October 27, 2024 • 23 mins
10/27/24
The Healthy Matters Podcast
S04_E01 - Elder Essentials: Keys to Aging Gracefully and Caring for Older Adults
Though some of us might not like to admit it, it's a fact that right now, we're all getting (at least a little) older. But aging doesn't have to be scary, and there are certainly better practices to helping our loved ones - and ourselves - age in the best way possible. But what does "healthy aging" really mean? How do we distinguish a "senior moment" from something more serious? When is the right time to talk to a geriatrician?
On the next episode of the show we'll introduce the "5 M's" of geriatric care with geriatrician, Dr. Kerry Sheets (MD). They are: Mind, Mobility, Multi-Complexity, Medications and Matters Most, and they help provide a framework for navigating the aging process. She'll help us understand each of these and give us tips on healthy aging, and how to give the best possible care to our elders. Aging is a part of life, and there's certainly a lot to know about it, so tune in and get senior savvy with us!
Resources mentioned in this show:
fivewishes.org
honoringchoices.org
The National Institute on Aging
Got a question for the doc or a comment on the show?
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Keep an eye out for upcoming shows on social media!
Find out more at www.healthymatters.org
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilton .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilton , and welcome
to season four. This is thefirst episode of the New
Season, and I am joined by Dr.
Carrie Sheets . We are gonnatalk today about navigating
health challenges later in lifeor caring for older adults. Dr
. Sheets is a geriatrician,which means she's a doctor for
older adults, and we're gonnatalk about things like healthy
(00:40):
aging, caring for older adults,things like dementia. We're
gonna cover all of that. SoCarrie , thanks for being on
the show.
Speaker 3 (00:45):
Thanks for having me. It's
Speaker 2 (00:47):
Great to have you here. You're a geriatrician. I
know what that is, but tellothers if you could, what does
a geriatrician see? What arethe common things that you do
in your practice? Yeah,
Speaker 3 (00:55):
So as a geriatrician we focus on care of older
adults. We see a variety ofchronic conditions, things like
hypertension, diabetes, chronickidney disease, heart disease,
and dementia. I will say thatage is the biggest risk factor
for a whole lot of chronicconditions. We often see more
than one chronic condition aswell. So
Speaker 2 (01:13):
We often talk about age being a risk factor for
things happening, but when is acondition considered normal
part of aging versus when it'ssomething you have to do
something about, for instance,forgetfulness or , uh, muscle
aches and pains. Is that normalor is that something that needs
to be fixed?
Speaker 3 (01:32):
That's a good question. I think the answer is
somewhere in between. We talk alot with patients about what
matters most to them and whatthey're hoping to do in daily
life, and we use that to guidewhat we treat and what we maybe
watch and just see if it getsworse. So for example, if you
have knee pain and you'rehaving trouble walking and it's
starting to make it hard foryou to do what you need to do
(01:53):
around the house, that would bea time that we would start to
talk about treating the kneepain. We might do things like
physical therapy andstrengthening or talk about
medications that can helpalleviate the pain. So
Speaker 2 (02:03):
I would imagine that many people listening are older
adults themselves or are caringfor an older adult and they're
wondering, well, I don't have ageriatrician. You know, when
does somebody see you?
Speaker 3 (02:14):
We often talk about geriatric care as focusing on
the five mss . So these aremind, which is mood or memory
and thinking changes, mobility.
So starting to have difficultygetting around multi
complexity. So that's whensomeone has multiple chronic
conditions at the same time,medications, sometimes we see
that older adults are taking alot of medications or that they
(02:35):
have to take medications acouple times a day and then
matters most. So reallythinking about what's most
important to an older adult.
Speaker 2 (02:42):
Okay, that's awesome. The five m's , I don't
know, , you know, myyears of practicing and I've
heard the five M's , could yourattle those off
Speaker 3 (02:48):
Again? Yeah, it's mind mobility, multi
complexity, medications andmatters most.
Speaker 2 (02:54):
Yeah, that's really helpful to kind of put it into
that framework. So let's dothis then. If we could, I want
to start out with the top one.
Let's talk a little bit aboutwhat are some of the things
that happen to people as theyage with their mind? Well
Speaker 3 (03:08):
That's, so there are normal brain changes that
happen with aging. For example,as you're getting older, you
might notice that you'rethinking is a little bit slower
or it takes a little bit longerto think through problems. Or
you might have more troubleremembering names of someone
that you just met, things thatare a little worrisome and that
you'd wanna talk with yourhealthcare provider about. Or
if you're starting to get lostwhile you're driving, if you're
(03:31):
having trouble talking, thatyou're having so much trouble
finding words, that it's makingit hard to have conversations.
Or if you're starting to havedifficulty with tasks that you
used to be able to do thingslike managing finances or
cooking.
Speaker 2 (03:42):
So I think a lot of people of every age have some
difficulties with memories.
Well , how do you know ifthat's problematic? Because ,
because they always do say thatlosing your , uh, cognitive
function isn't normal, butthere are , it is kind of
common to be forgetful, isn'tit?
Speaker 3 (03:57):
It's common to be forgetful and it's really we're
all forgetful, especially ifwe've had a poor night's sleep
or if we're under a lot ofstress. It's the type of
forgetfulness that's startingto make it difficult to do
daily tasks. So for example, ifyou're forgetting to pay bills
that you never forgot to paybefore or if you go to the
grocery store and really can'tremember what you're supposed
to buy, it's that type offorgetfulness that makes it
(04:18):
hard to function where we startto worry.
Speaker 2 (04:20):
So I know this isn't a show about dementia. Um, uh,
listeners, we did do a showabout dementia and uh , I'll
tell you a little bit moreabout that, but I want to touch
on that since we're on thismind section. What is dementia?
Speaker 3 (04:32):
Dementia is an often progressive condition where
someone has so much troublewith memory and thinking that
it starts to interfere withdaily tasks. There's a lot of
different causes of dementia.
The most common cause, and theone that most people are
familiar with is Alzheimer'sdisease.
Speaker 2 (04:46):
So listeners, I mentioned that we did do a
whole show on dementia with Dr. Sheet's colleague in the
division of geriatric medicineat Hennepin Healthcare, who is
a researcher and an expert ondementia. That was with Dr.
Anne Murray. That was about ayear ago. So I encourage you to
go back to the archives andlisten to episode 16 of season
two. If you wanna seek a deeperconversation and understanding
of dementia back to you Dr.
(05:08):
Sheets . So when would someoneseek care? We're still on
dementia. When would someoneseek care? Is it when literally
they just can't get throughtheir daily lives and who would
they seek care from?
Speaker 3 (05:19):
Anytime you're worried about your memory, it's
a good thing to bring it upwith your primary care
provider, they can often dobrief memory tests or memory
screens in clinic that can giveus a sense of whether there's
problems. They can help youdetermine whether it's okay to
watch and wait right now orwhether it'd be good to see a
specialist to get more in-depthmemory testing.
Speaker 2 (05:38):
And lastly, before we move on from this mind
stuff, what's the latest inresearch on dementia? What's
out there? What's the hope ,uh, for the future? There's
Speaker 3 (05:46):
Been a lot of talk recently about therapeutics for
Alzheimer's disease. So there'snew medications that have come
out that are starting to treatthe underlying pathology of the
disease. So for example, takeamyloid out of the brain.
There's a lot of hope aroundthese and I am hoping that over
the coming years we'll have alot more treatments.
Speaker 2 (06:03):
Yeah, I do too, because it is such a common ,
uh, diagnosis and frankly, oneof the things that is I think
still on the rise, isn't it?
Speaker 3 (06:12):
It really depends on what data you look at. So in
high income countries, someestimates suggest that dementia
is becoming less common. And abig part of that is probably
that we're treating things likehigh blood pressure and
diabetes or high blood sugar,which are big risk factors for
dementia. We also have a lot ofolder adults who have a lot of
years of education and that'sreally protective for cognitive
(06:32):
decline. Yeah,
Speaker 2 (06:33):
That makes some sense, doesn't it? Okay, let's
switch gears if we could. Let'stalk about another one of your
ams and it was mobility. Whatare some of the challenges in
mobility that come with aging?
Speaker 3 (06:43):
Challenges with mobility are really common. As
we get older, they can rangefrom starting to walk a little
bit more slowly and maybe havetrouble with balance all the
way to needing to use anassistive device. So something
like a cane walker, awheelchair to help get around.
There's a lot of differentcauses and mobility issues, but
I do wanna say it's somethingthat we can intervene on and
treat. So it's a great thing totalk with your healthcare
(07:05):
provider about.
Speaker 2 (07:05):
Yeah, you mentioned walkers and wheelchairs and
canes and all that. I, youknow, in my internal medicine
practice, I do tell patientsthat, especially at a certain
age , uh, one of the things Iworry most about is the
complications of a pretty badfall. A hip fracture is a big
deal and in fact it can cause anumber of complications. It can
be exceptionally dangerous forpeople because you do lose your
(07:26):
mobility then lots of thingshappen. You don't wanna get a
hip fracture. What advice wouldyou give people if they're
starting to notice in their ownhomes that they're struggling a
little bit with mobility, maybethey're a little wobbly on
their feet or getting in on andoff the toilet is hard or
anything like that. What tipswould you give people on
mobility? So
Speaker 3 (07:44):
The first thing is to think about your home
environment and see if you canmake it as safe as possible. So
this can be removing triphazards like cords or rugs that
are rolling up. It's also goodto talk with your healthcare
provider about it. Physicaltherapy is really effective at
helping you maintain strengthand balance as you're getting
older. There's also a lot ofresources online where you can
(08:05):
learn about balance exercises.
We know that balance naturallydeclines as we get older and we
can counteract that withpracticing balance.
Speaker 2 (08:12):
What do you tell your patients who are reluctant
to use things like a cane or todo these things at home?
Because, you know, I've livedhere for my whole life, it's
fine. I know what I'm doing andI'm not walking around with a
cane or I'm not doing this, youknow, I don't know. People have
a fierce sense of wanting to beindependent and and vibrant.
What do you tell them?
Speaker 3 (08:32):
Yeah , I would say first you're not alone. That
for many older adults,transitioning to using like a
cane or a walker is a reallybig adjustment. What we talk
about is that these are toolsthat can help you stay in your
home longer and help you do thethings you want to do for
longer. So even though using acane or walker might not be
something that you're hoping touse, it really can be a way to
maintain independence in otherareas.
Speaker 2 (08:53):
Another one that I know is hard for many adults is
driving. What do you tellpeople about when is it time to
consider other ways of gettingaround? Because it's a massive
deal with remainingindependent.
Speaker 3 (09:06):
It really is. Um, I think we most commonly talk
about driving in the context ofdementia and thinking about
when it's time to, to put thekeys away. Occupational
therapists can do drivingassessments to help give you a
sense of how safe or not youare on the road. I also
encourage patients to reallylisten to friends and family.
They often have a good sense ofhow, how things are going on
(09:26):
the road. And if they're askingyou to, to stop driving or to
limit driving, it can meangreat opportunity to ask for
help as well. You know, to saythat , say, this is something
I'm willing to do, but I'mreally gonna need to help
getting places that I want togo.
Speaker 2 (09:39):
Yeah. Great tip.
Speaker 3 (09:40):
Okay. I'd like
Speaker 2 (09:41):
To circle back, Carrie , about what you, you,
you led off at the beginningwhen I was talking about what
does a geriatrician do and Ithink it's sort of the third m
this multi complexity. What doyou mean by that?
Speaker 3 (09:51):
That means that as we get older, often older
adults have two or more chronicconditions. In fact, over half
of older adults in the UnitedStates are living with two or
more chronic conditions. Andthat can mean more medications,
more doctor's appointments,more need for monitoring. And
so really adds this complexityaround medical treatment and
it's something we like to thinkabout and make sure that we're
orienting care around whatmatters most to each patient.
Speaker 2 (10:14):
Yeah, that makes sense. Could you, could you
also touch about on mentalhealth, because you talked
about chronic conditions and Ithink a lot of people think,
yeah , I got heart disease, Ihave high blood pressure, I
have this, that, or the otherthing. But what about the, the
intersection of mood andisolation and and things like
that? Not all older adults areisolated and not, you know,
many are active and vibrant,but it is a risk, isn't it? For
(10:37):
some people
Speaker 3 (10:37):
It is a risk. We know that feeling lonely or
being socially isolated is arisk factor for some medical
conditions. It can be reallyhard if someone has lost a lot
of friends and family torecreate that sense of
connection. We'll talk a littlebit later about resources and I
think the good news is thereare ways to maintain and build
new social connections. Andthat will help not only with
your mental health, but alsowith the management of the
(10:59):
chronic conditions.
Speaker 2 (11:00):
We are going to take a short break. We are talking
with Dr. Kerry Sheets , who isan internal medicine physician
and a specialist in geriatrics.
So she's a geriatrician. Andwhen we come back from the
break, we'll cover the last twoof the m's , which is
medication and making plans.
And we'll give some practicaltips for caregivers of aging
adults, including how importantplanning is as your parents or
loved ones start getting upthere a little bit in years. So
(11:23):
please stay with us and we willbe right back
Speaker 4 (11:28):
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(11:50):
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Speaker 2 (12:06):
And we're back talking with Dr. Carrie Sheets
. She's a geriatrician and aspecialist in the care and the
study of the conditions ofolder adults. I did have
mentioned that earlier, butyou're a massive researcher and
maybe I can ask you just onesentence about that a little
bit later. Let's get to thefourth of the five MSS you were
talking about and that wasmedications.
Speaker 3 (12:24):
We think about medications in older adults
because the more medicationssomeone is on, the greater risk
there is of side effects and ofinteractions between the
medications. We also thinkabout them because as we get
older, the way that our bodyprocesses and responds to
medications changes and somedications that might have
been well tolerated and safewhen you're 40 might have a
different effect on you whenyou're 70. So we like to
(12:46):
identify those and minimize thenumber of medications and
minimize the potential for sideeffects.
Speaker 2 (12:51):
How much of that do you think is our healthcare
system that has a tendency toprescribe a lot of medications?
Uh , um, guilty. I'm , I'm partof that system. We all are, but
it's, we're not quite as goodat stopping medications . So I
have patients all the time,they landed in the hospital for
pneumonia and they came out onthree more medications than
they went in with. And whilenobody told me to stop 'em, I'm
(13:14):
just still taking them. What doyou think about that? What
should people do when they areat their doctor's , uh, visit
about their medications?
Because sometimes, I gotta behonest, I forget to look, oh ,
you're on these 22 medicationsand maybe shouldn't be.
Speaker 3 (13:27):
You can ask your doctor to do a medication
review or refer you to see apharmacist to do a thorough
medication review. It takessome time, but for most
patients we can remove at leasta couple medications. The other
thing I would say , if you'renoticing that you're taking
medications a lot of times aday and it's just starting to
make other activitiesdifficult, that's another great
thing to bring up with yourhealthcare providers so that
(13:48):
you can look at ways forsimplifying the regimen.
Speaker 2 (13:50):
You know, and there's all kinds of aids to
help us with medications.
There's clock wheels andthere's electronic ones. I know
, uh, somebody who uses anelectronic one that talks to
them when it's time to taketheir medicines. Those are
incredibly helpful aids pillboxes and things for some
folks. But it is alsoindicative of the fact that
(14:10):
people are on a lot of meds.
Speaker 3 (14:12):
It is , and I will say we do encourage patients to
use pill boxes. It's not alwayseveryone's favorite tool, but
it really can be a way toreduce the risk of a medication
error. And especially if you'reon a lot of medications, we
just wanna make sure that we'rekeeping you safe.
Speaker 2 (14:26):
Yeah. I I am a massive proponent of using pill
boxes of some kind. Most peoplecan't take one medication
correctly. It is not easy totake . If you have a single
antibiotic for an earache andyour doctor tells you to take
this thing two or three times aday for 10 days, most people
will miss a dose. It's noteasy. So could you, before we
get off of medications, I'm,I'm kind of intrigued by this.
(14:47):
What, do you have a favoritetype of pill box ? Is it just,
is it the kind that are in a, acircle or is it, does it make
any difference? Just go buyone?
Speaker 3 (14:54):
It doesn't make any difference. My favorite pill
box is the one that works for apatient. So , so pick one you
like and that you think you'lluse and that's gonna be the
best for you. And
Speaker 2 (15:01):
Then you just load it up at the beginning of the
week. Yep .
Speaker 3 (15:03):
Load it up at the beginning of the week. If
you're having a little bit oftrouble with your memory and
thinking, have a family memberor friend double check it just
to make sure that everything'sin the right place.
Speaker 2 (15:12):
Yeah. Really good tips, Gary , about medications
. Some of them are so importantand, and so I don't wanna
minimize the importance. Someof your medications are
critically important, so I'mnot suggesting that people just
start stopping them, but it isgood to make sure that you know
what you're taking and thatyou're taking them correctly
and that you need them all.
Let's talk about the fifth m,which is matters most. And I
(15:33):
want to , I wanna focus on thata little bit 'cause I, I think
it is so important, and it'ssomething that maybe is the
hardest. One of all of thesethings is to focus on what
matters to you. Could you,could you help us out with
that? Yeah. It's
Speaker 3 (15:42):
Something we talk a lot about in geriatrics because
when we're thinking about mindmobility, multi complexity and
medications, we really wannacenter the care plan and what
matters most to an older adultand their family. So for
example, if getting to the hairsalon every week is important
to you, or if minimizing thenumber of medications is
important to you, that'ssomething we wanna focus on.
And make sure that thetreatment plan is focused on
(16:04):
you accomplishing those goals.
Speaker 2 (16:05):
So who starts that conversation?
Speaker 3 (16:08):
You can start it with your doctor or oftentimes
your doctor is gonna start thatconversation with you. You can
also talk about it with othermembers of the care team. So if
you're in connected with asocial worker with a nurse,
that can be another good ,great place to talk about your
goals.
Speaker 2 (16:21):
What about goals for later in life? What about your
advanced plans for how you wantyour last years and time to be?
Speaker 3 (16:30):
We encourage patients and families to talk
about plans early and talkabout them often. It's always
great if you can talk aboutwhat you want and what you're
hoping for while you're able tohave those conversations. And
it can also help your family inthe future because it can give
them certainty that whatthey're doing is consistent
with what you would want. Thereare a lot of great tools online
(16:51):
that can help you have theseconversations. Some of them are
five wishes, honoring choicesor the National Institute on
Aging also has some greatresources.
Speaker 2 (16:59):
These are all online on websites?
Speaker 3 (17:01):
Online On websites, yeah . So
Speaker 2 (17:03):
We will put a link listeners, we will put a link
on the show notes to thesewebsites. And these are just
websites that you go that kindof talks you through these,
these tough conversations and
Speaker 3 (17:12):
They have documents you can download that can give
you a framework for how tostart the conversation and what
sort of things to talk about.
Speaker 2 (17:19):
What do you recommend to people about what
they used to call living willsthen were advanced directives
and then healthcare power ofattorneys. There's a whole
bunch of mumbo jumble words.
What is the most importantthing for people to have done
in order to have the bestchance of getting the end of
their life be according totheir wishes?
Speaker 3 (17:39):
We talk a lot with patients about assigning
someone to make decisions foryou if you're not able to.
There are a lot of parts ofadvanced directives are living
wills, but that's oftenconsidered the most important
piece. And then once you'veidentify that individual, if
possible, have a conversationwith them about what you want,
that will really help them makethose decisions if they are
ever, if they ever need to makethose.
Speaker 2 (18:00):
So I have that happen to me all the time. I
mean, not in my personal life,but in the hospital or in
something and, and there's a ,I designated my daughter to be
my power of attorney, myhealthcare decision maker and
daughter says, mom wouldn'twant this, so we're not gonna
pursue this course. Then longlost brother from Sacramento
shows up and says, wow , no, Iwant to do that. How, how do
(18:24):
you recommend we approach that?
I mean, or family membersapproach that? Do you just, do
you , do you make sure all yourkids have a conversation or, or
is it all just up to oneperson? What do you think?
Yeah,
Speaker 3 (18:35):
That's a good question and I think it will
depend a little bit oneveryone's family and sort of
the dynamics in that family.
Writing down your wishes canreally help with that. You
know, if there's a documentthat everyone can see that can
help if there's any conflict atthe time, decisions need to be
made. I will say we don't seethis very often, but if you
have a family member you don'twant involved in the decisions,
(18:56):
you can also state that.
Speaker 2 (18:57):
Yeah, boy , I never thought of that. Just straight
up say no , you know, Joey fromSacramento doesn't get to be a
part of it. I guess that thatmakes , um, some, some sense. I
wanna ask you about whendecisions need to get made that
are so difficult for an olderadult who's still cognitively
intact and making decisions.
(19:18):
But for instance, livingsituations, families are all
the time talking about, well,maybe it's time for mom to move
to an assisted living, or maybeit's time to for dad to go to
the nursing home, this, that,or the other thing, and mom or
dad don't wanna do that. How dowe avoid an unsafe living
situation? But at the sametime, honoring the integrity of
(19:39):
elders. People don't, you know,I think sometimes we start to
talk to our older adults likethey're five again, no, these
are elders deserving of respectand they have their own agency
and yet hard decisions have tobe made.
Speaker 3 (19:51):
It can be, it can be really challenging for a lot of
families. So let's say ifthis's something you're
currently going through, you'renot alone. There is a range of
care available and sometimesthat can be helpful. So it
ranges from in-home care with,from someone like a personal
care assistant or a home healthaide all the way to a skilled
nursing facility or a nursinghome where someone's gonna be
getting help with daily taskssuch as dressing, bathing, and
(20:13):
eating. In terms of talkingwith a loved one about it being
time to make a transition. Itcan be a great time to talk
about what matters most. Andoften when someone moves to a
place like an assisted livingfacility, getting help with
things like meals and maybemedication management actually
makes them more independent inother areas of their lives . So
I like to talk about thebenefits and how sometimes
(20:36):
getting help with a coupleparts of life can really help
you focus on the things thatare important to you.
Speaker 2 (20:41):
I'm gonna shift just for a minute about the current
state of academics ingeriatrics. I happen to know
that Dr. Sheets is a , aresearcher in, in the care of
older adults and in the scienceof aging. What are you working
on?
Speaker 3 (20:55):
Yeah, I, right now I'm really interested in the
concept of healthy lifespan,which is thinking about not how
we can help people live longer,but how we can help them stay
healthy and independent forlonger. And really thinking
about , um, promotingindependence later in life.
Speaker 2 (21:11):
So, so important.
That is really cool that thatis being done. The science of
geriatrics is being advanced atHennepin Healthcare where both
Dr . Sheets and I work and hasbeen for decades. We train
geriatricians 25 years of afellowship in geriatrics that
we've doing here. We haveinternationally known
researchers such as Dr. Murray,who was on that episode in
season two, episode 16 aboutdementia. We have active
(21:35):
researchers like Dr. Sheetsright here at Hennepin
Healthcare , who are providingwhat I would call some of the
best quality care for olderadults. In summary, we had five
areas to think about in aging.
What were they
Speaker 3 (21:48):
Remind mobility, multi complexity, medications
and matters most
Speaker 2 (21:53):
Really great framework for the care of older
adults. So before I let you go,Carrie , what would you leave
with our listeners? If you, ifyou could leave , uh, a thought
with, with people listeningtoday, what would that be?
Speaker 3 (22:04):
I would be to think about what matters most to your
loved one and your family andreally try to center care
around that.
Speaker 2 (22:10):
Dr. Sheets , thanks for being with us on the
podcast today. Thanks
Speaker 3 (22:13):
For having me. It's
Speaker 2 (22:13):
Great to have you as a colleague here and I really
appreciate your expertise andcare of older adults.
Listeners, many of us will haveto deal with aging parents
eventually, as I'm sure some ofyou out there already are. So I
hope you found today's episodeboth interesting and helpful.
Please realize you don't haveto navigate this issue alone.
There are plenty ofprofessionals and resources to
help you along the way. Thanksfor listening and be sure to
(22:35):
join us again in two weeks timefor another great episode. And
in the meantime, be healthy andbe well.
Speaker 1 (22:43):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(23:05):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember , we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(23:27):
time, be healthy and be well.
Welcome to the Healthy Matters podcast with
Dr. David Hilton , primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you. And nowhere's our host, Dr. David
Hilton .
Speaker 2 (00:18):
Hey everybody, it's Dr. David Hilton , and welcome
to season four. This is thefirst episode of the New
Season, and I am joined by Dr.
Carrie Sheets . We are gonnatalk today about navigating
health challenges later in lifeor caring for older adults. Dr
. Sheets is a geriatrician,which means she's a doctor for
older adults, and we're gonnatalk about things like healthy
(00:40):
aging, caring for older adults,things like dementia. We're
gonna cover all of that. SoCarrie , thanks for being on
the show.
Speaker 3 (00:45):
Thanks for having me. It's
Speaker 2 (00:47):
Great to have you here. You're a geriatrician. I
know what that is, but tellothers if you could, what does
a geriatrician see? What arethe common things that you do
in your practice? Yeah,
Speaker 3 (00:55):
So as a geriatrician we focus on care of older
adults. We see a variety ofchronic conditions, things like
hypertension, diabetes, chronickidney disease, heart disease,
and dementia. I will say thatage is the biggest risk factor
for a whole lot of chronicconditions. We often see more
than one chronic condition aswell. So
Speaker 2 (01:13):
We often talk about age being a risk factor for
things happening, but when is acondition considered normal
part of aging versus when it'ssomething you have to do
something about, for instance,forgetfulness or , uh, muscle
aches and pains. Is that normalor is that something that needs
to be fixed?
Speaker 3 (01:32):
That's a good question. I think the answer is
somewhere in between. We talk alot with patients about what
matters most to them and whatthey're hoping to do in daily
life, and we use that to guidewhat we treat and what we maybe
watch and just see if it getsworse. So for example, if you
have knee pain and you'rehaving trouble walking and it's
starting to make it hard foryou to do what you need to do
(01:53):
around the house, that would bea time that we would start to
talk about treating the kneepain. We might do things like
physical therapy andstrengthening or talk about
medications that can helpalleviate the pain. So
Speaker 2 (02:03):
I would imagine that many people listening are older
adults themselves or are caringfor an older adult and they're
wondering, well, I don't have ageriatrician. You know, when
does somebody see you?
Speaker 3 (02:14):
We often talk about geriatric care as focusing on
the five mss . So these aremind, which is mood or memory
and thinking changes, mobility.
So starting to have difficultygetting around multi
complexity. So that's whensomeone has multiple chronic
conditions at the same time,medications, sometimes we see
that older adults are taking alot of medications or that they
(02:35):
have to take medications acouple times a day and then
matters most. So reallythinking about what's most
important to an older adult.
Speaker 2 (02:42):
Okay, that's awesome. The five m's , I don't
know,
heard the five M's , could yourattle those off
Speaker 3 (02:48):
Again? Yeah, it's mind mobility, multi
complexity, medications andmatters most.
Speaker 2 (02:54):
Yeah, that's really helpful to kind of put it into
that framework. So let's dothis then. If we could, I want
to start out with the top one.
Let's talk a little bit aboutwhat are some of the things
that happen to people as theyage with their mind? Well
Speaker 3 (03:08):
That's, so there are normal brain changes that
happen with aging. For example,as you're getting older, you
might notice that you'rethinking is a little bit slower
or it takes a little bit longerto think through problems. Or
you might have more troubleremembering names of someone
that you just met, things thatare a little worrisome and that
you'd wanna talk with yourhealthcare provider about. Or
if you're starting to get lostwhile you're driving, if you're
(03:31):
having trouble talking, thatyou're having so much trouble
finding words, that it's makingit hard to have conversations.
Or if you're starting to havedifficulty with tasks that you
used to be able to do thingslike managing finances or
cooking.
Speaker 2 (03:42):
So I think a lot of people of every age have some
difficulties with memories.
Well , how do you know ifthat's problematic? Because ,
because they always do say thatlosing your , uh, cognitive
function isn't normal, butthere are , it is kind of
common to be forgetful, isn'tit?
Speaker 3 (03:57):
It's common to be forgetful and it's really we're
all forgetful, especially ifwe've had a poor night's sleep
or if we're under a lot ofstress. It's the type of
forgetfulness that's startingto make it difficult to do
daily tasks. So for example, ifyou're forgetting to pay bills
that you never forgot to paybefore or if you go to the
grocery store and really can'tremember what you're supposed
to buy, it's that type offorgetfulness that makes it
(04:18):
hard to function where we startto worry.
Speaker 2 (04:20):
So I know this isn't a show about dementia. Um, uh,
listeners, we did do a showabout dementia and uh , I'll
tell you a little bit moreabout that, but I want to touch
on that since we're on thismind section. What is dementia?
Speaker 3 (04:32):
Dementia is an often progressive condition where
someone has so much troublewith memory and thinking that
it starts to interfere withdaily tasks. There's a lot of
different causes of dementia.
The most common cause, and theone that most people are
familiar with is Alzheimer'sdisease.
Speaker 2 (04:46):
So listeners, I mentioned that we did do a
whole show on dementia with Dr. Sheet's colleague in the
division of geriatric medicineat Hennepin Healthcare, who is
a researcher and an expert ondementia. That was with Dr.
Anne Murray. That was about ayear ago. So I encourage you to
go back to the archives andlisten to episode 16 of season
two. If you wanna seek a deeperconversation and understanding
of dementia back to you Dr.
(05:08):
Sheets . So when would someoneseek care? We're still on
dementia. When would someoneseek care? Is it when literally
they just can't get throughtheir daily lives and who would
they seek care from?
Speaker 3 (05:19):
Anytime you're worried about your memory, it's
a good thing to bring it upwith your primary care
provider, they can often dobrief memory tests or memory
screens in clinic that can giveus a sense of whether there's
problems. They can help youdetermine whether it's okay to
watch and wait right now orwhether it'd be good to see a
specialist to get more in-depthmemory testing.
Speaker 2 (05:38):
And lastly, before we move on from this mind
stuff, what's the latest inresearch on dementia? What's
out there? What's the hope ,uh, for the future? There's
Speaker 3 (05:46):
Been a lot of talk recently about therapeutics for
Alzheimer's disease. So there'snew medications that have come
out that are starting to treatthe underlying pathology of the
disease. So for example, takeamyloid out of the brain.
There's a lot of hope aroundthese and I am hoping that over
the coming years we'll have alot more treatments.
Speaker 2 (06:03):
Yeah, I do too, because it is such a common ,
uh, diagnosis and frankly, oneof the things that is I think
still on the rise, isn't it?
Speaker 3 (06:12):
It really depends on what data you look at. So in
high income countries, someestimates suggest that dementia
is becoming less common. And abig part of that is probably
that we're treating things likehigh blood pressure and
diabetes or high blood sugar,which are big risk factors for
dementia. We also have a lot ofolder adults who have a lot of
years of education and that'sreally protective for cognitive
(06:32):
decline. Yeah,
Speaker 2 (06:33):
That makes some sense, doesn't it? Okay, let's
switch gears if we could. Let'stalk about another one of your
ams and it was mobility. Whatare some of the challenges in
mobility that come with aging?
Speaker 3 (06:43):
Challenges with mobility are really common. As
we get older, they can rangefrom starting to walk a little
bit more slowly and maybe havetrouble with balance all the
way to needing to use anassistive device. So something
like a cane walker, awheelchair to help get around.
There's a lot of differentcauses and mobility issues, but
I do wanna say it's somethingthat we can intervene on and
treat. So it's a great thing totalk with your healthcare
(07:05):
provider about.
Speaker 2 (07:05):
Yeah, you mentioned walkers and wheelchairs and
canes and all that. I, youknow, in my internal medicine
practice, I do tell patientsthat, especially at a certain
age , uh, one of the things Iworry most about is the
complications of a pretty badfall. A hip fracture is a big
deal and in fact it can cause anumber of complications. It can
be exceptionally dangerous forpeople because you do lose your
(07:26):
mobility then lots of thingshappen. You don't wanna get a
hip fracture. What advice wouldyou give people if they're
starting to notice in their ownhomes that they're struggling a
little bit with mobility, maybethey're a little wobbly on
their feet or getting in on andoff the toilet is hard or
anything like that. What tipswould you give people on
mobility? So
Speaker 3 (07:44):
The first thing is to think about your home
environment and see if you canmake it as safe as possible. So
this can be removing triphazards like cords or rugs that
are rolling up. It's also goodto talk with your healthcare
provider about it. Physicaltherapy is really effective at
helping you maintain strengthand balance as you're getting
older. There's also a lot ofresources online where you can
(08:05):
learn about balance exercises.
We know that balance naturallydeclines as we get older and we
can counteract that withpracticing balance.
Speaker 2 (08:12):
What do you tell your patients who are reluctant
to use things like a cane or todo these things at home?
Because, you know, I've livedhere for my whole life, it's
fine. I know what I'm doing andI'm not walking around with a
cane or I'm not doing this, youknow, I don't know. People have
a fierce sense of wanting to beindependent and and vibrant.
What do you tell them?
Speaker 3 (08:32):
Yeah , I would say first you're not alone. That
for many older adults,transitioning to using like a
cane or a walker is a reallybig adjustment. What we talk
about is that these are toolsthat can help you stay in your
home longer and help you do thethings you want to do for
longer. So even though using acane or walker might not be
something that you're hoping touse, it really can be a way to
maintain independence in otherareas.
Speaker 2 (08:53):
Another one that I know is hard for many adults is
driving. What do you tellpeople about when is it time to
consider other ways of gettingaround? Because it's a massive
deal with remainingindependent.
Speaker 3 (09:06):
It really is. Um, I think we most commonly talk
about driving in the context ofdementia and thinking about
when it's time to, to put thekeys away. Occupational
therapists can do drivingassessments to help give you a
sense of how safe or not youare on the road. I also
encourage patients to reallylisten to friends and family.
They often have a good sense ofhow, how things are going on
(09:26):
the road. And if they're askingyou to, to stop driving or to
limit driving, it can meangreat opportunity to ask for
help as well. You know, to saythat , say, this is something
I'm willing to do, but I'mreally gonna need to help
getting places that I want togo.
Speaker 2 (09:39):
Yeah. Great tip.
Speaker 3 (09:40):
Okay. I'd like
Speaker 2 (09:41):
To circle back, Carrie , about what you, you,
you led off at the beginningwhen I was talking about what
does a geriatrician do and Ithink it's sort of the third m
this multi complexity. What doyou mean by that?
Speaker 3 (09:51):
That means that as we get older, often older
adults have two or more chronicconditions. In fact, over half
of older adults in the UnitedStates are living with two or
more chronic conditions. Andthat can mean more medications,
more doctor's appointments,more need for monitoring. And
so really adds this complexityaround medical treatment and
it's something we like to thinkabout and make sure that we're
orienting care around whatmatters most to each patient.
Speaker 2 (10:14):
Yeah, that makes sense. Could you, could you
also touch about on mentalhealth, because you talked
about chronic conditions and Ithink a lot of people think,
yeah , I got heart disease, Ihave high blood pressure, I
have this, that, or the otherthing. But what about the, the
intersection of mood andisolation and and things like
that? Not all older adults areisolated and not, you know,
many are active and vibrant,but it is a risk, isn't it? For
(10:37):
some people
Speaker 3 (10:37):
It is a risk. We know that feeling lonely or
being socially isolated is arisk factor for some medical
conditions. It can be reallyhard if someone has lost a lot
of friends and family torecreate that sense of
connection. We'll talk a littlebit later about resources and I
think the good news is thereare ways to maintain and build
new social connections. Andthat will help not only with
your mental health, but alsowith the management of the
(10:59):
chronic conditions.
Speaker 2 (11:00):
We are going to take a short break. We are talking
with Dr. Kerry Sheets , who isan internal medicine physician
and a specialist in geriatrics.
So she's a geriatrician. Andwhen we come back from the
break, we'll cover the last twoof the m's , which is
medication and making plans.
And we'll give some practicaltips for caregivers of aging
adults, including how importantplanning is as your parents or
loved ones start getting upthere a little bit in years. So
(11:23):
please stay with us and we willbe right back
Speaker 4 (11:28):
When Hennepin Healthcare says we are here for
life. They mean here for you,your life, and all that it
brings. Hennepin Healthcare hasa hospital, HCMC and a network
of clinics both downtown andacross the west metro. They
provide all the primary careand specialty care you would
expect to find, but did youknow they also have services
like acupuncture andchiropractic care available at
(11:50):
many of their primary careclinics and at their
integrative health clinic indowntown Minneapolis. Learn
more@hennepinhealthcare.org.
Hennepin Healthcare is here foryou and here for life.
Speaker 2 (12:06):
And we're back talking with Dr. Carrie Sheets
. She's a geriatrician and aspecialist in the care and the
study of the conditions ofolder adults. I did have
mentioned that earlier, butyou're a massive researcher and
maybe I can ask you just onesentence about that a little
bit later. Let's get to thefourth of the five MSS you were
talking about and that wasmedications.
Speaker 3 (12:24):
We think about medications in older adults
because the more medicationssomeone is on, the greater risk
there is of side effects and ofinteractions between the
medications. We also thinkabout them because as we get
older, the way that our bodyprocesses and responds to
medications changes and somedications that might have
been well tolerated and safewhen you're 40 might have a
different effect on you whenyou're 70. So we like to
(12:46):
identify those and minimize thenumber of medications and
minimize the potential for sideeffects.
Speaker 2 (12:51):
How much of that do you think is our healthcare
system that has a tendency toprescribe a lot of medications?
Uh , um, guilty. I'm , I'm partof that system. We all are, but
it's, we're not quite as goodat stopping medications . So I
have patients all the time,they landed in the hospital for
pneumonia and they came out onthree more medications than
they went in with. And whilenobody told me to stop 'em, I'm
(13:14):
just still taking them. What doyou think about that? What
should people do when they areat their doctor's , uh, visit
about their medications?
Because sometimes, I gotta behonest, I forget to look, oh ,
you're on these 22 medicationsand maybe shouldn't be.
Speaker 3 (13:27):
You can ask your doctor to do a medication
review or refer you to see apharmacist to do a thorough
medication review. It takessome time, but for most
patients we can remove at leasta couple medications. The other
thing I would say , if you'renoticing that you're taking
medications a lot of times aday and it's just starting to
make other activitiesdifficult, that's another great
thing to bring up with yourhealthcare providers so that
(13:48):
you can look at ways forsimplifying the regimen.
Speaker 2 (13:50):
You know, and there's all kinds of aids to
help us with medications.
There's clock wheels andthere's electronic ones. I know
, uh, somebody who uses anelectronic one that talks to
them when it's time to taketheir medicines. Those are
incredibly helpful aids pillboxes and things for some
folks. But it is alsoindicative of the fact that
(14:10):
people are on a lot of meds.
Speaker 3 (14:12):
It is , and I will say we do encourage patients to
use pill boxes. It's not alwayseveryone's favorite tool, but
it really can be a way toreduce the risk of a medication
error. And especially if you'reon a lot of medications, we
just wanna make sure that we'rekeeping you safe.
Speaker 2 (14:26):
Yeah. I I am a massive proponent of using pill
boxes of some kind. Most peoplecan't take one medication
correctly. It is not easy totake . If you have a single
antibiotic for an earache andyour doctor tells you to take
this thing two or three times aday for 10 days, most people
will miss a dose. It's noteasy. So could you, before we
get off of medications, I'm,I'm kind of intrigued by this.
(14:47):
What, do you have a favoritetype of pill box ? Is it just,
is it the kind that are in a, acircle or is it, does it make
any difference? Just go buyone?
Speaker 3 (14:54):
It doesn't make any difference. My favorite pill
box is the one that works for apatient. So , so pick one you
like and that you think you'lluse and that's gonna be the
best for you. And
Speaker 2 (15:01):
Then you just load it up at the beginning of the
week. Yep .
Speaker 3 (15:03):
Load it up at the beginning of the week. If
you're having a little bit oftrouble with your memory and
thinking, have a family memberor friend double check it just
to make sure that everything'sin the right place.
Speaker 2 (15:12):
Yeah. Really good tips, Gary , about medications
. Some of them are so importantand, and so I don't wanna
minimize the importance. Someof your medications are
critically important, so I'mnot suggesting that people just
start stopping them, but it isgood to make sure that you know
what you're taking and thatyou're taking them correctly
and that you need them all.
Let's talk about the fifth m,which is matters most. And I
(15:33):
want to , I wanna focus on thata little bit 'cause I, I think
it is so important, and it'ssomething that maybe is the
hardest. One of all of thesethings is to focus on what
matters to you. Could you,could you help us out with
that? Yeah. It's
Speaker 3 (15:42):
Something we talk a lot about in geriatrics because
when we're thinking about mindmobility, multi complexity and
medications, we really wannacenter the care plan and what
matters most to an older adultand their family. So for
example, if getting to the hairsalon every week is important
to you, or if minimizing thenumber of medications is
important to you, that'ssomething we wanna focus on.
And make sure that thetreatment plan is focused on
(16:04):
you accomplishing those goals.
Speaker 2 (16:05):
So who starts that conversation?
Speaker 3 (16:08):
You can start it with your doctor or oftentimes
your doctor is gonna start thatconversation with you. You can
also talk about it with othermembers of the care team. So if
you're in connected with asocial worker with a nurse,
that can be another good ,great place to talk about your
goals.
Speaker 2 (16:21):
What about goals for later in life? What about your
advanced plans for how you wantyour last years and time to be?
Speaker 3 (16:30):
We encourage patients and families to talk
about plans early and talkabout them often. It's always
great if you can talk aboutwhat you want and what you're
hoping for while you're able tohave those conversations. And
it can also help your family inthe future because it can give
them certainty that whatthey're doing is consistent
with what you would want. Thereare a lot of great tools online
(16:51):
that can help you have theseconversations. Some of them are
five wishes, honoring choicesor the National Institute on
Aging also has some greatresources.
Speaker 2 (16:59):
These are all online on websites?
Speaker 3 (17:01):
Online On websites, yeah . So
Speaker 2 (17:03):
We will put a link listeners, we will put a link
on the show notes to thesewebsites. And these are just
websites that you go that kindof talks you through these,
these tough conversations and
Speaker 3 (17:12):
They have documents you can download that can give
you a framework for how tostart the conversation and what
sort of things to talk about.
Speaker 2 (17:19):
What do you recommend to people about what
they used to call living willsthen were advanced directives
and then healthcare power ofattorneys. There's a whole
bunch of mumbo jumble words.
What is the most importantthing for people to have done
in order to have the bestchance of getting the end of
their life be according totheir wishes?
Speaker 3 (17:39):
We talk a lot with patients about assigning
someone to make decisions foryou if you're not able to.
There are a lot of parts ofadvanced directives are living
wills, but that's oftenconsidered the most important
piece. And then once you'veidentify that individual, if
possible, have a conversationwith them about what you want,
that will really help them makethose decisions if they are
ever, if they ever need to makethose.
Speaker 2 (18:00):
So I have that happen to me all the time. I
mean, not in my personal life,but in the hospital or in
something and, and there's a ,I designated my daughter to be
my power of attorney, myhealthcare decision maker and
daughter says, mom wouldn'twant this, so we're not gonna
pursue this course. Then longlost brother from Sacramento
shows up and says, wow , no, Iwant to do that. How, how do
(18:24):
you recommend we approach that?
I mean, or family membersapproach that? Do you just, do
you , do you make sure all yourkids have a conversation or, or
is it all just up to oneperson? What do you think?
Yeah,
Speaker 3 (18:35):
That's a good question and I think it will
depend a little bit oneveryone's family and sort of
the dynamics in that family.
Writing down your wishes canreally help with that. You
know, if there's a documentthat everyone can see that can
help if there's any conflict atthe time, decisions need to be
made. I will say we don't seethis very often, but if you
have a family member you don'twant involved in the decisions,
(18:56):
you can also state that.
Speaker 2 (18:57):
Yeah, boy , I never thought of that. Just straight
up say no , you know, Joey fromSacramento doesn't get to be a
part of it. I guess that thatmakes , um, some, some sense. I
wanna ask you about whendecisions need to get made that
are so difficult for an olderadult who's still cognitively
intact and making decisions.
(19:18):
But for instance, livingsituations, families are all
the time talking about, well,maybe it's time for mom to move
to an assisted living, or maybeit's time to for dad to go to
the nursing home, this, that,or the other thing, and mom or
dad don't wanna do that. How dowe avoid an unsafe living
situation? But at the sametime, honoring the integrity of
(19:39):
elders. People don't, you know,I think sometimes we start to
talk to our older adults likethey're five again, no, these
are elders deserving of respectand they have their own agency
and yet hard decisions have tobe made.
Speaker 3 (19:51):
It can be, it can be really challenging for a lot of
families. So let's say ifthis's something you're
currently going through, you'renot alone. There is a range of
care available and sometimesthat can be helpful. So it
ranges from in-home care with,from someone like a personal
care assistant or a home healthaide all the way to a skilled
nursing facility or a nursinghome where someone's gonna be
getting help with daily taskssuch as dressing, bathing, and
(20:13):
eating. In terms of talkingwith a loved one about it being
time to make a transition. Itcan be a great time to talk
about what matters most. Andoften when someone moves to a
place like an assisted livingfacility, getting help with
things like meals and maybemedication management actually
makes them more independent inother areas of their lives . So
I like to talk about thebenefits and how sometimes
(20:36):
getting help with a coupleparts of life can really help
you focus on the things thatare important to you.
Speaker 2 (20:41):
I'm gonna shift just for a minute about the current
state of academics ingeriatrics. I happen to know
that Dr. Sheets is a , aresearcher in, in the care of
older adults and in the scienceof aging. What are you working
on?
Speaker 3 (20:55):
Yeah, I, right now I'm really interested in the
concept of healthy lifespan,which is thinking about not how
we can help people live longer,but how we can help them stay
healthy and independent forlonger. And really thinking
about , um, promotingindependence later in life.
Speaker 2 (21:11):
So, so important.
That is really cool that thatis being done. The science of
geriatrics is being advanced atHennepin Healthcare where both
Dr . Sheets and I work and hasbeen for decades. We train
geriatricians 25 years of afellowship in geriatrics that
we've doing here. We haveinternationally known
researchers such as Dr. Murray,who was on that episode in
season two, episode 16 aboutdementia. We have active
(21:35):
researchers like Dr. Sheetsright here at Hennepin
Healthcare , who are providingwhat I would call some of the
best quality care for olderadults. In summary, we had five
areas to think about in aging.
What were they
Speaker 3 (21:48):
Remind mobility, multi complexity, medications
and matters most
Speaker 2 (21:53):
Really great framework for the care of older
adults. So before I let you go,Carrie , what would you leave
with our listeners? If you, ifyou could leave , uh, a thought
with, with people listeningtoday, what would that be?
Speaker 3 (22:04):
I would be to think about what matters most to your
loved one and your family andreally try to center care
around that.
Speaker 2 (22:10):
Dr. Sheets , thanks for being with us on the
podcast today. Thanks
Speaker 3 (22:13):
For having me. It's
Speaker 2 (22:13):
Great to have you as a colleague here and I really
appreciate your expertise andcare of older adults.
Listeners, many of us will haveto deal with aging parents
eventually, as I'm sure some ofyou out there already are. So I
hope you found today's episodeboth interesting and helpful.
Please realize you don't haveto navigate this issue alone.
There are plenty ofprofessionals and resources to
help you along the way. Thanksfor listening and be sure to
(22:35):
join us again in two weeks timefor another great episode. And
in the meantime, be healthy andbe well.
Speaker 1 (22:43):
Thanks for listening to the Healthy Matters podcast
with Dr. David Hilden . To findout more about the Healthy
Matters podcast or browse thearchive, visit healthy
matters.org. Got a question ora comment for the show, email
us at Healthy matters@hcme.orgor call 6 1 2 8 7 3 talk.
There's also a link in the shownotes. The Healthy Matters
(23:05):
Podcast is made possible byHennepin Healthcare in
Minneapolis, Minnesota andengineered and produced by John
Lucas At Highball Executiveproducers are Jonathan, CTO and
Christine Hill . Pleaseremember , we can only give
general medical advice duringthis program, and every case is
unique. We urge you to consultwith your physician if you have
a more serious or pressinghealth concern. Until next
(23:27):
time, be healthy and be well.
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