Interview with Dr. Karen Gilbert

Dana Serrano: Good morning. I have fantastic Dr. Karen Gilbert here. Karen, thank you for being with us. She is the vice president of education and quality assurance for Alzheimer’s Community Care and has been since 2013. Karen, thank you so much for being here today. I am delighted and honored that you are here to talk to our community about what Alzheimer’s Community Care does. And I’d love for you to just make a little introduction and tell us about yourself.

Dr. Karen Gilbert: Thank you. It is a privilege that we really appreciate. I do want to clarify I am a nurse who’s prepared at the doctoral level. So we want to make that very clear. I’m not a physician. What that education has prepared me to do is take evidence from research. What are the best behavioral interventions with those we care for in our day centers? What is the best foundation for supporting the caregiver? So, we take that evidence-based research and actually apply it to benefit our families. As you said, I have served the organization for a little more than 12 years now, been a nurse 50 plus and this is literally the most innovative model of care I have ever had the privilege to serve and our overarching goal is keeping the family together in the community. Caregivers call us, they are experiencing a considerable amount of stress and burden caring for a loved one with Alzheimer’s disease or one of the many related disorders and they need help. And in fact, the organization was founded by caregivers. They knew as caregivers that they could have benefited with that type of help. So that was the original job of the organization was family consultants who worked with the caregiver to start to help them meet the variety of needs that they have. And then shortly thereafter we were able to start opening the adult day centers to provide a safe therapeutic environment for their loved one during the day. And so we have day centers in Palm Beach, Martin, and St. Lucy counties and we have family navigators that are nurses and social work professionals. They are working with the caregiver and some other services we may get into that help optimize the well-being and safety for their loved ones.

Dana Serrano: Fantastic. I love that. I I actually did not know that it was founded by caregivers, which makes so much sense. Makes such a difference. I myself started my company Geek Mechanics in Florida and Stride Therapy in Georgia as a caregiver for my mother and a physical therapist in the field. So I understand how well needed this is. It really you don’t know the gaps until you’re personally going through a situation no matter what your professional background is. So that’s that’s fantastic. Can you tell a little bit about Alzheimer’s community care presently in its its entirety and the scope of what it does?

Dr. Karen Gilbert: Oh, that is a great question. We are we are small but mighty. Actually we are not-for-profit. So we are able to to the benefit of families to help them with funding that we get. We do get some funding from the state. We have private foundations that fund many of our services. So basically when a family member calls us, the first meeting they have is with that family navigator. The family navigator is trying to determine where they are at in this process. How long has their loved one been having symptoms? Do they even have a diagnosis? Many of them don’t. So we’re able to guide them to those specializing neurologists that can give them that quality diagnosis, identify are there any treatments that are appropriate and safe for them, is there a clinical trial they may want to consider. We are also connecting caregivers with other resources that they may need. They may need an elder law specialist. They may need a link to the area agency on aging to learn about what different coverages they have. For instance, if the loved one is a veteran, even one day in active service, there’s certain coverage they will have for some of our services. Many of them need clarification. What does Medicare cover? What do the Medicare HMOs cover? And so on and so forth. So that that first meeting with that navigator is incredibly important and the navigator can start to develop a plan. Every family has a different hierarchy of needs. We can never go in with some preconceived notion of what they need. We have to listen. We have to observe. We not only do an evaluation of their loved one to see where they are cognitively. I’ll get back to that in a moment. But we’re also doing an evaluation of the caregiver to gauge their stress level. And we use again only evidence-based tools to do this. There’s a tool called the Zarrett burden interview. It’s been around since 1983. It’s used in many countries, so it’s well recognized and it helps identify where that caregivers’s stress points are. It’s a series of 12 questions. And then our navigators will plan how often do we need to get back with that caregiver. It might be weekly, it might be every two weeks, it might be monthly. So it might depend on how much other family support they have or are they on their own. So again, every single family is different. If they need the services of our specialized adult day center, then of course we make that appointment for them to have a tour of the day center and evaluate which might be best for them. So, for instance, we currently have nine specialized adult day centers and it could be that there’s one a little closer to the house, but dad is a veteran. And if we go to the next day center, that day center has six veterans. That’s important. So, we look at that. Also, we’ve we’ve navigated a retired teacher to a day center that we know has several retired teachers. So they have that peer and they can have that engagement. So there’s a lot of thinking that goes into this. The day centers oh and by the way that navigator service is free of charge to the family. The family is only investing their time. There is no fee to the family whether the meeting is one hour or four hours. And if they’re willing to invest their time, we can start helping them navigate. Now attending the day center we can’t offer free by law we have to have nurses we have to have individualized care plans, therapeutic activities at least 70% of the day a lot of obligations to have that very special license but the vast majority of our attendees are funded as I said a veteran of active service even one day in active service they’ll be covered including transportation to and from and including the meals. We serve all of the Medicaid plans that serve our three counties, Palm Beach, Martin, and St. Lucy. And so Medicaid will do the same. And then we have a variety of other programs. We also have some state funding through the Alzheimer’s disease initiative. And for that, a family might have a co-pay. It is income-based. Many families have a $1 a day co-pay. So it’s it’s quite affordable. So there’s really no financial barrier there either. Another service that we have is electronic locator equipment. Our navigator will evaluate that loved one to determine the level of risk that they may actually leave the home unattended, unsupervised, which can become, as we all know, a very dangerous situation. So we provide the education how to reduce the risk that they will leave a supervised setting, but then we also provide the technology. So we have radio frequency devices and we have GPS devices and we figure out which is best for that family and then we place that device at no cost to the family. So that is our lost on foot silver alert process. We’ve had our service in place for 12 years. And in those 12 years, close to 300 reports have been given to us from caregivers whose loved one left the supervised setting, either the home or the grocery store or the shopping mall. They turned around and all of a sudden their loved one was gone. Not one has ever been injured. So the program works and again no cost to the family for that either. So we definitely encourage that they take advantage of that education and those technologies. And then of course we have all of the education we do. We do a tremendous amount of community education, not only about the services we have, but about all the evidence that is now available that lifestyle strategies can protect your brain health for a lifetime. We would love it if our day centers were empty 10 years from now, if they were no longer needed. And so we are trying to inspire the general population as to what they can do to preserve and protect brain health. We have a very active health professions education program. Since 2014, we have taught over 2,000 undergraduate nursing students. This is something we don’t do at no cost to the schools. They get classroom training and then they get to actually rotate through the day centers and see what it’s like to be responsible for the care of a severely cognitively impaired person for seven or eight hours and with many and we’re working with Palm Beach Atlantic, Palm Beach State and several Kaiser University campus schools of nursing. We know that those students will graduate and they want to work in ICU and they want to work in the emergency room and medical surgical units. We know that. But what we tell them is the strategies you will learn how to communicate with a cognitively impaired adult, how to deescalate a challenging behavior, how to understand what they need when they can’t actually tell you what they need. Those are skills that will serve you wherever you work.

Dana Serrano: So true. You will encounter cognitively impaired patients no matter what setting you’re in.

Dr. Karen Gilbert: And so we are hoping to develop a truly dementia capable health care workforce. We have taught about 60 graduate nurses going back for master’s and doctoral degrees and we’ve had several hundred going back to earn a bachelor’s degree and then we teach existing health professionals. So we’ve taught about 350 physicians and physician assistance students, occupational therapy students from Kaiser University in Fort Lauderdale. We are open basically whoever approaches us we will say yes we will take your students because there is no structured education on Alzheimer’s and related disorders in health care curriculum so we are trying to fill that void so we truly can have a dementia capable community of health care and social service workers. You know we are concerned because by and large every caregiver calling us already has a loved one in middle stage disease. And we know this because we ask when did you first start seeing a change? What was the first problem they had cognitively that you noticed? The typical answer is a minimum of five years prior to the phone call. So they are no longer in

Dana Serrano: Yeah.

Dr. Karen Gilbert: They’re no longer in early stage disease. Middle stage we have nothing medically for them. Any of the advances that have come out of research only help those with early stage disease. Early stage again often missed. The person themselves may know something’s happening but they don’t want to share that information. It’s frightening. It absolutely is. And often the caregivers incorrectly believe that the changes they’re seeing are just part of getting older. So what we’re out there teaching is you should expect to age brain healthy whether that is to 75, 95 or 105. And you can make that happen with those lifestyle strategies that you choose. So our main job of course is caring for the families. The participant who comes to our day center who we are working all day. It’s like a brain gym. We are working them cognitively. They do math. They do spelling. They do trivia. They are dancing and building crafts. So we have a combination of physical and cognitive activities. And then of course they’re socializing with people like themselves. So they are successful all day which is huge. So can we prove that it’s stabilizing and slowing the progress? No, we can’t. But anecdotally we know how long they are able to stay together in the family home. And that’s huge. They they are not moving to a nursing home. With this support, the family is able to continue caring for this loved one in the home for absolutely as long as possible. Our navigators will help them should needs change, should the needs become overwhelming to the caregiver, but often linking them with hospice service and those with a diagnosis of Alzheimer’s or related disorder are eligible and hospice gives tremendous support. We do find there’s a lot of misapprehension about hospice. Caregivers often think no I can’t do that. It it it means I’m giving up. So we have to teach them. No, it doesn’t. I have a relative that I was a caregiver for. She was on hospice more than two years. So they gave her just tremendous support. She had a nurse visiting, a social work professional, visiting, physical therapy visiting, way more service she would have had if she had just stayed on her standard Medicare. So it was just she had a hospital bed to prevent any pressure wounds. It was really a wonderful adjunct for her with late-stage disease. So we try to encourage the outreach to hospice because again that helps them stay together in the community. So just educating about a lot of the different things they can do has been tremendously helpful for our families. In the rare instance that we get a call and it sounds like the symptoms are new, we are going to encourage them get back to primary care immediately and make sure all of the potentially treatable reasons for suddenly having cognitive issues are covered. Things like clinical depression, which primary care can screen for, vitamin B12 deficiency, D3, underactive thyroid. These are things that can be easily done in the primary care setting. And then at the same time, we advise them as to all of the available specializing neurologists that can make a quality diagnosis if there really is something neurocognitive going on. So time is important. The earlier it’s diagnosed, the more options there are to get some stabilization or even reversal of symptoms, which has been happening when those in early stage adopt an anti-inflammatory diet like the Mediterranean, when they start getting a little exercise every day, socializing, making sure that they do not have hearing loss that needs to be treated, making sure they’re keeping up with their dental cleanings. This is now tied to the development of Alzheimer’s if oral health is poor. So we give them all of those strategies. And we have real life examples of people who did jump on that at the earliest sign and whose symptoms actually started to reverse. Now, they’re not cured because the pathology that causes the Alzheimer’s is still there, but by getting inflammation down, they can actually restore better function.

Dana Serrano: It’s a great way to put it. That’s what we want everybody to know.

Dr. Karen Gilbert: In in a presentation I did this morning and talking about lifestyle, I said, “Okay, who has control over your lifestyle?” And of course, everyone in the room said, “We do.” We said, “Yes, should you choose to exercise it.” So, there are so many strategies from not smoking to making sure you’re getting that good restorative sleep at night, of course, to the diet, the dental health, the hearing exam. It makes sense. The more of those strategies you adopt, the better protected you are. So, that’s the other half of what we’re doing. Job one is caring for the families. absolutely the most important. But at the same time, we are trying to actually instigate an improvement in population health by people realizing they really have control over what’s on the plate, over whether or not they smoke, about how serious they are about protecting that nightly sleep and so on.

Dana Serrano: Absolutely. I love that. No, that’s fantastic. And it’s interesting because I believe that there is starting to become a mental shift in the community on what happens when you are diagnosed with Alzheimer’s or related disorders. So we’ve always thought of once we have this diagnosis, especially coming from a caregiver perspective, the thought is and we get this a lot even at at our company from caregivers and families. Do we put them in memory care? Do we what is the next step of support? And while absolutely there is a place for memory care once the caregiver is overwhelmed and there’s safety concerns that that is absolutely an appropriate step. However, I think looking at, as you mentioned, the supportive services that are offered in the community, as you mentioned, hospice, um, our, you know, our services are an excellent example of having support and caregivers covered by Medicare coming in the home and then an adult day center, which I feel has really not gotten the best reputation in years past on what it looks like. So, if you can speak a little bit to what it looks like current day, because I do believe a lot of caregivers and families have a picture in their head of what an adult day setter looks like and how would that really improve the quality of life in in present day.

Dr. Karen Gilbert: I think that is a great question and I think often what they envision is the same type of image they envision in a nursing home that people are sitting in wheelchairs, their head is down, they’re they’re asleep. And we are exactly the opposite. The specialized adult day license is actually based on legislation that our organization drafted way back in 2011. And so it has all those strict requirements and to earn the license we have to show the surveyors from the Florida Agency for Healthcare Administration that we are meeting every single one of those standards and that is 70% of the time we’re open basically open eight hours a day has to be engaging the participants in therapeutic activity. So they need to be working cognitively, physically, socializing with each other. Because that’s the only quote unquote medicine we have for someone in middle stage. There’s no pill, there’s no infusion, there’s nothing that makes any significant difference medically at that stage. And so it’s a very active environment. We have live music, we have concerts and it is absolutely stunning when you see a participant who might not at all be verbal. They may not speak at all but when that music starts they may even close their eyes, start clapping, start tapping their feet. They are engaging and that is where that therapeutic interaction comes from. So, it’s it’s typically a place that’s buzzing with different activities except for when we’re trying to get everybody settled, get all the hands washed for lunch. Of course, there’s going to be a little bit of downtime there and then the afternoon snack. We allow them to relax and have their snack. But it is a very active environment and we’re able to do that because we’re doing it for eight hours. It’s very difficult for a nursing home or an assisted living to keep up that level of activity because they have to give 24-hour care. So you know again those require this the specialized Alzheimer’s adult daycare act was actually signed into law in 2012. So as we came up for our every 2-year survey now we were held accountable to that statute and then we earned that license. So all of our day centers are licensed as specialized. There are 40 or so statewide with that license. We are the largest single provider with our nine and we we will soon be opening two additional in Palm Beach County. You know, the county is huge. So, we we need to cover some areas there. So, that really we invite them to come tour and then they can see that for themselves. And I will tell you we understand and again I was a caregiver as well how difficult it is to admit to yourself as a caregiver that your loved one is really experiencing this decline. And often what we say is their loved one is obviously middle stage. The caregiver might still be early stage. So, we need to empathize with them. We need to bring them along gently. And often we’ve had a a couple tour and the spouse, let’s say the wife will say, “Oh, my husband is not like the people in that room.” And actually they are. So, we understand that that’s difficult. And often when they see the result of them interacting with others, they are convinced. Okay, I’m picking him up and he’s smiling ear to ear. He’s still singing that last song you did. And then they see the difference from when they were keeping them at home. No caregiver in the home could possibly give this level of activity. They would wear out very quickly. So, sometimes caregivers think if they do not work outside the home, they feel guilty if they engage their loved one in a program. We need them not to feel guilty. They need a break from 24/7 caregiving. Absolutely. If they don’t take care of themselves, they really can’t be there for their loved one. So, they need that break, whether it’s just to to do some shopping, get a haircut, read a magazine. They need to know that that’s okay and they need So, we’re thrilled. I I know you’re involved and very aware of the new program that Medicare has rolled out, the GUIDE program for those with standard Medicare, the original form, not the HMOs, not PACE and not hospice. The original Medicare program now allows caregivers to access either a home health agency so they can have a break in the home or access to a day center and it it it will pay those facilities for the family. So the family doesn’t have to there’s no obligation. The family doesn’t have to pay for this. It’s another benefit from the Medicare program. So we want people to know about that as well. At at the current time it allows for $2500 for either home health or day center or a little bit of both. It’s not a tremendous amount, but it is a start. And we’re hoping that when the Centers for Medicare and Medicaid Services start getting the feedback about how well the families do when they take advantage of GUIDE, which is Guiding an Improved Dementia Experience. That’s what it stands for. that they will increase that allowance because frankly what they’re doing is they’re spending a little to ultimately save a lot. There’s and and a way I could illustrate that our staff in the day center has a tremendous amount of training and they know how to interpret behavior. They know what everybody’s usual is. usual appetite, usual demeanor, usual physical strength and so on. When that person changes, they know something’s up because they normally thrive on routine. So, if they love bingo and today they’re not engaging, we get worried. Now, of course, we will do vital signs. We have nurses there. The vital signs are usually normal, but we’ll try taking them to the bathroom, a snack and a drink, redirecting them to their other favorite activity. If they don’t re-engage, we know something medical or medication related is going on. We’re not going to wait for them to spike a fever because by then they could be critically ill, right? So, we will call the caregiver. will say, you know, let’s, you know, please pick up dad, get him to his doctor’s office. We think something’s brewing. And we track all of those events. And what do we typically get back as a report? Urinary tract infection, common as we age, men and women. Early pneumonia, they’re not coughing. They’re not short of breath. Same thing with COVID 19. Those who went out and came back with a diagnosis of COVID did not have fever, were not coughing and did not have shortness of breath. What they showed us was that change in behavior that we were not able to redirect. You know, they are not able to say it hurts when I take a deep breath or it hurts when I urinate or my back hurts or my tooth hurts. Part of the cognitive decline is they can’t verbalize those needs. they can’t problem solve and figure out what to do and so they will act it out with behavior. So my point there is we I know we have prevented so many emergency room visits and hospitalizations because we have guided the caregiver in nipping it in the bud. Very hard to prove a negative. We just know it’s true. So that is a stunning way to save a tremendous amount of health care expense. So when a caregiver takes advantage of the day center, undoubtedly there’s not only savings in terms of quality of life, which is always better if we can stay out of the ER and out of the hospital, but also cost to the health care system. So that’s a lot of the teaching that we do as well. I will tell you, I know many listeners are familiar with the Silver Alert, the Florida Silver Alert, and our organization actually led the team that created the original Silver Alert, and that was signed into law in 2011. And then 10 years ago, the state came back to us. That was really for drivers. It’s been a very successful program, finding those who actually take a vehicle and go missing. But 10 years ago they asked us to devise the lost on foot process which is a little different. There’s no car to look for and they could be in any direction on the ground. So we again led an interdisciplinary team law enforcement social service agencies and together we came up with the lost on foot process. Now, we of course already had our electronic locator program in place since 2013, since 2 years earlier, but now we were able to share this with many more providers. We do teach law enforcement routinely in all three of our counties. We teach them about lost on foot events. We teach them how to communicate with someone. They’ve gotten a call, this person is missing on foot. And of course, the picture will be circulated on their computers and their vehicles. We tell them how to talk to that person when they spot them. If the person says, “I’m going to work.” And law enforcement says, “No, no, no. Your daughter said you retired 20 years ago.” That may not go over well, right? Because that person believes it is 20 years ago. His long-term memory has taken over and he really believes he’s supposed to be at work. So, we teach them what to say instead. That will deescalate. Yes, I heard you’re going to work. Tell me about that. Tell me about your work. Let them get it out. And then when they do, you know, but your daughter called. She wanted us to find you because the boss said everybody’s getting today off, right? That’s a better way. So, we do a lot of teaching with law enforcement. And then we always end the session teaching those officers and and sheriff’s deputies how they can protect their brain health.

Dana Serrano: Fantastic. Always part of what we of what we teach and so important since the community at large. If we examine the fact that the health community, the health care community and professionals do not have the tools and education provided to them right out of school in program to learn about this. How can we expect the rest of the community, our law enforcement, our our firefighters, our ENTs, how how do we expect any of them to really follow suit and understand how to engage an individual? It’s it’s a huge gap that we’re trying to close.

Dr. Karen Gilbert: You know, our staff who are working in a day center Monday through Friday must have by Florida law an initial 8 hours of comprehensive training approved by the Department of Elder Affairs. They must have a minimum of 4-hour annual updates. We actually do 12 hours. Hospitals have no requirement. There is no statutory requirement in Florida for hospital staff to be educated. So we have great hospitals and great people in them, but they cannot know what they’ve never been exposed to. So often that patient is not understood in that setting. Their behaviors might be medicated instead of understood as a message. And we get it. That’s how they know to care for patients. So we do have hospitals reaching out to us. We’re thrilled to see that because they don’t have to, but they are reaching out saying, you know what, we need this education. So we are I have a 4-hour program coming up on Monday for a hospital in the Treasure Coast. So we’re thrilled to see that they’re reaching out and want to know more. So the the education is not even across the board. Nursing homes only get four hours once in a lifetime. Home health agency is three hours, hospice three hours. So, you know, in an ideal situation, everybody would have the same level, but we’re doing our best to inspire them to seek it, even if it’s not required by law. You know, know that your staff really needs some more tools and some more theory behind how to engage with your patient or resident in a facility in a most therapeutic way.

Dana Serrano: Right. Absolutely. And it’s interesting because again as as a caregiver, I’ve been doing this nearly nearly 18 to 19 years now with my mother who was misdiagnosed and medicated. Her symptoms did not start so clear and directly as short-term memory loss, but more behavioral and executive functioning. And I can tell you that not having support and and the the way that support was viewed in the past with cognitive care was really about it’s either myself, a family member that’s with me in the home or if I hire a caregiver for a few hours a day, that’s the support. But to your point, if you have consistently have therapists coming into the home, hospice, a day center program, which sees this patient, this person, this resident in a routine every day, and can also identify things that are going on, a shift, a change, something’s not right. In the event that the caregiver at in the home, whether it be a spouse, a child, doesn’t pick up on due to overwhelm, is so helpful just to know that someone else is there to back you up. That is a different version of support than even I had 10 10 short years ago. Totally different. Totally different.

Dr. Karen Gilbert: Exactly. And I experienced that also with my dad way back in the ’90s where even the diagnosis wasn’t clear. And he was diagnosed with Alzheimer’s, but as I learned more about this, I came to the realization it probably wasn’t Alzheimer’s. He had undiagnosed atrial fibrillation and for two years had what they called fainting spells. Those weren’t fainting spells, those were strokes. He had borderline high blood pressure his entire adult life, although he really tried. He was never overweight. He stopped smoking at 52. But he had the risk factors and it was totally missed. So we know a lot more now about getting what we call a quality diagnosis and it’s not easy. That’s why you need the neurologist. A large percentage of people diagnosed with Alzheimer’s also have Lewy body pathology which is a different protein pathology largely as you would know in physical therapy a movement disorder related to Parkinson’s. So you really need that specialist who can figure that out and then determine what is the best course. I’ll I’ll get on my soap box for a moment with preventive strategies. Half of US adults have high blood pressure. Half. And the estimate from the Centers for Disease Control is that fewer than half of them have it under control. High blood pressure damages blood vessels, including the ones that feed the brain, right? And so they’re at higher risk for stroke and for ultimate cognitive decline. When you have a stroke, brain cells will die and faculties will decline. Type two diabetes. Now, type one is a is a different beast. That’s autoimmune. So that one you can’t necessarily prevent. But type two is highly preventable or reversible should it begin. We have close to 30 million in this country that we know of being treated for type two and the CDC estimates another 90 million are actually on their way to developing type two and only half of them know it. Not everybody goes for an annual physical. You know, part of our training is never skip your annual physical. Type two comes on gradually. You might feel fine, but in the background, that blood sugar is starting to rise and eventually it will cause a lot of problems. So, some people take comfort in only being pre-diabetic. What I go out there and say is no such thing. You’re either diabetic or you’re not. Because even in the pre-diabetic phase when your sugars are higher than normal, that same damage is starting. Damage to nerves, damage to blood vessels. And I thought I was alone in that in being so um how shall I say strident about that position. But a few weeks ago, I was listening to a webinar from Dr. Richard Isacson, internationally known expert in Alzheimer’s and related disorders based in Boca Raton. And in his webinar, he said, “You’re either diabetic or you’re not.” He said, “No pre-diabetes.” So, this is what we really want people to adopt. There is no safe space. You know, they used to talk about prehypertension. No, you either have high blood pressure or you don’t. And you know, we we almost need to do this global intervention to say don’t take comfort in being pre this or pre that. You wouldn’t have your dermatologist leave a pre-malignant lesion on your arm. You’d have them remove it. You wouldn’t have a colonoscopy with pre-malignant polyps and have the physician say, “Oh, I just left them there. They’ll be okay.” We don’t accept it for other things. So, now we need to not accept that pre-notion for metabolic health. One in three Americans has metabolic syndrome. One in three.

Dana Serrano: Insane. Wow.

Dr. Karen Gilbert: this we are we are not really healthy. So but this is a great opportunity and there have been so many who have said I listened and I took it I had a nursing student who was with me and then she came back again for another rotation six months later and she said you know I listened to you and I lost 30 pounds and I’m no longer on blood pressure medication. Wow. So, that’s the other notion. You know, sometimes you can get pills that will lower your numbers, but there’s some evidence out there that says it might not be actually fixing the metabolic damage going on in the background, right? So, always better to prevent any disease, better to prevent than to try to cure. But especially with metabolic disease, with type 2 diabetes, with high blood pressure, for so many people, they are reversible should they begin, right? And that’s what we really would like people to be inspired to take advantage of. You know, we very much believe, oh, there’s a pill for everything. But it’s not always the best the best, right?

Dana Serrano: At that point, it’s it’s as you mentioned, the the train has already left the station. We really need to educate people ahead of time and manage these events at every stage, whether it’s at the preventive stage or all the way to, you know, middle stage.

Dr. Karen Gilbert: What is metabolic syndrome? Diabetes, high blood pressure, high triglycerides, and a waist measurement that’s more than 35 for women, more than 40 for men. You don’t need a doctor to tell you that. you have you have a tape measure, you can you can assess yourself and decide that maybe you need to start doing something. And that that is just so powerful. People don’t have to wait for the cure, but the common denominator for all of this seems now to be inflammation. and inflammation causes diabetes, high blood pressure, cancer, cardiovascular disease, and Alzheimer’s. So, that anti-inflammatory diet, getting that exercise 2 and 1/2 hours a week. this is targeting stress, reacting to stress in a healthier way that is going to reduce the generalized inflammation that puts you at risk for all of this. And there are many new studies for Alzheimer’s that are targeting inflammation, not the amyloid. Many people have a lot of a dysfunctional amyloid, but they don’t have symptoms. And that’s largely believed because they don’t have the inflammation inflammation in the body. You also have neuroinflammation in the brain damaging brain cells. So glad to see that uh it’s a different focus. Uh by and large the treatments for reducing inflammation do not have the side effects of the current therapeutics casula and lemi brain bleeds and brain swelling. they don’t have those side effects. So these are different opportunities that we hope will become more and more available. But we can start start teaching people from the earliest age how to reduce inflammation largely largely diet and exercise, stress, sleep of course and of course not smoking. So to the extent someone is motivated to be proactive and be preventive, it’s right there in front of us.

Dana Serrano: I think that’s fantastic. I I really appreciate not just your time today, but the fact that you are spearheading the educational piece you as well as the organization Alzheimer’s Community Care. I always say that these sort of inspirations and and and communication into the community is just the starting piece. You’ve already started the ball rolling and you’ve already saved many many lives just in the in the preventive education that you’ve put out there. As you know, Alzheimer’s does unfortunately increase your mortality rate. So just by putting this out there into the universe and to the community is really a way to get the word out there and not only provide support to those who are already on the journey, but hopefully really to prevent the journey, which is really the new focus that most people don’t understand.

Dr. Karen Gilbert: Well, I will tell you these strategies, we actually have a a pretty detailed handout, just one page that has all of these different strategies. For a lot of them, it gives a website if you want to dig a little deeper. The not smoking, how to get adequate sleep, the diets. We’re happy to send that to anyone listening or watching. We have a very simple email and it’s the word education@alzcare.org alz.org. and we’re happy to send it out and share it with whoever wants to read up and take advantage of the different strategies they can start adopting.

Dana Serrano: Fantastic. And of course, I’m going to share the link to Alzheimer’s community care so they can get in touch with you and your organization. Amazing, Karen, what you and your your colleagues have done. I’m I’m so honored to have you here today and and to speak with us and our community. Thank you for everything that you do.

Dr. Karen Gilbert: Well, likewise, because we can’t do everything, and the service you’re able to give, cognitive therapy in the home covered by Medicare is huge. So, we want everyone to know about that opportunity as well. Even if the person is attending a day center, if they could do better with a little more, we want to see them have that opportunity also. So, it really does take a village. It takes us, it takes the community organizations, the state-run organizations, it takes everyone to put that real safety net around these families. So, we’re we’re thrilled to be part of it.

Dana Serrano: The the beauty of this and and I can speak to this for having been on on this path with my family for for some time now is that it does make a difference. You know, I’m about 18 years into this and even 10 years ago, the support and the awareness wasn’t there. So, it’s it’s it’s happening. We can see the results already and we haven’t even looked at how that’s going to affect the health of the next generation as of yet. But it but it already has. I can tell you that for sure.

Dr. Karen Gilbert: We hope so. We want to move in that direction. So, thank you so much. Have you have a wonderful day. I appreciate you being here today and and for all that you do, Karen. Thank you.

Dr. Karen Gilbert: It’s a privilege to have been with you. Thank you so much. Take care.