Exploring the Role of Urban Environments on Aging in Italy

Dr. Christina Prevett // #GeriOnICE // www.ptonice.com 

In today's episode of the PT on ICE Daily Show, join Modern Management of the Older Adult division leader Christina Prevett discusses how environmental factors influence all aspects of the aging experience, including movement, nutrition, and social interaction.

Take a listen to learn how to better serve this population of patients & athletes, or check out the full show notes on our blog at www.ptonice.com/blog.

If you're looking to learn more about live courses designed to better serve older adults in physical therapy or our online physical therapy courses, check our entire list of continuing education courses for physical therapy including our physical therapy certifications by checking out our website. Don't forget about all of our FREE eBooks, prebuilt workshops, free CEUs, and other physical therapy continuing education on our Resources tab.

EPISODE TRANSCRIPTION

INTRODUCTIONHey everybody, Alan here. Currently, I have the pleasure of serving as their Chief Operating Officer here at ICE. Before we jump into today's episode of the PT on ICE Daily Show, let's give a shout out to our sponsor Jane, a clinic management software and EMR. Whether you're just starting to do your research or you've been contemplating switching your software for a while now, the Jane team understands that this process can feel intimidating. That's why their goal is to provide you with the onboarding resources you need to make your switch as smooth as possible. Jane offers personalized calls to set up your account, a free date import, and a variety of online resources to get you up and running quickly once you switch. And if you need a helping hand along the way, you'll have access to unlimited phone, email, and chat support included in your Jane subscription. If you're interested in learning more, you want to book a one-on-one demo, you can head on over to jane.app.switch. And if you decide to make the switch, don't forget to use the code icePT1MO at signup to receive a one-month free grace period on your new Jane account.

CHRISTINA PREVETT Hello everyone and welcome to the PT on Ice daily show. My name is Christina Previtt. I am one of our lead faculty for our geriatric division. I am also one of our leads in our pelvic division, but today we are going to talk about all things older adults. So I have been away for the last two weeks because my family and I took, my husband and I took a vacation to Italy. And it was the first time I've ever been in Europe. It was an incredible, incredible trip for a lot of different ways. But of course it got my Jerry brain working and reflecting on differences in culture and the way that we interact with older adults and how I saw older adults who were moving around their environment in Italy. And so, I just kind of wanted to go on today and talk a little bit about some of those differences. If you have followed the MMOA podcast, you know that Ellen and I and some of our MMOA team did a grouping of episodes around the blue zones. So the blue zones are areas around the world that have a above average number of individuals who live to 100. And it's been a big area of research and trying to figure out like the secret sauce of being able to live to a hundred. And one of them was actually in Italy. So it was in Sardinia and that was, that's not where I was. Um, I was in Rome and Maori, but a lot of the concepts and themes that they were talking about in the, that mini series and in the book on the blue zones, it made a lot of sense and it just made me highlight or see a lot of the differences in our North American culture than what we're seeing over in Europe. And Going into Rome was the craziest experience. It's so busy. It is almost impossible to drive. And then going into Maiori, which was in the southern part of Italy, we were in a very small town, not one of the bigger touristy towns along the Amalfi Coast. And it was being in Maori that I really saw some of, or I was more able to really look at how individuals are aging in different areas, in different countries, and made me think a lot about our aging experience in North America. So the biggest thing that I saw in our culture, and these are things that we cannot control, and I'm going to kind of bring this back to our course content, is It is very difficult. The environment at which a lot of the cities in Europe being so old are developed. are very walkable. They're very walkable and it almost is not disincentivized, but it's almost a net negative to have a vehicle. In Rome, for sure, it would be terrifying to drive around Rome. But even in Maiori, like a lot of the areas were very condensed in terms of the groceries and where you would grab most of your main amenities for the week. And it allowed for individuals to walk a lot of their tasks. And not only was that environment one where walking was really the main source of transportation, the environment at which you were walking was not a straight plane. This was a big area, like it was obviously had a coastal, like mountainous coastal plain. And so there was a lot of steps. And so one day my husband and I, we went on a lemon hike or a pathway of the lemons, which I became obsessed with, but it was literally a straight shot up. It was, I think we did like 17 flights of stairs to get to the pathway. for this hike and there were houses that were littered across the side and so I saw a person they were in probably their early 70s and they had groceries in each of their hands and they were gradually working their way up these steps. And a lot of the times, we know some of our recommendations for our older adults is to walk more. When you're walking around this town, you are going up and down hills. And there is an intensity to that. My heart rate was not low. And when you're adding in groceries in your hands and there isn't a handrail, it forces you almost to maintain a certain amount of physical activity in order to maintain your independence. And so the first thing that I was really, it really struck me about being in an Italian city was how the environment really was conducive to movement. And it wasn't low intensity movement. It was actually quite high intensity movement just because of the way that the city was built. And it made me reflect a lot on our thoughts of just walk more, right? Like there's a lot of debate about is walking intense enough for us to be able to incur either some physical activity benefit or to be able to maintain physical activity as we get older. And when I compare and contrast the way that cities are designed in North America that has so much more space and does not have the same historical architecture that's trying to be maintained, we don't have walkable cities in a lot of ways, right? If I think about the current city that I live in, it is very, very spread out. And it is almost impossible outside of the downtown center for you to be able to walk and have yourself walk to get groceries or pick things up. It is always the knee-jerk reaction that you get into your car and go places. And when you are walking, at least where I am, I'm not in like a beautiful area like Colorado that's all hills and mountains. It's pretty straight plain. And so When that happens, a lot of the blue zones are in areas where physical activity is forced into your day-to-day interactions. If you want to go see your friend, you have to walk up the hill to their house. If you want to get groceries, then you need to go down four flights of steps to get to the market. That is not the same. And so when we think about our industrialized cities, And the way that technology and car transportation has really changed the way that we build out different cities, what we recognize is that when our environment does not create opportunities for physical activity, that is when purposeful movement needs to be scheduled in a person's day. And I think this is a really interesting concept, right? Because the blue zones were in a lot of these areas where the environment was conducive to intense exercise, at least in a moderate intensity zone because of the way that the cities were developed. That is not true in a lot of the areas where we are practicing. And so this This dichotomy between just walk more can work, but the intensity oftentimes isn't there because of the way the environment is set up. And when that environment isn't set up to encourage physical activity throughout our day, we can very easily get into the slippery slope of sedentary behavior. And when that occurs, we have to make purposeful movement a priority in our day. And this is not just for our older adults, this is for everybody. But this is where gyms come in, right? This is where purposeful exercise programs now are coming front of mind and are becoming a really important aspect of our culture. Because so many of us now, or the people that we are working with, our older adults that we are working with, are not in gyms. those environments anymore, like that is not the way that our environments are set up. And so we have to be mindful of that when we're thinking about our interventions. So the difference in the environment and how easy it was to walk with intensity when we were in Italy was so, so different than what we see in our very typical North American cities, where you have to get into your car. That was probably one of the biggest things, is just looking around the environment and seeing just the stark differences. One of the things that I also really enjoyed watching, especially when I was in a small town in Italy, was the way that slow-paced, naturally occurring, intergenerational conversation happened. When I was walking down a street with my husband, I would look around and people would walk and they would see people in the city square and there were moms with their little kids and they were talking to older members of the community. And again, the environment made it so that this intergenerational conversation happened as a natural consequence of a person's day. And instead of rushing by each other, and maybe giving a head nod of acknowledgement if we weren't head down in our phone, people stopped and interacted. Now, I'm not saying that everybody in Europe is in this area, but definitely the area that I was in, which is very closely structured to the way that Sardinia is, I saw these interactions happen every day where you are walking down the street and they had a place to go, but they weren't so rushed that the thought of a five minute conversation was something that they could not handle, or they weren't ready for, or they weren't rushing from one place to the other. And then these social interactions occurred where you could just see this transfer of knowledge that was happening from older generations to younger generations. And there was just this sight of respect and reverence of these communications that was just so lovely to see. Again, I'm not saying the North American culture does not have that front of mind, but we live in a place where I don't know many people who stay in the very close proximity bubble of their family, right? Like I talk to clinicians every single weekend where I say, where are you from? And they say, oh, well, I'm living in North Carolina now, but my family, of, yeah, my family is in Michigan, or it's not abnormal for people to be very far away from their family or their loved ones. And the culture is so busy that even calling loved ones weekly can be something that has to take a lot of conscious effort because it's so easy to get into the rhythm and fast pace of the week that, and this is speaking to myself as well, that those stop and pause conversations with someone on the street. They're not as commonplace and especially across generations where you're seeing a mom with their little baby stop in a group of older Italian men who are playing a board game outside in the community square and you're seeing that interaction happen in such a beautiful way. And so seeing some of that intergenerational communication because of the way that the environment was set up was just so lovely to see and made me think a lot about how we have this loneliness epidemic in North America. And it is really from the fact that we are so spread out, we are so far apart, that it makes it really difficult for those interactions to happen very naturally. And it creates this spot where, you know, my grandmother had 10 children. My mom was one of 10. We don't see that size of family as often anymore. And there would be times where my mom would visit for 45 minutes, but that was the only interaction that my grandmother had throughout the day. And her kids would call, and this is not like a negative on them. It is very much the fact that, you know, the way that our culture is set up now is that those interactions don't happen very genuinely or very easily. And they take a lot of effort and there's a lot of things on our time. And so that, again, that environmental piece is like this big umbrella where the environment was set up that allowed for physical activity, but it also allowed for social interaction. And so subsequently with those two things, it being very easy, those barriers were almost stripped away for movement and for interaction. What I noticed was that the pace and stress of life was very different. So we went from Maori, we went back on a plane or on a train rather to the Rome terminal, which is a crazy busy terminal. And on the last day of our trip, we ended up going back around rush hour. So we took a six o'clock train from Salerno and we went to Rome. So we ended in Rome around 7.30, which is peak prime time. And if anyone has been in a train station or taken public transportation, I used to go into Toronto and Union Station is a very big hub. Toronto is a very big center for commuting. So the GO train is very busy. And if you are in Union Station around rush hour, It is true chaos. People are trying to get on the train, but they're still on the clock, so they're on their phones. There is a rush to get a seat. It is stressful. You find out 10 minutes before, which is similar to the Rome Terminal, about where you are going, and it is a rush. It is so busy, and there is this stressful environment that is in the air, and people get so used to it because they do this every single day. Their commutes are really long. I was kind of expecting to see that in Rome, right? Like Rome is a very big central hub for Italy. It essentially mimics what we see in Toronto or other big city centers. But even though people were dressed and heading to work, that stressful environment wasn't there. People were walking casually to their job. They were not racing. They were not running. And it made me think about the underlying stress that our culture and our community is under. and how this translates into our aging experience. Like what is our nervous system primed for when we are in a very high stress state all of the time? And then we retire after being in that high stress state for 40 years and go into retirement, right? There is a well-known statistic that there is an increased incidence of health events in the year following retirement. And there's a lot of conversations around, you know, purpose and drive and changes in status. But maybe part of that is that you're changing your sympathetic drive so drastically that your body is having a hard time adjusting and it can show underlying issues. The stress piece on our culture in North America, even in the busiest centers of Rome, like the chaos of the Colosseum or around the Basilica, it was not there. Like that feeling of underlying stress and tension for having a group of people who are all very hastened and rushed to get into a lot of different places, despite Rome being crazy busy with tourists, like they were telling us about the millions of people that come into Rome every year for tourist related activities. And it was wild to me to see how much of a difference, even with that amount of tourist attraction, even with that bustle and busyness, that that underlying stress was not there from even people who are local to Rome, who are working in Rome. And so I think about how that presence of stress for us in middle age, what does that do on the system or on the resiliency of the system with age? And so Again, the change in the environment really was opening up my eyes to a lot of the things that we see in our fast-paced cultures and made me reflect a lot on how that changes a person's aging experience. And when you are forced to do movement and you retain a certain amount of physical capacity, and that allows you to engage in life, that allows you to live at a pace that is amenable for your mental health, and you're surrounded by, honestly, so much beauty, it just makes me think about how Italy can so easily create successful agers. And I'm not saying that North America can't and that the US and Canada can't, but it definitely takes more effort, I think, in North America. I think we need to think a lot more about the way that we are aging and the way that we are interacting with our environment, with our people, and make a conscious effort to engage in physical activity, engage in purposeful interactions, engage in a pace of life that works for us and our family. And that is just so ingrained and it is so easy to do in Italy because of some of the cultural considerations that are there when we are working or we are seeing individuals interact. Now, of course, I am the outsider looking in, I am an aging researcher who just finds this super fascinating, but I want to know what your guys' thoughts are. If you've visited Europe, especially if you've been in a small town in a European country Do you see those differences? How can we think about the way that the environment in a lot of European countries and cultures is set up to make successful aging a little bit easier? How can we create that with our people? How can we create that type of environment that makes successful aging easier, that makes successful aging for us easier? Because that environmental switch it just takes away a lot of the work of it. Like there was no processed food in the markets. If you wanted to get processed food, you would really have to look hard for it. And that was in Rome too, right? There wasn't a ton of candy, like there was pastries and things like that, but you were making it when you were in Maiori. And it just, it made some of those health promoting decisions easier to make and more intuitive. So it made me think a lot about that. I have had an incredible time, but seeing some of the older adults in Italy was definitely one of the highlights for me and seeing just the way that they interacted. All right, if you are aiming to get into one of our MMOA live courses, we have two courses going up this weekend. So I'm going to be in Bismarck, North Dakota with Trissa. We are also in Richmond, Virginia this weekend. June 8th and 9th, we have a smaller course in Spring, Texas. So if you're looking for a lot of one-on-one time and attention from the instructor, that is Jeff Musgraves going to be out there in Spring. So really encourage you to jump into our live course. Today is the last day to sign up for MMOA level one. So if you are hoping to get into our online course, that is your last opportunity is going to be today. We get started this week on the circle platform on our ice physio app. I'm super excited for that and all of the newness of the app. If you have any questions or comments, I want to hear about your European aging experiences. Let me know. Otherwise, have a really wonderful week, everyone. And I'm going to get off here before Alan kicks me off.

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