Dr. Monique Williams 0:00
In COVID you see some similar issues where if you look at the literature for counties that are predominantly African American, the rate of mortality and disease in those counties has actually gone up as compared to the data from just May. So there was a report that came out today that was reported in Bloomberg, and was from a Johns Hopkins study that showed that the rate of mortality is probably 2.5 times higher and African Americans who live in a predominately African American county as compared to non Hispanic whites, and overall for the country for African American and Latino populations, mortality and disease rates for COVID are about twice as high as the non Hispanic white population. So it's really quite concerning. And some of the thoughts on this are that the disparities could be mediated by the fact that people of color it might be more likely to hold the front line jobs where they're working in a job where there's greater risk of exposure and more engagement with the public. That could be a factor. Another thing that's being fleshed out is making sure that there aren't any inequities in access to care and getting care. And there have been some anecdotal cases that have been discussed in the media where one of the concerns is that people may have presented for care, and were turned away and told it wasn't COVID. And so that's another area that's concerning. And one of the areas that I've always worked with with Alzheimer's Disease and dementia, in general, is the fact that diverse populations tend to have fewer reputable sources of health information. And one of my concerns is that something similar can occur also with COVID. And that would be one of my hypotheses that if people are not finding enough reputable media outlets that they find trustworthy to get information, then misperceptions can be propagated.

Welcome to the Psychology of Aging Podcast

Dr. Regina Koepp 1:42
I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and families. I created the psychology of aging podcast to answer some of the most common questions I get about aging. Questions about mental health and wellness changes in brain like with dementia, relationships and sex, caregiving, and even end of life. Like I say in my therapy group, no topic is off topic, we just have to have a healthy way of talking about it. So if you're an older adult, or caring for one, you're in the right place. Let's get started.

Download your free COVID-19 Wellness Guide for Older Adults

Dr. Regina Koepp 2:23
With COVID rates on the rise, and African American and Latinx folks two to three times more likely to have COVID than white Americans. I wanted to bring an expert on the podcast today to share a little bit about why there is this health disparity and what we can do to protect ourselves, our families, and strengthen our community in the midst of COVID. Let me start by saying if you're an older adult, or caring for one during COVID, I created a COVID-19 Wellness guide for older adults and you can download it for free. I'll link to it in my show notes or you can download it directly at www.drreginakoepp.com/covidwellness.

Dr. Regina Koepp 3:21
Now let me introduce you to today's guest. Dr. Monique Williams completed her medical residency and fellowship at Barnes Jewish hospital, then joined the faculty at Washington University School of Medicine. Dr. Williams was a clinician and director of the African American outreach satellite at the Knight Alzheimer's Disease Research Center until 2012. Dr. Williams also served as associate professor and interim chief of the Division of Geriatrics and Palliative Care at Texas Tech University Health Science Center. She also served as the Director of Geriatric Outreach and Education at the Texas Tech Garrison. Center on Aging. Her research interests focus on minority aging, minority research participation, Alzheimer's Disease, bioethics and health disparities, and currently as a primary care physician in St. Louis County. She's involved in community clergy and health, professional education and outreach. I am delighted to interview Dr. Monique Williams today.

Dr. Regina Koepp 4:26
Dr. Monique Williams, thank you so much for joining me on this Psychology of Aging podcast. It's such an exciting thing to be interviewing you today. So thank you so much.

Dr. Monique Williams 4:38
Oh, thank you. It's a pleasure to join you today and be able to discuss issues related to geriatrics and covid.

Dr. Regina Koepp 4:45
Well in such important issues, especially now that the covid rates are on the increase and on the rise again. And I think that information that you have to share with us today will really help a lot of older adults and their families. Can you start with some basics like tell us a little bit about your geriatric medicine practice and what you do on a day to day?

Dr. Monique Williams 5:04
Oh, yes. So I over my career I've worked in academic medicine. I've also worked in a for a large long term care company where I covered about a dozen nursing homes. I've also worked for the nation's largest provider of hospice and palliative care. And now I work in private practice, which is kind of the classic model of care that most people experience. And so in my practice, I've emphasized care of older adults. So I have a substantial proportion of patients who are 85 and older or, you know, definitely 65 and older. And then for some variety and carry some people in their late teens early 20s. So we have a heterogeneous group, but the vast majority are older patients. And one of the things that I try to emphasize in the practice is bringing the culture of geriatric care to primary care where there is a greater amount of time spent with patients to be able to provide patient education. For example, if I'm introducing a new medication, making sure that the patient feels comfortable administering it. For example, if it's a new injectable, do they know how to drop the dial? Do they know how to check the solution every time they use it? Or if they're using an inhaler? Do they know exactly how to use the inhaler if they attach a spacer? Or how do they use a spacer? So it's something that I've taken from my academic medicine experience where each patient encounter is longer and there is greater engagement and also understanding how the different aspects of a person's life fit together. For example, if you know somebody likes to go and work out in the morning, is that going to work with their medication regimen or some of their other treatments? And how can that be integrated in well?

Dr. Regina Koepp 6:42
Oh, yeah, the person centered approach rather than medicine centered approach.

Dr. Monique Williams 6:47
Exactly. Not just these are your seven meds, but are there barriers? What are your questions? And one of the things that's really interesting that's become a trend in primary care to is the use of patient portal for all patients. So that's really very interesting because you get older adults who find another mode of communication with their providers and a way to get additional information. And it's really it's nice to have templates to be able to provide patient education. One of the other things that's useful with the patient portal is giving people access to reputable sources of health information, which is one of my big concerns because when you do a search online for health topic, you can find some rather not accurate, unusual, out there sources that pop up pretty easily while the more useful, accurate evidence based sources may be harder to find. So for example, when I send people a message, you know, this is the new medication that we're starting. It's Rosuvastatin or Crestor for your cholesterol. I'll also include a link to Medline Plus that includes the medication information and when they're in the office, I do a couple of sample searches to show them how it works and all the different resources they can get. And always tell them you know, tell a friend share the information to try to get good dissemination. have accurate resources for people.

Dr. Regina Koepp 8:03
Wonderful. So a minute ago you were talking about bringing geriatric medicine or geriatric care to primary care. Can you explain what a geriatrician is?

Dr. Monique Williams 8:12
So geriatricians are specialists in the care of older adults. So gerontology is the larger umbrella of the science of aging. And then geriatrics is the clinical care aspect. And so geriatricians are physicians who either complete an internal medicine residency, so three years in internal medicine or family medicine residency, and then our fellowship trained in geriatric medicine. So the typical geriatric fellowship is a year but in some academic settings, it can be one year, two years or three years. I did a two year research geriatrics fellowship at Washington University School of Medicine because I was very interested in dementia and dementia disparities research. So I did a two year training and you get extensive education and all the aspects of care of older adults communication: How does physiology change? And you get a lot of training in pharmacology, you know, what's the appropriate starting dose for an older adult? What are medications that may not be as optimal for older adults. So geriatricians are the specialists in the care of older adults. But one of the things that we try to do as geriatricians is to disseminate that knowledge base to all providers, because one thing that's relevant is that there are not a huge number of geriatricians in the country. But having everyone attuned to geriatric care is very important.

Dr. Regina Koepp 9:30
Yes. I think a lot of your insights from today are going to help folks get familiar with how to integrate geriatric thinking into whatever they're doing. So I'm, I'm so glad you're here. Okay, so how did you become interested in working with older adults? And then you talked about working with disparities in dementia? How did that become an interest of yours?

Dr. Monique Williams 9:55
So I come from a multi generational family of Scientists. So my maternal grandfather had a degree in chemistry. And he used to read medical journals for personal interest and enrichment, even though he wasn't a physician, which was pretty funny, and he would actually reference them like a doctor, which was really quite funny because I remember one time when I had hiccups, he referenced an article that said that a couple spoonfuls of sugar would alleviate the hiccups. My mom said, "that's a complete fabrication dad". And then years later, when I was in med school actually pulled the journal and he cited the exact correct journal, and apparently was quite a reference for that. And so there's a lot of emphasis on science and physiology throughout the family. When I was a kid, both of my parents are molecular biologists and geneticists. And so when I was four years old, I told my mom I ran up to my mom and I said, "Mom, I need to see the family doctor" so insisted on going to see Dr. Van Kirk, she takes me there. And when my mom tells the story, she explains the doctor comes out of the room and he goes, "your daughter's not sick" and my mom goes, "but we're at the doctor's" and he goes, "No. Actually she was asking for career advice. The reason for the urgent visit was that she wanted to know if she could specialize in care of older adults and study memory. So I gave her a pep talk and told her she could be a geriatrician and do dementia research. So her career is pretty much set. She's very happy."

Dr. Regina Koepp 11:11
Wait a minute. And you were four?

Dr. Monique Williams 11:13
Yeah.

Dr. Regina Koepp 11:14
My gosh.

Dr. Monique Williams 11:18
I told my mom, I said, I asked him, I said, so I really want to care for older adults. That's really where my passion lies. And I said, but you know, and I in kids, they tend to cry a lot for no reason. And that kind of stresses me out. I want to focus on older adults. And my dad's great grandmother, my great great grandmother lived to be 114. She was sharp as a tack. She had osteoporosis and actually, her dogs and her chickens got into a squabble. And while she was trying to achieve peace between the animals, she tripped and fell and broke her hip when she was 106 years old. So at that time, she would have been the oldest orthopedic patient at the teaching hospital. And so they told her, you know, we really, we really don't think we can operate you're far too old and she said, "I've been old forever, What's your point?" And she said, you know, "find a medical reason I can't have surgery." They couldn't find anything wrong with her. So they did her hip replacement. She made the front page of the B section of the newspaper, and lived to be 114 and was only really having clinical decline in the past. You know, the last three to six months of her life. She cooked the Sunday meals, she did everything from scratch. She had her chickens in her garden and walked three miles a day. So, I wondered, why was she so cognitively intact? And then there are other people who aren't and I was really intrigued by that as a kid. There's there's quite a bit of longevity in the family her her son in law, my great grandfather, he passed when he was 100. And people kept going struck out struck down in his prime we were so surprised. So young, so...

Dr. Regina Koepp 12:40
Wow. So you you saw longevity in your family and you thought why are they thriving and other people declining at younger ages or developing dementia or... so did you come up with your first research study at five then?

Dr. Monique Williams 13:01
No, but I used to think it was funny. I used to always grill my dad's friends about their genetics research and stuff. And they were kind of like kids kind of precocious. I think she's gonna go into research.

Dr. Regina Koepp 13:10
I think she'll go far. We're talking about disparities, we're talking about why one person thrives, and another person declines. Now, when you talk about disparities, and we talk about health disparities, can you elaborate on that for us?

Health Disparities: What they are and what we can do about them

Dr. Monique Williams 13:33
So that would include any any inequitable outcomes in a disease process. So one of the issues that's been getting a lot of press, not for older adults, but for the population in general, is the fact that maternal mortality and perinatal mortality for women of color, particularly African American women is astoundingly high. I know within the past week, there was a 26 year old woman who had an emergency cesarean section and passed, but had no medical history in the past other than the one pregnancy. So one of the concerns is when you see inequitable outcomes for disease. So for example, the prevalence of Alzheimers Disease is about two times higher and African Americans and certain Hispanic groups as well and what mediates that is still not fully defined. Or if you look at other diseases like cardiovascular outcomes, there can be higher rates of stroke mortality or myocardial infarction mortality in African Americans or other minority groups. And the disparities in COVID are actually substantial as well. And one of the things that I always talk about is when you talk about dementia disparities, it's often multipronged like, you know, knowledge, access and rate of disease and mortality and outcomes. And in COVID, you see some similar issues where if you look at the literature for counties that are predominantly African American, the rate of mortality and disease in those counties has actually gone up as compared to the data from just may so there was a report that came out today that was reported in Bloomberg and was from a Johns Hopkins study that showed that the rate of mortality is probably 2.5 times higher and African Americans who live in a predominantly African American county as compared to non Hispanic whites, and overall for the country for African American, and Latino populations, mortality and disease rates for COVID are about twice as high as the non-Hispanic White population. So it's really quite concerning. And some of the thoughts on this are that the disparities could be mediated by the fact that people of color, it might be more likely to hold the frontline jobs where they're working in a job where there's greater risk of exposure and more engagement with the public, that could be a factor. Another thing that's being fleshed out is making sure that there aren't any inequities and access to care and getting care. And there have been some anecdotal cases that have been discussed in the media where one of the concerns is that people may have presented for care and were turned away and told it wasn't COVID and so that's another area that's concerning. And one of the areas that I've always worked with with Alzheimer's Disease and dementia, in general, is the fact that diverse populations tend to have fewer reputable sources of health information. And one of my concerns is that something similar can occur also with COVID. And that would be one of my hypotheses, that if people are not finding enough reputable media outlets that they find trustworthy to get information, then misperceptions can be propagated, for example, there was a notion about 5g towers, propagating COVID which, of course was not feasible or biologically possible, or, you know, the original mythology around the disease that it was not going to affect African Americans. And so some of that perpetuated for a bit so people might have been symptomatic and thought, but we don't get COVID. And so I think that one of the things that needs to be relevant is to make sure that as we learn more and more about the disease process, that there's adequate, diverse representation, in terms of clinicians, clinician investigators, and then also community members who engage in a dialogue of what we need to do in terms of initiatives. And also making sure that there aren't any inequities and access to protective equipment, personal protective equipment, you know, the appropriate supplies to reduce, you know, the risk of spread, and all the other pertinent interventions, and plus that access to care is being addressed. So I know in the major cities, one of the things that's going on is making sure that there are testing sites that are representative of the population in various different areas and not just one testing site that might be kind of in a posh suburb that's not accessible to a good proportion of the population, and also getting buy in from community leaders who also serve as one of the mediators of healthcare decisions, which is really important in diverse populations, because one of the ways to mitigate disparities is to have the involvement of clergy and other trusted community members to advocate for the need for testing and that's been one intervention that's been very effective in communities.

Dr. Regina Koepp 18:01
Yeah, well, you just shared a whole wealth of information. One of the things that was standing out to me when you were talking about access to care was also provider bias, even unconscious bias to continue to challenge and learn and grow about their own hidden or unconscious biases. Because even when we say or verbalize, there are lots of studies that say even when we verbalize anti racist language, our body language can convey fear and distrust and how essential that is even for conveying health information. The other thing that you were talking about that just really stood out to me is, was it last month and I live in Atlanta, and it was our primary election was right, or, you know, in kind of this COVID hotspot, my voting place was predominantly African American and folks of color. And we had to wait for three hours. We had to move inside. And so all of us in order to vote, we had to go inside because there was a thunderstorm. And the ACLU showed up to see if it was being mishandled. There were so many issues with voting in predominantly black neighborhoods in Atlanta. That I mean, it made I don't know if you also saw that on the national news, but but it was just astounding and put people you know, so you had to choose my safety, my COVID safety or risk versus my right to vote, and my need to vote. And then this history of voting that has been denied to these communities of color black communities, in this particular state. You know, it was, it was there was kind of atrocity after atrocity. And it was right all around Ahmad Arbery, which happened in Georgia and George Floyd and Breonna Taylor and it was just compounded grief compounded atrocities compounded racism related stress and trauma. And then and then COVID. And then you're going to have, you know, folks feel like they're going to receive adequate health care, and they're getting all of these other messages that they're not even going to receive adequate voting. So why would they receive adequate health care? I mean, it's, I appreciate what you're talking about, because you're saying it's healthcare, it's access to health care. It's who's conveying these messages? Are we getting community leaders involved, like clergy and to help invigorate trust so that information gets disseminated and like you're doing in your own practice, you're educating your patient on how to find the best practice. In medicine and where to find science based information?

Dr. Monique Williams 21:05
Yeah, and a part of it is having consistency. So actually, we did a focus group study. And one of the things that we found in the focus group is that people said, a lot of research teams go into the community once. They try to talk to people and they leave, get the data and never come back. And so one of the concerns from the community is, do you come back and come back and return with the research results? And do you disseminate the results? And if you disseminate the results? Do you have it at, you know, at a fancy hotel in Buckhead that might have a history that doesn't work in the community? Or do you have the programmatic activity in a culturally resonant location? So for example, where I live, there was one hotel where Ella Fitzgerald performed and St. Louis was segregated and people couldn't go. So one group that I've worked with wanted to have an event there, I said, Oh, no, no, no, no, I've heard enough about how people couldn't go to see Ella Fitzgerald and people are still mad about it. So that's not the right venue. But then you pick a venue. That's that's appropriate, and that is welcoming to the community. So I think that that's a consideration that clinicians and investigators need to have. Because just because you talk about, you know, an intervention or an intervention or a research project in one venue, that doesn't necessarily mean that that is going to be sufficient. And one of the things that's really crucial is to have consistent engagement with the community because one of the concerns is that healthcare infrastructure, or researchers show up with an agenda. They didn't get what they want, and they leave. And so one of the questions is, do clinicians and researchers have a commitment to the community are they going to actually engage with the community in a sustained manner? And so, when I worked at Washington University School of Medicine, I did a lot of health disparities research and community engagement and I used to go out, and I would often have, you know, three or four or five activities in a week and I remember one year we had 58 major activities than a bunch of little minor activities, but it's the question of being consistent and being there. And I remember one time I went to a church, and my 114 year old great, great great grandmother was Christian Methodist Episcopal and she taught me every hymn, every verse. So we're in the church never been in there before my life and they start singing a hymn I'm singing along, my husband looks at me and he goes, you don't have the hymnal open. I'm like, I don't need the hymnal. I was taught all of this and, you know, having consistent engagement with the community is really crucial. And you know, and coming from a sense of understanding that is your community, you know, and not necessarily just, if there's you know, race or ethnicity congruence for the clinician or research or the community. One of the research nurses I used to work with was White and she actually had worked in the she worked in an inpatient hospital for first year of nursing and then her second year of nursing she was doing newborn baby wellness and mother educate maternal education and Roxbury and African American community in Boston. And she worked in the African American community her entire career until she retired her mid 60s. And it was an you know, everybody knew her because they were like that so and so she's she's been coming here for 30 years, everybody knew her. And she was a fixture in the African American community, and a trusted, reputable source of information and people knew, if you called on her for assistance, she could get you the right resources, even if she wasn't the right go to person, she would help you. And it's having that sustained involvement in the community that really helps to eliminate barriers and where you feel like, you know, someone's a trusted source of clinical care. They're a trusted source of assistance. It's really impactful.

Dr. Regina Koepp 24:37
So what are you seeing in terms of COVID in your own practice?

Dr. Monique Williams 24:42
So actually, with one thing that's interesting about the healthcare systems in St. Louis, they really have a nice collaborative Task Force. So the culture and style across every healthcare system is identical. It's very interesting. So there are several level levels of precautions to ensure that we get expeditious decisions. But of possible COVID cases, but they tend to stay out of the general ambulatory clinic. So they wouldn't people wouldn't be seen in a typical primary care clinic, if they're, you know, if somebody needs to be evaluated the emergency department, there's a suspicion that they need to be evaluated, there's a call ahead to the emergency department and the person is triage and treated in a in an area that's that all the you know, full throttle, cautions for for COVID. And then if somebody is more in a kind of, you know, mild to moderate symptom spectrum, then they would be evaluated within each healthcare system has specialty respiratory clinics, and they've geographically placed them across the region. So that there's good representation and pretty much all of the neighborhoods where people would be geographically convenient to pop in for an evaluation. So they would go to a specialized respiratory clinic where there are precautions, the rooms have negative pressure to treat to prevent spread of COVID. And there's a whole process and all the protective equipment. So there are good measures in place to get people evaluated. Another option would be if someone's you know, starting with symptoms, they can have a virtual visit. So they'd have a telehealth video visit and then they can go to a testing site that would be convenient to them to be able to get tested. So we have a whole infrastructure in place that's region wide, that's helping to provide optimal care to people. And it's the thing that's nice is there's real symmetry between the healthcare system. So anywhere you go, it's the same type of process and algorithm. And so if somebody gets lost in the system between healthcare entities, they're still going to see the same style of care, which is really very nice.

Dr. Regina Koepp 26:30
Oh, yeah. And then providers can convey the same information. And you know, you're getting give accurate information... and consistent information.

Dr. Monique Williams 26:40
It's nice to have the consistency and to know, for example, if someone's sick where they can get tested. The other thing that's really nice is that a couple of our safety net healthcare systems are doing these large scale, socially distance waiting in your car model, testings and they do a large social media blast, you know, to say next Thursday, there'll be testing and blah, blah, blah, church and the snack provided or something like that, you know, so people take it to go lunch after they get their testing and that type of thing. So that's been a really good way to get people tested broadly. And then, and like you're saying there's a, there's a regional task force that has a consensus on information and disseminating information. And they really do drill down very nicely on what the data mean, what the implications are, and then reinforcing the message about the importance of wearing masks the importance of social distancing, and making sure that good, accurate, consistent information is getting to the community.

Dr. Regina Koepp 27:34
Great. So now, what are your recommendations for older adults surrounding COVID?

Dr. Monique Williams 27:42
So what I would advise is that even though we're seeing parts of the community in various areas open up, our management of the disease has not changed the way you might see you know, certain parts of the population going back to work and getting back integrated in the community. That is different, but still The most crucial component that we have for for preventing the spread of covid is still social distancing. So wearing a mask, trying to avoid unnecessary outings from the home is still relevant because truly in terms of the disease process, nothing is changed. So, wear your mask socially distance. Try to stay home as much as possible to the extent that you can do contactless transactions, that can be very, very helpful. Because although people might be getting back to some aspects of being integrated into society, for older adults, or for anyone who has a chronic health condition that can make them more susceptible. It's relevant to keep with the notion of staying home as much as possible until we have some more effective interventions.

Dr. Regina Koepp 28:46
Now, given that we spent some time talking about African American folks in their elevated risk for COVID or the toll of COVID. How would you describe that as the elevated risk or elevated effect?

Dr. Monique Williams 28:57
It's, I would say there's an there's a greater range of COVID infection in in the African American community and then Latinx communities. The question is, what's mediating that? And some of that could be related to, you know, for example, if a lot of people are working within the healthcare infrastructure, certain components of healthcare teams and healthcare systems are very diverse, that could be a factor or, for example, if people are working, you know, there is the case of the bus driver that someone coughed on. And one of the concerns is if you're a frontline employee who's got a lot of exposure to the public every day, that could be a factor. And that's one of the reasons why, you know, when people do have to go out and shop being very considering the fact that those frontline workers in the stores, those frontline workers who are you know, helping with distribution and materials are really in a place where they're getting repeated exposure, you know, being considerate of that is really crucial, is really crucial.

Dr. Regina Koepp 29:46
Yeah, so not to put them at risk, even if you're being cautious. Now, what recommendations do you have for folks then? So, older adults, older African American folks or African American or Latinx folks who are working on the frontlines? How would you recommend that they stay? You know, I've been having this conversation with my husband and my friends about it's a privilege to be able to say that I'm working from home, it's a privilege to be able to say I can go into an office that's socially distanced. When many people don't have that option. When you have to go to the grocery store, maybe I was raised by a single mom with five kids, we had no dads, she had to work like there was no option other than working. And so many people are in that situation that my mom was in, right. My mom didn't have to deal with COVID. And so what what recommendations would you make then for folks who are on the frontlines and don't really have the option of, you know, they have to put food on the table?

Dr. Monique Williams 30:49
Yeah, I would say that, you know, keeping with the guidance on personal protective equipment is really important. And then one of the things that they've been talking a lot about in the media is that everybody's getting fatigued because this has been going on for a while, but not letting your guard down. I have a friend from high school who's an epidemiologist and she said, I just wanted to check in on how everyone was doing and just remind everyone that it's been a long haul, but it's still the beginning. So we're still in the process and understanding that and part of that is you know, trying to almost give oneself a pep talk to say, this is getting this is tedious, but you know, we kind of got it down pat, we've got it down to you know, an art and a science so, you know, keeping with the hand eye hygiene, wearing the personal protective equipment, keeping with that good habit of not touching your face, not touching your eyes, because you know, at the end of the day when one's fatigue might be might feel tempted to do that. So, you know, keeping with the the guidelines for social distancing as much as possible and then in the, you know, in the settings in the workplaces, where they're putting up the plexiglass and the protective gear that's very, very relevant. But then, for the public. One of the considerations too is if you're feeling like you might be under the weather, don't go out. If you've been instructed to quarantine stay at home comply with the quarantine because, you know, when you get quarantine guidance, that's essentially the health department advising of the importance of staying home because that's one of the one of the most important things that we can do to prevent the spread of disease. So I think it, you know, the individual who's working in the frontlines can be cognizant of all that they can do to prevent to prevent, you know, you know, exposure to disease. But then the other thing is, it's really important for the public as well to be considerate of that and, you know, people who are COVID positive need to be at home quarantine as they've been instructed to do.

Dr. Regina Koepp 32:36
Or even if they feel like they might be COVID positive.

Dr. Monique Williams 32:39
Or if they think they're symptomatic or if they've been otherwise told you've been exposed to someone in quarantine. Yes.

Dr. Regina Koepp 32:46
You have a history in working with senior care in terms of long term care in nursing home care, skilled nursing facility care. And so what are your top recommendations for senior care professionals surrounding older adults and COVID and caring for folks who are, you know, it's so hard right now on senior care communities and long term care communities, skilled nursing facilities, they're just getting hit so hard, some with COVID. So there are some senior care communities that have just been pummeled, and then others with the isolation that, you know, older adults are having to live with and endure right now. So what are your thoughts about that? And what do you recommend for those communities?

Dr. Monique Williams 33:29
So I would say for the COVID, it's still the Centers for Medicare, Medicaid has some great guidelines. CMS has excellent guidelines for long term care facilities in terms of recommendations for the precautions and so reviewing those documents can be really relevant. And I know that in the inpatient setting, one thing that we've done I think works well to in long term care is they have kind of a board that has like something inspirational and humorous every day and everyone in the staff kind of contributes and they rotate through it and it's kind of funny because you see all the all the disciplines and the clinical team kind of popped by the board to see what's the positive message for the day. And that can be very helpful. But I think, you know, doing all the diligence in terms of the precautions for, with PP with I, you know, with the distancing for residents, and then also with the cleaning protocols, because when I worked in one long term care facility, when I did quite a bit of long term care work, one of the things that I would actually do is we would, we would work with that with that custodial team. And we would actually review some of the science of what we were treating with what and it was really cool, because people come up to you and ask you questions later, like, you know, how long could a C diff spores survive on the surface and things like that? And so they went to the right person

Dr. Regina Koepp 34:37
And raised by a molecular biologist and a chemist, and yeah,

Dr. Monique Williams 34:42
So yeah, so it was so it would come so it'd be kind of relevant. So they would get a you know, good handle the science and we'd have these discussions and everything and everyone, you know, it's kind of like motivating the team on a daily basis is very relevant and with the isolation, I think one thing that can be relevant is thinking outside the box like the two teenagers in the United Kingdom who got a whole pen pal network, I think that could be kind of neat. And that would also be an interesting way to engage some of the high schoolers who might be a little bit disenchanted by this time of year, and have them do some letter writing campaigns. And that can be very interesting because one of the traditions in the long term care facilities in St. Louis is that the high school students are often very involved with things. For example, one of the, one of the systems of long term care facilities actually does an annual Mardi Gras theme. And you know, that would have fallen to the wayside this year. So they can kind of bring in some different things or some summer related themes and letters and, you know, different activities can be good. And then I know for some of the assisted living facilities, they're doing community education through zoom. And that's actually been picked up more than than, you know, initially had been anticipated. So that's been really good. And they'll, for example, they cover what do I need to know about the upcoming elections? How can I get my absentee ballot if you know that's something that that states permitting or different different updates and including, you know, COVID updates, or just different activities for people to learn. Some people are trying to teach people crafts and things like that via zoom. So I think thinking outside the box can be a really, in getting creative with the interventions can be really kind of fun. One of the community organizations that I work with, actually has done lecture series on civil rights history in St. Louis. And it's interesting because some of the, some of the people in their 80s and 90s still remember when those were news stories. And so they'll kind of say, this is what my mom told me about this, you know, when this when this protest happened, because one thing that's interesting about St. Louis is actually, in the 30s and 40s. There were a bunch of protests that went on locally that didn't get a lot of national attention. But, you know, to somebody that history has been very interesting or looking at different aspects of things, and that our libraries actually have a program that can be integrated with long term care where they have the author series available through Facebook Live. So that's been very interesting.

Dr. Regina Koepp 36:52
Oh, cool. That's a great idea. Yeah, collaborating with your local library. That's an excellent idea and I really love the pen pal idea.

Dr. Monique Williams 37:01
Yeah. And our history museum is actually doing women in civil rights and and they had a, they had a Harvard educated PhD who was talking about like she'd written a, she she's written a recent book that was called, "How to be less stupid about racism," but it was really about dismantling infrastructure that's affecting bias. And you know, there it's kind of a lot of energizing topics. So I think it could be anything. I love the simple idea though, because everyone loves a ladder and no one gets a letter anymore.

Dr. Regina Koepp 37:30
Did you have a pen pal growing up?

Dr. Monique Williams 37:32
I did.

Dr. Regina Koepp 37:33
Where was your pen pal?

Dr. Monique Williams 37:35
She lived in Liberia. And it was funny because I was she was my pen pal for years and every year she'd asked me if I could get rid of camera because you know, American kids have a lot of money. It was funny. I'd be like, I'm nine. No. Maybe Maybe next year.

Dr. Regina Koepp 37:49
So is your family okay then Monique? Healthy?

Dr. Monique Williams 37:52
They're all fine. So my. So my parents we haven't seen in person since gosh, probably March like early March. So actually I had COVID in March. So I was exposed to COVID at work in mid March around actually St. Patrick's Day, and knew exactly like I knew the exposure and then my nurse helped me deep clean the room and I sent everybody home. And then I was symptomatic on the 26th of March and had a fever for 14 straight days. But they made me get a COVID test immediately after I'd sent him on set. So it was negative, but occupational health said it's obviously COVID. So I was out of commission for a few weeks got better then was in the hospital sepsis and pneumonia. And so whenever anyone says COVID trivial. I'm like, No, it's not trivial.

Dr. Regina Koepp 38:35
Oh my god. Oh my god. That's serious. I'm sorry.

Dr. Monique Williams 38:41
And the thing is, it's like when people regain their sense of smell. They usually smell burnt plastic and horrible smells. I smelled churros. And I smelled churros and I smelled like dark roast coffee and doughnuts. I kept thinking I kept wondering why are masks from home smelled like churros. And I was like, Oh, I guess it's my regain of smell and Everyone else says, Oh usually smell burn plastic. And I said, No, I'm smelling churros really good coffee.

Dr. Regina Koepp 39:06
Oh my gosh, how scary for you though.

Dr. Monique Williams 39:09
Yeah, that was disconcerting. And it was funny because my mom kept saying, Why are you so cheerful? You know, you're sick. And I'm like, is it later on? She was like, you were very upbeat through everything. And I'm like, well, being negative wouldn't help.

Dr. Regina Koepp 39:19
You're very positive during sepsis and pneumonia. My gosh. Oh man, I'm sorry. That really sucks. I really feel for you.

Dr. Monique Williams 39:44
Yeah. But at least to the hospital was COVID there was this one guy on a radio personality who was in his mid 60s. And he said on the news that he was in the hospital and he didn't take COVID seriously, he'd been at it get together, and he got sick. And they said, We heard you were Catholic. We're calling for a priest for last rites. And he said he was like, last rites, and he was writing on the board because he was intubated. And he goes, What are you talking about? They're like, sir, you're not gonna make it. And he's like, Oh, no, I got stuff to do, like warn people about COVID. I need to live and he did. And he's become this huge advocate. He's like, Where are your masks? Stay at home.

Dr. Regina Koepp 40:37
Oh, my gosh, how terrifying.

Dr. Monique Williams 40:39
Yeah, and he said, when they said that, he was like, Oh, that's ridiculous. This is just like the flu. And then he's like, Okay, this is not like the flu. It's funny cuz nurses said he kept writing like, this is really bad. Okay, I'm not gonna do this again. And I understand.

Dr. Regina Koepp 40:49
Dr. Williams, thank you so much for your time and all of the great information and recommendations that you shared with us today. I really hope that people will take this COVID very seriously and I, I appreciate so much you're calling attention to it's not only protecting yourself it's protecting frontline workers, which which are not only healthcare workers, but our store workers, city bus drivers, subway engineers, all the people who we rely on to keep our cities running and getting food on our plates and, and just how essential their lives are as well, not only ours and taking this social responsibility kind of frame. So helpful. Thank you very much.

Dr. Monique Williams 41:38
And thank you so much for the opportunity to participate. It was a great pleasure.

Wrapping Up

Dr. Regina Koepp 41:42
I cannot thank Dr. Williams enough for sharing her time and expertise with all of us. In today's episode, we talked about the importance of each of our roles in the community. With the mantra, "I am my community and my community is me." Please use COVID safety precautions stay socially distant, don't go out if you're not feeling well, and wear a mask. Wearing a mask is an act of love. I know that COVID and social distancing is taking its toll and it's really been a long haul. And unfortunately, it's not over, we have to keep going. And we have to keep maintaining health and integrity in our community. So, if it's getting too much for you, if you're starting to notice that you're getting down and depressed, please, especially if you're an older adult or caring for an older adult, download my COVID-19 Wellness guide for older adults. I share lots of tips and strategies for maintaining wellness during COVID and I'll link to it in my show notes or you can just download it directly at www.drreginakoepp.com/covidwellness.

Subscribe & Leave a Review

Dr. Regina Koepp 43:01
That's all for today. If you like this episode, be sure to subscribe and leave a review subscriptions and reviews help people to find this show. And here's why this is so important. You've heard me say it before, and I'm gonna say it again until older adults are included in conversations as much as middle aged adults and younger adults. But older adults are often left out of the conversation when it comes to mental health and wellness. So we have to do our part to include them. And you can do that by subscribing and leaving a review. As always, the information shared in this episode is for educational purposes only, and should not take the place of licensed medical or mental health care. I'll see you next week. Same time, same place. Lots of love to you and your family. Bye for now.