Aging Well: Creating a Sense of Belonging - with Dr. Raj Shah

In this episode, we get the opportunity to take a deep dive with Dr. Raj Shah of Rush University Medical Center exploring ideas revolving around brain health, caregiving, and what it truly means to age well. Drawing from decades of dementia research and community-based work, Dr. Shah reflects on the power of connection, the role of care partners, and how belonging shapes our health across the lifespan. Together, they unpack the small, meaningful actions at home, in clinics, and throughout our communities that can make aging a more supported, inclusive, and thriving experience. 

Resources: 

Dementia Friends Illinois - Illinois Cognitive Resources Network 

Dementia Friendly America 

Dementia Friendly Illinois Monthly Meetings - Illinois Cognitive Resources Network 

Dementia Friendly Initiative – AgeGuide 

Dementia Friendly Efforts in Illinois 

Raj Shah | LinkedIn 

Design For Belonging Initiative  

Memory Cafe Directory 

2025 Walk to End Alzheimer's | Alzheimer's Association 

How the CARE Act Helps Caregivers 

Facebook: facebook.com/AgeGuide
Twitter: twitter.com/AgeGuide
Instagram: instagram.com/theageguidepodcast
Podcast: ageguide.org/the-age-guide-podcast
Website: ageguide.org

Transcript

 0:02
 Welcome to The Age Guide, the podcast where we give voice to older adults and caregivers, challenge ageism, and offer guidance to help you thrive on the journey ahead.

 0:14
 I'm Gretchen Knowlton, your host exploring the policies and ideas transforming the aging experience.

 0:22
 This season, we're diving into what it really means to age well, from staying connected and keeping our minds sharp to finding our passion and building more age inclusive communities.

 0:34
 Today, I'm joined by Doctor Raj Shah, a geriatrician and professor at Rush University Medical Center to talk about brain health.

 0:43
 Doctor Shaw spent over 2 decades advancing research on dementia and healthy longevity.

 0:50
 He also helps lead Dementia Friendly Illinois and the Center for Community HealthEquity, which work to make our communities more inclusive and informed about aging.

 1:00
 Dr.

 1:01
 Shah, welcome to the Age Guide.

 1:03
 We're so glad to have you here.

 1:05
 Thanks for having me on the podcast today, and I really appreciate the opportunity to speak with you.

 1:11
 It's going to be a fun conversation.

 1:14
 So Doctor Shah, you've spent your career at the intersection of geriatrics, brain health and community based research.

 1:24
 Can you take us back to a moment early in your training or your practice when you realized that aging and dementia care was going to be central to your work?

 1:36
 Yeah, I, I don't think it was like 1 moment, but maybe a culmination of a lot of events in the course.

 1:43
 I, I could not tell you when I was like 26 and finishing up my residency that this is what I'd be doing 30 years later.

 1:52
 But it's been OK and I really have enjoyed it.

 1:55
 But I, I think what happened is I trained in medicine in the 1990s and I really liked everything I was doing in medical school at the University of Illinois at Chicago.

 2:07
 But when I really enjoyed was like being able to work with individuals over the life course of their experience and think about how from the time they were born to the time they died and everything in between.

 2:20
 And so that's why I chose family medicine as a specialty to go into for my residency.

 2:25
 And I did my residency at West Suburban Hospital in Oak Park.

 2:29
 And it was a really great environment to be exposed to how to take care of individuals from all different backgrounds in life.

 2:39
 You know, I didn't have all the words at that time, but even simple things such as we would deliver 2 babies right next to each other on the maternity floor.

 2:51
 And if anybody knows anything about West Suburban Hospital and where it's at in the city, it's on the border with Austin Blvd.

 2:58
 That separates 2 communities.

 2:59
 The last community of Chicago, which is Austin and the neighborhood there.

 3:03
 And then Old Park, the first suburb right outside of the city.

 3:07
 And, and you would just know, even if both babies had the same experience, were well taken care of from loving families, that somewhere along the line, things would be different in their trajectories and experiences based on the opportunities provided and experiences that would happen.

 3:25
 But what I also learned was we would do visits in the home with, with our nursing colleagues to check in on, well, baby checks with families.

 3:37
 And what I started realizing is it didn't matter what I said when I was following somebody in the office.

 3:43
 What really mattered was grandmother usually in the house.

 3:47
 And grandmother had significant internal wisdom and knowledge over multiple generations.

 3:53
 And I realized that if I could kind of figure out a way in my career to partner with the grandmothers of the world, I could potentially influence like 3 generations of care.

 4:04
 And that's what drove me into geriatrics and, and doing my geriatrics fellowship at Rush I.

 4:10
 And then while I was there, I started rotating through experiences in the clinic, in the memory clinic, and eventually joined the Rush Alzheimer's Disease Center as a faculty, a young faculty member, evaluating people for memory loss and eventually became, you know, the medical director of the memory clinic.

 4:32
 And for me, it wasn't like it was about a neurologic condition because it was very clear to us that Alzheimer's disease, dementia was, you know, one of these factors that look like a rare disease, but was really affecting a lot of people.

 4:46
 And, and as a result of that, we had to take a public health approach and we had to think about it in different ways as far as how it would influence the life course of individuals.

 4:59
 So I looked at, I've always looked at dementias like the number one primary care condition for older adults.

 5:07
 And I know that's a little bit different when we, you know, everybody thinks about it from a neurologic condition or a psychiatric condition, but it really because it not only affects the person, it affects their caregivers that expects their communities and all of those places have to come together.

 5:22
 So that's what kind of got me into this space.

 5:25
 And I, I'm really glad like small little hints for mentors along the way help me to continue in this pathway.

 5:32
 And the journey has been tremendous to get to meet people and to interact with them and to work together how we can support people to age better.

 5:40
 Yeah, well, it sounds like quite a journey.

 5:42
 So you mentioned the grandmas and some mentors.

 5:46
 Is there a particular person that stands out in your mind or a particular story?

 5:52
 I think early on, you know, I, I did have a few patients that I was seeing in my clinic and, and evaluating them for memory loss and then following up on the care.

 6:03
 And, you know, I'd always be surprised.

 6:05
 And this was known to us, right?

 6:06
 Like we were taught this in medical school.

 6:08
 Like there's that difference between the illness experience and the disease.

 6:12
 Two people can have the same exact disease, but their experience of the disease can be very different.

 6:19
 And I remember continuing to run into a family where the they have been married for like 50 years and the spouse really was anxious about having the loss of memory and what that would mean.

 6:35
 But somehow the husband kind of took every step to like, maintain his composure, to help keep things calm, to help reorient her and to make her feel that she was loved and cared for.

 6:49
 And then it was just always amazing to me.

 6:51
 Like in my like every quarter I would see them and see this experience and then you would see some other families where the same sort of thing was happening.

 6:59
 But they, they just, it was hard for them to find that group strength to work together to support the person with the dementia and they struggled with needing more medications and more support and everything.

 7:14
 And I had just realized there were so many things we could do at that time in the early, you know, 9, late 1990s, early 2000s, when I was starting to practice in the 2000, we didn't have great medications.

 7:25
 We have some that had just joined in the market to help with symptom control.

 7:29
 We didn't have a lot of options, but the biggest option we had was to connect people to improve the caregiving experience and to improve sort of their community experience so they didn't feel isolated.

 7:41
 So I, I continue to remember stories like that of individuals and seeing the caregiver in a relationship and how they learned and adapted to each other over that maybe 5-10 years of the experience.

 7:52
 And it, it, you know, many people would ask me like, why are you doing Alzheimer's disease work?

 7:59
 Why do you take care of people that have dementia?

 8:01
 Isn't that sad?

 8:02
 Isn't that like, you know, every day you feel like depressed, right?

 8:05
 And the reality is, no, you would see remarkable people doing very simple things day in and day out to kind of deal with all of those challenges and to make the journey better.

 8:15
 And I would learn from them.

 8:16
 They were my best teachers.

 8:18
 So let's talk a little bit more about those caregivers.

 8:22
 Like you said, the caregivers are such essential partners in any aging journey, whether there's dementia or not, but especially when there's some dementia involved.

 8:33
 And you saw that early on, even when the research wasn't as advanced to the point where we are now.

 8:41
 But already that connection piece was making sense.

 8:44
 And we still, we know that still connection is one of the most valuable things in healthy aging, right?

 8:50
 We've been talking about that on our podcast quite a bit.

 8:53
 So what do you think needs to change and how we engage and support these caregivers so that they can keep doing this really difficult, challenging, but rewarding work that they do?

 9:04
 Yeah, I, I mean, I think there's a couple of things that I, I feel we have to help with the caregiver experience.

 9:11
 So one piece is to remind people that inherit that role as sort of being the caregiver in the family, that they also need to take care of themselves.

 9:25
 And, and I know that sometimes counterintuitive for a lot of people that, you know, like I have to dedicate my mission to helping a person that has the condition.

 9:35
 But we just saw it time and time again, right?

 9:37
 Like if we didn't give time for the caregiver to reflect, to pause, to take care of their own personal needs, to develop as their own person, their health would suffer.

 9:50
 And, and multiple studies have shown this over time, mental health, physical health suffers.

 9:55
 And I would keep telling them the worst thing that can happen in the case for taking care of your loved one living with Alzheimer's disease or another dementia, a related dementia, is that they, they would lose your abilities to be there with them, right?

 10:10
 And so you got to take care of yourself too.

 10:12
 A very hard thing to say sometimes with sometimes to help people to pause, to be OK, we're taking some time for themselves is a really important message.

 10:21
 I think I learned early on that we have to provide even close to, you know, right after we make the diagnosis so that people can as, as caregivers understand that they're human too and that they have their own needs and, and have those needs have to be supported.

 10:38
 I, I give a classic small example of that with another family where the husband had, you know, there there's a little difficulty in our society for asking people for help because there's sort of a narrative in general, like we have to be superhuman.

 10:54
 We have to control the situation.

 10:57
 You know, we have to do things independently rather than interdependently.

 11:02
 So he was taking care of his wife.

 11:04
 They were married, you know, again, 4550 years.

 11:08
 And he would get people that would come and ask, you know, like, oh, I, I know you're taking care must be hard.

 11:14
 What can I do to help?

 11:15
 Right?

 11:15
 And at first he didn't know what the answer was.

 11:18
 Like you said, oh, don't worry about it, I can do it, you know, it's going to be fine.

 11:22
 But then what he did and he told me this and I told other caregivers, this is he.

 11:27
 He took a candy jar.

 11:29
 And whenever he thought of some little tasks that he could need help with, he would write it on a slip of paper and put it in the candy jar.

 11:38
 And then when somebody would ask him, right, like what can I help you with, he would say, you know, if you want to help, just go to the candy jar, pull one of those strips of paper out, and then you can maybe help me with that, right?

 11:51
 Tools like that made such a difference in reducing some of the barriers for people to ask for help and for people who want to help to have something to do, right, so that they can follow through if that's the commitment they wanted to make and that build community and other people to help.

 12:07
 They meant to be part of their journey with them.

 12:10
 So that's the first thing, right, Like get help, know how to ask for help.

 12:15
 The second thing I think that's really difficult is even though we have rule laws like the Caregiver Act, which are supposed to identify people as caregivers and especially when they are brought into the hospital, it's it was a great, it was a very nice law.

 12:29
 Took a lot of work to get those on the books, but it's still not being fully implemented.

 12:34
 And I, I think we got to keep encouraging identifying who that caregiver is.

 12:39
 It is hard for some families to understand that's the role they play because they don't use those terms, right?

 12:46
 Like they, they say, oh, I'm the wife or I'm the husband or I'm the daughter or I'm the son-in-law.

 12:53
 So they don't always think of themselves as the caregiver and be able to articulate that to their healthcare providers.

 13:00
 Like, hey, you know, I'm the caregiver and you know, if something happens, I just want to have my name on the record so you can call me so I can help you in caring for this loved one.

 13:13
 So identification of the right time.

 13:15
 I mean, people have been working with the word caregiver.

 13:17
 They they've now changed it to sometimes care partner to reflect that's a duality role rather than, you know, one side giving all of their, you know, giving and the other side receiving always.

 13:26
 It's like a dual experience.

 13:29
 And so we have to find the right words.

 13:30
 I totally get it to reflect the idea that, you know, it's an interconnection and a dynamic and both sides are supporting each other, but we still have to do better at identifying people and for people to feel proud that that's a role that they're doing and taking on.

 13:45
 And although it may be difficult, that it's a role they can learn from and grow from as a person.

 13:51
 So I think I'd say those are like 2 big things, right?

 13:54
 Like get some time and reflect that you're a human, you can't control everything.

 13:57
 Ask for help and then also identify yourself, right, as the caregiver and, and, and feel that value.

 14:05
 And maybe as a society, we have to express that value to our caregivers that do this.

 14:09
 We couldn't take care of the people with dementia without the caregivers, right?

 14:13
 And we know for every one person with dementia, there's a main caregiver, but usually there's about 5 or 6 other informal caregivers, grandkids, you know, other people helping out, right?

 14:24
 And all of them play a role in that network and structure to support that person.

 14:30
 I like the way you say that is, it's really, it is important for the whole community to kind of wrap our brains around this idea of care partners, caregivers.

 14:42
 I like that term too, by the way, care partners.

 14:44
 I'm going to have to start using that one.

 14:46
 It, it definitely levels the, the field a little bit and it's not quite such a dynamic where one person is always doing the caring.

 14:56
 But I, I think you're so right that the, the whole community needs to recognize the value of caregivers so that caregivers themselves can start to recognize it.

 15:07
 I feel like if all of us start to think about this role a little bit more than when we find ourselves in a caregiving role, it's going to be really natural for us to identify and to reach out and ask for help.

 15:19
 So it's all of us that kind of need to be a part of this, this movement, if you will, to change our our thinking around caregiving and what it means and how much it helps our society to have caregivers involved in aging care overall.

 15:37
 So I like the way you put that long way to go still, but everybody's taking steps in that.

 15:42
 And I think and, and we have to, we have to get to a societal view and an ethic that, you know, caregiving is an important role.

 15:51
 It's an important role in us being humans, right?

 15:54
 And, and it's something that we, we, we can't just count in like dollars and cents terms, right?

 16:01
 Like it's, it's a low paying job if you're a formal caregiver.

 16:05
 So it doesn't have as much value in our society.

 16:08
 But, you know, even informal caregivers, they're spending, you know, I, I think we have, it's over, you know, a million or more hours every year is spent on informal caregiving.

 16:18
 That adds value to our communities to thrive and to get through difficult times.

 16:24
 And we have to, you know, respect that and, and, and highlight the meaning of that.

 16:29
 Yes.

 16:30
 And most of us will at some point in our life, if we haven't already experienced being in the role, being a care partner to somebody who is aging.

 16:39
 Most of us will have that experience.

 16:41
 And it's like you don't really realize what what that all entails and what you might need until you're in that position.

 16:48
 So your work, it sounds like, extends way beyond the walls of your hospital or clinic.

 16:54
 And then you're also working in the field of dementia friendly communities and community health.

 17:02
 So you talked a little bit about this whole community aspect.

 17:06
 When did you start to look to community partnerships for improving outcomes or how did that happen?

 17:12
 Yeah, yeah.

 17:13
 I mean, I think, I think it's a realization early as you're working to support people clinically for their care around dementia.

 17:23
 You only see them for brief snippets of their life and experience.

 17:27
 And there's, there has to be that understanding and a support of that invisible, not always mentioned or spoken about network that's out there taking care of somebody.

 17:38
 And, and I think where it hit me, I, I will say is in the probably about 5 or years into my practice, I started going to some of the Alzheimer's Association walks, you know, to end Alzheimer's disease.

 17:53
 And, and we would always sponsor something at Rush and the Rush Alzheimer's Disease Center for those wards.

 17:58
 We would have our table, we would try to make it a family event for us to go out there with our own family and our, our children to be there and to meet each other in a different setting than in an academic or clinical setting.

 18:12
 But you would have like people come up to you when you were in that park.

 18:16
 Hopefully it was a nice sunny day and like fall and and they would be bringing their family and introduce their family members to you as you're standing.

 18:26
 Oh, you know, Doctor Shah, I wanted thanks for being here.

 18:28
 I'm glad you're here.

 18:29
 I wanted, you know, you took care of my husband.

 18:33
 I wanted to show our other family members that are coming on the walk with us to support them.

 18:38
 Right.

 18:38
 And then you would see like the buses come from not only the support that was given by the family, but by the community and a lot of the residential care settings and their staff would come, right.

 18:52
 And and then you'd start realizing, like there's an entire broad community doing all of this work together.

 18:58
 And, you know, we still don't have the best treatments.

 19:00
 We're working really hard to try to figure those things out.

 19:03
 And we're making some progress, you know, over the last 25 years with a lot, a lot of people working together with us in clinical research and trials to find new answers.

 19:13
 But what gets us through that is all of those relationships.

 19:18
 And so we started looking, you know, and thinking about that broader as the state Alzheimer's disease assistance centers around the state.

 19:30
 So it was Raj Northwestern SIU, Southern Illinois University.

 19:35
 And about 15 years ago, we kept talking like what can we do with our collective abilities to maybe make a difference?

 19:42
 And we were seeing some of the work that the Target Foundation had funded in in Minnesota to develop sort of this public health community based engagement to become a dementia friendly community.

 19:59
 And we kept looking at that and saying, wow, that would be a great model if we could bring it into like Illinois and.

 20:05
 The group of us that formed that activity initially and volunteer time called the Illinois Cognitive Resources Network, kept looking for that.

 20:13
 And then they had a meeting at the White House Council on Aging and they decided to make it that, a national program, and they wanted state technical leads.

 20:21
 And we were on it, right?

 20:22
 Like we said, we have to do this.

 20:23
 And we applied and we got the state lead and, you know, we added and we kept meeting people and working through it.

 20:31
 And we're at 48 communities now that have gone through that process of, you know, reflecting on the people in their community that are living with dementia and are their caregivers and other multi sectoral approaches to try to help to support people so they don't feel stigmatized, alone or isolated.

 20:52
 And every community that we've run into has done their unique things to achieve that and to think about their local context.

 20:59
 And it's been really humbling to see, honestly, right?

 21:03
 Like people coming together, thinking that through as a community group, finding value in it, and then growing that over time.

 21:12
 You know, we did a little bit to set the story of the narrative, like we could change this around, but then people did the hard work going on thinking through that from different community perspectives out of a labor of love mainly, you know, like that, that it was important for them to do this for their area.

 21:28
 So I think it's been wonderful to watch that and to support that community effort so that people don't feel alone, don't feel disconnected.

 21:36
 Yes.

 21:38
 So what does a dementia friendly community look like?

 21:41
 What makes 1 dementia friendly?

 21:43
 Yeah, a couple of pieces.

 21:45
 So as I mentioned, probably the biggest pieces, reflecting on people in their community and their experience that are living with them at Alzheimer's disease or other related dementias and their caregivers and asking them what is it you really need?

 21:57
 Rather than guessing and trying to understand patterns, I think you need a lead organization, some group that's going to be able to help, to organize people to come together, but they can't do it alone.

 22:10
 And it's probably, we're finding for sustainability, it's good to have a couple of other organizations in the wings to help out.

 22:17
 And they can come from all different backgrounds, right?

 22:19
 Every community, it's a different group that takes that lead and and tries to organize things.

 22:25
 You need a couple of sectors, different sectors representing the community to be present in the planning.

 22:31
 We found libraries, librarians have been great partners.

 22:35
 We found first responders.

 22:37
 Police officers see the value in this because they get the calls to find somebody that might have wandered away and, you know, try to help.

 22:44
 We have the healthcare sector for sure.

 22:46
 We have local businesses, right, that want to get involved and be supportive for people that might have to mention their families to be able to get out and to experience what it's like to be in the community.

 22:59
 So, so it, it varies.

 23:00
 It doesn't, you know, and I think that you need at least two other groups with the main organizing group to represent a few sectors you work together or to kind of put together a plan of action about what we would do as a community.

 23:14
 We as the Illinois Cognitive Resources Network, review those applications, kind of give tips.

 23:19
 Hence, we organize meetings with other group of the 48 communities that have made it through to share their ideas.

 23:26
 So there's a big supportive like community of belonging around this to help people to advance.

 23:31
 And then we get the application to the best possible role so it can be presented nationally for consideration.

 23:38
 And then once the community gets that designation, it's just the first step.

 23:42
 And it's like, then how did they help build off of that to keep thinking creatively about what programs they can add and how they can help people in their community?

 23:51
 But it's really been interesting to see so many communities do this.

 23:54
 And Illinois being a leader in this just has to see.

 23:58
 That's great.

 23:58
 So you said there's 48 in Illinois alone, right?

 24:02
 And we got a few more coming up.

 24:03
 We're getting close to the 50 mark.

 24:04
 So all right, so it's, it's definitely happening.

 24:08
 That's exciting.

 24:09
 So people are listening to this and they're interested in check either checking to see if their community is dementia friendly or starting to go in that direction.

 24:18
 Who did they contact?

 24:20
 Yeah.

 24:20
 So probably the easiest thing they can do is just in, in like their web browser, they can just type in dementia friendly Illinois and that will get to the website calledilbrainhealth.org.

 24:34
 And then one of the web pages we host is the dementia friendly communities in Illinois.

 24:39
 And they can see it on a map, like where the communities are, they can see it in a table.

 24:44
 They can understand some of the key contacts in our community.

 24:47
 And we have it on the website there like the, you know, how to contact us if they're interested in thinking about moving forward and we can help advise them.

 24:55
 Great.

 24:55
 And we'll link to that in our show notes too.

 24:58
 So I want to go back to something you said at the very beginning.

 25:00
 At the start of your career, your journey, you worked closely with communities both on Chicago's West and South Sides, I believe as well.

 25:10
 What is 1 structural barrier to brain health that you can see?

 25:16
 And what would we need to do differently at maybe a systems level to remove those barriers for folks in terms of their brain health, their longevity, how well they age?

 25:29
 Yeah, that's wow.

 25:30
 That's a great question, actually, of that.

 25:33
 There's so much to think about in that space.

 25:37
 I, I think there are a few pieces, but I'll stick with one of the bigger pieces.

 25:42
 And we see this, we don't think about brain health until something goes wrong, right?

 25:50
 And this happens with high blood pressure too, just as an example.

 25:53
 This is not rare, right?

 25:55
 Like even we know with all the medications and treatments we have to control blood pressure and lifestyle choices, it is still very hard to get everybody under control for their blood pressure.

 26:05
 And we do have, you know, systematic issues about who gets to access blood pressure control, who gets to access the medication, who who gets treatment and support.

 26:17
 But we don't think about the blood pressure as being a problem because we don't feel it for most of the time as it's like developing over twenty, 30-40 years before somebody has a heart attack or a stroke.

 26:28
 And the same thing kind of with brain health, right?

 26:30
 Like these are really slow, steady processes that happen over time and our brain is so resilient.

 26:37
 It does its best, it's absolute best to keep going and to adjust and to accommodate changes that are happening.

 26:45
 So we don't feel it in our day-to-day lives.

 26:47
 Sometimes we can't even see it on the brain imaging if we imaged everybody or seeded blood tests.

 26:53
 We just can't.

 26:55
 But I, I do think we have to, you know, understand that in the end, our brain is part of our body holistically.

 27:04
 We have to take care of our entire body.

 27:06
 And if we do, we'll be more likely to achieve better outcomes as we age.

 27:12
 And so the first thing is we don't think about the brain until something happens that makes us recognize something is not working with our brain.

 27:20
 And then the second piece that's a little bit difficult from a storytelling and a narrative approach is we think the brain is separate from the rest of the body.

 27:28
 We're in reality, they're combined right and they all work together.

 27:34
 So we have to bring all the pieces into play.

 27:36
 And that's why, you know, what we're finding is even the non medical things to deal with Alzheimer's disease that were recently showed in some of the lifestyle clinical trials, they focus on things like movement and socialization and, and good diets.

 27:53
 And, and they're hard, but honestly, those things don't just help your brain, they help your heart, they help your kidneys, they help your, you know, how long your liver, they help your entire body.

 28:03
 So we got to kind of keep trying to do those things and create environments to support that throughout.

 28:08
 And then help to if something is changing, how do we evaluate it early, hopefully find ways that we can support people if those changes are happening to delay and slow the progress so that people can enjoy more of their lives.

 28:24
 Have you found that it's more difficult to access resources that support those healthy lifestyles in certain communities based on socioeconomic dynamics, race and ethnic dynamics, issues of equity, right?

 28:37
 What have what have you seen around that?

 28:40
 Yeah, yeah.

 28:41
 We, we're definitely seeing, you know, those differences throughout, especially in the Chicago region.

 28:49
 There's a long history of, you know, separations and making decisions that are not really, you know, part of the natural environment.

 28:59
 But this is what humans do.

 29:01
 We make social environments and and we set rules around those social environments.

 29:06
 And sometimes those rules lead to, you know, different access points for different groups and that leads to, you know, outcomes that are not so that everybody gets the chance to the best health possible.

 29:22
 And I would say it's like a continuum, right?

 29:24
 Like it, This is not just like when you're 65, our communities have to worry about this.

 29:30
 This is that we are finding risk factors, you know, that seem to be associated with developing birth brain health, developing dementia, start from early life and could keep continue into older adults.

 29:42
 So it's that build up of constantly not getting some services along the way or access to appropriate healthcare that we have to keep breaking down right to get every community the best chance to have its residents achieve well-being.

 29:58
 And that's where we've been looking in my other work with the Center for Community HealthEquity, which is Co directed by Rush and DePaul and brings together, Rush doesn't have an undergrad campus.

 30:08
 We're mainly Health Sciences.

 30:10
 So it's nice to have DePaul as a broader university working with us and bringing faculty and students from different disciplines to engage with our health faculty and then work with community members to figure out these patterns.

 30:26
 And you know, it shouldn't be that if you take the L track from where I work at Rush University and I try to go towards Oak Park where one of our hospitals are in our system in Rush Oak Park, that within two stops, you see the average life expectancy drop by about 10 to 15 years.

 30:46
 And then it goes back up by the time you finish that Six Mile distance.

 30:51
 So there's a lot we have to do, right?

 30:54
 And, and the and, and affect how simple things done regularly can make a difference.

 31:00
 And one thing we've been thinking about with these complex problems is where does this idea of the logging fit in as sort of a way to help communities to support each other and to be stronger and connected to handle and grow and overcome some of these barriers.

 31:19
 You said belonging.

 31:20
 What does that mean?

 31:22
 Yeah, belonging is slightly different.

 31:24
 It's not the exact opposite from like loneliness.

 31:26
 I think the opposite of belonging would be something like othering.

 31:32
 So, but belonging is the sense it's, it's actually in our, in Maslow's psychological hierarchy.

 31:41
 It's like it's, it's love and belonging is the third step after you have your food and your safety, right.

 31:48
 And, and I think the idea behind it is that if we create an atmosphere where people can feel they're part of something bigger and they can come as their authentic self, be invited to be in spaces, be invited to handle discord and to deal with healing together.

 32:10
 And then to be able to celebrate advances, they do better over time.

 32:17
 And and belonging is a feeling.

 32:18
 I can't force people to feel like they can belong, but you can create environmental post and human centered designers have been looking at this like how do you send signals that a community is forming this?

 32:30
 And there are ways.

 32:31
 And if you can create that a little bit more.

 32:34
 And that's why the dementia friendly movement is so important is because it's creating that sense of belonging.

 32:39
 Like people can fit as come as who they are and be part of a process that's bigger than themselves.

 32:47
 And and you can get it's not something that's so like resource dependent that you need a lot of money to achieve belonging.

 32:56
 OK, so you can actually move things forward in the right pathway wherever a community is starting.

 33:02
 So I don't know if that's a full answer, but that's something we're really exploring a little bit more to see if that's a pathway to improve people's health and well-being.

 33:10
 Healthy aging, help to support people with dementia if that does occur.

 33:15
 Yeah, so I like this idea of belonging.

 33:18
 It sounds like it is more in depth than just inclusion.

 33:25
 So you can invite people, and people can come and join you and you can have a diverse group, but if people feel different and they feel like they're not being accepted for those differences, it doesn't matter that they're included, they're not.

 33:38
 They don't really belong.

 33:39
 So belonging is more of a deeper concept.

 33:42
 I think like if we really want to look at interconnectedness and the importance of people being socially connected, we need to talk about belonging.

 33:50
 So that's a good, a good thing to be working on.

 33:52
 I'm really curious like what people learn in this space and what they've experienced and shared because it, it, it's come from multiple disciplines we're learning that have used the term belonging and thought about it from sociology to psychology to public health to business.

 34:06
 But I, I, I think there's so much room in that space to work and it supports the other complementary things people have been focusing on that are really important, like how do you prevent isolation?

 34:19
 How do you prevent loneliness?

 34:20
 They're all complementary, somewhat overlapping measures.

 34:25
 But but I think if you go from like even just the simplest ideas in Maslow, it's like, it is like you've got to get that safety level, you've got to get the food and security level.

 34:36
 If you can get those two levels, your next thing is you got to create love and belonging, right?

 34:41
 You've got to have that belonging piece.

 34:43
 Yeah.

 34:44
 So you said that there are some simple ish things that you can do.

 34:49
 Can you give us maybe one or two examples of something that creates this belonging?

 34:54
 Yeah, I think 1st is looking at every event, everything you do to bring people together with the lens of belonging.

 35:04
 11 suggestion I found really helpful is there's work by a professor at the D School at Stanford and she wrote a book based on her experiences working with community groups in Oakland that we're forming about what are these artifacts we can create to support belonging.

 35:23
 And she wrote a book called Design for belonging.

 35:26
 And her name is Doctor Susie Wise WISEI always really do suggest that as an option.

 35:34
 It's a very you can find it, you know, any of your booksellers and it's it's a simple book to read, but it gives you some good hints about the process.

 35:44
 I'm glad you mentioned that because I actually own that book and now I just need to read it.

 35:47
 Yes, exactly.

 35:48
 Now you'll have an option to read it.

 35:50
 Yes, but there and then I think it's like being she has like sort of like 10 moments of the longing, the way she describes it, but it's thinking more explicitly when you're setting up a meeting or an organization get together about how those pieces fit in.

 36:10
 Like are you including all those steps and moments in your thinking?

 36:14
 So it even comes from the simple, like, how do you how do you attract people to come into the space where the meeting is held?

 36:23
 So, so how like even when we're having the conversation today, you sent me an invite.

 36:28
 So that was the way I had to get here.

 36:30
 You had to make a choice about who you were going to invite and why, right?

 36:35
 And then how do you make sure that choice is going to allow for as much belonging to happen?

 36:41
 And then I got here today, right, for this interview.

 36:44
 So what does it feel like to be on a Zoom interview and how you log in and how people greet you when you come in to make you feel like you should be part of the activity?

 36:54
 Those are like an important steps.

 36:56
 So the early steps are usually and most of the time we spend a good amount of time thinking about those, like the invitation and then the entrance.

 37:04
 But once people get in that space, how are you going to allow people to join in the conversation?

 37:09
 How are you going to let them share when there's differences and agree to disagree sometimes as a pathway and then find healing if things came out from the past where they didn't feel like they were brought in?

 37:23
 And those are, I think that's what we see sometimes in these groups with dementia friendly.

 37:27
 They they might not have thought about it explicitly, but eventually they get to the point by talking with actual caregivers and people with dementia about what they need rather than anticipating what they need.

 37:39
 They get better, right?

 37:40
 Because they're opening up that space to really listen to what's happening, the individual unique needs.

 37:47
 Yeah.

 37:47
 And it and it may not be the exact same needs we would think, right?

 37:51
 Like I give a classic example there of some work early was I think in originally in Japan and then some other places like in the United States did this with some chains to based on coffee houses and they started training the workforce in their coffee houses to recognize who comes in at 1:00 PM in the afternoon from the community.

 38:13
 That's not your person racing to go to their job and trying to pick up their coffee drink really fast so they can get in their car.

 38:21
 That's usually somebody who's older, that needs a little bit more time, wants to relax, wants to get out of their house right and and be part of something a little bit bigger and feel like they're a little bit in a community setting.

 38:35
 And so they train their baristas and others to be able to slow down and make the menu a little bit easier around that time, be more patient in allowing people to choose, especially if people had like a little card or a that, you know, I'm here with my loved one, they have dementia.

 38:53
 They would, they would give them a special menu that had just like 4 choices instead of 20, full lettering and that kind of thing.

 39:00
 Yeah.

 39:00
 So like little things like that start making a big difference in the community.

 39:04
 And, and a lot of people said, yeah, we just want to get out once a day, right?

 39:07
 So we don't feel like we have to stay in our home 24/7 and, and, and we can feel like we're engaging so little.

 39:15
 And that's why I think dementia cafes have, you know, become really popular as an option for a lot of community.

 39:22
 Are there some in the Chicagoland area?

 39:24
 Yeah, there's an entire like, organization.

 39:26
 I think we have it on our website too.

 39:27
 OK, we'll link to that too.

 39:29
 Around that Memory cafes, they call them.

 39:32
 I should correct on terminology, but but they're really helpful, like for the communities to do and sometimes they have hosted a library or a local place, you know, and it's just getting people out and meeting each other, talking and feeling connected.

 39:45
 So yeah, these are these little blogging design things that can be done to help people and to celebrate, celebrate the little wins, right?

 39:53
 Like there's, there's so many things that are sometimes hard, but if we can make a little win here, we can build on that.

 39:59
 We can make another little win, make things better.

 40:01
 Yeah, and I think everybody would like to get behind that.

 40:04
 Like you said, the baristas are involved and that's a low time in their day.

 40:08
 They're probably happy to be facilitating an easier way for people to engage there.

 40:14
 It's something where they can feel good about themselves too.

 40:17
 Maybe make a new friend, have some new conversations with somebody they otherwise wouldn't have just by thinking, changing their thinking a little bit.

 40:23
 And I think everybody in the community could get behind something like that.

 40:27
 And my big recommendations, stay curious.

 40:29
 I mean, honestly, it is, it is amazing to me.

 40:32
 Some of the stories I've heard from my older adult patients that even had early stages of dementia.

 40:38
 You, you kind of you're seeing them at a stage in their life when they're like in their late 70s and 80s and you think about them just at that moment.

 40:46
 But if you open up the curiosity and give them a chance to talk about what they've seen in the course of their lifetime, you will find some amazing, amazing stories, right?

 40:57
 They have a lot to give a lot of wisdom how they also they paid it forward in some ways.

 41:03
 They made the world better for us to be here, right?

 41:05
 In different ways.

 41:06
 And now if you just listen to their stories and give them that opportunity, they light up.

 41:11
 I, I give this classic example.

 41:12
 Once I had to go see a person with dementia in a nursing home on the north side.

 41:18
 And I started talking to him and I asked him like, what he did before.

 41:25
 And he told me he was the last intern that worked with Frank Lloyd Wright.

 41:33
 Wow, cool.

 41:35
 And then at some moment, he pulls out his sketchbooks from in the 50s and when he was named architect of the year for his work, right.

 41:44
 But he would have never got that story if he just weren't curious about what the time and ask.

 41:51
 And then he was so happy.

 41:52
 I mean, at that moment, he felt so comfortable.

 41:55
 It wasn't about like trying to evaluate his memory, but he was just so glad somebody just asked him about who he was as a full person, right?

 42:03
 And remembered and give him a chance to remember.

 42:05
 And those are precious moments, right?

 42:07
 That's what it's belonging and a feeling of connected As for a lot of people.

 42:12
 So, yeah, be curious.

 42:13
 Even if you're a younger person, you will not imagine what some of the stories you hear are right, Right.

 42:19
 And you can learn from and they can add into your quality of life too, and make your day better.

 42:24
 Yes.

 42:24
 I think that's really encouraging right now, especially as we look around us and so many people are frustrated with the way the world is going right now on both sides of the political spectrum.

 42:37
 People are frustrated, and it feels like there's so much division.

 42:41
 But I think if we can learn from the experience of some of our elders, older adults have a lot to teach us.

 42:48
 They've been through things before.

 42:51
 Or some people who are younger might be thinking it's the end of the world.

 42:54
 I've talked to some older adults who are like, you know what, We've been here before and we can do this, and we have to learn from the experiences in the past.

 43:04
 So, yeah, it's good advice for right now in this time and moment.

 43:08
 Doctor Shaw, thank you for that.

 43:12
 So to wrap us up, I'd like to ask you a final kind of challenge question.

 43:19
 If you had to choose one tip to improve our aging experience, maybe we can share this at, you know, as we're recording this Thanksgiving is coming up, maybe we can share this around the Thanksgiving table with everyone that we're meeting with for Thanksgiving.

 43:35
 What tip to improve our aging would you give us?

 43:39
 What I would like, if people can realize, and I know it's a little bit of a hard thing, right, is that aging starts even before we're born and continues through our lifetime, All right?

 43:55
 So we can make a difference in aging at any point in our life.

 44:00
 We don't have to wait until we're 65 or 75 or 80.

 44:05
 And the, the reason I say even before our birth, we, we understand the importance of prenatal care, right?

 44:11
 Like the experiences we have in that nine months of gestation with our mom, All right, really set the course for how we do in the core and the rest of our lives, at least in some ways in helping to set up patterns of experiences.

 44:29
 So we have to take care of our moms, right?

 44:31
 We have to take care of women that are pregnant and the families that support them.

 44:35
 And when you're born, it's like every step along the way and, and there.

 44:39
 And I think if we can make it more that aging is just part of a normal human experience, a normal experience for not just even humans, but for everything, it's that we don't get so scared about it, right?

 44:52
 We don't try to avoid it as, as you know, like we have to stay young forever.

 44:59
 The the idea is that we can grow with aging.

 45:04
 It's not something we should be afraid of.

 45:06
 And we can do things throughout our lives to make that experience more meaningful to us and for others around us.

 45:12
 So maybe my tip is to think about aging is just not for people over age 65, right?

 45:17
 Like it's for anybody from somebody that's zero to 100, right?

 45:23
 Perfect, perfect.

 45:25
 Thank you.

 45:25
 That's really good advice.

 45:27
 And I'm going to use that at Thanksgiving, and I'll get back to you and let you know how it goes.

 45:33
 Thank you so much for coming on the podcast.

 45:35
 Doctor Shaw, it was wonderful to talk with you.

 45:37
 Oh, thanks for having me today.

 45:39
 It was a great conversation and I really appreciate all the work that you're doing with Age Guide to support this.

 45:44
 Thank you.

 45:53
 Hello, and welcome to your Medicare minutes.

 45:55
 My name is Val Guzman.

 45:57
 I'm the benefit access specialist here at Age Guide.

 46:00
 Today we're going to clear up some information about who is eligible for Medicare.

 46:05
 Generally, a person is eligible for Medicare if they are age 65 or older and they are AUS citizen or a lawfully admitted resident with five years of continuous residency.

 46:17
 Other people may qualify for Medicare if they have a disability or if they have certain health issues like end stage renal disease.

 46:25
 Most people have to pay for Medicare unless they qualify for cost saving programs with strict income and asset limits.

 46:34
 The Social Security Administration confirms eligibility and processes enrollment into Medicare.

 46:40
 Visit ageguide.org For more information on Medicare eligibility or call Age Guide at 1-800-528-2000.

 46:50
 Thank you for joining us on The Age Guide, where we explore the insights, experiences, and practical strategies that help us thrive as we age.

 47:00
 To learn more about how Age Guide Northeastern Illinois is advocating for older adults and caregivers, visit us at ageguide.org or call our offices at 630-293-5990.

 47:16
 And if you enjoyed this episode, please share to help others find us.

 47:20
 Join us next month as we continue exploring what it means to age well.