Tips for Caregivers of Dementia Patients with Dr. Dionis Kononov

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Transcript

Host: Tessa Lackey:

Caring for a person with Alzheimer's or other forms of dementia is no secret that this is a whole other job for caregivers. Welcome to Prescribed Listening by the University of Toledo Medical Center. I'm your host, Tessa Lackey. In this episode of Prescribed Listening, we're discussing some tips specifically for caregivers with Dr. Dionis Kononov from UTMC, Senior Behavior Health. Now, without giving too much away, as we get started, you can expect to learn something from this episode, whether you're just getting started on this journey with a new diagnosed loved one that you're caring for and you're trying to figure out navigating this new role in your life.

Or if you're someone that's been doing this for a while and you're just looking for some fresh tips on how to improve day-to-day functioning for yourself and the loved one that you care for. We look at different strategies for functioning in the home, out in public, and also improving yours and your loved one's mental health. So here's our episode with Dr. Kononov, Dr. Dionis Kononov. Thank you for joining us today. So tell us a little bit about what you do at UTMC just to give us an introduction to you.

Guest: Dr. Dionis Kononov:

Yeah, so my primary position currently at UTMC is the medical directorship of an 18 bed geriatric psychiatry unit where I mostly provide inpatient psychiatric stabilization, diagnosis, and manage various psychiatric conditions as well as primarily the various dementias.

Host: Tessa Lackey:

So today we're here talking about Alzheimer's and dementia and the wonderful, loving, amazing, incredible people who care for their loved ones and who have been diagnosed with this disease, whether it's Alzheimer's or any other forms of dementia, and really just need an extra hand, and we're looking to give them some tips today kind of about that. So after a diagnosis has been made, whether it's Alzheimer's or another form of dementia, what are some things that caregivers might notice in their loved one that might be different than they would normally see in that person?

Guest: Dr. Dionis Kononov:

So the first thing that I advise family members, and this is sometimes taking place even before the diagnosis is made, but a change from their behavioral norm, their behavioral baseline. So whatever the individual's behavior was prior to maybe several months back, maybe they're more of a social individual and are now isolating, not going to family gatherings nearly as much. Certainly social changes can happen fairly early on. Now if we're looking at something specific such as Alzheimer's early on, there may be forgetfulness regarding certain events such as, oh, I don't remember last Thanksgiving, who was there in terms of the family or what conversation we had. And these little gaps in information tend to expand and expand in frequency, in amount of information that is no longer remembered and soon the individual's ability to recall whatever is happening on a given basis. So this conversation, for example, starts to dwindle and so it's difficult to keep up in a conversation.

Consequently, this causes people to stress out and become much more anxious in social interaction. Maybe the book club that they usually go to or their regular breakfast that they have with their children becomes much more stressful if you're not able to follow along in the conversation. And so we see patients start to isolate, start to cancel on family, start to not engage as much with the world outside of their home. And when they do, that anxiety, that sense that a person feels of not being in control of their reality because I'm no longer able to track the information very well, is very, very disheartening, very stressful, and so predisposes itself to increasing in anxious symptoms in irritability sometimes at loved ones.

Host: Tessa Lackey:

That would be really frustrating for, I mean the person who has this disease and it's not something they can control either. So as someone who's a caregiver or maybe a sibling or a daughter or a child or anything like that, is it helpful to... Let's say your parent is someone that has dementia and they decide, I'm not going to come to Thanksgiving this year or I'm not going to come to this event, and it's rooted through that anxiety. Is it helpful to push them and say, "No, mom, you're coming to Thanksgiving this year. I'm not just going to let you sit at home"?

Guest: Dr. Dionis Kononov:

That's a difficult question to answer in an absolute fashion. It really depends on the individual. It depends on how often are they avoiding, how often are they actually socializing. You want to cater to the individual's demands themselves. So for example, if they have not been out of their home in many months and it absolutely is paramount that they socialize with someone else, maybe there is a depression or a sense of depression setting in, it might be important to increase socialization. On the other hand, you really don't want to create a new stressor or push someone if they really are not willing to do so. It is important to maintain as much of a sense of autonomy for the individual as possible.

Oftentimes during these early stages, there's a sense of loss of independence and control over your life that can be taken very poorly if family is on your case over and over, do this, do that, don't drive, don't go here, don't do your bills by yourself. So it's a fine line between, you almost have to get the training wheels back on in the individual's life, but at the same time, make sure that they have confidence and belief in their own abilities, to not demoralize the individual during this rough transition.

Host: Tessa Lackey:

So during that training wheel period that you're working through, so let's say it's something like they can't drive anymore, would maybe a solution be, hey, I know you can't drive to the bookstore, but I'll take you every Thursday or something to go or whatever fits into everyone's schedule and life to be able to do that thing that you want to go do as you're able to? Obviously this would depend on people's schedules and as much as they can.

Guest: Dr. Dionis Kononov:

Absolutely. The important aspect in terms of something like driving ability is that driving, for many of us is serving multiple purposes. For some people it's a means of getting out of the home and out of social interaction or maybe stressors that they might be having with their dog, with their loved one, and it's a way to cope. It's a way to de-stress, maybe go for a drive. It's a way to express yourself. It's a way to exert control over machinery, a vehicle, it depends on proclivities that people have and so no longer being able to drive, you really have to comprehend what that's going to do for your loved one.

So for example, just as you brought up, if the individual has a direct need of sustenance, food, shopping, then if they're not able to drive to do so, other routes have to be taken care of so that the individual can get groceries, be it meal delivery, be it family needs to step up and take the individual grocery shopping, cab services for doctor appointments may be necessary in terms of supplementing whatever family can or can't do. Figuring out if bus is an option depending on physical limitations, cognitive limitations, but it's not as simple as, okay, I will take you to your doctor's appointment and I will take you to the grocery store. You have to look for some of the hidden necessity that an individual may have from driving, from the ability to go wherever they please.

Host: Tessa Lackey:

Yeah, there's definitely a sense of freedom that's just gone all of a sudden. It seems like when in this example with driving to where can't go anywhere, almost kind of go and do exactly what you want to do at the drop of a hat compared to the way you could before.

Guest: Dr. Dionis Kononov:

Yeah.

Host: Tessa Lackey:

Yeah. So when you are interacting with that loved one and something happens where they don't recall something, I imagine a first instinct for people is to say, "No, grandma, don't you remember when we did this, this, and that?" Is that helpful? And is there anything that may be better to say instead of that if not?

Guest: Dr. Dionis Kononov:

So overall, the first principle that you should really follow is safety first, safety of the individual and catering what you verbalize to them first from a safety standpoint. Past safety, it's living in the individual's environment. I say this to family members, to staff in the hospital that you really want to be almost a spirit guide in that person's journey through life. The reality of it is if they are not able to recall what happened five minutes ago or are not able to recall the appointment times or where they were going, you're not going to convince them otherwise. You cannot make a part of their brain work that is no longer functioning. And so telling them that this is the true reality, here is their reality is going to create distress, distrust, it's going to alienate you from them.

So part of it is go along with the information that the individual's presenting. If they believe that they are currently 60 years old or maybe in their fifties and are not aware that their husband has passed, you don't remind the individual that their husband has passed. You're creating negative emotion that is not going to stay from an informational sense. You're not empowering the individual by reminding them that hey, reality is actually this or you're not capable of doing this, this, or that. Even though it may feel like the right thing to do, you're not going to convince the individual.

Host: Tessa Lackey:

I like the visual way or just the frame of mind of putting it, whereas you're a spirit guide on their journey guiding them through what's going on in their world.

Guest: Dr. Dionis Kononov:

Yeah. And that's important in regards to understanding that while yes, you're there guiding the individual, it doesn't mean you allow the individual to jeopardize their health. So certainly if someone is wanting to go out into the snow with no clothes on, you need to maintain safety. However, trying to argue with an individual oftentimes is not going to be the route for this, and you may have to take more of a parental role of this is what we have to do, I know you may not understand this at this time, but I am doing this for your own good and for your own safety. There's a lot of parallels unfortunately between raising a child and oftentimes securing the life and prolonging life of an individual suffering from Alzheimer's or vascular dementia in a reverse fashion where that autonomy of adulthood after your teen years is established and now after adulthood as memory is declining, as cognitive ability is declining, that autonomy is also declining all the way down to complete dependence on a caregiver.

Host: Tessa Lackey:

So this is a scary diagnosis. And so in the early stages, is there anything that's important for family members or caregivers to focus on?

Guest: Dr. Dionis Kononov:

Primarily I would first say is establishing resources and a safety system, so that includes close linkage with a primary care physician that includes any consultant services, be it neurology or psychiatry, who typically manage dementia associated progress and medication options. Ensuring that there's social services, maybe a case manager that is involved navigating insurance, navigating additional help that may be necessary, getting occupational therapy involved in the home to ensure that safety is maintained and oftentimes rechecking the home environment every year, every two years as physical and cognitive functioning changes you may need to adjust the home environment. Then furthermore, taking a look at legal decision-making aspects such as setting up a power of attorney both medical and financial or looking at guardianship to potentially be in place. Really depends on the individual's family, depends on the individual's decline in terms of what might be more appropriate, but all of these aspects have to be taken care of, especially earlier on before it gets more difficult to manage.

Host: Tessa Lackey:

It sounds a lot like baby proofing your home, but in this example, the baby has different things in place like adult things in place that they need to take care of as well too.

Guest: Dr. Dionis Kononov:

Yeah. And even directly to that example, when we're talking about more moderately progressed Alzheimer's or severe progression, you may have to outright baby proof the home, something like vertical locks, we oftentimes find ourselves recommending to family where an individual is wandering in the middle of the night or wandering outside of the home even during the day, perhaps the season isn't right, and so it's an immense health concern. Getting locks that are above the door as opposed to where they normally are next to the handle can be a saving measure and really baby proofing the home through those means or color coding. I've had patients color code their stove more because they realize that they get sidetracked with the little circle indicators of which burner is which. And so okay, let's improve your ability to recall to visually acknowledge what you're doing in the environment. This also may include sticky notes that are left in various places using reminders, setting alarms on a phone, so these are the more practical baby proofing aspects that can be done, but definitely first and foremost, the social scaffolding needs to be in place.

Host: Tessa Lackey:

So kind of getting into some of those strategies you had just mentioned, talking about things like color coding your stove and stuff like that. So what are some other strategies that you've seen work well for caregivers and their loved ones, just for daily functioning purposes?

Guest: Dr. Dionis Kononov:

And again, it depends on what level of progression we're talking about here, but some other strategies that works for people is taking a look at physical limitations, not just cognitive limitations and is it possible for the individual to navigate their home up and down the stairs? Is there a heart failure aspect involved? Is there a hip replacement or knee problems that are there that would preclude someone from going up and down the steps? Is there an ability to centralize everything on one floor of the home as opposed to having bedroom upstairs, dining room, living room, bathroom on the middle floor? Well, maybe everything needs to move to the middle floor so that the stairs can be avoided.

Maybe the laundry has to be changed in terms of how it's done. Certainly setting up reminders for bills. Oftentimes we may have occupational therapy advise a patient who can navigate a smartphone still to set up reminder apps or banking apps such as there's this one called Prism that is able to remind you of various bills, various due dates on your phone to keep track of, okay, this is when this is due, this is when I need to take a look at my finances. But certainly the old school route of just using a calendar as well can be appropriate. Setting alarms on either alarm clocks, phones, can also be beneficial. Reminder calls from family for major events or major appointments can be beneficial but limited based on what resources family themselves can do.

Host: Tessa Lackey:

Is something like, for lack of thinking of a better way to phrase it, like a visual calendar, if you had a whiteboard on the refrigerator for example, and you had things like, oh yeah, Thursday is Susie's birthday, or don't forget to take the chicken out of the fridge or something like that.

Guest: Dr. Dionis Kononov:

For many people that's quite beneficial.

Host: Tessa Lackey:

Okay, okay. I would think that that would be too, I live and die by Google Calendar itself too, the tasks portion of that, and then the Google Calendar is free as well, and you get a notification right to your phone.

Guest: Dr. Dionis Kononov:

Well, and for some people, even to-do list much like a grocery store list for everything else and their life may be beneficial, and this isn't even specific to cognitive decline. It can be used lifelong to live and die by a to-do list, Microsoft to-do, Outlook has this as well.

Host: Tessa Lackey:

Isn't there different grocery apps where you can have a grocery list and then just reorder that same thing?

Guest: Dr. Dionis Kononov:

Yes.

Host: Tessa Lackey:

That seems like something that would be really easy for people to... Instead of doing a whole, because grocery shopping is its own monster.

Guest: Dr. Dionis Kononov:

And especially if you utilize the same service, be it Kroger or if you're doing delivery of groceries, for many people that's an underutilized resource, especially during the winter months, especially depending on your mobility, utilizing something like Meyer or Kroger, it saves your common purchased items, and so it becomes a whole lot easier to navigate something like that.

Host: Tessa Lackey:

I think there's some places too that... Can't you get a subscription for the year and then they'll just deliver it as well-

Guest: Dr. Dionis Kononov:

Yep.

Host: Tessa Lackey:

... too? Yeah, that seems like that'd be really, really helpful.

Guest: Dr. Dionis Kononov:

There are also social services of meal delivery services, but this is where making sure that you're involved with your primary care physician and getting perhaps a case manager on board to navigate what is available, what isn't. Oftentimes just going through your insurance company, if you take the time to go through the phone trees with your insurance company, they have additional services where they could help you navigate this. The Alzheimer's Association as well is a very valuable resource that has many individuals that can help with this as well as help with advice, with support for family members of those suffering from Alzheimer's as well.

Host: Tessa Lackey:

So when your loved one is with other people that may not understand the disease or the diagnosis that they have, how can you help people to understand your loved one with Alzheimer's? Or any tips in general, just for helping people to understand at one moment at a time? Because people aren't going to understand the full realm of it in that moment too.

Guest: Dr. Dionis Kononov:

The first thing is patience and recognizing that most of what the individual is going to be doing if it's an inappropriate or bothersome to this outside person is not intentional. It's not malicious. It's having a little bit of patience with an individual to make mistakes, to maybe not remember how to say something, to maybe fumble around a little bit before needing to step in, but ultimately it's still a human being and while memory may be declining and maybe the individual needs a little bit more of reminders, or maybe they're to the point where they're acting a little bit different than what others are used to, it's just being able to be patient.

Host: Tessa Lackey:

Yeah. Yeah. I think that would probably be at the root of it I would imagine too. So just being patient, giving yourself grace and they can't control it. It's not anything they're doing on purpose.

Guest: Dr. Dionis Kononov:

And oftentimes depending on the level of progression, depending on the type of dementia as well, you can have isolated memory problems where every other functioning of the brain is intact. So the ability to hear, the ability to understand what is visually happening, the ability to control social graces and etiquette may be intact and memory is the only factor that is impaired. Now, in other cases, you could have other types of dementia where memory is actually intact, memory is present, recall of the conversation is going to be present, but maybe I cannot determine items in space or how to navigate in a city or how do I appropriately put my clothes on, but I could remember well, I can still reason through interaction and keep track of information, but visual planning is now impaired. And so it has to be catered to the individual, but ultimately patience and no matter what your loved one is experiencing, patience and support.

Host: Tessa Lackey:

Yeah, they're still your loved one at the end of the day. So for that person that has dementia or has Alzheimer's itself, does keeping a healthy diet and exercise routine, is that something that's helpful from the disease progressing more?

Guest: Dr. Dionis Kononov:

Let's say for example, I'm suffering from Alzheimer's. It's early in the course. It is imperative to maintain a good balanced diet, to exercise so that everything else is kept in tip-top shape. So to speak, if you utilize an analogy of a car, my engine may be breaking down and me changing the tires or getting oil service done isn't going to change that engine breaking down, but I would really rather not have to deal with a flat tire and an engine that's breaking down as opposed to just dealing with the engine. And so ensuring that everything is as good as it can be brings up the importance of diet, exercise, making sure that your energy is as good as it can be. Sleep is really paramount to a lot of mental health, not just cognitive based disorders. It's very underutilized, very underappreciated, I would say besides diet and exercise, really the most important thing you can stabilize is routine sleep.

Oftentimes we see as a cognitive decline is taking place for individuals, be it mild to moderate, it can drastically change with just a bad night of sleep. We are no longer nearly as resilient as we are when we're younger, where maybe we could pull in all night or maybe we're stuck taking care of a sick animal or a sick child, and so you lose several hours of sleep. When we're younger, we can navigate through that the next day. Maybe we're not at a hundred percent capacity, but we can still persevere through. When you're already having a cognitive decline, this becomes a whole lot more detrimental to the individual. We start to see a decline in sleepy associated with possible new symptoms for the individual where perhaps they might become delirious, disoriented to the environment, maybe they may start seeing or hearing things that they normally wouldn't and just stabilizing sleep, getting a good night's rest can have a profound benefit for the individual.

Host: Tessa Lackey:

And I imagine it's not something that when you are younger that you can just say, "Oh, I'm going to drink a cup of coffee or an energy drink in the morning and then I'll be fine," either.

Guest: Dr. Dionis Kononov:

Usually for this type of decline and the impact of sleep, you cannot persevere through it with something like coffee. Coffee and caffeine as a whole are essentially blocking a signal in the body that tells us that we are tired so that we could function to our maximum capacity, irrelevant of the fatigue that sets in. It doesn't create functioning where there is none, and so decline in sleep and the cognitive burden of such caffeine, coffee sources is not really going to fix this.

Host: Tessa Lackey:

So the best thing to do-

Guest: Dr. Dionis Kononov:

You need the rest.

Host: Tessa Lackey:

You need to go take a nap.

Guest: Dr. Dionis Kononov:

Yeah.

Host: Tessa Lackey:

Okay, gotcha. So what are some other ways that just increasing that mental stimulation can benefit these patients?

Guest: Dr. Dionis Kononov:

What we do know is that there are certain factors throughout life that tend to be protective against dementia. You can look at most of them as being related to the amount of cognitive stimulation that we experience. So be it later time to retirement, be it higher level of education, be it higher social engagement, multiple languages being spoken. Some of these we have within our control. Some of this we no longer do. As much as I would love to get a new linguistic skill, it's probably a little bit too late for me, especially considering all the time constraints of day-to-day life. However, ensuring that you continue to engage with loved ones, ensuring that you maintain appropriate hobbies, what is important is ensuring that you stay a lifelong learner. It's a difficult recommendation to make because it's a very abstract recommendation, but time and time again, what seems to keep people going and persevere is that thirst for knowledge, that curiosity, that learning about something different, something new as opposed to the same old routine that can get very stagnating from a cognitive standpoint.

Host: Tessa Lackey:

And with being a lifelong learner, would you say that that's from the stance of just as a human being, no matter what age you're at or from, once you have this diagnosis, just continue...

Guest: Dr. Dionis Kononov:

No matter what age.

Host: Tessa Lackey:

Okay.

Guest: Dr. Dionis Kononov:

No matter what age, it is beneficial for us as human beings, as people. But certainly once there's a memory decline that is taking place, and if you have conscious awareness that this is what I'm going through, some people do, some people do not. Some people are not aware of their outright decline that's taking place, but ensuring that you stay as busy as possible without going overboard.

Host: Tessa Lackey:

So what are some examples that you would give for, I mean, just continuing that lifelong learning. So if learning a language isn't something you're interested in, is something like reading a book series or going to the zoo and learning about animals or just really anything that sparks your interest?

Guest: Dr. Dionis Kononov:

Absolutely, anything that sparks your interest, anything that's applicable to you that you are willing to do. So certainly if it's going to the zoo, that can be both a physical and a cognitive activity. If it's engaging your grandchildren in their life and their activities, reading a book together, not only the emotional bonding aspect of this and the stress reliever that this can provide for grandparents, but also the importance of that interaction for the child. It strengthens the ability that is there and provides a much more holistic sense of comfort. I will also say religion is a very important aspect to many people. If you are involved in Sunday service, to continue to socialize, to continue to go to Sunday mass, if you do Bible study, whatever it may be that you are accustomed to doing throughout your life, making sure that you keep that up.

Host: Tessa Lackey:

Keeping up a sense of normalcy essentially. Yeah, that makes a lot of sense.

Guest: Dr. Dionis Kononov:

For some people, this has also come down to the struggle of I may be still employed, working, and I'm noticing that there is a decline taking place, and you go and get a diagnosis, get testing done, and it's confirmed that there is a memory decline happening that this may be early course of Alzheimer's. What do I do then? Do I completely abandon that phase of my life and go into this new phase doing what? Well, the answer to that is usually no. Usually if we're that early, it's finding appropriate transitions and how to channel what kept you going, what kept you waking up on a given day to function, to live another day, be it the purpose that we have with our employment, be it the need to take care of someone else, be it the need to entertain channeling those aspects of yourself into another avenue.

So for example, if you are used to being a nurse and taking care of others, maybe nursing is no longer an appropriate field for you, but then that role of nurturing still has to be channeled into something. So maybe volunteer work, not with people, but maybe with animals or maybe taking up hobbies that you could channel that quality of yourself so that it isn't deteriorating and isn't neglected.

Host: Tessa Lackey:

Yeah, and I would think that as someone that's a caregiver itself too, that it's important to also for them lean into those things of being a forever learner and keeping some sense of normalcy, whether it's you go to church every Sunday, or you have your knitting club on Wednesdays or something that you keep up those things that you love too, because this doesn't seem like it's an easy thing for these caregivers. So naturally, and obviously this process is stressful for those caring for a loved one and just trying to be there for that person. So what are some things caregivers need to consider when it comes to their own health?

Guest: Dr. Dionis Kononov:

Really it's even paying attention to your own health. Typically, we find ourselves from a treatment team on the educational aspect, on the intervention aspect of needing to get involved with our caregivers for our patients, that you are burning out. You are doing everything you can for your parent, for your loved one. What about yourself? Many times, those of us in a caregiving role tend to divert all of the mental and physical resources towards the individual that we're caring for, be it our child, be it our parent and neglect or don't acknowledge our own needs. Be it our needs for socialization, be it relaxation, be it you time asking yourself, when is the last time that I did something on a given day that I wanted to do, not that I felt obligated to do or that I ought to do? There's a difference between I want to versus I ought to, and we drive through life with a lot of oughts, a lot of this is the right thing for me to do.

This is what's marking that checkbox in my head for a righteous, good, hardworking human being versus this is what my spirit and soul wants to do. Maybe it's something as simple as just laying on the couch and doing nothing. You need to have you time present. More importantly, acknowledging that just because you may want time to yourself is not a personal failure or a disservice to the loved one, because what happens when we don't take care of ourselves as the caregiver is quickly, the situation starts to spiral out, and so your burning out ends up impacting how you engage with the loved one, with individual suffering from Alzheimer's, which in turn is impacting their behavior towards you.

And pretty soon you have conflict that's developing when ultimately this could have been avoided by ensuring that you also take care of yourself, knowing when to pause and step away from the situation or knowing when to recruit additional help, be it from other family members or social services is important. Sometimes having a respite stay is beneficial for others where I am taking care of my loved 24/7 at home, I need a short couple day break where maybe our loved one can go and stay and be looked after and taken care of while I recuperate and recover.

Host: Tessa Lackey:

And it sounds like in those instances when you are starting to realize that you're burned out, taking that personal inventory and just saying like, okay, am I burned out? Where am I at? In general, do I need a break or anything like that. Is really important too.

Guest: Dr. Dionis Kononov:

Yeah, I think having moments where you acknowledge that you are not behaving the way that you normally would, just as I said earlier in the progression of what symptoms to look for as in our loved one, just as their delineation from baseline activity needs to be noticed, so too for the caregiver, it needs to be noticed. If you notice or see yourself responding in a way that you usually would not to your loved one, maybe your frustration tolerance is down, or maybe you snap and verbally say something that you normally wouldn't or raise your voice or the tone changes acknowledging that I am not behaving like myself, and taking a pause and looking at why is that? Am I sleeping? Am I taking care of myself? Am I getting nutrition? Am I getting socialization? And what could I do about that if the answer is no?

Host: Tessa Lackey:

Yeah. Yeah. There's one example that comes to mind to me. Have you ever heard of Brene Brown before? So she's a motivational speaker and she's done a bunch of TED Talks and stuff, but she gives this example with couples, but it sounds like as a personal thing, I think it's a good visual example. She talks about with your partner to say, if you're trying to do something together, looking at each other and saying, I only have 20% today, and if the other person has more than 20%, then that's the person that has more motivation to do the thing. But when you're doing a personal inventory and looking yourself saying, okay, how much do I actually have? And if you tell yourself it's a really low percentage, then you need to take a day off and lay on the couch maybe for a while or something.

Guest: Dr. Dionis Kononov:

We discuss a similar concept of having a battery and not just a physical battery that we all, I feel like knowledge throughout life and are taught to conceptualize our physical ability and the energy in that regard, but there's also a social stress-based limit that we all have, and acknowledging when that limit is reached and forcing yourself or pushing yourself to do more than what you can actually tolerate on that given day, in that moment, in that week is a recipe for disaster. So acknowledging that there's other fatigue and exhaustion than just physical exhaustion in knowing when to utilize additional help.

Host: Tessa Lackey:

Yeah. You're one person, not a robot.

Guest: Dr. Dionis Kononov:

Yeah.

Host: Tessa Lackey:

Thank you again, Dr. Kononov for joining us today. If you're interested in scheduling an appointment with UTMC psychiatry and with someone in our Senior Behavior Health Department, you can call (419) 383-5695. That number is also listed in our show notes. And if you like this episode, don't forget to hit subscribe so that you can receive more health tips from our UTMC experts. We'll see you next time.