A lost set of keys … missed dental appointment … forgetting the name of an acquaintance, these may be signs of normal aging. Coupled with other symptoms, however, they may also signal the start of dementia or other conditions that early-on could be mistaken for dementia—amyotrophic lateral sclerosis (ALS), depression, Parkinson’s disease or even a small stroke. These “neurocognitive conditions” all affect a person’s ability to think and reason. They also can’t be diagnosed with a simple blood test or during a 30-minute doctor’s appointment. Accurately diagnosing a neurocognitive condition requires a comprehensive evaluation by a multi-disciplinary team of healthcare experts. Thanks to Dignity Health, Yavapai Regional Medical Group that important service is now available in our community. The Cognitive Assessment and Support Clinic – the first of its kind in northern Arizona – was recently launched. The new Clinic brings together the expert team needed to conduct comprehensive cognitive (brain) assessments all under one roof. Cognitive Vitality and Assessment Sam Downing, MD, Director of Geriatrics and Palliative Medicine at Dignity Health, Yavapai Regional Medical Group, is leading the team that developed the Cognitive Assessment and Support Clinic. During this episode of Healthy Conversations, Dr. Downing highlights how the Cognitive Assessment and Support Clinic will help people learn more about their individual brain health. He also outlines scientifically proven strategies for staying mentally vital as you age. Dr. Downing calls this “enduring quality.” Why a Cognitive Assessment Clinic? The Cognitive Assessment and Support Clinic fills an important community need for our aging population. In Yavapai County, approximately 32 percent of the population is 65 years of age or older, according to the Centers for Disease Control and Prevention. That’s significantly higher than Arizona’s statewide average of 18 percent. In addition to supporting the needs of an aging population, the Cognitive Assessment and Support Clinic also reflects a new approach to cognitive health in the healthcare community. “We know that people can suffer from different kinds of organ failure,” explains Dr. Downing. “Heart failure occurs if the heart isn’t pumping as effectively as it should. Some people experience liver failure or kidney failure. So, it makes sense that we can also experience brain failure. This is the brain’s decline over time, possibly related to aging but also possibly due to disease processes that keep the brain from functioning as it should.” A 360-Degree Check of Your Brain Health What does an evaluation at the Cognitive Assessment and Support Clinic include? The assessments take place over a 3-hour appointment and feature an array of tests, screenings and exams, including: Neurocognitive test – This exam is conducted by a neuropsychologist—an expert at the relationship between the brain, behavior and cognitive function in multiple areas including memory, orientation, language, and executive functioning. “A major benefit of the neurocognitive exam is that it serves as a baseline to measure any future changes in brain function,” Dr. Downing says. Physical exam – A primary care physician conducts a physical exam and recommends screenings and tests the patient needs. This physical may identify causes for memory issues unrelated to dementia, such as lack of vitamin B-12, other medical issues or mental health conditions. “The Cognitive Assessment and Support Clinic team will work with partners in the community on behalf of patients,” says Dr. Downing. “If we identify an issue like depression, for example, we’ll reach out to local mental health partners – psychologists and counseling colleagues – to arrange assistance for the patient.” Medication evaluation – The risks, benefits, side effects and interactions of the patient’s medications – from over-the-counter to prescription – will be reviewed by a clinical pharmacist. “Often, we find that seniors are not only taking way too many medicines, but many are confused about how to take their medications correctly,” notes Dr. Downing. “The Cognitive Assessment and Support Clinic is a great opportunity to sort that out for people.” Social impacts – A social worker talks to the patient and family about their current living situation: work status, means of transportation, financial management and more. “This portion of the cognitive assessment is especially helpful for families and caregivers, who unfortunately are often overlooked,” Dr. Downing says. “Our social worker will identify people who need additional support at home and recommend valuable resources.” Functional assessment – This is a check of the patient for balance problems and any difficulty with walking. These issues pose an obvious safety risk and are also an indicator of certain neurocognitive conditions. Nutritional assessment – The link between diet and brain health has been established by extensive research. A review of the patient’s diet and a discussion of the ways in which diet can support brain health takes place. Sensory evaluation – Vision and hearing loss are part of aging, but when unaddressed they can affect the brain, lead to social isolation, and even contribute to dementia. “Early Alzheimer’s disease is often associated with a loss of smell,” Dr. Downing says. “That’s one reason a sensory screening is important to a cognitive assessment.” Getting Results Following an evaluation at the Cognitive Assessment and Support Clinic, patients and the providers they designate will receive a report of the team’s findings. The report will include specific recommendations for follow up. “In my work, I’ve found that as people age they want to be fully engaged in life both physically and mentally,” Dr. Downing says. “They want a quality of life that endures. Supporting that goal is the overarching purpose of the Cognitive Assessment and Support Clinic.” To learn more about the Cognitive Assessment and Support Clinic, and other YRMG Geriatric Services, contact Geriatric Services at Dignity Health, Yavapai Regional Medical Group, at (928) 775-5567.

Osteoporosis is called a silent disease because it’s often not detected until a bone fracture occurs. But your body may be talking to you long before that happens. Loss of height over time and back pain may be signs of bone loss. “Osteopenia is the beginning of osteoporosis,” says Sierra-Amber Mabry, RT, Prescott Medical Imaging (PMI) at Dignity Health, Yavapai Regional Medical Center (YRMC). “Osteoporosis causes low bone mass and makes you more susceptible to spontaneous, non-trauma fractures.” An estimated 10 million Americans, 80 percent of them women, suffer from osteoporosis. An additional 44 million Americans have osteopenia, placing them at increased risk for osteoporosis. How DEXA Works Screening for bone density – how strong your bones are – is the only way to determine if you have osteoporosis or osteopenia. The imaging experts at PMI in Prescott and the Breast Care Center at Dignity Health, YRMC East in Prescott Valley use advanced dual energy X-ray absorptiometry (DEXA) technology to: Measure bone density and loss Assess risk for bone fractures Screen for osteoporosis, osteopenia and other bone-related health problems YRMC’s imaging facilities use Hologic equipment which scans your hip bones and lower spine, or your forearms. These exams are painless and use a much lower level of radiation than standard X-rays. “The radiation from a DEXA scan is lower than the amount of radiation you receive in a single day from background radiation sources like the sun and the environment,” says Mabry. Getting Ready for Your DEXA A DEXA scan takes a total of 20 minutes from the changing room to the exam room. During the exam, you lie on your back as the scanner passes over your body. Your radiologic technologist will place a sponge block under your knees to alleviate lower-back discomfort. “Unlike an MRI or a CT scan, DEXA scans are open,” Mabry explains. “The DEXA X-ray table doesn’t have an enclosed tube, which can make some people feel claustrophobic.” If you’re scheduled for a DEXA, Mabry recommends that you: Bring the DEXA order from your provider Wear comfortable clothing Leave your jewelry at home Don’t take calcium pills for 24 hours prior to your scan “We’ll ask you to change into a gown for your DEXA exam,” Mabry says. “The purpose of this is to ensure we have uniformity for every exam so that we don’t have to repeat your scan. It also saves you time if you arrive in clothing you can change in and out of quickly.” Understanding your DXA Scan Results Your DEXA scan results are sent to your physician within 24-48 hours after the exam. Your results are available to you within 72 hours on YRMC Care Connect, YRMC’s patient portal. DEXA scan results are presented as a “T-score” and fall into the following ranges: +1.0 to -1.0 = normal bone density -1.0 and -2.5 = osteopenia or low bone density -2.5 or below = osteoporosis “Lots of people don’t know that osteopenia and osteoporosis are treatable,” Mabry says. “Your doctor can give you medication and your bone density can improve. This means you’ll be less likely to suffer a non-trauma fracture in the future.” You can also speak to your physician about other ways to improve your bone health, including: Consuming a calcium-rich diet Taking calcium and vitamin D Doing weight-bearing exercises (walking, jogging or light aerobics, for example) Giving up smoking Avoiding alcohol or consuming alcohol in moderation For more information about the DEXA exam, visit PMI’s website or the Breast Care Center’s web community. To find out if you should undergo a DEXA scan, speak to your physician.

It’s rare for Palliative Medicine physician Larry Parsons, MD, to meet someone who understands his medical specialty or how it benefits patients with serious illnesses. Dr. Parsons directs inpatient Palliative Medicine at Dignity Health, Yavapai Regional Medical Center and is part of the Palliative Medicine team at Dignity Health, Yavapai Regional Medical Group. A dynamic communicator, Dr. Parsons helps patients and their families understand their medical choices and what they mean. “What I bring to hospitalized patients is a big-picture view of their health status,” says Dr. Parsons. “Heart doctors assess the patient’s cardiac health; kidney specialists focus on the patient’s kidney function; and palliative medicine physicians look at the entire patient. We take a holistic approach to healthcare.” What does the Palliative Medicine holistic approach include? This holistic approach means Palliative Medicine experts consider your physical, emotional, spiritual and family needs, which may include: Managing symptoms (pain, shortness of breath, weakness, fatigue and more) Addressing quality of life issues Alleviating emotional distress, anxiety or depression Assisting with advance directives Arranging for spiritual counseling Explaining and discussing a patient’s clinical status “This takes time,” Dr. Parsons says. “It means getting to know folks, learning what’s meaningful to them, and becoming familiar with their support systems. How is their illness affecting their life? Do they understand their clinical situation? Because I come with time, I can help people explore what’s important to them.” During this episode of Healthy Conversations, Dr. Parsons discusses YRMC’s Palliative Medicine program. He also shares a compelling story about his family’s experience with medical decision making. Palliative medicine is not hospice care A common assumption people make is that Palliative Medicine and Hospice are one in the same. In fact, they are two different services. For example, the Palliative Medicine team works with patients – and their physicians – as they are pursuing medical treatment. Additionally, Palliative Medicine can begin most any time during an illness. Hospice is an option for people who have a life expectancy of less than six months. A comprehensive Palliative Medicine program At YRMC, Palliative Medicine is available for inpatients – people hospitalized at YRMC East or YRMC West – or in the community through Dignity Health, Yavapai Regional Medical Group, Palliative Medicine. According to Dr. Parsons, it’s rare for a Palliative Medicine program to offer both inpatient and outpatient services. “Our community is very fortunate to have Palliative Medicine for hospitalized patients and as an outpatient service,” Dr. Parsons says. “It’s clear that YRMC understands the importance of this type of care for all patients.” If you’re hospitalized at YRMC East or YRMC West, you may request a Palliative Medicine consultation with Dr. Parsons through your attending physician – also called a hospitalist – or contact Dignity Health, Yavapai Regional Medical Group, Palliative Medicine at (928) 775-5567.

Setting up a home fitness program doesn’t have to be complicated, but there are a few steps you can take to ensure you’re successful, and of course, safe. What’s step one? “Make sure your program includes full-body exercise,” said Danyelle Schott, Certified Personal Trainer, Yavapai Regional Medical Center’s (YRMC’s) Pendleton Center West in Prescott. “That means incorporating both weight-bearing and aerobic exercise into your home fitness program.” There are lots of home friendly options, including: Aerobic Exercises—Jumping jacks – regular or modified, as recommended by Schott – or marching and jumping rope are all good forms of aerobic exercise you can do at home. If you have stairs, you can walk them, too (remember to hold the rail). Weight-Bearing Exercises—Examples of weight-bearing exercises include squats, sit-to-stand from a chair, pushups and planks. During her YRMC Healthy Conversations presentation (video below), Schott shares tips on how you can modify these exercises for your fitness level.  Set Your Goals … Track Your Progress “I tell people that their goal should be to raise their heart rate every day for at least 30 minutes,” Schott said. “A starting point would be doing this twice a week and gradually building to 30 minutes.” Which brings us to the importance of tracking your progress. It’s good to know where you started in order to appreciate your progress and stay motivated. There are plenty of apps available to help you track your workouts. There’s also nothing wrong with the low-tech approach of logging your daily workout information – number of reps and times – onto your computer or paper calendar. Weight-Bearing Exercise You can build your strength without a costly set of weights by doing “bodyweight” exercises. Squats, pushups and lunges are examples of bodyweight exercises that allow you to focus on form without adding resistance. You’ll get stronger with these and work multiple joints and muscles all at the same time. If you want to add weight, Schott outlines common household items you can use in her presentation. She also highlights home fitness workouts using a chair. Safety Always If you live and exercise alone, Schott recommends finding a fitness friend. “You can get together virtually with Zoom or Skype while you work out,” she said. “This will keep you accountable and safe. Also, always keep a phone and chair nearby in case you’re injured while exercising.” Fitness Resources, Training and Classes! Download and print this Living Room Workout tip sheet that Schott highlights as a guide for your home fitness plan. You can also contact YRMC Community Outreach to request the chair exercise pamphlets Schott recommends in the video. Reach us by email (communityoutreach@yrmc.org) or by phone at (928) 771-5738. If home fitness isn’t for you, YRMC’s Preventive Medicine and Wellness teams in Prescott and Prescott Valley offer personal training from experts, like Schott. There are also a variety of fitness classes including SilverSneakers®, Silver&Fit® and Renew Active™. Subscribe to YRMC HealthConnect to keep up-to-date on Healthy Conversations topics or checkout our calendar. You can register for future presentations or watch past presentations at YRMC HealthConnect (scroll to the bottom of the page).

“Into each life some rain must fall.” These words are more than song lyrics or a familiar expression to Cheryl Van Demark, PT, C-IAYT, Physical Therapist and Yoga Therapist at Yavapai Regional Medical Center (YRMC). They’re part of a self-compassion practice Van Demark teaches in the YRMC Self-Care Program for Chronic Pain called RAIN—Recognize, Allow, Investigate and Nurture. RAIN is from the work of psychotherapist Tara Brach, PhD. Sprinkle Some RAIN into Your World During Practicing Self-Compassion, a YRMC Healthy Conversations presentation, Van Demark teaches you how to practice RAIN and introduces you to the benefits of self-compassion. “RAIN is a template for a self-compassion practice that can either be brief or lengthy, according to your individual needs,” she explained.  Van Demark also notes that self-compassion literature suggests employing the “Golden Rule.” This means treating others as you want to be treated, but directing it inward to yourself. “To quote Zen Master Thich Nhat Hanh,” said Van Demark, “compassion is a verb. It’s the action we take to relieve suffering in ourselves or others.” Be Kind to Yourself How do we put self-compassion into action? It could be, for example, by recognizing your personal need for exercise in order to maintain your physical and mental health. The nurturing, or action, could be to carve out 30 minutes a day for a brisk walk. “Today in particular we’re confronted with global and individual suffering—social, economic, psychological and more,” said Van Demark. “This calls out loudly for us to practice self-compassion.” Self-Care Program for Chronic Pain Van Demark also oversees YRMC’s Self-Care Program for Chronic Pain. Through this program, participants learn to work in concert with their bodies and minds to understand and ease chronic pain. Self-empowerment techniques and physical therapy are also important components of the program. For more information, contact Cheryl Van Demark (cvandema@yrmc.org). Subscribe to YRMC HealthConnect to keep up-to-date on Healthy Conversation topics. Check out our calendar for upcoming presentations and register or view past presentations at YRMC HealthConnect.