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Anna H. Chodos – Healthcare Tips for Older Adults

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Anna H. Chodos - Healthcare Tips for Older Adults
Anna H. Chodos – Healthcare Tips for Older Adults

As our population ages, the demand for health care services and products for older adults is increasing.

The U.S. Census Bureau estimates that by 2050 there will be more people over age 65 than under 18 years old in America which means that the senior population is growing faster than any other segment of society.

As we age, our bodies change. Some of these changes are due to the natural aging process, while others are caused by external factors.

These external factors in older adults can result in unmet needs. These needs can be physical, psychosocial, or spiritual.

We all know that when you don’t get your basic physical needs met, it can have devastating effects on your emotional well-being as well as your overall health.

Whether those needs are related to eating or bathing, if they aren’t addressed correctly, the consequences of these challenges are a decline in quality of life, and an increased risk for poor health outcomes including hospitalization and even death.
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Timestamps:

[00:00] Introduction to the channel
[01:20] Introduction to Dr. Anna H. Chodos
[01:56] Share with us a little bit about yourself on a personal level?
[03:36] What is your take about the current health care coverage?
[06:33] What do you think are the top three healthcare mistakes one should look out for?
[13:10] Do you know what type of coverage to look for if you want to avoid any of these mistakes?
[14:27] Advice for people who find themselves feeling overwhelmed, with the prospect of taking care of their aging parent?
[18:58] What are the most common mistakes that you see people make when they are trying to take care of their own health?
[22:10] What do you think the aging population in America will look like in 2050?
[26:36] How does aging in America affect politics and social norms?
[29:06] With regard to Alzheimer’s, will we have a cure for Alzheimer’s by 2050?
[32:37] Falls are a big issue for seniors. Is this becoming more than just another inevitable side effect of growing old?
[38:06] What initiatives are professionals taking for seniors and those with disabilities to ensure they don’t succumb to injuries caused by falls?
[40:43] Closing remarks
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Bio:

Dr. Anna H. Chodos is a brilliant and compassionate physician with wide-ranging interests in the care of older adults, both as a clinician and an academic. She has served as Chair of the Department of Medicine at UCSF, Director of the Geriatrics Division within UCSF General Internal Medicine, Chief Medical Officer for San Francisco General Hospital where she led the development of its new patient safety program, Associate Professor in the Division of Geriatrics at UCSF School of Medicine, Co-Principal Investigator for the Geriatrics Workforce Enhancement Program based at San Francisco Health Clinic Network (SFHCN), and Principal Investigator on research studies investigating access to timely primary care for frail elders with complex needs living in poverty or without insurance.

Learn more about Dr. Anna H. Chodos:
LinkedIn: https://www.linkedin.com/in/annachodos/
Website: https://profiles.ucsf.edu/anna.chodos
Twitter: https://twitter.com/annachodos
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Transcript:

Hanh:
Hi, I’m Hanh Brown. And thanks for tuning in. The topic today is healthcare for older adults, particularly the underrepresented. As our population ages, the demand for healthcare services and products for older adults is increasing. The U.S. Census Bureau estimates that by 2050, there will be more people over age, 65 than under 18 years old in America. Which means that the senior population is growing faster than any other segment of society. As we age our bodies change, some of these changes are due to the natural aging process while others are caused by external factors. These external factors in older adults can result to unmet needs. And these needs can be physical, psychosocial or spiritual. We all know that when you don’t get your basic physical needs met, it can have a devastating effect on your emotional well-being as well as your overall health. So whether those needs are to eating or bathing, if they aren’t addressed correctly, the consequences of these challenges are a decline in quality of life and an increased risk for poor health outcomes, including hospitalization and even death. So, today my guest is Dr. Anna Chodos, Geriatric Medicine at Harvard University. She’s also an associate professor of medicine and a practicing clinician educator. So for the past 20 years, her clinical work has concentrated on understanding the unmet needs of older adults. Her mission is to help seniors live better lives by providing them with the care they need so that they can remain independent longer. So Dr. Anna, welcome to the show.

Anna:
Thank you. Thanks so much, Hanh for having me.

Hanh:
Great. Great. So, other than your professional profile, can you share with us a little bit about yourself on a personal level?

Anna:
Yeah, absolutely. Of course that’s, that’s easy to share. And also I was very fortunate to do medical school in public health school at Harvard, and probably got my earliest and most influential mentorship there in geriatrics. And particularly under the geriatrics group at the Beth Israel Deaconess Hospital. Shout out to my main mentor Ann Sivini, but I ended up doing residency in primary care and internal medicine and then a fellowship in geriatrics at UCSF in San Francisco, University of California. So that’s where I am now. And I practice in our affiliated safety net setting, which is our hospital called Zuckerberg, San Francisco General Hospital. And I do all outpatient work essentially. So that’s sort of my day to day is outpatient work with people with cognitive complaints and dementia and sort of general comprehensive geriatric assessment. So personally I grew up on the east coast, ended up on the west coast and definitely, really love it out here. And I guess what is another personal thing? Really enjoyed the hiking in the mountains. And I was so east coast centric growing up, I didn’t realize that mountains were much bigger on the west coast. So that was a learning point for me. And really enjoy like all the things we get to do out here.

Hanh:
Well, great. Great. Well, thanks. Thank you so much for being here. All right. Well, let’s get started. So what is your take about the current health care coverage?

Anna:
I think, so the patients I typically work with have either public benefits related to age. So generally speaking, Medicare and social security or benefits related to being low income. So that would be things like Medicaid or social supplemental security income SSI. So one, one thing that I think happens to everyone as they either sort of spend down into public benefits or age into public benefits is they start to really understand the massive bureaucracies associated with these programs and are become very familiar with how to get these be eligible, apply. I think one big potential advancement that everyone is sort of aware of is Medicare Advantage and people will start, I think, experiencing more what it’s like to be in the Medicare Advantage plans and hopefully reap some of the benefits, which is some expanded coverage that Medicare previously didn’t cover, like hearing aids and other services. And also there’s going to be more of a population management focus for those folks, which to some people will certainly probably feel limiting, but on the positive side may really help us grasp what that those population needs are. And one thing I think we all can agree on is that the healthcare system, even as it’s increased its focus on quality and value often doesn’t really understand what that means for older people, because historically all of our metrics have been how much healthcare care people getting. Not necessarily how much does it fit? What’s right for them? And those are some of the adjustments that are gonna hopefully start to happen. On the flip side. I don’t actually, and probably won’t have that much experience with Medicare Advantage patients because they’re not going to be the ones coming to see me. They’re not going to really be able to get those programs as Medicare, Medi-Cal, or Medicaid patients. But I think that’s a big change that people should hopefully look to learn more about what those programs can offer, how it might fit their needs and take advantage of all the Medicare counseling. Sometimes states have additional programs to help support people. And unfortunately, I can only really speak to California at this point, in terms of my personal knowledge, but I do know like our counseling program, High Cap can be really useful to people who are really confused about all these different options and the advantage plans, the drug plans.

Hanh:
Great. Great. I agree. I know there’s a lot of information and growth and interest from Medicare Advantage to providing in-home care and that’s exploding business and, interest from Medicare Advantage. So that’s great. So now, so as we age, it becomes more and more important to maintain our health. And this is the time when people are at their most vulnerable, so they need to be extra careful about what goes in or, or on them, if they want to avoid any common healthcare mistakes as they get older. So what do you think is the, let’s say top three of these mistakes that should you look for or look out for?

Anna:
It’s such a good question. And I do think as you’re, I really like the way you’re framing it, there’s a lot you can do to maintain your health, even improve it. Even as you’re maybe experiencing more chronic health conditions and symptoms. But I think the biggest things I see that people don’t really address and I don’t think it’s has anything to do with motivation or internal desire for health. I think it’s just, there’s not a lot of good information out there about it. The three things I think I see the most are people don’t address hearing loss early enough. It’s such a big factor in longevity of cognitive health. So even if you don’t want to hear anything and you don’t want to hear anybody around you, which might be a perfectly reasonable way to approach life depending on who’s around you the, the loss of hearing is we detect it so late in most people, and it’s harder to correct. Like we lose the ability to hear certain things that don’t necessarily come back when we correct it later. And it’s much harder to use hearing aids. And there’s, it’s so tightly associated with cognitive decline. So I really emphasize it as a brain health thing, not just a hearing thing, because most people are highly motivated to prevent cognitive decline. Like people really don’t want to lose their innate ability to manage their own lives and, and get through the world. So that’s probably the biggest one, which is definitely really unsexy and nobody gets real excited when I talk about hearing loss, but I love to remind people to correct hearing. The other is Advanced Care Planning. And I know a lot of people kind of step away from that because it’s a lot, it can be a very heavy seem like a very heavy topic. I really emphasize that it’s, it’s life planning, like any other aspect of life planning and it’s not necessarily death and dying planning or all these fancy decisions about CPR and dialysis. It’s really just practical planning for if you experience incapacity, meaning you can’t make decisions for yourself. And what we’ve seen with COVID, that can happen in a heartbeat. People get very ill, they can’t advocate for themselves, and then there’s nobody listed. There’s nobody, there’s nobody in the plans to take over. And the reason that’s so important is people don’t realize just how vulnerable you are in the health system. When that happens, there’s nobody there to be your advocate. And then you really are at the mercy of the system. And I wish the system always did the right thing for every person, but that actually might be something, no one knows what the right thing for you is. So thinking of it as incapacity and sort of practical planning, more than big decisions about really waiting end of life decisions, cause that might not even be the relevant thing for you at that time. And then the last, and then the last thing is physical activity is like the only magic pill we have, the more physically active you can be in a way that fits you, whatever your health conditions are, whatever your resources are. Is it a walk? Is it a gym? Is it a trainer? Whatever is it, is it a pretty modest goal of 30 minutes of walking? Whatever it is, is so much better than inactivity and is literally the magic bullet for the brain and the heart, the muscles falls, it’s sort of cannot be emphasized how, how much good some physical activity does. And that’s something, I think we also have a really hard time in health care, adequately supporting and helping people find ways to incorporate that in their lives.

MUSIC:

Hanh:
When you talked about a care plan boy, isn’t that the truth, because on a personal level, the earlier that you discuss and plan and have those difficult conversations, you’re more likely to have options, right? But when let’s say you don’t discuss, plan and react in a crisis, boy, your options are very few and it’s tends to be ones that are less desirable. So I echo that very much.

Anna:
Yeah. And I think most people are also really motivated by not burdening their support system, which is an interesting, we can dig into that as well, because here we are, we’re all interdependent on each other. It’s really hard to never burden your the people around you with anything. But, it ends up actually being so much more stressful and burdensome to people around you when that planning hasn’t been done. So I think sometimes I can motivate people to work with me and their, their surrogates or their support system, just by saying like I think we can all imagine that if something happens, it’s going to be really stressful for Jim or Mary to figure this out on their own. If we do this together now, it might really help them.

Hanh:
True. True. And I think you mentioned physical, the third component or the third mistakes that you see people make. The activities and so forth based on everything that you shared, those are all lifestyle choices, right? And I think we talked a little bit before this conversation, so, I mean, for sure, I think we have the power to own many of this and so great points. Thank you. Now, do you know what type of coverage to look for if you want to avoid any of these mistakes?

Anna:
I think again, exploring if you are eligible for some of the advantage plans. Cause I know some of them include, like gym memberships and things like that. I mean, to be, to be honest again, it would be so depending on where you live and what your eligibility is. I think the other thing that is just important to consider would be the medication coverage. Cause a lot of people pick either the part D or a plan that doesn’t fit well with actually their needs. And then that becomes just a financial problem because the medications they need are not the medications they’re on whatever plan they ended up picking. So that’s like my main advice about coverage. And again, my apologies to those in the audience that may have more advanced questions because a lot of my patients are kind of forced into certain plans, unfortunately.

Hanh:
Yeah. Yeah. So now, okay. So I’m going to just change gear a little bit. So if you have any advice for people who find themselves feeling overwhelmed, with the prospect of taking care of their aging parent?

Anna:
Yes, and I think, and I’m sure you will have some additional advice, as well, as soon as I’m done here. I think one of the biggest factors is I find that when I talk to people, it’s, as if we’re, we’re starting a new, every single time, like everyone is doing this in isolation. And that is I think, a great motivation for the work you’re doing with this podcast and what needs to just be happening more and more places. So more people have access to information and community around how this stuff goes. I always emphasize particularly for very pervasive issues like if the issue is now someone’s having cognitive impairment and, or to the level of dementia, which is sort of the more severe and functionally relevant, cognitive impairment part of the spectrum a lot of physicians and even social workers you’ll go to get advice may not actually be the best. It may be those communities that people who are already doing this work in the California. We have the Family Caregiver Alliance in their local bay area, but they have a national website and they have a phone number that anyone can call. And it’s just very broad support for education resources just planning your way through it. And it addresses all those topics that everyone seems to encounter. Like, how do we cross this threshold of I’m noticing you may need more support. You may not be noticing it. Maybe you’re resistant to really talking about it with me or addressing it for lots of reasons. How do you start to address that? That’s really hard. And I think reading a diversity of perspectives and experiences going to a support group, listening to other people talk about how they dealt with it may be really helpful. And a physician really like the primary care provider really may not have a lot of experience with that. There aren’t a lot of aging specialists and a lot of clinics don’t have social work that specializes in older adults either. The American Geriatric Society has some resources like their Health and Aging website. I think it’s HealthylnAging.org and they have some tips not on everything. So again, a diversity of resources. But, and I think I’ve heard some of your other guests mentioned this too. It’s it’s also not one size fits all. This is going to be an individual process and it’s gonna really take off from whatever that starting point is of the relationships in that, that situation, whether it be friends, neighbors, I see a lot of neighbors helping neighbors, because there’s a lot of people who do not have relatives anymore or, or not close relatives. And so, how do you navigate that on just with the people there? And that’s going to be its own special formula. And not expecting too much, like a lot of physicians, I find we’ll just start talking to the caregiver or the friend who brought the person as if they’re just going to take over and do a bunch of stuff that may not be the dynamic they have. So acknowledging what dynamic is there, what strengths of that interpersonal relationship are and what the challenges are, and don’t expect things to rapidly change necessarily, but kind of have a realistic starting point and then really turn to the community that’s out there on Facebook, on the Web, on trustworthy caregiver organizations.

Hanh:
Yeah. And I think we’re all had to overcome that notion seeking help admitting that, Hey, this is predicament that I’m in and I really need resources just overcoming that paradigm, stereotyped that it, it’s it’s bad. So I think that’s important. So now what are the most common mistakes that you see people make when they are trying to take care of their own health?

Anna:
I think I’ve already said a lot about Hearing and, vision is also important, but everybody wants to correct vision. That seems not to be a barrier. But physical activity. The other one is that I haven’t mentioned that is probably the biggest looming one is medicines. So people, our relationship to medicines really changes as we age. And that’s partly physiologic because our kidneys process them differently, our muscle and fat ratios change. And that actually affects how we store and process medicine because some get stored in fat, some get stored in our more water-soluble areas like muscle or other organs. And so we just simply have different responses to medicines. And the really tricky thing, particularly about older people in regards to medicines is they both get more benefit and experience more harm. And it just depends on what’s going on with that person. So, they’re more likely to benefit because they’re more likely to have a condition that really needs that medicine, but they’re more likely to have the side effects or the harmful effects as well. So we just always have to do a very careful review of medications. What’s really working? What might be having side effects? And the syndrome of polypharmacy, what we call poly-pharmacy or inappropriate medications for older adults is just a really important one. And a lot of physicians, again, no disrespect to my incredibly brilliant, dedicated colleagues across medicine, but they don’t coordinate well. And often they have not updated themselves about what medications are best for older people. And under what circumstances. So considering other conditions, considering other medications, considering whether or not there’s cognitive impairment, all the things that really change the game for whether or not medications are safe, effective, appropriate, inappropriate. And so it really falls upon the consumer and healthcare, Right? As the patient to say, Hey, are these medications still the best for me? And to speak up when there are side effects that they don’t think are appropriate. And unfortunately that’s, that’s a big one too. And I, and I know HealthlnAging.org has some good resources on their website for the most common medications that are challenging. But I think the biggest mistake is like, my doctor told me to take this, I’m going to take it, and I’m not going to mention these side effects or I’m gonna buy this over the counter thing because it says it’s good for sleep. And just, just not really paying attention to all the meds and, and having a thoughtful conversation with their kids. Physician.

Hanh:
Very True.

MUSIC:

Hanh:
So let’s take a glimpse of what Americans aging population might expect in 2050. Well, in 2050, there will be more than a hundred million people over 65 years old. So that’s about 10% of the U.S. Population. This will present new challenges for everyone, from politicians to marketers who are trying to plan ahead for what I guess can only be described as a crisis in the making and has not yet been adequately, adequately addressed. So what do you think the aging population in America will look like in 2050?

Anna:
Yes. Well, we know the things we know, and that are really wonderful and exciting is just the diversity of older adults. We have a diverse population in America in terms of cultural background language, race, ethnicity. And I think that’s really exciting and cool. I think hopefully there will be more of an inclusivity kind of model of all sorts of different older adults and having more voices of older people really infused in culture, on the radio, on the internet, social media. I think a lot of those things still really leave out older adults and their voices and lived experiences. So I think that’s to come because that’s just the reality. Most of us will be living in communities that are more like 20% people, 65 and older, that will be most cities. So but I think the other realities are both good and challenging. So the good is for the most part things that are really game changers are declining. And what I mean by that are dementia appears to be declining in incidents. So per population there’ll be fewer percent of people with dementia, but the overall number is going to be a lot higher just because there’s going to be so many older adults. Functional impairment is less is, is more condensed. So people have more functional impairment, meaning they need some assistance with activities of every day, like cleaning, cooking, shopping, dressing, bathing. Those are all examples of what I mean when I say functional impairment. Those things will get more, it’s called the compression of morbidity. So people have longer lifespans and a lot of the challenges like the functional impairment and the really symptomatic health conditions are compressed into fewer years towards the end of life. But people are going to be living so much longer that we’re going to have a very large percentage of people that need some assistance around that time. So I think it’s just going to be a very mixed and exciting bag of things to really dive into, to make sure that people live lives of like incredible dignity and joy towards the end of life. But that we also like totally eyes wide opened realize like what support people are going to need. Sorry. The other thing I will say though, is I think that the widening income gap is a very real problem also because the people who tend to be poorest in older age are oldest. They’ve spent down their assets and they tend to be women and they tend to live alone racial and ethnic minorities. So people who identify as Latin X or African-American also tend to have much less, but financial means as they get older. And so I think that’s a reality as well. Like our safety net for the poorest older adults is going to be really challenged.

Hanh:
Yeah. Yeah. Wow, I want to make a correction. I think you, you, you mentioned it. Yeah. It’s actually 20%. I think I said 10%. Incorrect. It’s it’s people 65 years and older. It’s going to be 20%. I think

Anna:
it’s 20%, right? It’s like a fifth of the.

Hanh:
It is. It is. I had it in my notes is item number 10 to remember.

Anna:
Oh

Hanh:
So

Anna:
Yeah.

Hanh:
So glad you mentioned. Well, great. I know you’ve talked about this a little bit, but how does aging in America affect politics and social norms? Do you have any thoughts on that?

Anna:
I wonder the same thing myself all the time, because you look at Congress and it’s like these are the people I want to hang out with. They’re all in their eighties. This is, these are my folks. They are officially old I think most people don’t really like the term old. And I kind of agree with that because it conjures a lot of biases and who’s old, anyway? If everyone is so different, once you reach 60, like the diversity of abilities and health is so all over the place, right? It’s just very, very heterogeneous. So it’s such a diverse group of people. But they’re also massively over-represented, it seems in our leadership and there’s good reason for that. There’s a ton of wisdom experience. Like there’s wonderful reasons for older adults to be essentially running our country. But I don’t see it reflected in a lot of the policy towards a more compassionate world of aging with dignity. Having said that Biden has also currently put forth a lot to improve the future of aging with supporting more home and community-based services and caregiver, caregiver support. And in California we have the Master Plan on Aging. So Newsome was very dedicated towards improving aging going forward. Of course, we’ve had some distractions in the way of the pandemic and other crises here. But I just, I don’t see it getting called out that much as it’s as a special area of consideration or that seems to deserve. So I’m not sure. I think our policy and politics is, is as blinded by our age-ism as everything else.

Hanh:
Yeah. I echo that. I often think about that. And I think it’s great that the seniors are in those positions because it comes with wisdom and experience and empathy and so forth, but it sure seems like it’s not reflected, you know? And it’s very unfortunate. So with regard to Alzheimer’s, will we have a cure for Alzheimer’s by 2050? What do you think?

Anna:
I know you also I think you’ve asked other guests this too. And I usually like condense everything everyone said. There is, I believe it’s the Alzheimer’s Association that has a tracker and every year they update it. So with everything that’s in development, what looks promising, blah, blah, blah. We’ve had this recent debacle of the recent medication that was approved, that doesn’t really have a clinical endpoint. It has this intermediate end point of reducing some amyloid in the brain, which is one of the big findings in Alzheimer’s that people have a lot of amyloid plaque in their brain. And so the, the idea is if you can reduce that you can improve the symptoms of Alzheimer’s and the progression. Are we capable of huge bounds and leaps in scientific advancement in therapeutics? Obviously? I mean, the COVID pandemic was a good example of how, when the guard rail when a lot of bureaucratic barriers are removed and a ton of money is poured into developing something, you get a result. The caution though is it’s been decades already. They keep,

Hanh:
20 years.

Anna:
Yeah. They keep, unfortunately not finding a cure and it’s possible. That I think given the complexity of the disease and the complexity of the brain and the frankly there’s a there’s neuroplasticity that we can always learn at every age we can always learn, but we can’t really regrow a whole lot of the brain and still successfully recover. So I think there’s just a lot of a lot of challenges, that’s, that’s clearly a head for that. And to predict, honestly, I think would be really hard. It turns out to be quite the bear to, fight. Although having said that I’m not I’m not a neurologist, I’m not a pharmaceutical person and I’m not, certainly not a basic scientist. So I do have colleagues that I work with in my dementia clinic who feel like, not only is that definitely going to be the case, but we need to now very, very clearly delineate who has Alzheimer’s versus other kinds of dementias in the clinical care we do, because right now, frankly, that’s not that relevant because we don’t have targeted therapies. So we often label people as having dementia and we don’t necessarily come down super firmly on what kind of disease is causing the dementia syndrome. And they would argue we should be doing that now because the second the door opens to a therapeutic, we will need to quickly triage people into a treatment plan. So I think there’s definitely a glass half full viewpoint on this in terms of what’s coming down the pike and that hopefully we’ll have something by then.

Hanh:
That’s great.

MUSIC:

Hanh:
Well, let’s talk about falls. That’s a big, big issue for seniors. Well, at first, it seems like it’s a natural process of aging to see a bone mass decrease in older adults, but with the increased risk for falls as we age and an ever growing population of people over 65. So is this becoming more than just another inevitable side effect?

Anna:
the really, I’m so glad you ask about falls, cause it is a huge, potentially preventable thing that really affects people’s lives. The quality of their lives. If there’s an injury or a serious injury and many falls do result in at least a temporary injury. And some result, of course in death. Falls are extremely common. It’s like a third of people over 65 every year will fall. And I think the main take home about falls is it tends to be multifactorial. So, if someone’s saying they’re falling, or if they’re in the hospital for a fall related incident or go to clinic because they hurt their wrist cause they fell or something, it really should trigger a sort of A to Z assessment to see, what can we improve to reduce the future fall risk and the risk of falling again? The one aspect of that, which you brought up and is so key and we often forget, or we think about separately is the bone mass issue. I really think of it as two sides of the same coin. If the person isn’t also being assessed for bone fragility or osteoporosis essentially, then we’re not doing a complete job because the person who falls and has osteoporosis is at astronomically higher risk of a serious fracture. Than the person who doesn’t have osteoporosis. So there’s sort of an approach you could take that would just address a lot of risk factors right out of the gate and be sort of more preventative if you haven’t ever fallen. And then there’s a bunch of things you would also and could do again, if you did fall. And the main things are, again, physical activity, particularly things that address a balance and hip strength and turns out Tai Chi is the exercise that has the best evidence consistently like great, great evidence for Tai Chi in fall prevention. But anything that really addresses those two things. So balance and lower extremity strength medicine. So I kind of think of it and I can be a little bit obnoxious with colleagues. And I’m just like, are you trying to push the person over from the inside? Like there’s so many medications that cause people to fall and the big ones are too many blood pressure medicines when it’s sort of not appropriate anymore. Like the person’s over controlled, you would say, so like three or more blood pressure medications. Benzodiazepines and sleep medications, basically, I go on a bit of a, a tirade about it with people and really try to get back to basics. Sleep hygiene, healthy sleep habits, exercise during the day, bright lights in the morning, no lights in the afternoon, watch the caffeine. Things like that. Not no light. Sorry, not like a, not like a dark room, but like not TV screens, phone screens alcohol and other intoxicating things like cannabis. You need to be careful. Doesn’t mean you can’t do it at all, but you need to be careful. Vision and turns out. Here’s my favorite one hearing, if you can correct those. The, it actually turns out it helps. Cataract surgery helps and then home modifications. And a lot of municipalities county cities, whatever have free home modification resources for older adults that people don’t know about. So things like grab bars or other modifications that make the home safer. And things like cords, throw rugs, things like that, a home safety assessment would address. A lot of times I’ll I’ll order the home physical therapy specifically for something like that or home occupational therapy for, for modifications to the home, but also just like a general safety assessment. So it is again, geriatrics rightfully has a reputation for being very unsexy because we just deal with like really practical stuff. But the devil really is in the details and what people don’t appreciate, understandably is just how dramatically their lives can change with a serious fall. And it can seem infantilizing frankly, to overemphasize it with people. But it’s what I see time and time again, people ending up in the hospital with a serious fall and then spending a year recovering and having to go to rehab and like basically nobody wants that, right? Yeah.

Hanh:
Very true. Very true. So what initiatives are professionals taking for seniors and those with disabilities to ensure they don’t succumb to injuries caused by falls?

Anna:
So, some practices, especially when the Medicare Annual Wellness Visit got started. We’ll do screens. And the screens are usually like for your regular primary care visit, they’ll do the screen. They’ll usually be, do you use an assistive device? Do you feel like you’re have any imbalance and have you had a fall in the last it’s either six months or a year? Depends on the question. The CDC has a whole program. It’s actually really great. It’s Stride. I’m all of a sudden doubting myself and I’m pretty sure it’s Stride. And it has assessments that it has things you could do. It has exercises you can do to prevent falls to actually like an superb resource. So people will do the assessments on there when people come in for primary care. And then my recommendation to colleagues, especially if I’m not able to assist in the management of that particular patient, is think of all your next step turnkey recommendations. So you detected the person’s higher fall risk. You have to do that A to Z assessment. And the CDC resources will really help walk you through that. But again, these, in a lot of ways, these resources are out there and people don’t use them. So the health, the home safety evils through like a home health care agency, like a home physical therapist evaluation. Usually there needs to be like a entering reason for that service to get in there. But the physician can usually come up with one like their had in your fall or had to fall in the home. And then public health departments will have fall prevention programs that you can tap into with these like home modification resources. And then the doctor’s main job I would say would be to that assessment of osteoporosis balance issues that you could address like diabetes neuropathy, B12 deficiency, they do their medical assessment and then the osteoporosis assessment to make sure if there is osteoporosis that we’re treating that to reduce the risk of a serious fracture.

Hanh:
Wow. Great. Many, many great points that all of us, right? Because we’re all aging. We all have to be mindful of this for ourselves and for our parents and grandparents.

MUSIC:

Hanh:
So do you have anything else that you would like to share?

Anna:
I should be prepared for that question and I thought I was, but you were asking such great questions. I think the main thing I want to share is it, I know it’s overwhelming. I guess I would say there’s so much that can change about our bodies and our circumstances as we get older. And just to acknowledge like our system does a fairly poor job of supporting people broadly. I think when people are in crisis, resources, sometimes swoop in. But the more we sort of chip away at these things, the less overwhelming, I think it can be when it all kind of comes to roost. So things like coming up with really advanced care plan, but like an incapacity plan, if you can just think of it as like goodness forbid something happens, it could even, it may have nothing to do with age, but I just happen to be 70. It could be, I get hit by a car, whatever it is, what, what is going to happen? What happens with my stuff, with my benefits, with my medical decision-making? We usually have to come up with a plan for that in advance. And then knowing that most people experience a need for some additional assistance that they didn’t need before. That doesn’t mean your in any way, weak, abnormal, not doing for yourself. That’s just the reality for sure. The realities of life. As we see it, right? Constantly, what would my plan be? What resources would I have? And we have such an age, blind dementia, blind society. That unfortunately for the moment, it is more on us and it is more on our support systems. I have a lot of families, older adults and their families that come and they’re overwhelmed. They’ve been trying to figure stuff out on their own and they are just kind of in disbelief that it’s really, truly all on them. And I really try to be a partner and I try to give them as many resources, they can. And help create that feeling of perspective. Like we’re going to chip away at this. We may not solve everything right away. So like, let’s settle in a little bit for a long haul to figure out all of these pieces of your mom’s care or your dad’s care bit by bit. And what’s going to work for her. What’s going to fit for her. But there are communities out there and I just, I wish I felt like more people felt good, felt proactive about accessing those caregiver communities, those locally, or just on the internet, to sort of start making those plans so that it didn’t have that feeling of isolation overwhelm, that is so common. And my greatest hope for the future is with work like yours. And so many of your guests that this is not like all on people in their individual situations. And it’s not a last minute thing a crisis thing. And that people’s mental health and physical health doesn’t need to suffer to help support older people in their lives or older people who are doing it on their own or just with themselves and their spouse or partner whoever’s in their lives. I just, I think it really robs people of the opportunity to enjoy some of the great things about aging and having all this lived experience and,

Hanh:
Right.

Anna:
being able to engage in society. Anyway, I don’t know that that’s super positive, but other work to do, and we will get there. And I know I want to be part of it and I clearly you do, so.

Hanh:
Yeah, no, it’s perfect. Everything that you said, I echo the, I’m not saying anything cause I don’t have any, you couldn’t have said that better. I couldn’t have said that better myself. Cause I think it’s so valuable that we all just take ownership and responsibility because it’s not on the physicians, the politicians. It’s really, we taking ownership of lifestyle choices and then despite whatever level of cognition that we’re we’re at knowing that our bodies will decline. But somewhere along the way, find the joy, find the blessings despite the decline because there’s still life, despite the decline, right?

Anna:
Oh, yeah. And that self-compassion, I think you’re speaking to of we’re going to do what we can do. And actually we do have a lot in our hands that we can do to improve hopefully parts of the aging process that are less comfortable or more more challenging, but life also will happen, right? So we should all be expecting that it’s still something’s going to happen. One of the things an older person said to me this was right around the time of the pandemic and she was really struggling with social isolation. And we were just reflecting about her life and well-being. She was she’s in her early eighties and she was just saying really the most surprising thing about aging has just been, I knew something was going to happen, but I really didn’t know what. And then it’s when the, what happens or something happens and you’re really trying to figure out how to manage that. And some of it, I think is just psychologically and physically harder than others, right? We all start to realize the importance also on top of everything of luck. And for her, she, she had a really serious gait issue and it felt like on top of the restrictions with COVID have feeling really vulnerable and isolated. She was also having a lot of trouble walking. And I think that she just was having a really hard time psychologically adjusting and she’s a psychiatrist. So she definitely had the skills, but I think, yeah, both, but exactly as you were saying, that, that there’s these parts of us that need to build that resilience so that when these things do happen, hopefully we can navigate those choppy waters, too.

Hanh:
Mm hm. Mm hmm. Wow. That’s a lot of great insight and I hope people who are listening now or in the future can just take these as lessons learned and feel like they can take ownership and they have lifestyle choices. They can add to their longevity, add to their healthcare plans and continue to have a quality of life, despite of the decline. So thank you so much.

Anna:
Hanh., thank you so much. This was wonderful. Really appreciate it.

Hanh:
Take care.

Anna:
Okay. Have a great day. Bye.

Hanh:
B-bye.

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Episode 127

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