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The TGB Geriatrician is Dr. Bill Thomas (bio), a world-renowned geriatrician, author, blogger (ChangingAging) and creator of the Eden Alternative.

Most recently, he has partnered with the Picker Institute, a leading foundation for health care reform that places a person's needs, interests and desires at the center of their care. Dr. Thomas and Picker operate an advocacy program called RealCareNow to promote patient-centered care – of which this series on Time Goes By is a part.

category_bug_geriatrician.gif In the past here, we have discussed how our energy and stamina have waned as we've gotten older. In this week's episode of The TGB Geriatrician, Dr. Bill Thomas and I talk about what he calls elders' “energy budget.”

[EDITORIAL NOTE: We are working on creating transcripts for these videos for readers who are hearing impaired and expect to include them soon.]

Children and elders have a number of things in common and when Dr. Thomas mentioned kindergarteners' nap time, that clicked with me. I do take afternoon naps now and then when I feel particularly tired, but I wake feeling drugged and sluggish so I save them for when I have evening plans to not fall asleep in the soup.

I know that I don't have heart problems and what was most useful to me was the idea of budgeting my energy better throughout the day, not rushing through my to-do list as fast as possible. I've been trying this in the ten days since Dr. Thomas and I recorded this video – even on Thanksgiving Day – and it's helping.

On days when weather allows, instead of soon after sunrise, I've been postponing my walk to mid or late morning after I've gotten a few things done. I'm experimenting with any shopping or errands out of the house to later in the afternoon. So far, the new pacing seems to have helped to keep me from collapsing before I want my day to be done.

I think part of the change is psychological; when I know ahead of time that I have somewhere to be at 3PM, I don't allow my energy to flag until I am home again. And, I'm giving myself a reading break for an hour at lunch time before returning to working on a blog post, vacuuming, cleaning the bathrooms or whatever else was on my list for the day.

Dr. Thomas's phrase, energy budget – which I'd never heard before – says it succinctly and has helped me to think about organizing my time in a new way.

[Is there an elder health issue you'd like Dr. Thomas to discuss? Leave your suggestions in the comments below and they may turn up in a future video. Remember, Dr. Thomas cannot advise on specific personal health problem.]

At The Elder Storytelling Place today, Steve Kemp: LONG LOST NEWS: President Denies Codpiece


Thanks, Ronni for this new addition to TGB & yes, I do have a question about sleep. Since my late 60s I've had problems with staying asleep, with sleeping soundly & face at least 2 or 3 nights of no sleep, just a restlessness for 6-7 hours. Needless to say, I'm left exhausted on the days following no sleep. I do not nap, but rather catch up on reading during most afternoons & I do walk regularly& do lots of household chores in 2 houses. My friends have the same issues with sleep. Looking forward to Dr. Thomas recommendations. Dee

This was great information, and gives me some ideas on how to change things within my day concerning fatigue.

I would like to see a blog on dementia and confusion and ideas of how that should be handled. I just read a blog at Dr. Thomas's site concerning "remotavion therapy" (which really ticked me off on the mindset of this being on a test)and the blog made me think about how I saw CNA's in a nursing home handling a dementia patient that was confused, as they argued with her that there was no baby to bring her, and she wanted them to bring the baby to her room. I would have handled it by telling her that the baby was sleeping, or would bring the baby later for a visit. I am curious of opinions of how this works for others that encounter dementia concerns.

I adore this new feature!
More useful, well explained information
(and the video format is very enjoyable).

Thanks to you and Dr. Thomas Ronni.

Dr Thomas is a wonderful addition to your already terrific blog. It is refreshing to hear his and "your" actual voices. I am 61 and also experiencing the afternoon doldrums. Good to know it's pretty normal. My doctor did check my Vitamin levels and had me start Vitamin D supplements which may help. The jury is still out on the actual effectiveness of Vitamin D, but I live in Minnesota so we are short on sunshine which also makes me tired. I will now work on budgeting my energy too. Whatever works!
Thank you both.

It's great to have him back. Thanks both of you.

I find I have more energy overall now that I do aerobics every day, but drinking more water is a key component of my wellness. Perhaps there are other basics the two of you might discuss.

Yes, transcripts. Is there a voice activated program that will help with this?

I loved it when Dr. Thomas said that the way some elders manage their energy budget is exquisetly beautiful.

In all honesty, managing my energy budget is not so much planned as having no choice. On days when I have had a good night's sleep I try to do housework and take advantage of having energy. I plan my day around how I feel when I get up.

Because there are nights when I awaken after 3 hours sleep and can no longer go back to the arms of Morpheus, I watch a video or do other things requiring no energy or thought.

I also schedule all doctor appointments after lunch because having one in the morning can often be more than I can cope with.

Sometimes you just 'do what you have to do.'

I love this new feature and seeing you. Right on about the medical issues. I turned out to have mild sleep apenea and was prescribed a c-pap machine. Now I sleep 7 hours instead of 10 or 12, and stopped falling asleep every afternoon.

I do nap some afternoons. I get up groggy if I sleep too long so I take my kitchen timer and set it for 45 minutes, 10-15 to fall asleep and half an hour nap. Works for me and eliminates the groggy feeling.

This is a great new feature. A lot of useful insights today in just a few minutes.

A topic for Dr....how to have strategies to prevent falling. DOUG

Good idea. The older I get the more my sense of balance declines. My doctor says this is normal but I sure don't like it as I have fallen numerous times. So far I haven't broken anything but I am concerned.
I went to physical therapy for a few months to work on balance. This helped somewhat but the results were not lasting.

Any suggestions would be great.

Thank you for the topic today. I am dragging and trying to figure out why. The idea of an energy budget is good. I must try this. I also have high and low points through the day. My peak is in the morning about an hour after the coffee kicks in.

Thank you too for thinking about people with hearing impairments. I do a better reading than listening.

I like the term "energy budget." This is what I do - if I have plans for the evening I don't do much during the day so I'll have 'zip" when I'm out.

Never make an appointment of any kind in the morning - I'm slow getting started so I make my appointments anytime after 1:00.

Only time I'm out the door in the morning is when I have to catch a plane!

Another great video!
I've come to the conclusion that I really need a bigger energy budget. Love that term.

Mage's comment made me wonder if having a regular exercise regimen or maintaining a physically active lifestyle might be key to hanging onto energy. I contrast my hubby's virtually zero activity and his need to take a long afternoon nap plus a pill at night with my usually good 8 - 9 hrs with no naps. He tires very easily, which frustrates and worries me. Checkups reveal no heart problems. He's just "out of shape". Granted, there are 7.5 yrs difference, but he was like this when he was my age (near 75). Possibly there's just an individual difference, but I believe that a lifetime of 'couch potato' vs. a physically active style explains much about stamina deficits in aging... and at any life stage, for that matter. Dr. Thomas, is this supported in the medical literature?

I'm up early and very active until around 2 p.m. I have my main meal in the middle of the day. I always rest in the afternoon and sometimes I nap.
My favorite time to exercise is after 5 p.m. when I do water aerobics and aquazumba and walk the dog.
My weekly yoga class helps with my sense of balance and overall strength.
No doubt about it: staying active, getting enough rest and sleep, and eating well are the keys to good health and energy in old age.

For balance I would suggest continuing to do the exercises you did at physical therapy at home. They won't continue to work for you if you stop doing them.

Dr. Thomas -

Any opinions about using Wii for exercise - aerobic and balance?

We ran across it when my husband was in rehab and enjoyed it so much that we bought Wii Fit Plus and have been using it daily for 15 minutes to 1/2 hour.

Sometimes we just use the basic one for play, like the bowling.

Christine Miserando of the www.butyoudontlooksick.com web site pertaining to the overwhelming fatigue of the invisible disease, lupus, early rheumatoid arthritis, fibromyalgie...has a wonderful "spoon" theory that has gone across the world in popularity. It's a concept I've tried to use--not always successfully in the 54 years of my RA. I say, to myself and others, " I can do 2/3rd of a day--I can't do 3/3rd. If I'm out in the morning and evening, I have to rest in the afternoon; morning/afternoon/no evening; afternoon/evening/no morning;
Please read the story in the link--it will help you understand not only invisible illnesses, but the increasing fatigue of aging.

I'm convinced that finding a consistent activity pattern has become more important now that I'm older. Necessity had me in a forced one for so many years that letting down to an erratic one for a year was more of a health issue than I anticipated.

What works best for me are appointments first thing in the morning when possible. My part time work generally follows, when I have patients, the hours before, during and after mid-day. I nap only occasionally; prefer evening social activities. Don't put in the long hours I once did.

Katie is right about interactions with many dementia patients in my experience and opinion. CNA needed some educating.

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