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Longevity part 3: Investing in access

Specialized labs, a new heliport and cancer treatment options are just a few of the access-to-health care improvements made both in the high country and on the Western Slope in the last two decades.

By investing in staff, facilities and transportation, Valley View Hospital in Glenwood Springs reduced its patients’ need to travel for specialized care, said Dr. Frank Laws, an electrophysiologist and interventional cardiologist at Valley View.

On the other end of the Roaring Fork Valley, Aspen Valley Hospital consolidated several health care services into one campus, providing a single destination for its patients’ care needs, Aspen Valley CEO Dave Ressler said.

Many of Colorado’s recent leaps and strides toward better, more accessible health care were facilitated in part by the state’s expansion of Medicaid under the Affordable Care Act in 2013, said Cara Welch, the Colorado Hospital Association director of communications. 

Rural hospitals provide the foundation of health care throughout the state, but on the Western Slope, those hospitals can play an even larger role when requiring special services could mean an hours-long trip to Denver or Salt Lake City, Utah.

In the rare life-or-death situation, time spent on the road can play a deciding role in the outcome. On the flip side, people with special care needs, such as oncology, cardiology and chronic pain management, often choose where to live based on the services available within the area.

These factors combined with the rising cost of health care have contributed to a growing demand outside the metropolitan centers.

“Access to care is a major issue right now,” Laws explained. “A lot is economics, a lot of it is distance, but across the board the need is the same.”

Glenwood Springs

Valley View Hospital’s heart and vascular cath lab brings patients from around the region as well as internationally.
Courtesy of Valley View Hospital

When Laws hired on with Valley View in 2006, many of the hospital’s patients were traveling to Denver or out-of-state for some of their cardiology needs, he said. 

“I was recruited to enhance Valley View’s cardiovascular services and start a cardiac catheterization laboratory (cath lab),” Laws explained. “Learning how far people had to travel for certain services and procedures was a big eye-opener when I came here.”

A cath lab is a facility with diagnostic imaging equipment used to visualize the heart’s arteries and chambers as well as treat any abnormalities found. 

As an interventional cardiologist, Laws provided the expertise needed to run the lab. Additionally, the facility drew more specialists to the hospital. Valley View’s cath lab was up and running by February 2007, just a few short months after Laws arrived. 

The hospital also built a heliport in 2006, creating the ability to ensure patients with needs beyond the services provided could receive timely care.

“Prior to the heliport construction,” Laws said, “if you needed to be transported anywhere by air, we had to take you by ambulance to the airport in Rifle and catch a flight from there.”

During a year-long sabbatical in 2014, Laws studied cardiac arrhythmia at the Tufts University School of Medicine. 

Upon returning to the Glenwood community with his newly earned expertise, Valley View was able to start treating atrial fibrillations, a chaotic arrhythmia that arises in the heart’s top left atrial cavity, Laws said.

“Atrial fibrillation is very common in the mountains because of the prevalence of sleep apnea,” he explained. 

The combination of services, specialists and equipment added since Laws’ arrival in Glenwood served to reduce travel times for patients, but also attracted new patients from around the globe.

“The fact that we have created a destination program also provides an economic impetus for the area,” Laws said. “Having these services nearby reduces stress on the patients and the family’s that often have to care for them throughout treatment.”

Aspen 

Dr. Heather Murphy conducts a “virtual visit” with a patient as part of Aspen Valley Hospital’s telemedicine services and commitment to expanding health care access throughout the area.
Courtesy of Aspen Valley Hospital

Three phases into a four-phase master facility plan, Aspen Valley has endeavored to consolidate Pitkin County’s health care services into one convenient location, Ressler said. 

“Our hospital’s vision is to foster our community as the healthiest in the nation,” he said. “We are looking at our social responsibility as a community-owned organization very differently than hospitals traditionally have in the past.”

As part of a special tax district, the hospital receives a portion of property taxes collected around Pitkin County to fund its operations. 

One of Aspen Valley’s tenets is increased access to primary care, which was a focus during its recent expansions.

“Nowadays, data and evidence better illustrate the amount of total health care costs that can be contributed to chronic conditions,” Ressler said. “By taking a more holistic approach, a primary care practice can have greater impacts on the individuals willing to manage their lifestyles.” 

Constructed in 1977, the hospital has undergone a number of expansions in recent years providing space for in-house ear, nose and throat services, expanded cardiology services, ophthalmology and primary practices.

The campus also leases space for general surgery, orthopedics, obstetrician/gynecologists, a pain clinic, rheumatology, pulmonology and endocrinology, Ressler said. 

“By locating practices here on the campus, a patient can have adequate parking, and get all of their services done in one location,” he said. “Breast health is another example of where we have expanded. Our patients used to have to travel to Denver for breast biopsies and ultrasounds.”

While the pandemic reinforced the need for quality tele-health services, Aspen Valley was investing in its long-distance health care options prior to COVID-19.

Using an electronic platform, eClinicalWorks, the hospital enhanced its abilities to track medical records digitally.

“The improvements we made to our services in the last 10 years removes barriers to care,” Ressler said.

Statewide 

Keeping Colorado’s rural hospitals open is one of the best ways to ensure residents maintain a high level of access to care, Welch said.

“We’ve seen a lot of rural hospital closures around the country, but that’s not happening here,” she said. “That is in large part because the state was quick to step up and expand Medicaid.”

A rural hospital has not closed in Colorado since the ’80s, according to the hospital association’s data.

Welch said community support and strong hospital leadership also played major roles in keeping Colorado’s hospitals open.

“Collaboration of our hospitals as a system is another factor,” Welch explained. “At times, they may compete for some business, but they collaborate in a number of ways that benefits all the hospitals throughout the state.”

Those efforts have paid off in a number of ways, particularly with reducing the need for patients to travel, Welch said.

“A lot of the higher acuity specialty care do still tend to come to the Denver Metro area,” she said. “But, all our hospitals have really focused on what services they need to provide their communities, so people don’t have to travel as far.”

Editor’s note: This is part 3 of a four-part series on longevity in the High Country. The series is being produced in partnership with the Glenwood Springs Post Independent, The Aspen Times, Vail Daily, Summit Daily News and Steamboat Pilot. Read more at postindependent.com/longevity

An unclear correlation: Colorado clinicians and researchers talk Alzheimer’s and other dementias risk, care in mountain communities

It isn’t noticeable at first, starting with changes to the brain that the brain can compensate for, meaning no real impact on day-to-day functions or cognition.

But as time passes the brain can no longer compensate for these changes and the damage it’s experiencing. Subtle problems with memory and thinking begin to pop up. Subtle turns to noticeable. Noticeable turns to inhibiting the ability to carry out everyday activities and eventually to requiring around-the-clock care.

This is the broad view progression from pre-clinical to severe Alzheimer’s disease, a degenerative brain disease that becomes worse with time and age, and is the most common cause of dementia, as explained by the Alzheimer’s Association.

In Colorado, an estimated 76,000 people are living with Alzheimer’s dementia, and that number is expected to increase 21% to 92,000 by 2025, a 2020 Alzheimer’s Association report states. As of July 2019, 14.6% of Coloradans or roughly 840,000 people were 65 or older, U.S. Census data show.

But while generally speaking it’s been shown that living in higher altitude communities in places like Colorado can lead to a more active, healthier lifestyle and even prolonged life, how does living at altitude impact and correlate with degenerative brain diseases that cause dementia, like Alzheimer’s?

In short, the answer is complicated and not well researched by scientists and clinicians, as explained by Dr. Huntington Potter, director of the Alzheimer’s and Cognition Center at the University of Colorado Anschutz Medical Campus.

“As far as I know, there isn’t a lot of evidence one way or another about high altitudes versus low altitudes for Alzheimer’s disease risk,” Potter said. “We can’t say one way or another whether high altitude is a risk factor for Alzheimer’s.”

DEMENTIA AT ALTITUDE

Alzheimer’s disease is namely the result of the accumulation of the protein fragment beta-amyloid outside of neurons in the brain and of an abnormal form of the protein tau inside neurons, as described by the Alzheimer’s Association.

These accumulations over time can contribute to the damage and death of neurons by interfering with neuron-to-neuron communication at synapses, an Alzheimer’s Association report says, and can block the essential transport of nutrients and other essential molecules inside neurons — resulting in early symptoms of memory loss, apathy and depression; later symptoms of impaired communication, disorientation, confusion, poor judgment, behavioral changes; and ultimately difficulty speaking, swallowing and walking as neuron damage gets worse.

At the Alzheimer’s and Cognition Center, which is part of both the CU Anschutz Medical Campus and School of Medicine, clinicians and researchers are dedicated to discovering effective early diagnostics, preventions, treatments and ultimately cures for Alzheimer’s disease and related neurodegenerative disorders, according to its website.

For Potter, that means looking at biomarkers or diagnostic proteins in the blood that can help clinicians predict the disease earlier; conducting projects that look at the longitudinal sort of lifespan of people with Alzheimer’s disease; and other research that can quickly be translated to better care, treatment and hopefully a cure.

Right now, the center is studying a drug called Leukine, which preliminary data shows may actually improve Alzheimer’s disease in the short term, Potter explained. The center also is studying other drugs that attack the disease, which so far are looking very promising as well.

“Leukine may be the first one we found that looks promising but we have several coming up that look promising as well,” Potter said.

“It’s been a tremendous privilege to work with all of the clinicians and scientists and scientist clinicians at the Alzheimer’s and Cognition Center, and we’re absolutely determined to make Colorado one of the places that discovers the cure for Alzheimer’s disease.”

When it comes to looking at the potential correlation between living at high altitude and the risk for Alzheimer’s and other dementia-inducing diseases, Potter and Dr. Peter Pressman of the Alzheimer’s and Cognition Center said it would take great effort, time and funding to research.

Pressman, who is a behavioral neurologist and researcher with the center, said on top of securing and carefully selecting a large group of people living at altitude to participate in a study, researchers would also have to follow that group for around a decade to get meaningful results — which is not impossible, but not easy.

“It’s easy to fund a study for a few years. People give you money to do something for two to three years, but two to three years is not enough time for a process as slow as Alzheimer’s and dementia to really even pick up,” Pressman said. “I’m not saying that’s not possible, it’s doable, but it would take some effort.”

Dr. Brooke Allen, neurologist, founder of Roaring Fork Neurology in Basalt and medical director at Renew Roaring Fork, an assisted living and memory care center in Glenwood Springs, expressed similar thoughts.

Allen said as a part of any mild cognitive impairment or dementia evaluation, her team checks the oxygen level a patient has and considers the altitude at which that person spends most of their time.

Lower oxygen levels can certainly contribute to people experiencing confusion, dizziness and mild short-term memory issues. But outside of looking at oxygen levels and how they could be contributing to symptoms, Allen said she doesn’t consider altitude a higher risk situation.

“I’ve never really personally looked and it … but I think doing a retrospective sort of epidemiology review would probably make sense at first to even see if there’s a need to research it,” Allen said.

At Roaring Fork Neurology, where Allen and her team diagnose and treat headaches, migraines, concussions, Parkinson’s disease, dementia and other disorders of the nervous system, about 25% of the practice is treating patients with some sort of dementia or mild cognitive impairment, Allen said — a percentage that’s stayed fairly stable over the past 10 years she’s been working in the Basalt area.

This mild cognitive impairment means patients haven’t lost the ability to carry out the activities of daily living, but are having some trouble with things like using new equipment, not being able to work a remote control or having more trouble with finance calculations, Allen said.

To treat patients experiencing this mild cognitive impairment, Allen’s team first looks at risk factors like age, gender and DNA, which are not modifiable but are contributors; high blood pressure, diabetes, sleep apnea, high cholesterol, obesity, and exercise levels, which are modifiable; and B12 levels, signs of infection, a potential brain tumor or structural abnormality and oxygen levels, factors which can “reverse” the symptoms being experienced if they exist and are addressed.

But overall, Allen said she feels Roaring Fork Valley residents 65 and older tend to be much younger than their age in terms of their lifestyle, which is a positive in terms of dementia prevention.

About four years ago, Allen and her team conducted a long-term pre-clinical Alzheimer’s trial as part of the Alzheimer’s Prevention Initiative’s Generation Program, a study that looked at the effectiveness of preventative treatments for individuals between 65 and 75 who had no symptoms of dementia.

Allen said over 250 people came in to participate in the study and all generally led healthy, active lifestyles.

“I think in our valley, I’ve experienced meeting those kinds of people and not thinking of altitude as a risk factor but as a lifestyle opportunity in a rural area like ours,” Allen said of the people who participated in the recent study.

Looking at this potential correlation between living at high altitude and risk of Alzheimer’s dementia and others is not just a difficult feat for Colorado researchers — little research with concrete findings exists nationally and globally as well.

One study published in 2015 by Dr. Stephen Thielke in JAMA Psychiatry looked at deaths attributed to Alzheimer’s dementia reported in 58 counties in California to try to determine whether rates of dementia were associated with average altitude of residence. The study found that the counties at higher elevation generally had lower rates of dementia mortality.

“Oxidative abnormalities have been long proposed to be central to the pathogenesis of dementia,” the study research letter states. “One group of researchers previously found that hypoxia prevents neurodegeneration in rats in experimental Alzheimer disease and hypothesized that adaptation to induced hypoxia may prevent dementia. To our knowledge, our work is the first to find epidemiological evidence for such effects. Additional work is needed to determine whether this relationship holds in other populations.”

But beyond this study, there isn’t much conclusive evidence for or against a correlation, as emphasized by Dr. Brent Kious, a psychiatrist, assistant professor and researcher with both University of Utah Health and the school’s Department of Psychiatry.

Kious has studied the link between living at high altitude and major depressive disorder, anxiety and suicide, and said he and his research team have been interested in the impact of altitude on the incidence and median age of onset of Parkinson’s disease, but has not studied this impact or the effects of altitude on dementia risk.

However, Kious said decrements in cognitive performance due to chronic exposure to moderately high elevation might not necessarily translate into an increased risk of dementia, since the symptoms of dementia depend both on baseline cognitive performance and on pathological neurodegenerative processes.

“It is not clear whether altitude would affect those neurodegenerative processes or not, though there is some reason to think that they involve oxidative damage … so relative hypoxia might slow them,” Kious said via email. However, he went on to note that relative and prolonged hypoxia has also been associated with dementia risk, too. “In any case, a good epidemiological study of the association between altitude and dementia should control for things that might be associated with both.”

BETTER UNDERSTANDING AND ACCESS TO CARE

While there may not be good data for or against high altitude as an Alzheimer’s and dementia risk factor, there is evidence that people living in more rural communities do not have the same access to dementia care and treatment as those living in urban areas.

According to the 2020 Snapshot of Rural Health in Colorado, produced by the Colorado Rural Health Center, 721,500 people are living in rural Colorado and 19% of the rural population is age 65 or older. Rural is defined as a non-metropolitan county is no cities over 50,000 residents, the snapshot report says.

In Pitkin County, which is considered rural, 20.3% of the population is 65 or older, according to 2019 census data. And while Chad Federwitz, a gerontologist — specialist in the field of gerontology, or study of aging — and manager of Pitkin County Senior Services, says Alzheimer’s dementia and other dementias aren’t really prevalent locally and that he hasn’t seen any correlation or link between living at high altitude and dementia risk, he does know anecdotally that people may move downvalley, to Grand Junction or the Front Range if they have onset or early dementia because of lack of care resources in the upper Roaring Fork Valley area.

“Given the nature of our rural-ish community, we don’t have the same resources,” Federwitz said, referring to things like long-term assisted living and memory care options, professionals trained in Alzheimer’s disease, dementia and gerontology, and at-home caregiving service providers. “You can go to Grand Junction or the Front Range and have pages and pages of resources, as a opposed to (a handful or so) here.”

Before Federwitz started as the manager of Pitkin County Senior Services, he spent about seven years working in dementia care in the Boulder area, and is an Alzheimer’s Association community educator.

He said he feels education and access to informed and professional dementia and memory care is extremely important for Alzheimer’s and other dementia patients especially because there are still a lot of misconceptions surrounding what Alzheimer’s and dementia are, and unique challenges that come with caring for someone who has a degenerative brain disease.

Allen expressed similar thoughts, noting that a big part of dementia care and treatment is caregiver access and preventing caregiver burnout, especially with more severe states of dementia.

She said she feels a lot of times where people with dementia live in relation to their support system “matters in terms of their outcomes.” And while Allen feels there are an unusually large number of people that live in the Roaring Fork Valley that don’t have family in the valley, many people do tend to have good support networks through friends, which is important if that person is experiencing dementia.

“It really does take a village to help individuals cope with the changes happening in the brain and a lot of times that’s really picked up by a friend,” Allen said. “Oftentimes adult children of these individuals don’t live here, but we try to identify someone to support them, and there certainly are resources in the valley for homecare and private caregivers.”

But while there are some dementia care resources in the Roaring Fork Valley and other more rural Colorado communities, the Alzheimer’s and Cognition Center is working to do more to develop meaningful relationships with health care providers and dementia patients in the state’s mountain communities as part of its mission.

According to Pressman, who is heading this charge on behalf of the CU center, a lot of projects are in the planning stages and process of acquiring funding, but include virtually educating medical providers, nurse practitioners and primary care doctors on Alzheimer’s and general healthy brain aging, and mutual, participatory research with rural Colorado communities and communities of color.

Pressman explained that a lot of research related to Alzheimer’s overwhelmingly is based on middle class, well-educated, white participants. And so while researchers think they know a lot about the disease in general, they really only know about the disease related to this demographic group.

Through the center’s outreach and efforts to better connect with underrepresented communities, Pressman hopes to conduct better science and better serve the larger Colorado community.

“What motivates me is trying to do good work, trying to do good science and to makes sure our results actually represent real life,” Pressman said. “We want to make sure we’re helping everybody, not just a niche group, and that our services are available equitably to as many people as possible.”

Although there’s no clear correlation between living in higher altitude, mountain communities and dementia and Alzheimer’s risk, it is clear that as America’s aging population reaches 65 and older, these medical conditions will remain a relevant risk for seniors.

And with this continued risk and prevalence comes a need for more education, more research, more awareness and more connections surrounding the conditions, according to Federwitz.

“We all agree dementia is a horrible thing that can be overly daunting for everyone connected … but you as a person with a family member who has dementia or as a person with dementia, you’re not alone,” Federwitz said. “In my opinion and experience, there are hidden blessings. Joy can still happen. Happiness can still happen, laughter can still happen, genuine connection can still happen, even if all of those things happen in a moment.”

Editor’s note: This is part 2 of a four-part series on longevity in the High Country. The series is being produced in partnership with The Aspen Times, Vail Daily, Glenwood Springs Post Independent, Summit Daily News and Steamboat Pilot. Read more at aspentimes.com/longevity.

New procedures for old bones: Orthopedics helps aging population keep moving

Vail resident Harvey Simpson skied roughly 30 days this last season. It was a fraction of the 100-day seasons he enjoyed a few years ago, but it was, of course, an abbreviated season.

Also, Harvey is now 94 years old.

“I’m looking forward to next season,” he said. “Getting back up to 75 days again.”

For Simpson, skiing is the activity that keeps him young. And skiing is indeed, oftentimes, a young person’s sport, which no doubt helps Simpson feel young while he’s doing it. But the fact that he has some kind of activity keeping him going is the more important part, said Gini Patterson with Timberline Adult Day Services in Frisco.

“Whether you have a history of a physical impairment — we’ll call that a total joint replacement — or a mental issue like memory loss, it’s so important to stay active, mentally and physically,” she said.

Simpson has had two total joint replacements, one on each hip. He said he wouldn’t be skiing without them.

“The pain was just too great,” he said.

Following his second hip replacement, Simpson took a hard look at his technique. Now that he was skiing pain-free, would it be possible to be a better skier at 90 than he was at 80? It was, indeed, possible, said his coach, Gunnar Moberg. With a renewed focus on technique, Simpson hit the slopes with a new passion. His advice to aging skiers: “Improve your technique, and don’t fall.”

Ski racing at 85

A combination of improved technique and total joint replacement technology has made masters ski racing more competitive than ever, especially in the older age categories.

Eagle resident Charlie Hauser, bored with traditional skiing, took up the competitive side of the sport in his 70s.

Now 85, he is preparing to enter a new age category as a downhill ski racer, after competing in his last race in the 80-84 division in February. He says there’s more ski racers competing into their 80s than you might think.

“We’ve got all sorts of people with a couple of (replaced) knees or a couple of hips, or all four of them,” Hauser said. “These people just keep going.

“One of the greatest things that have happened is total joint replacements,” Hauser added. “It has taken people who would have been absolute cripples, and restored them to functionality. These people that have had total joints would not be competing otherwise, none of them.”

Hauser, himself a former surgeon, says the culture in the High Country of Colorado is different when it comes to being active.

“The orthopedists here are replacing joints because they want their patients to go back to skiing, and go back to their other activities,” Hauser said. “In other parts of the country, which aren’t as familiar with this, they’ll say ‘we’re replacing this, but you can’t ski anymore.’”

Recreation expectations

The Steadman Clinic’s philosophy, “keeping people active,” has been the company’s goal since Dr. Richard Steadman first started performing microfracture surgery in Vail in the early 1990s.
Special to the Vail Daily.

Dr. Ray Kim, an orthopedic surgeon who replaces hips and knees at The Steadman Clinic in Vail, said the expectations placed on orthopedists across Colorado’s High Country are more than you’ll find in other areas of the country or even the state.

Kim worked in Denver before moving to Vail.

“The patients that I took care of in Denver were different compared to our patients up here in the mountains,” Kim said. “Not that the folks in Denver are not active, I think in general people from Colorado enjoy recreation and are active, but I do think the activity expectations and demands of our community up here in the mountains is at a higher level. We just have a very high percentage people who are aggressive skiers, aggressive hikers, aggressive cyclists, it’s just part of the thread of our community here. People just really worship recreation.”

Kim says when patients visit him from outside of the community, often times it is because they are aware of that culture.

“We have folks that have flown in from other parts of the country and even from outside the country that understand the recreational culture here in Vail, and seek out having a knee or hip replaced because of our understanding of that philosophy,” Kim said.

Kim said that was also what attracted him to The Steadman Clinic.

“Richard Steadman’s vision of keeping people active … his whole goal was to get them back on the ski mountain,” Kim said. “And we’ve kept that tradition going over the years, in multiple different disciplines. His specialty was obviously knee preservation, but the clinic has expanded that to include everything from spines to hands to foot and ankle.”

Keeping people active

A patient with The Steadman Clinic enjoys some powdery turns on Vail Mountain during the clinic’s ski day for patients in January of 2020.
Special to the Vail Daily.

The Steadman Clinic still uses the slogan “keeping people active,” which was based on Steadman’s philosophy.

“We know there’s huge advantages to keeping people active, there’s a lot of benefits from a cardiac standpoint, from a bone density standpoint, from a fitness and weight loss standpoint, and now there’s recent studies looking at behavioral health advantages to staying active,” Kim said.

For some aging people, Patterson said a big knee or hip replacement surgery may not be possible. That’s why she embraces a philosophy based on Olympic silver medalist skier Jimmy Huega’s “can-do” effort to stay active following his diagnosis with MS.

“Do what you can do to stay active,” she said. “That philosophy applies whether you’re in your 20s and diagnosed with MS, or you’re in your 90s and your mind is not working as sharply as it used to. What can you do?”

Patterson is currently caring for a 97-year-old woman at Timberline.

“She is still physically active, and still walks,” Patterson said.

Kim said he believes that the longevity people enjoy in the mountains is directly linked to the dedication people in the high country of Colorado have to staying active.

“The higher activity level drives better health and longevity,” he said. “I just can’t find any other explanation.”

Recent suicide ‘cluster’ in Roaring Fork Valley prompts concern by officials

Public health officials expressed concern last week after four Roaring Fork Valley residents died by suicide in the past month, including three deaths in a five-day period.

“That’s a lot,” said Jess Beaulieu, Pitkin County’s mental health program administrator. “This is really unusual. It’s a cluster of suicides.”

It began with a suicide in Carbondale in late September, according to law enforcement sources and Michelle Muething, executive director of the Aspen Hope Center. However, three more deaths occurred beginning Oct. 9 with a man found in Aspen, followed by the suicide of another man Oct. 11 in Snowmass Village and a third Sunday in Basalt, according to Snowmass Village Police Chief Brian Olson, Aspen Police Officer Braulio Jerez and Muething.

“Four different people, four different ages, four different walks of life, four different life circumstances,” Muething said. “We always seek questions of why. I don’t know if there are any answers.

“Life is tough.”

Many involved in law enforcement and mental health in the Roaring Fork Valley pointed to the offseason as a possible source of emotional trauma. Social networks can break down as people’s jobs and housing are interrupted by the slow-down, leaving instability or more downtime as a consequence, Beaulieu said.

“All of that can contribute to mental illness or a lack of mental health,” she said.

Whatever the source, the problem appears to be getting worse.

Law enforcement in Aspen, Pitkin County and Snowmass Village responded to 199 mental health-related calls in the past three months, Beaulieu said.

“That is a really big number,” she said. “There were 78 calls in September, which was higher than (those in) July and August.”

Aspen Valley Hospital is seeing double the number of mental health-related cases this year over last year, Beaulieu said. And not only are the number of mental health calls rising, so is the severity, she said. Doctors are seeing more acute mental health cases requiring what is known as an “M-1 evaluation,” which means the person is unstable enough to be evaluated at the psychiatric hospital in Grand Junction, Beaulieu said.

Muething said she’s not sure how much stock to put into theories blaming the shoulder season for an uptick in suicides.

“It’s a theory,” she said. “(But) it’s not what prompted at least three of these (latest suicides) … which was mental health issues.”

The Aspen Hope Center offers emotional trauma counseling services in Garfield, Eagle and Summit counties, and none of those communities have experienced a suicide spike similar to the Roaring Fork Valley in the past month, Muething said.

“There’s a million theories about suicide,” she said. “The bottom line is if we knew how to prevent suicides, suicides would stop.”

The best way to stop a suicide is to reach out if you are worried about a friend or family member, Muething said. And if the first person you talk to isn’t receptive, keep reaching out until you find someone who is, she said.

“Become an advocate for someone you know is in trouble,” Muething said. “Don’t stop trying. Don’t assume you know someone and you think they’ll be OK.”

Suicide affects the wellness of a community as a whole, especially one as small the Roaring Fork Valley, Beaulieu said.

“I know five people who knew each of these people (who died),” she said. “Word travels quickly and it really rocks people’s worlds. It’s much more tangible and visceral than you would find in a larger, more urban landscape.

“There’s an awareness that it’s not just the suicides that are tragic, but there’s some sensitivity that this is really upsetting for those of us still here.”

Numerous resources exist for those in crisis. The Aspen Hope Center also offers trauma counseling for those left behind after a suicide.

jauslander@aspentimes.com

Longevity: Why there’s more depression, anxiety and suicide at high altitude

STEAMBOAT SPRINGS — Living in a mountain resort community above 8,000 feet certainly has its draws, but also its drawbacks. Rents are higher, affordable housing is hard to find, quality jobs are fewer and cost of living is more expensive.

All those factors contribute to the fact that high altitude living doesn’t always offer the stress-free lifestyle people are seeking or expect of a picturesque mountain community.

Steamboat Springs has a duality issue, in that, the normed behaviors of heavier drinking and drug use stand in stark contrast to an extreme focus on wellness and physical health.

Resort communities, in general, have a higher prevalence of substance use across the board, said Amy Goodwin, a licensed professional counselor and behavioral health counselor with UCHealth Yampa Valley Medical Center. That’s because of the norming trends for drug use.

The idea of being on a permanent vacation when living in resort communities contributes to a mindset that encourages indulgence patterns. Being surrounded by indulgence or overindulgence can influence what is believed to be normal behavior, she said.

Warning signs of suicide

Comments or thoughts about suicide (suicidal ideation)
Increased alcohol and drug use
Aggressive behavior
Withdrawal from friends, family and community
Dramatic mood swings
Impulsive or reckless behavior

Higher altitude can worsen mental health 

Observed behaviors and personal anecdotes suggest the initial mood experienced at altitude is euphoria followed by depression. Multiple symptoms can emerge over time, including irritability, anxiety and apathy.

That’s according to “Hypoxia,” a 1963 study conducted by Edward Van Liere and J. Clifford Stickney.

The initial euphoria is a result of increased dopamine, the neurotransmitter contributing to feelings of pleasure, when entering high altitude. Dopamine is a short-burning fire, and then it’s gone, Goodwin explained. 

“So, when the ‘Rocky Mountain high’ burns off, then what we’re left with is depleted dopamine and serotonin,” she said.

Most of the existing behavioral studies of high altitude effects, however, center on hypoxia, which is decreased blood oxygenation due to higher elevation. Studies suggest hypoxia could negatively alter serotonin metabolism, which, in basic terms, contributes to feelings of wellbeing and happiness.

Emotions, such as anxiety, grief and confusion, are more intensely felt at elevation because of the lower oxygen concentration. Serotonin helps humans put things into perspective. 

“Don’t sweat the small stuff — that’s a serotonin skill,” Goodwin said. “Without serotonin, we can’t put things aside.”

Distress signaling is an alarm, not a disease, she said.

“Whether it’s depression, anxiety, confusion or deep despair, those are alarms from our body that something is wrong,” she said.

The role of mental health providers is to help people figure out what has gone wrong when those signals arise. Goodwin stressed that people shouldn’t be afraid of those alarms but should learn to read and understand them.

Physiological effects of altitude have been studied for decades, but there have been few investigations of the associated mood and behavioral changes.

Goodwin agrees that altitude’s effect on mental health is an understudied area, with the answer to why the effects occur not being as well investigated.

“Philosophically, I think that our focus on mental health has been so much on neurotransmitters and the chemistry associated with that, that we have forgotten to look sometimes for causality,” she said. “Why can’t we look at why?”

It’s an endemic issue to the field of mental health research, she added.

“When we have the pharmaceutical companies running the research, they’re not going to be interested in altitude because they can’t give you a pill for altitude,” she said.

suicides statistics in Garfield country colorado
Statistics provided by Garfield County Public Health.

Being mindful

Cristen Malia grew up in Northern California and moved to Colorado when she was 18 years old.

Today, as a clinical mental health counselor at Minds in Motion in Steamboat, she performs human-centered therapy. The talk therapy incorporates several elements including teaching mindfulness.

Mindfulness has become a mental health buzzword. It is the psychological process of bringing one’s attention to experiences occurring in the present moment. It’s meant to focus a person on their thoughts, feelings and body sensations so as not to become overwhelmed by them.

It’s one of Malia’s main practices.

It’s about living life in the moment. Such a simple idea can have dramatic effects on a person’s mental wellbeing, Malia said.

As a longtime yoga teacher, Malia also tends to use the fundamentals taught in yoga during therapy, if a client is comfortable with that.

The mind-body connection is personally apparent to Malia, who developed Lyme disease, a tick-borne bacterial illness, while living in Colorado. Her chronic illness was intensified because of the low oxygen levels at higher elevation. Inflammation isn’t as easy to reduce at altitude.

“In my healing, I would often go to sea level and noticeably feel better there,” she said.

But it was never a mental burden because she was able to find healing at altitude by being outdoors.

“I feel that another element of my healing that made a profound effect was being able to be outside and in fresh air,” she said.

It’s a balancing act, she admitted. She realized the trade-offs she made when opting to live at altitude, specifically in Steamboat — a cost-benefit analysis, as she put it.

“Maybe the altitude compromises my oxygen intake and inflammation, but there are so many other pieces that I get benefit from,” she said of her high altitude surroundings. “There’s less emotional burden for me here because I love the mountains, I love nature, the things that Steamboat can offer.”

suicide-at-altitude

A thriving mind

Thriving at altitude isn’t just about physicality. It’s also crucial to focus on mental wellbeing.

Yoga, a globally popular practice, offers tools to encourage mental wellness. It’s not always just about postures but also learning how to breathe in an efficient and nourishing manner, said Malia, who is also a registered yoga teacher at Rakta Hot Yoga and Wellness Studio in Steamboat.

“(Breathing) impacts our nervous system and our mental health; it’s all connected,” she explained.

One of the biggest practices to enhancing mental wellness is rest, according to Malia.

“If we could all just slow down,” she said, “which is hard for people in this town to do — myself included in that. If we can rest as hard as we play, I think that would be really beneficial.”

But Malia is referring to deliberate and intentional rest. It’s not about scrolling through social media or zoning out in front of the TV, rather it’s taking a slow walk, sitting by the river, paying attention to aspens blowing in the wind.

“It’s the little things,” she said.

Mindfulness and meditation play into achieving that rest.

“The practice of mindfulness asks us to pay attention to what’s happening in our present moment experience,” she said. “When we get better at doing that … we can also get better at taking care of ourselves.” 

At that point, people become aware of what they need or come to the realization they’re going too fast or using energy unwisely.

“It doesn’t have to be in a state of meditation, but paying attention to the moment in a kind and compassionate way,” she said.

Despite the negative effects on mental health, people still flock to live in high altitude areas. That’s because, according to Goodwin, the human brain tends to focus on the positives; people want to know where to find happiness. And when considering the many aesthetics of the community and opportunities for recreation, “it would be really hard to talk the human brain out of focusing on that.”

“Hyperbaric hypoxia is a thing,” she said. “But I doubt that’s going to resonate over, ‘I can get a ski pass and hike the mountains every day.’”

24/7 Colorado Crisis Services

Local Crisis Hotline: 1-888-207-4004 or text TALK to 38255
National Suicide Prevention Lifeline and online chat: 1-800-273-8255

Takeaways from Tuesday’s Longevity finale — striking the mental health conversation

Frank King and the mythical George Bailey from the film classic “It’s a Wonderful Life” have something in common, the self-proclaimed “mental health comedian” related during Tuesday evening’s Longevity Project finale.

Giving the keynote address before about 80 people at Morgridge Commons to conclude the Post Independent’s series “Striking a Conversation: Mental Health for All Ages,” King said the power of starting a conversation can ultimately save lives.

His George Bailey revelation came after speaking at a dental conference, when a woman who was in the audience approached him and revealed that she, like King, suffered from what’s known as “chronic suicidality.”

The woman explained that, until hearing him speak, she always thought she was the only one who tended to come back to suicide as an option whenever things weren’t going well.

“That’s the power of starting the conversation,” King said. “People need to know they’re not alone, and maybe something I’ve said has taken them just far enough off that path. …

“And it hit me. I’m George Bailey. … I got a chance to see what other people’s lives would be like if I were not there to speak,” he said, using the analogy of that iconic moment in the movie when Bailey gets a glimpse of what life would be like in his hometown had he never been born.

“I cannot kill myself, because I would take all those people with me,” King said.

Attendees also heard from a group of panelists, including Carson DeFries, intergenerational program coordinator for the University of Denver’s Knoebel Institute for Healthy Aging; Kevin Patterson, CEO for Connect for Health Colorado; and Jackie Skramstad, clinical operations manager at Mind Springs Health.

Following are eight key takeaways from the event:

1. Connect

Skramstad said it’s critical to “demystify” mental health. That means being open about it and connecting with people who may be struggling, she said.

“We feel much more comfortable talking about other health issues, yet we still have a lot of reticence talking about mental health,” Skramstad said. “But the more we do it, the more comfortable we’re going to be. …

“As human beings we have a desire to connect to others to have a sense of belonging, and to have a purpose.”

2. Socialize

DeFries offered that it’s important to continually find ways to socialize with others and, as people age, to have a support network that can help them continue to engage.

Loneliness can lead to depression and anxiety, she said. That’s especially true for older people.

“If you have a group of friends you can count, it helps with your self-esteem, your sense of belonging and your sense of security,” she said.

3. Intergenerational sharing

Another key to maintaining a healthy mental well-being for seniors is to engage with younger generations, including younger members of the family, DeFries said.

“It’s important to bring different generations together to exchange ideas, share skills, knowledge and stories,” she said.

In particular, “the grandparent-grandchild relationship is really special, and it’s where you see a lot of benefits and impact.”

That also helps with the social development of the younger generations, DeFries said.

4. Unplug

Limiting exposure to the constant barrage of media, and especially that which can be divisive, is one key to maintaining a positive mental well-being, Skramstad offered.

That doesn’t mean not staying up on what’s happening, but knowing when enough is enough and to unplug on occasion.

“When I talk about limiting your exposure, yes, stay informed and know what’s happening, but be able to put your cell phone aside, or turn off the news, and limit how much you’re taking in,” she said.

5. Look for the positives

On the flip side of unplugging is to look for the positives amid all the negative, Skramstad added.

“How many times do people do random acts of kindness, and we just don’t notice, because we’re so busy. And yet we notice all the terrible things that are happening in the world.

“We don’t stop to see people being amazing human beings.”

6. Slow down

Patterson shared his perspective about understanding how the brain is connected to the rest of the body, and to recognize when it’s time to listen to the signals that the body is sending out.

“We have to figure out how to listen to it differently, and how to respond to it differently,” he said. “It’s also about how to help ourselves differently and seek that kind of support, so that we can move forward and try grow a little bit differently in our lives.”

Slowing down means taking time to take care of oneself, Skramstad offered. “Go out and find what brings you joy.”

7. Whole health

Panelists also spoke to the movement within the health-care community to provide a wide array of health services in one setting, including both physical and behavioral health.

“It’s about figuring out what’s missing, and then how do we fund and plug those holes,” Skramstad said.

Integrated health care is crucial, Patterson said.

Sometimes, a patient has a specific physical problem that they need to address.

And “sometimes they might just want to talk,” he said.

“I think that having a place where it’s comfortable and familiar, and that they know they can trust, is really, really integral.”

8. Share the step

Taking that first step to seek help for a mental health issue can be the most difficult part, panelists agreed.

But if someone can help walk that first step with them, it’s much easier, Skramstad said.

“I don’t know of a way to connect with people that doesn’t involve taking a step with them,” she said.

DeFries added that it’s good to “look inwardly” when trying to help someone else. “Think about what you like doing … and are there opportunities to share that with others.”

Watch video

jstroud@postindependent.com

How life at altitude impacts people — and animals

STEAMBOAT SPRINGS — People living at higher altitudes tend to be healthier, but definitive evidence as to why remains elusive.

There is debatable data, and some contradictory studies, as well as the persistent prospect that, especially in a place like Colorado, a lot of it has to do with selection: healthier people with healthier habits choose to live at higher locations.

There’s also somewhat of a “survival of the fittest” aspect, noted Dr. Will Baker, a cardiologist with UCHealth Heart and Vascular Clinics in Steamboat Springs and Craig.

Some thrive in a more challenging climate and geography with less oxygen, and some don’t.

It also very much depends on the individual, of course.

People with underlying health issues, especially related to the lungs and heart, may find their conditions exacerbated by the altitude.

In general, said Baker, people with chronic lung problems, especially Chronic Obstructive Pulmonary Disease (COPD), will have a harder time living at altitude. The same goes for some heart conditions.

However, there is also research showing altitude having potential protective effects on the heart.

In a 2014 National Center for Biotechnology Information study titled “Effects of Living at Higher Altitudes on Mortality, author Martin Burtscher wrote, “The available data indicate that residency at higher altitudes are associated with lower mortality from cardiovascular diseases, stroke and certain types of cancer. In contrast, mortality from COPD and, probably also, from lower respiratory tract infections is rather elevated. It may be argued that moderate altitudes are more protective than high or even very high altitudes. Whereas living at higher elevations may frequently protect from development of diseases, it could adversely affect mortality when diseases progress.”

In studies spanning the globe, researchers have seen several consistencies in people living at higher elevations: they weigh less, have less cardiovascular disease and some types of cancer and live longer.

But it isn’t so straightforward to say that if you come to — or are born at — a higher altitude, you will lose weight, be healthier and live longer, noted Baker.

It’s a lot more complex and so is the available research.

For example, while increased exposure to ultraviolet rays may increase the risk of skin cancer, the increased levels of Vitamin D intake may also have protective effects that “profoundly influence cardiovascular mortality,” according to Burtscher.

Some studies show people with asthma do better at higher altitudes. Some show they do worse.

And in terms of what Burtscher described as moderate versus high or very high, 6,000 to 7,000 feet can treat a body differently than 9,000 to 10,000 feet.

“High altitude to a physiologist starts around 5,000 feet, altitude where the body senses changes in the oxygen level and starts to respond by increasing breathing,” according to the Institute for Altitude Medicine in Telluride.

There is a reason the U.S. Olympic & Paralympic Training Center is located in Colorado Springs, noted Dr. Brent Peters, a pulmonologist at UCHealth Pulmonology Clinics in Steamboat Springs and Loveland.

It’s 6,035-foot elevation is a “sweet spot” that provides the most conditioning benefit in terms of ideal oxygen deprivation.

The relationship between lower body weights and altitude comes with several hypothesis.

A 2013 study in the International Journal of Obesity found a strong association between altitude and obesity in the United States. Using data from more than 400,000 people, researchers found people living closest to sea level were four to five times more likely to be obese, compared to people living significantly above sea level in Colorado.

One possibility is simply that people exercise more — though the study did control for that factor and still saw people losing weight.

One theory has to do with eating fewer calories — altitude has been shown to increase levels of leptin, a protein hormone that plays a role in appetite control and metabolism. Hypoxia (lack of oxygen) also is known to cause a loss of appetite.

In terms of how a body living at altitude varies from one living at sea level, the primary thing that happens in terms of physiology, said Baker, is that the blood compensates with a higher amount of hemoglobin, which increases the amount of oxygen that can be carried.

One thing Baker does see on a regular basis is more severe impacts from sleep apnea.

Sleep apnea is defined by the Mayo Clinic as “a potentially serious sleep disorder in which breathing repeatedly stops and starts.” 

Peters, who travels around the state providing care, said he also sees an “acceleration” or “exaggeration” of sleep apnea in patients.

“They basically don’t breathe well at night,” Baker said. They wake up frequently and feel fatigued the next day. Often those people sleep better and feel more energetic at sea level.

There’s also a wide spectrum of sleep apnea and different kinds, Peters noted. Most sleep apnea cases are classified as obstructive, in which a person can’t breathe normally because of an upper airway obstruction, occurring when throat muscles relax.

Central sleep apnea, which is less common, “occurs when your brain doesn’t send proper signals to the muscles that control breathing,” according to the Mayo Clinic.

Peters said he sees more central sleep apnea in Colorado than other places.

According to a Medlink Neurology report, “Central sleep apnea due to high-altitude periodic breathing affects about a quarter of people who ascend to 2,500 meters (8,202 feet) and almost 100% of those who ascend to 4,000 meters (13,123 feet) or higher.”

Kids can also experience difficulty sleeping at higher altitudes, said Dr. Steven Ross of Sleeping Bear Pediatrics.

Before they can verbalize how they feel, very young children may seem restless at night and irritable during the day, he said, especially above 7,500 feet.

If a normally energetic kid sits down and whines on the Uranium Mine Trail while hiking or at the top of a ski run, there’s a good chance they are experiencing effects of altitude, Ross said, and aren’t just spoiled and lazy.

And that goes for kids who live here as well as visitors, he said.

When recreating at higher altitudes, Ross advises parents to make sure kids are hydrated and well protected from the sun. Make sure they get good sleep, and “factor in patience,” he said. Be aware that kids may not have the same endurance they do at lower elevations.

High altitude effects on babies

Altitude does play a significant role as babies develop in utero, described Allyson Daugherty, a neonatal nurse practitioner with Childrens’ Hospital Colorado who cares for newborns in the special care nursery at UCHealth Birth Center in Steamboat Springs.

Babies born at higher altitudes (especially over 8,000 feet) are typically smaller in size.

“Altitude contributes to overall growth from a weight perspective,” she said.

And, for those tiny developing lungs, mothers making it to the 36-week mark is imperative, she said.

Lungs continue to develop until two to five years of age, Daugherty said, but those last few weeks in utero is crucial, and the primary reason doctors want to see mothers, particularly at higher altitudes, make it to term (40 weeks). “The more premature a baby is, the more susceptible the baby is to respiratory distress.”

Babies can become hypoxic, she said, and frequently need a little more oxygen during those first few months of life as their lungs mature — especially if they are born prematurely.

A lot of babies born at UCHealth Yampa Valley Medical Center are given supplemental oxygen, Daugherty said, as are babies who are born in Denver and travel to Steamboat or are going home to elevations higher than Steamboat.

Even babies who make it to 36 weeks may need some support to continue their lung development after they are born. But those lungs can, and usually do, mature fully after birth without any lasting detrimental effects. 

“A huge portion of babies (born at YVMC) go home with oxygen whether they are pre-term or term,” she said.

The American Academy of Pediatrics recommends parents sleep in the same room as their babies at least up to 6 months of age, Ross said, something even more important at high altitude. The optimal recommendation is sleeping in the same room through 12 months of age.

The good news is, said both Peters and Baker, most people — young and old — adapt quite well and relatively quickly.

Peters noted that many of his patients are “snowbirds,” and he asks them to take note of any differences in how they feel living at the different elevations.

Both doctors say it is rare they will tell a patient they should move to a lower elevation.

Only in the most extreme cases, Baker said, will he tell a patient they should move — when, even with supplemental oxygen and other medical interventions, in the face of significant lung or heart disease, “We just can’t keep them in a safe zone.”

Of course, many people who do live at altitude, especially as they age, use supplemental oxygen.  

Supplemental oxygen, as well as medication, can help people with pulmonary hypertension (high blood pressure of blood vessels in the lungs), which can worsen at higher elevations.

Aside from those rare cases, some people make their own decision if they find they feel more energetic and are able to be more active at sea level, Peters said.

There’s also the eternal importance of maintaining a general level of fitness. Baker thinks this may have more to do with people living longer at high altitudes than anything else.

“It’s not cut and dry,” emphasized Peters. For people, especially as they get older, altitude may stress the lungs, but the low humidity and clean air can also make it easier to breathe. Some people may feel better higher up, some worse.

What about my dog?

For the average healthy dog or cat, without any underlying diseases, altitude doesn’t have any significant negative impact on your pet’s health, said Rocky Mountain Veterinary Ultrasound Dr. Kim Radway.

But when an animal has heart disease, which happens with aging, altitude can increase the severity of the impacts of the disease.

Radway also said she sees a significant increase in the amount and severity of pulmonary hypertension in high altitude dogs and cats — which means high blood pressure in arteries leading in and out of the lungs.

If the high blood pressure becomes too severe, it can cause disease and failure of the right side of the heart.

Radway sees more cases than the average vet because she travels around the region giving cardiac ultrasounds — the only way to diagnose pulmonary hypertension. It is much more common in dogs than cats.

In addition to the dogs living at high altitude, Radway said she often sees pulmonary hypertension present itself suddenly in dogs traveling relatively quickly from sea level to higher altitudes.

To treat the condition, Radway prescribes the pet equivalent of Viagra. No, she said, your male (unnuetered) dog is unlikely to experience the same side effects as a human male because of dosage.

But, like in humans, the drug increases blood flow to particular parts of the body — including the lungs. It doesn’t provide a complete reversal, she said, but works pretty well. There are also several other medications that can help, as well as oxygen and restricting exercise.

Signs your dog might have pulmonary hypertension include rapid breathing, coughing, signs of lethargy, and syncope, which is a loss of consciousness due to lack of normal blood flow to the brain.

Another altitude side effect Radway sees is an increased negative impact on pets from smoke — whether that be cigarettes, cigars or marijuana.

For helping your furry friend guard against negative impacts of altitude, Radway recommends decreasing the animal’s exposure to airway irritants, and if traveling back and forth to low altitudes, giving your dog time to adjust.

While heart disease is hard to prevent, she recommends preventing heartworm — particularly when traveling to places where it can be 70 degrees or warmer for a full 24 hours. And there are medications that can alleviate some of the effects of heart disease.

Like humans, dogs can get altitude sickness, though it is much less common. Symptoms include vomiting, excessive drooling, panting, ear discomfort and lethargy. In extreme cases, it can cause a build up of fluid in the lungs and brain.

Prevention tips include making sure your dog is hydrated, giving them time to acclimate and taking it easy.

To reach Kari Dequine Harden, call 970-871-4205, email kharden@SteamboatPilot.com or follow her on Twitter @kariharden.

Editor’s note:

This is part two of a four-part Longevity Project from the Steamboat Pilot & Today. The series also includes profiles on Routt County locals who are thriving at altitude.


“The Mental Health Comedian,” Frank King headlines Post Independent’s Longevity Project Tuesday

The Post Independent’s Longevity Project, Striking a Conversation: Mental Health For All Ages culminates Tuesday with a performance from, “The Mental Health Comedian,” Frank King.

A writer for the Tonight Show with Jay Leno for over 20 years, King has lived with mental illness for decades.

“I would say that humor has saved my life, all my life,” said King. “I believe that my sense of humor is just part of the wiring that also contains my major depressive disorder.”

In addition to performing comedy 12 weeks a year on Holland America Line cruise ships, King speaks on college campuses across the country about mental health and suicide prevention.

“There is a stigma surrounding mental illness,” said King. “There is a separate stigma surrounding thoughts of suicide. It scares people and therefore they don’t talk about it.”

King, however, will speak to these issues and more Tuesday night at Morgridge Commons Meeting & Conference Center, 815 Cooper Ave., in Glenwood Springs.

Doors to the Longevity Project’s main event featuring King open at 5 p.m.

A local panel comprised of Carson Marie De Fries, Jackie Skramstad and Kevin Patterson will start the event with a presentation beginning at 6 p.m.

Defries serves as Intergenerational Program Coordinator at the University of Denver, Skramstad works as a clinical operations manager at Mind Springs Health and Patterson takes on the responsibility of being Connect for Health Colorado’s CEO.

Following the panel’s presentation, King will begin at 7 p.m.

Tickets to Tuesday’s event cost $15 and include appetizers. They can be purchased here.

“I will explain why a comedian is talking about depression and suicide – that’s always the elephant in the room – and then I will give them actionable, take home advice. What I call signs, symptoms and solutions for depression and thoughts of suicide,” King said of what those in attendance Tuesday can expect. “We can save lives, simply by starting that conversation.”

mabennett@postindependent.com

Watch: Nadine Roberts Cornish talks conscious family caregiving

Nadine Roberts Cornish was the speaker of the fourth Longevity Project micro-session event hosted by the Glenwood Springs Post Independent at Glenwood Springs Library on Tuesday, September 10.

Before the event, the senior advisor and author spoke to us about her passion for supporting family caregivers.

Longevity Part 4 — maintaining mental wellness into the late adult and senior years

Mental illness is just a part of life for longtime Glenwood Springs resident Lynne Jammaron.

It’s something she deals with both personally and in her efforts to help others through their own struggles.

Diagnosed with bipolar disorder at age 19, Jammaron has lived with mental illness all of her adult life. Her experience runs the gamut: ups and downs, manic moments, mood swings, breakdowns — and the returns to well-being.  

Now 56, she doesn’t let the illness define her. But her willingness to share her experiences can provide a defining moment for others struggling with their own mental health.

“People need to know, first and foremost, that they’re not alone, and that they’re not the only one dealing with something that isolates them and fills them with fear and dread …,” Jammaron said.

Jammaron leads a weekly Connection Recovery peer support group in Glenwood Springs through the Roaring Fork Valley chapter of the National Alliance on Mental Illness (NAMI).

In her own journey, Jammaron had the strong support of family, including husband Glen, along with a good network of friends and a caring church family. But she recognizes that not everyone has that level of support, which is why she became involved with NAMI.

Glen, in particular, was a rock in her life during the tough times.

“We did this together as a team, just trying to find a balance, a good state of mind and a good relationship,” she said.

Outside of family, there was also NAMI and its support groups.

“It was amazing to me to see that there were a lot of other people who dealt with what I was dealing with,” Jammaron said. “We want people to know that they can come to a place of hope, health and healing, just as I have done.”

LATE-LIFE CONCERNS 

Those who attend Jammaron’s and other support groups in the Valley span the age spectrum. But she has also observed that the vast majority of people who regularly take part tend to be older adults who have learned through the years to manage their condition.

Millions of adults in the United States with a mental health condition have adapted through medication, regular psychiatric care and any of a variety of support mechanisms. It’s something they will continue to live with and adapt to as they get older.

According to statistics compiled by NAMI, one in five adults in America will experience a mental illness on some level, and nearly one in 25 (10 million) adults live with a serious mental illness.

Half of chronic mental illness starts around age 14, and three-quarters by age 24, according to that same set of statistics. But the stress and anxiety of later adulthood and post-retirement can also be a concern on the mental health front.

“Depression is not more common in the elderly, but it often does present itself for the first time when a person is older,” said Dr. Jules Rosen, a geriatric psychiatrist from Summit County who recently retired as chief medical officer for Mind Springs Health.

Rosen spent the last six years with Mind Springs, while also teaching as a professor of psychiatry at the University of Colorado. Prior to that, he was a professor of medicine and chief of geriatric psychiatry at the University of Pittsburgh for 32 years. 

Dr. Jules Rosen, retired chief medical officer of Mind Springs Health, speaks at the 2018 Longevity event in Glenwood Springs.
Chelsea Self / Post Independent file

“Late-life depression can strike out of the blue,” Rosen said.

There are late-life stress factors to be aware of — final career advancement, the transition to retirement, financial security, health concerns and physical limitations that come with aging, and the sense of mortality when friends or loved ones die.

But there doesn’t have to be a specific cause for depression or late onset of a more serious mental health condition, Rosen said. A condition may have gone undiagnosed for many years, but only shows itself later in life. 

In any case, “without treatment, it can be a very serious and even fatal condition,” Rosen said.

“Of all the fatal illnesses late in life, though, depression is the most treatable. When I see somebody with straight-forward major depression late in life, my expectation is 100 percent recovery. It may take four weeks, or it may take four months, but it can be treated.”

Short of a clinical diagnosis for a more serious condition, a person’s mental wellness associated with aging issues can benefit from a visit to a mental health counselor, Rosen added.

LET’S TALK

Oyen Hoffman, a family therapist and member of the behavioral health care team at Mountain Family Health Centers in Glenwood Springs and Rifle, said he works with a lot of people in their 50s and 60s who are struggling with the transitions that come with that period in a person’s life.

“That’s when people start to evaluate their life — where they are, where they thought they would be, where they’re headed,” Hoffman said.

Oftentimes, those concerns revolve around finances, and whether they’ve properly prepared for retirement, he said.

“But they tend not to think about purpose and meaning and the values in their life,” Hoffman said. “Their job might be their identity … then they retire, and they don’t have that purpose.”

Boredom and depression can set in during early retirement. There’s also an uptick in alcoholism and suicide rates during that period of life, he noted.

“There are a lot of things that aren’t in the retirement brochure,” Hoffman said, adding that it’s healthy to have the conversations around that transition well ahead of time.

Medical challenges that come with age can also affect a person’s mental well-being, Hoffman added.

“Hearing loss can be a real contributor to depression, and if we’re not able to catch that we could be missing something,” he said of Mountain Family’s focus on integrative health care that looks not only at a person’s physical health but the mental side of it, as well.

If a person can’t hear well, they’re more likely to isolate and shy away from social settings, which can lead to depression, he said.

“Isolation is the worst thing — for everyone and everything,” adds Gary Schreiner, also a family therapist at Mountain Family and head of behavioral health services for the multi-county network of community health clinics in Garfield, Eagle and Pitkin counties.  

“We’re social animals, so when a person feels isolated, whether they’re depressed or bipolar, whatever, it’s going to make it worse,” Schreiner said.

Keeping people active and involved in social settings is important, whether it’s therapy for someone with a diagnosed mental health condition, or someone just looking to stay active and engaged in late life, he said.

Being single as one ages is a common struggle, whether it’s the result of losing a spouse to death or never having married in the first place, or remarried after a divorce.

“I can’t tell you how many folks in retirement tell me they just wish they had someone to share their life with,” Hoffman said. 

“The lack of a close personal relationship is the health equivalent of smoking a pack of cigarettes a day. So, we have to have relationships. We’re hard-wired for relationships.”

NAMI web file

MENTAL HEALTH IN ELDER CARE

For people diagnosed with a mental illness earlier in life, whether it’s clinical depression, a mood disorder or severe psychosis, continued psychiatric care later in life is crucial, according to Dr. Rosen.

It’s also important for patients, and their medical doctors, to understand the possible conflicts between medications intended to control a mental health condition, and those prescribed for medical conditions such as high blood pressure.

“I’m 68 now, and so many of my contemporaries are on six to eight different medications,” Rosen said. “Different drug interactions can cause side effects that can affect both mood and cognition.”

Over-the-counter medications can also be a concern, which is why a comprehensive approach to a person’s health care is critical, especially later in life, he said

“We need to know every single medication that our patients are on,” he said.

As a person ages, the lines can also be blurred from a layman’s perspective between what might appear to be a psychotic episode, but which might actually be the onset of dementia, Rosen also emphasized.

That’s where integrated treatment is important, and something for families to consider when a loved one starts to show signs of decline.

“Bipolar late in life can look like Alzheimer’s Disease, so it’s important to know what we’re dealing with,” Rosen said. 

“As people age, treating bipolar is really an art,” he added, noting that doctors have to stay on top of medication dosages to avoid toxic reactions due to a lifetime of using a particular drug, such as lithium.

Left untreated, late-life depression can also speed the physical decline, Rosen said.

If an older person constantly says, “I don’t feel well,” that alone can be a sign of depression, he said. 

Again, finding ways for older people to stay active and engaged in social settings is critical, Rosen, Hoffman and Schreiner all three concurred.

BEYOND THE STIGMA

A few years ago, NAMI partnered with suicide response agency Aspen Hope Center and Aspen Strong to raise awareness and start a conversation in the region about mental health issues. 

An educational event at the Wheeler Opera House in Aspen drew a standing-room-only crowd, said Linda Spencer, another NAMI group organizer and board member for the organization.

A separate meeting with area police chiefs and sheriffs followed, which focused on the difficulties law enforcement agencies contend with in dealing with someone who has a mental illness.

“We had no idea when we started this that it was going to grow so fast,” Spencer said of the peer-to-peer and family support groups. 

 

Lynne and Glen Jammaron
Provided

Jammaron would like to expand her own outreach to area churches, as her own church family has been one of the places where she found support and understanding.  

She and Glen have also become advocates for expanding mental health services on the Western Slope. 

“It’s very hard for someone dealing with a mental health break, and there’s no place to go,” she said.

West Springs Hospital in Grand Junction, which is the only psychiatric hospital on the Western Slope and is operated by Mind Springs, expanded last year. Already, it has a wait list, Jammaron said.

“When you have a loved one needing 24/7 care, and you have to go to Denver … you lose that intimacy,” she said. “We need those resources here.” 

jstroud@postindependent.com

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