
Older Vermonters need your help,
Older Vermonters need your help,
Would you like guidance on how to use the Age Well website and what information is available to you as a provider? We’ve curated a collection of the most relevant information for you on this page as a launching point.
Scroll the page to learn more or use the jump links in this section to take you to a topic.
Jane Catton, Age Well CEO: Hello everyone, my name is Jane Catton and I’m the CEO at Age Well. I want to welcome you to our show tonight called Aging Matters, brought to you by our special sponsor, MVP Healthcare. We’d like to thank them very much for their sponsorship.
Before we jump into our show, I’d like to tell you a little bit more about Age Well. Age Well is the largest Area Agency on Aging in the state of Vermont, and we serve clients in four counties, in Franklin, Grand Isle, Chittenden, and Addison.
Last year we served over 15,500 clients and let me tell you a little bit more about the programs that we offer. You may have heard of Meals on Wheels or home delivered meals. This is a tremendous program, where we bring nutritious food, therapeutic diets to our clients, straight to their homes. We have congregate meals, we also have wonderful events that include food activities and music all around the state.
The other wonderful part of our programming is the wellness portion of our programs, and that includes evidence-based programs that are related to activity. Some Wellness exercise you may have heard of Tai Chi or Tai Chi for arthritis, so these are activities that our clients can take part in anytime.
We also have a wonderful group of social workers who are out in the field and they are providing a little bit more wraparound support for clients who may need more help so that they can stay independent at home.
All of our clients are over the age of 60 years or under the age of 60 with a disability on long-term care Medicaid. The last program, that is so important to us, is our volunteer program. It is over 1100 people strong and our volunteers really are the backbone of our home delivered meals program – but not only that, they offer friendly visitation they might do some transportation to doctors’ visits, or any other thing that our client may need help with.
So, as we’ve learned a little bit about Age Well, our show Aging Matters will be sharing interesting topics that we think are important to help people Age Well. So, every month I’ll be hosting different guests and we’ll be exploring topics of interest and today, I’m delighted to have a wonderful guest with us here today, Dr. Alan Ramsey. Welcome, and he’s here to discuss two very interesting topics. The first one is called the Social Determinants of Health and the second is called Food as Medicine.
So, Welcome Dr Ramsey again, nice to see you.
Dr. Ramsey: Thank you.
Jane Catton: And before we jump into some questions, uh, specifically about our topics maybe you can tell us a little bit about your background and what interests you about what we’re going to speak about tonight.
Dr. Ramsey: I’d be happy to, and Jane thank you for inviting me to participate in this first program on how important aging is to all of us, all of our Vermonters. So, I’ve been a family doctor in Vermont for over 40 years, uh, most of that was spent at Colchester Family Practice in the Department of Family Medicine and then in 2012, I was appointed to the Green Mountain Care Board for five years, and so I moved my practice to the People’s Health and Wellness Clinic in Barre, Vermont, which is a free clinic.
So, as you might expect when you practice this long, your patients age with you. And so, aging becomes more how you age healthy, in a healthy way becomes more and more important. So, that’s where my interest in the Age Well Board of Directors evolved. You know, I’ve been on the Board now for five years and I’ve found that being involved in a community organization that can make things better for my patients as they age is a really important service, and so that’s what happened.
Jane Catton: Well, thank you, that’s… that is a tremendous background and we’re very lucky to have you here this evening. So, as I mentioned, Dr Ramsey, our show today will focus on the social determinants of health and a concept called food is medicine.
So, let let’s jump right in and um I’ve got a few questions to start us off. Tell us what exactly are the social determinants of health? We’ve heard this term in healthcare and in the social services. What are they?
Dr. Ramsey: Okay, well, let me start by saying healthcare organizations, insurance companies divide social determinants of health into a set of domains, but let me tell you what happens in the real world.
So, when I see a new patient at the People’s Health and Wellness Clinic, I always ask them five or six important questions. The first question goes without saying, do they have access to the Health Care System? Typically no, that’s why they’re being seen in our free clinic. Number two, do they have housing? Number three, do they have transportation? Number four, what’s their educational status or are they employed?
In other words, what’s the economic social determinant that they have to face? Are they lonely do they have family in the area? Do they have social contacts that prevent them from dipping from declining into a sense of loneliness? And lastly, and also very importantly do they have food security?
So, in the real perspective of an office, clinic, that’s what happens now. I’m asking those
Questions, knowing that there’s very little I can do in my clinic session to really reconcile some of those important issues.
Um so what I have to do is to look for Community Agencies that can… do provide services that I can’t provide in the office now. Are they important? It has been studied and looked at over and over again, that people who suffer for any one of these important social determinants of Health have poor health outcomes, they cost more in the Health Care System, they generate more problems in the system, so… so addressing social determinants of health and not only identifying them in primary care, but seeking out organizations like Age Well that can really participate in lessening the environmental effect of those things.
Jane Catton: Dr Ramsey, you touched on um the concept of the five domains, and one of them um, I understand from my research, it’s called Social and Community Context. So, as we think about the five domains, you talked also about social isolation. Loneliness is one of the domains more important than the others to focus on. Are they all an issue together? What do we do about these?
Dr. Ramsey: Well, that’s a great question, you know, in some people… um typically not as we age, younger people – employment, the economic issues, I think as we age and have fewer social interactions with… through work and family, loneliness can be a very critical issue.
Around these social determinants, loneliness means it can contributes to depression, contributes to cognitive decline, contributes to worsening self-care, contributes to acceleration of chronic disease processes, all of those things happen when a person becomes lonely and isolated and don’t have the contacts that they need.
Jane Catton: Thank you, those are so impressive. We, I don’t think we realize how impactful some of these social determinants are on people’s lives. So, let’s um take a moment, you know, and especially as you’re talking about isolation and loneliness, let’s talk a moment about the pandemic. And as we’re emerging out of the pandemic, in your practice, did you see the effects of the pandemic or the isolation that your patients, or even some of our clients, may have felt during that time. How do we address that there are still effects going on from, emerging out of the pandemic with regard to isolation or
social involvement, social activities?
Dr. Ramsey: Yeah, I think there’s still going to be a recovery period. I think we don’t know what the oncoming winter brings us in terms of flu and covid and now we worry about RSV. So, I think there’s going to be a slow, slower transition out of some of the consequences of the pandemic and those consequences for me, were more difficulty discussing other behaviors with my patients. Talking about smoking cessation, talking about immunizations, you know, talking about substance alcohol use all, of those things became more difficult as people were more isolated. So, we have… so, the idea is to think about how to engage that person with agencies outside of the clinic that can deal with loneliness can deal with some of these issues that’s another reason I got involved in Age Well. So, but there’s more than Age Well, you know, and I do make certain recommendations to my patients who I feel are getting more and more isolated, asking them to reach out a little more aggressively to their family and to their other social interactions, reach out to their church or synagogue or mosque or exercise classes. There are things that people can do as well, as uh utilize services in the community, there’s nothing probably more important than that, so staying healthy is another big part of avoiding loneliness. Stay healthy, eat well, stay physically fit.
Jane Catton: Wonderful, well thank you for those thoughts and those strategies. I think they’re very, very important to remind everybody.
So, as a community-based agency, one of Age Well’s main roles is to tackle food insecurity, among other things that you heard about earlier. So, the idea of nutrition being a big part of managing the social determinants of health, is this also important?
Dr. Ramsey: Yeah, you know, people don’t realize that… that, if you really think about it we almost have, in this country and around the world, an epidemic of diet-related chronic disease diet, or think – diet-related chronic disease in the United States. It’s manifested by obesity and rising… significantly rising rates of diabetes, but there are many other things that are involved in that. I call it epidemic of dietary-related chronic disease, and as a physician, I got very little training in nutrition. Yeah, and… and I and so, and I don’t think that’s changed much in the last 25 or 30 years of medical education. There’s just so many complex issues that take the place of learning about nutrition, learning about food as medicine.
Jane Catton: So, let’s shift gears a little bit then, and talk more about the idea of food as medicine. We’re hearing more about this term uh… everywhere we go now. What does that mean? What is it – food as medicine?
Dr. Ramsey: Well to different people, it means different things and you know, in an office setting, it might mean uh nutritional education, okay, and a community setting it might be therapeutic-designed meals, or trying to get people to transition to more fruits and vegetables, you know? So, it can mean a lot of different things to different people, but remember – what we eat is the one thing that we can control that can have an advantageous effect on how we age and how we stay healthy. How we eat, that’s a behavior. So… and it may be more important than any medicine that I prescribe, you know, and there have been studies about this. Studies about the impact of transitioning to fruits and vegetables, and the control of hypertension, the reduction of cardiovascular risk. There have been studies, I think they stopped doing studies because they were all so positive. So, we have a lot of information to support the fact that food is good medicine. It’s just that… that you know and when you’re isolated, when you’re lonely you do make poor choices, but I think in our program, and I know I hope you’ll be able to talk a little bit, about the therapeutically designed meal program.
Jane Catton: Definitely, um… just to take this a little bit further, it’s interesting that the concept of good food and nourishment is being promoted more and more as good medicine, but hasn’t this always been the case? I think you were alluding to this, we remember the old adage and apple a day keeps the doctor away. We’ve all heard that when we were growing up.
Dr. Ramsey: Certainly.
Jane Catton: So, what’s changed to make this concept new?
Dr. Ramsey: Well, I think the prevalence of chronic disease. Um, you know, change… but you know you remind me about some of the history here in… The best quote that I found was from a little over 2000 years ago, a a man named Hippocrates said, “let food be thy medicine and medicine be thy food.”
That was that is a very famous quote that turns up in all… in like the American Society of Nutrition uses that uh to to really say that we’ve talked about this for two thousand years, and the issues that we get into is that changing how we eat and changing our nutrition is something that is going to help us down the line. It’s not going to help us tomorrow and we seem to want quick fixes on everything now.
How does that apply to the aging Vermonter? Okay, the aging Vermonter is going to benefit over a shorter period of time by having the right nutrition to assist in the control of chronic conditions as they evolve. Okay, so an 18-year-old or a 20-year-old, or a 25 -year-old, over 20 or 30 years, changing them is going to have a big deal. A 60 or 65 or even 70 year old person who changes, who makes that transition to more plant-based nutrition is going to have a benefit fairly quickly, okay. They’re going to feel better, they’re going to have better exercise tolerance, that have better energy, they’re going to sleep better. those things have all been studied and proven.
Jane Catton: So wonderful. Thank you. So, it sounds like there’s many things each of us can do to manage our own health, which is the point you’re making. Definitely, like focusing on simple steps, to eat healthy foods. I know that Age Well offers therapeutic meals you mentioned this just a moment ago, through our Meals on Wheels program, and from your perspective as a family physician, can these tailored meals… talk a little bit more about how the tailored meals can help if a person’s challenged to plan meals. They might have a chronic disease, diabetes or even get the right kind of groceries, from what you know about therapeutic meals.
Dr. Ramsey: Well again, take looking at the evidence. There have been some very specific studies that have shown, you know, short-term and long-term benefits of a produce prescription program. Some insurance companies, some payers are saying that we will provide fruits and vegetables through a prescription program, and and have shown that that does things… that reduces the blood sugars, reduces the weight.
So, what we what our therapeutic meals are designed to do is to take away some
of that complicated decision-making around changing from eating one way to
changing to eating a new way. When you get a meal delivered that’s therapeutic, you don’t have to worry anymore about, “oh, you know, is this what’s best for me.”
So, I think that’s an important aspect of a… of our program. We don’t provide you
know a pharmaceutical uh orders or prescriptions for vegetables and fruits like something but we provide tailored therapeutic medication or meals.
Jane Catton: So, um, your… your conversations or your thoughts remind me of a story about a client who is actually on a therapeutic diet with Age Well for diabetes control
and he has reported that the portion sizes, the the types of foods he has on his diabetic diet, and just the frequency that he’s learning how to eat. He’s taking advantage of some dietary counseling, he is losing weight, his diabetes is coming under better control, and his family physician is singing his praises because he’s thought about his his diet to help manage his diabetes. So, I think you’ve hit on exactly um the right concepts, definitely.
Dr. Ramsey: I think we all have stories like that um where we juggle medications and do the best we can, and then finally we realize that a change in eating habits, a therapeutic meal is going to be medicine, it’s going to be food is medicine.
Jane Catton: So, let’s think, uh you talk about a fruits and vegetables prescription for health, think about eating healthy. What do you think is holding back our health care System of providing more support? Maybe? I think the insurers are starting to catch on.
Dr. Ramsey: Certainly, Health Systems all over are starting to catch on but what is really holding us back from investing in this kind of concept, of food as medicine, well… it’s complicated.
Again, some of it is short-term outcomes versus long-term gain, some of it is how we pay for health care, you know, and everybody on the Age Well board knows, having spent five years in healthcare policy on the Green Mountain Care board, it became very clear, that the way you’re going to control how the growth in health care costs in Vermont is to invest more in Primary Care Mental Health and community-based services, that is how we achieve the Holy Grail of controlling the growth and health care
costs in Vermont.
Now, has that happened? Not to the degree where we see health care costs being controlled okay so why does it some of it is how we invest we invest in acute care Crisis Care, Hospital Care, Urgent Care, but our investments in those three categories, Primary Care, Mental Health, and community-based services like Age Well, still lags behind the necessity – that what it need… where it needs to be.
Jane Catton: Well, let’s hope that over time, more investment in population health will come our way. So, um I want to thank you, Dr Ramsey, for sharing some very interesting insights into the social determinants of health and food is medicine. To wrap up some of our thoughts, if you could offer advice on what you think are the most important or maybe the most simple steps that older adults can take especially if they’re dealing with the challenges associated with the social determinants of health, what would that be?
Dr. Ramsey: Well, um stay connected to community-based services to your primary care office, make them aware of your needs, let offices help coordinate services or refer you to an agency where we care management services, like Age Well, can be provided. The um Health Care system, I I think of it metaphorically as an ocean, and there are certain things… like I think that the People’s Health and Wellness Clinic is a safe haven in this ocean. It’s like… you know, I think of Age Well as the same way. The Health Care system is complicated, difficult to navigate. People, particularly as they age, need all the help they can be they can get.
So, I would ask… I would suggest that I would suggest when things are getting worse emotionally, physically, think about ways to get into a counseling arrangement, counseling situation. Take advantage of volunteer programs, seek out community service programs that you can volunteer in that you’re passionate about that you really believe in.
So, there are things that can be done, um and it’s just a matter of accepting the help that’s out there.
Jane Catton: That’s wonderful, thank you for those thoughts. Dr Ramsey, I’d like to thank you for taking the time today to join us on Aging Matters, and to all our viewers. I hope you enjoyed our show today and please tune in next time as we dive into some new topics that will help us all to age well, and remember as Dr Ramsey so wisely suggested, if you or anyone you know needs help or assistance or any kinds of a support to help you stay at home to remain independent, please think about Age Well.
Our helpline staff are available five days a week and we have a Helpline number that I’m going to share with you. Please call 1-800-642-5119. We’re here to help. Take care and thank you for joining us, I hope to see you next time.
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