pretty liberal finding, they found that they didn't separate men from women on the genders, but they found that as long as you don't have more than you're having a big risk, if you have more than 21 units a week, that would be three drinks a day, alright, seven times three. But but but these diets, say you know, some alcohol in moderation is okay. But 21 is the outset is the is the top amount, okay? But if a person already is experiencing memory impairment, alcohol is not good. And so I have recommended out if people like the taste of wine there, there are pretty tasty, alcohol-free wine.

Dr. Paula Hartman-Stein 39:18
So anyway, so there's that they're keeping your blood pressure your your systolic at 130 or lower, you know, that's the top number. And then of course, depression and mood and keeping yourself more modulated emotionally and nature falls into that as a strategy. Okay, so that's where the articles don't specifically say which things to use, which strategies to reduce your, your stress level, but certainly, that is also a risk factor that we can modify. So those are some of the big ones right there. Yeah. The mood,

Dr. Regina Koepp 39:59
The mindfulness This helps with that. Activity level helps with that it kind of stimulates serotonin. Yes, yes. Yes. Yeah.

Dr. Paula Hartman-Stein 40:09
One other thing if I can mention that, that again, if people are caregivers of frail adults. Okay, and and Regina, you probably as a geropsychologist have heard of the pleasant events schedule. Those are you know, there's about 66 different pursuits or activities one can do well, I looked at that schedule, and one of them number one on the list actually is looking at clouds. Now this is something that most of us probably did as children. But I have so I've been experimenting with this with some groups that I'm still leading. And so and these are people that I'm working with now remotely, they are they are, they are fully intact. And these are not people with dementia or even mild cognitive impairment. And so I brought this up just to see what would be the response. Does that sound too childish or what? Well, lo and behold, the people loved it. And just to give you an example, one woman is a retired nurse from the Cleveland Clinic and her husband is a retired prosecuting attorney. They are in their mid 80s. And they're not visiting the grandchildren during the pandemic yet so. So she said to me, I took your advice, Dr. Paula. And so my husband and I go out and we actually look at the clouds. And we we love it, it makes us It gives us a lift, it's, it's it's happy, it makes us feel happy to something as small as that and people who are, oh, you know, in a nursing facility, hopefully they have a window, looking outside looking at the clouds, that little thing. So again, nature gives us so many gifts, so many gifts, we just have to take advantage of them, we have to use them. They're there for us to use, I believe.

Dr. Regina Koepp 42:12
You know, as you were talking, I was thinking for 10 years, I worked in a windowless office in a VA. I mean, really, my office was tiny it was I was almost like knee to knee with my patients. And I would sometimes have families of five in this tiny room. I worked, you know, older families and most of my families were African American families. And and if if a family wanted to bring multiple family members, welcome, you know, I would welcome them. And and I was reflecting on how important behind our hospital was a walking trail. And, and I would meet some years I didn't do this, I was just too busy. I would work through lunch and just seeing patients all the time. But there was a period where called palliative care psychologist who also had a windowless office working on in palliative care. And I would meet every day, and we would take a walk outside in nature, and how much we needed it and we would get come back to our desks and finish out the day. And and I'm thinking during COVID also, how complicated it was, you know, I did a group provided a group for health providers who were working in the ICU in COVID. ICU clinics. And I see us typically don't have windows,

Dr. Paula Hartman-Stein 43:40
right talk about stress.

Dr. Regina Koepp 43:42
Yeah. And just, and I and I'm thinking I kind of approach caring for older adults from a sort of systems framework where I think of the family system, I think of the health system. I think of, you know, the health of our health care providers is essential also for helping with the health of our older adults and families. So there's the older adult, there's the family, there's the health system, and we're all working together. And I just think how equally important. Our health providers need to be caring for their mental health and wellness and physical health by having breaks outside how older adults and i agree i would often give feedback to long term care communities. families would be coming in to my office, my windowless office, saying you know, our loved one is not getting out of bed, the staff are they need a Hoyer lift, the Hoyer lift is broken, like, you know how can we get the older adult out of the bed or the person living with a spinal cord injury out of the bed and outside for fresh air and sitting in the courtyard. And sometimes I would actually write orders back to the long term care community that the person has to get out of bed, the person has to get to a window or to outside for fresh air. And for many reasons, one is for sensory stimulation to first senses don't have the stimulation with natural light or with smell, or sound. Are it's distressing to our brain and we decline. And it affects our sleep cycle even.

The Benefits of Adding Plants in Assisted Living Communities

Dr. Paula Hartman-Stein 45:23
Yes, you're right on. If I can share this story today is very recent. I have Well, I had a friend she has since unfortunately died rather suddenly in November. She was in her early 80s. Healthy, we thought very healthy women moved from Northeast Ohio to Albuquerque to to a continuing care retirement community in the independent section. And so she she was there just for a few months before the pandemic hit. And she participated in October of 2020. In a virtual writing workshop that I did, she was she was a good writer and loved it. And she participated in this and touched all of us on this call, by her her piece, her narrative that she wrote, what she said, essentially, was that she was so desperately lonely, because they were very restrictive about no meals, no congregate meals, no visiting the only time she could go out, she still would drive, but she could go out to see your doctor and she had one family member in the area, they allowed her to go out for that. Well, she said the only way I survived this emotionally was fortunately I had a small balcony. And she said, Every, every evening, I went on the balcony and took in the Albuquerque sunset, and the Albuquerque night sky. And she said I could see the constancy in nature. And it, it showed me something bigger than myself. And that's what really helped her that was so touching to hear that. So again, she was able to utilize what's free. And again, something that we don't we don't teach our you know, we feel it. I think instinctively, most of us didn't know that there's research backing. I hope my words today give some inspiration to the older adults listening for themselves, as well as their grandchildren or children as well as anybody that they're taking care of. Please go outside get some plants. Oh, hey, there's a nut. I've got to tell you this. There's a there's amazing. Um, there was a study not so it was published very recently. And it was a group of people who were hospitalized for pretty awful surgery is to have their hemorrhoids removed. Okay, well, this was a randomized control trial. And so one group, I think it was 45 or 90 people. So 45 were in a hospital room where there were no plants, no ornamental plants. Another group had ornamental plants. Lo and behold, the ones with the plants did better. Got out of the same as our study back in the 80s. One other tidbit, which is just blows my mind. I didn't know this at all. I like art. And I do have some abstract art in my house. I also have nature. There's one behind me of Ian Adams, a famous photographer and a nature scene. Well, there's there's some newer research that shows that even having artwork depicting nature helps your mood better than if you're looking at even if it's beautiful to you, abstract art. And part of that may be the fractals. Fractals are our repeating patterns in nature, our brain likes to see patterns. And so fractals, like think of a broccoli head, if you break off a little, you know, flower lid or they call it up the broccoli, it is of the same shape and pattern as the whole. Okay, so same with veins in a in a leaf. They have a similar pattern to the whole tree. So there are these fractals in nature. And that's what Esther Sternberg talked about in that lecture I went to about 11 years ago about how fractal Light up those those pathways in our brain, those opiate rich pathways, and make us feel better. So there's something we're hardwired for this are hardwired, but we must not neglect it, we must nurture it, nurture, and have our doses of vitamin n. That's as important as, as vitamin D. Everybody knows about that. But how about vitamin N, and get rid of this nature deficit disorder?

Dr. Regina Koepp 50:30
I know that you are also offering a free webinar coming up about other ways to prevent dementia, you mentioned 12 to 19 strategies for preventing dementia that are based on science. If people would like to learn more about you and would like to learn more about that, where can they find you? Well,

Dr. Paula Hartman-Stein 50:52
Thank you for the question. Well, I have a website, centerforhealthaging.com. And we're starting a program with my colleague who's a culinary nutritionist, Bridget, from Texas, and in the cardiac area. So so we are doing a free session. And you can go to my website and find out, find out about it and sign up. And then after that we're doing five part 90 minute each. And Bridget is doing some very, we're both very practical people from Western Pennsylvania. And so she's doing some work in her actual kitchen, showing what you can do to try to get more of the good foods that are in your refrigerator and in your cupboard and make it so that that it will help your brain. I'll be talking about the other modifiable risk factors about reducing stress and depression moving more, sleeping better, and all the rest of that that I have recently learned about through culling the entire literature on this. So thank you for asking, and that center for healthy aging.com.

Dr. Regina Koepp 52:09
We'll link to that in our show notes.

Dr. Paula Hartman-Stein 52:11
Thank you.

Dr. Regina Koepp 52:11
Paula Hartman-Stein, thank you so much for your time and all of the information and education today. I hope we all get outside without our earbuds

Dr. Paula Hartman-Stein 52:22
Right at least look outside if nothing else.

Free Download

Dr. Regina Koepp 52:26

If you are concerned about a loved one with memory loss, download my free memory loss guide. In it I talk about the signs to be mindful of. I talked about the benefits of early diagnosis of dementia and what to do if you're worried that your loved one is showing some of the signs and symptoms of dementia. So head on over to the show notes and download that free memory loss guide now. That's all for today. Now it's your turn. All you have to do is subscribe, leave a review and share this episode with others so that they can be part of the conversation too. One last thing, a special thanks to Jhazzmyn Joiner, our psychology of aging podcast intern, for all you do. Lots of love to you and your family. Bye for now.