Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilton , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health healthcare and what matters to you. And now here's our host, Dr. David Hilton .

Speaker 2: 0:18

Hey everybody, it's Dr. David Hilton , and welcome to season four. This is the first episode of the New Season, and I am joined by Dr. Carrie Sheets . We are gonna talk today about navigating health challenges later in life or caring for older adults. Dr . Sheets is a geriatrician, which means she's a doctor for older adults, and we're gonna talk about things like healthy aging, caring for older adults, things like dementia. We're gonna cover all of that. So Carrie , thanks for being on the show.

Speaker 3: 0:45

Thanks for having me. It's

Speaker 2: 0:47

Great to have you here. You're a geriatrician. I know what that is, but tell others if you could, what does a geriatrician see? What are the common things that you do in your practice? Yeah,

Speaker 3: 0:55

So as a geriatrician we focus on care of older adults. We see a variety of chronic conditions, things like hypertension, diabetes, chronic kidney disease, heart disease, and dementia. I will say that age is the biggest risk factor for a whole lot of chronic conditions. We often see more than one chronic condition as well. So

Speaker 2: 1:13

We often talk about age being a risk factor for things happening, but when is a condition considered normal part of aging versus when it's something you have to do something about, for instance, forgetfulness or , uh, muscle aches and pains. Is that normal or is that something that needs to be fixed?

Speaker 3: 1:32

That's a good question. I think the answer is somewhere in between. We talk a lot with patients about what matters most to them and what they're hoping to do in daily life, and we use that to guide what we treat and what we maybe watch and just see if it gets worse. So for example, if you have knee pain and you're having trouble walking and it's starting to make it hard for you to do what you need to do around the house, that would be a time that we would start to talk about treating the knee pain. We might do things like physical therapy and strengthening or talk about medications that can help alleviate the pain. So

Speaker 2: 2:03

I would imagine that many people listening are older adults themselves or are caring for an older adult and they're wondering, well, I don't have a geriatrician. You know, when does somebody see you?

Speaker 3: 2:14

We often talk about geriatric care as focusing on the five mss . So these are mind, which is mood or memory and thinking changes, mobility. So starting to have difficulty getting around multi complexity. So that's when someone has multiple chronic conditions at the same time, medications, sometimes we see that older adults are taking a lot of medications or that they have to take medications a couple times a day and then matters most. So really thinking about what's most important to an older adult.

Speaker 2: 2:42

Okay, that's awesome. The five m's , I don't know, <laugh> , you know, my years of practicing and I've heard the five M's , could you rattle those off

Speaker 3: 2:48

Again? Yeah, it's mind mobility, multi complexity, medications and matters most.

Speaker 2: 2:54

Yeah, that's really helpful to kind of put it into that framework. So let's do this then. If we could, I want to start out with the top one. Let's talk a little bit about what are some of the things that happen to people as they age with their mind? Well

Speaker 3: 3:08

That's, so there are normal brain changes that happen with aging. For example, as you're getting older, you might notice that you're thinking is a little bit slower or it takes a little bit longer to think through problems. Or you might have more trouble remembering names of someone that you just met, things that are a little worrisome and that you'd wanna talk with your healthcare provider about. Or if you're starting to get lost while you're driving, if you're having trouble talking, that you're having so much trouble finding words, that it's making it hard to have conversations. Or if you're starting to have difficulty with tasks that you used to be able to do things like managing finances or cooking.

Speaker 2: 3:42

So I think a lot of people of every age have some difficulties with memories. Well , how do you know if that's problematic? Because , because they always do say that losing your , uh, cognitive function isn't normal, but there are , it is kind of common to be forgetful, isn't it?

Speaker 3: 3:57

It's common to be forgetful and it's really we're all forgetful, especially if we've had a poor night's sleep or if we're under a lot of stress. It's the type of forgetfulness that's starting to make it difficult to do daily tasks. So for example, if you're forgetting to pay bills that you never forgot to pay before or if you go to the grocery store and really can't remember what you're supposed to buy, it's that type of forgetfulness that makes it hard to function where we start to worry.

Speaker 2: 4:20

So I know this isn't a show about dementia. Um, uh, listeners, we did do a show about dementia and uh , I'll tell you a little bit more about that, but I want to touch on that since we're on this mind section. What is dementia?

Speaker 3: 4:32

Dementia is an often progressive condition where someone has so much trouble with memory and thinking that it starts to interfere with daily tasks. There's a lot of different causes of dementia. The most common cause, and the one that most people are familiar with is Alzheimer's disease.

Speaker 2: 4:46

So listeners, I mentioned that we did do a whole show on dementia with Dr . Sheet's colleague in the division of geriatric medicine at Hennepin Healthcare, who is a researcher and an expert on dementia. That was with Dr. Anne Murray. That was about a year ago. So I encourage you to go back to the archives and listen to episode 16 of season two. If you wanna seek a deeper conversation and understanding of dementia back to you Dr. Sheets . So when would someone seek care? We're still on dementia. When would someone seek care? Is it when literally they just can't get through their daily lives and who would they seek care from?

Speaker 3: 5:19

Anytime you're worried about your memory, it's a good thing to bring it up with your primary care provider, they can often do brief memory tests or memory screens in clinic that can give us a sense of whether there's problems. They can help you determine whether it's okay to watch and wait right now or whether it'd be good to see a specialist to get more in-depth memory testing.

Speaker 2: 5:38

And lastly, before we move on from this mind stuff, what's the latest in research on dementia? What's out there? What's the hope , uh, for the future? There's

Speaker 3: 5:46

Been a lot of talk recently about therapeutics for Alzheimer's disease. So there's new medications that have come out that are starting to treat the underlying pathology of the disease. So for example, take amyloid out of the brain. There's a lot of hope around these and I am hoping that over the coming years we'll have a lot more treatments.

Speaker 2: 6:03

Yeah, I do too, because it is such a common , uh, diagnosis and frankly, one of the things that is I think still on the rise, isn't it?

Speaker 3: 6:12

It really depends on what data you look at. So in high income countries, some estimates suggest that dementia is becoming less common. And a big part of that is probably that we're treating things like high blood pressure and diabetes or high blood sugar, which are big risk factors for dementia. We also have a lot of older adults who have a lot of years of education and that's really protective for cognitive decline. Yeah,

Speaker 2: 6:33

That makes some sense, doesn't it? Okay, let's switch gears if we could. Let's talk about another one of your ams and it was mobility. What are some of the challenges in mobility that come with aging?

Speaker 3: 6:43

Challenges with mobility are really common. As we get older, they can range from starting to walk a little bit more slowly and maybe have trouble with balance all the way to needing to use an assistive device. So something like a cane walker, a wheelchair to help get around. There's a lot of different causes and mobility issues, but I do wanna say it's something that we can intervene on and treat. So it's a great thing to talk with your healthcare provider about.

Speaker 2: 7:05

Yeah, you mentioned walkers and wheelchairs and canes and all that. I, you know, in my internal medicine practice, I do tell patients that, especially at a certain age , uh, one of the things I worry most about is the complications of a pretty bad fall. A hip fracture is a big deal and in fact it can cause a number of complications. It can be exceptionally dangerous for people because you do lose your mobility then lots of things happen. You don't wanna get a hip fracture. What advice would you give people if they're starting to notice in their own homes that they're struggling a little bit with mobility, maybe they're a little wobbly on their feet or getting in on and off the toilet is hard or anything like that. What tips would you give people on mobility? So

Speaker 3: 7:44

The first thing is to think about your home environment and see if you can make it as safe as possible. So this can be removing trip hazards like cords or rugs that are rolling up. It's also good to talk with your healthcare provider about it. Physical therapy is really effective at helping you maintain strength and balance as you're getting older. There's also a lot of resources online where you can learn about balance exercises. We know that balance naturally declines as we get older and we can counteract that with practicing balance.

Speaker 2: 8:12

What do you tell your patients who are reluctant to use things like a cane or to do these things at home? Because, you know, I've lived here for my whole life, it's fine. I know what I'm doing and I'm not walking around with a cane or I'm not doing this, you know, I don't know. People have a fierce sense of wanting to be independent and and vibrant. What do you tell them?

Speaker 3: 8:32

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 really big adjustment. What we talk about is that these are tools that can help you stay in your home longer and help you do the things you want to do for longer. So even though using a cane or walker might not be something that you're hoping to use, it really can be a way to maintain independence in other areas.

Speaker 2: 8:53

Another one that I know is hard for many adults is driving. What do you tell people about when is it time to consider other ways of getting around? Because it's a massive deal with remaining independent.

Speaker 3: 9:06

It really is. Um, I think we most commonly talk about driving in the context of dementia and thinking about when it's time to, to put the keys away. Occupational therapists can do driving assessments to help give you a sense of how safe or not you are on the road. I also encourage patients to really listen to friends and family. They often have a good sense of how, how things are going on the road. And if they're asking you to, to stop driving or to limit driving, it can mean great opportunity to ask for help as well. You know, to say that , say, this is something I'm willing to do, but I'm really gonna need to help getting places that I want to go.

Speaker 2: 9:39

Yeah. Great tip.

Speaker 3: 9:40

Okay. I'd like

Speaker 2: 9:41

To circle back, Carrie , about what you, you, you led off at the beginning when I was talking about what does a geriatrician do and I think it's sort of the third m this multi complexity. What do you mean by that?

Speaker 3: 9:51

That means that as we get older, often older adults have two or more chronic conditions. In fact, over half of older adults in the United States are living with two or more chronic conditions. And that can mean more medications, more doctor's appointments, more need for monitoring. And so really adds this complexity around medical treatment and it's something we like to think about and make sure that we're orienting care around what matters most to each patient.

Speaker 2: 10:14

Yeah, that makes sense. Could you, could you also touch about on mental health, because you talked about chronic conditions and I think a lot of people think, yeah , I got heart disease, I have high blood pressure, I have this, that, or the other thing. But what about the, the intersection of mood and isolation and and things like that? Not all older adults are isolated and not, you know, many are active and vibrant, but it is a risk, isn't it? For some people

Speaker 3: 10:37

It is a risk. We know that feeling lonely or being socially isolated is a risk factor for some medical conditions. It can be really hard if someone has lost a lot of friends and family to recreate that sense of connection. We'll talk a little bit later about resources and I think the good news is there are ways to maintain and build new social connections. And that will help not only with your mental health, but also with the management of the chronic conditions.

Speaker 2: 11:00

We are going to take a short break. We are talking with Dr. Kerry Sheets , who is an internal medicine physician and a specialist in geriatrics. So she's a geriatrician. And when we come back from the break, we'll cover the last two of the m's , which is medication and making plans. And we'll give some practical tips for caregivers of aging adults, including how important planning is as your parents or loved ones start getting up there a little bit in years. So please stay with us and we will be 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 has a hospital, HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find, but did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 12:06

And we're back talking with Dr. Carrie Sheets . She's a geriatrician and a specialist in the care and the study of the conditions of older adults. I did have mentioned that earlier, but you're a massive researcher and maybe I can ask you just one sentence about that a little bit later. Let's get to the fourth of the five MSS you were talking about and that was medications.

Speaker 3: 12:24

We think about medications in older adults because the more medications someone is on, the greater risk there is of side effects and of interactions between the medications. We also think about them because as we get older, the way that our body processes and responds to medications changes and so medications that might have been well tolerated and safe when you're 40 might have a different effect on you when you're 70. So we like to identify those and minimize the number of medications and minimize the potential for side effects.

Speaker 2: 12:51

How much of that do you think is our healthcare system that has a tendency to prescribe a lot of medications? Uh , um, guilty. I'm , I'm part of that system. We all are, but it's, we're not quite as good at stopping medications . So I have patients all the time, they landed in the hospital for pneumonia and they came out on three more medications than they went in with. And while nobody told me to stop 'em, I'm just still taking them. What do you think about that? What should people do when they are at their doctor's , uh, visit about their medications? Because sometimes, I gotta be honest, I forget to look, oh , you're on these 22 medications and maybe shouldn't be.

Speaker 3: 13:27

You can ask your doctor to do a medication review or refer you to see a pharmacist to do a thorough medication review. It takes some time, but for most patients we can remove at least a couple medications. The other thing I would say , if you're noticing that you're taking medications a lot of times a day and it's just starting to make other activities difficult, that's another great thing to bring up with your healthcare providers so that you can look at ways for simplifying the regimen.

Speaker 2: 13:50

You know, and there's all kinds of aids to help us with medications. There's clock wheels and there's electronic ones. I know , uh, somebody who uses an electronic one that talks to them when it's time to take their medicines. Those are incredibly helpful aids pill boxes and things for some folks. But it is also indicative of the fact that 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 always everyone's favorite tool, but it really can be a way to reduce the risk of a medication error. And especially if you're on a lot of medications, we just wanna make sure that we're keeping you safe.

Speaker 2: 14:26

Yeah. I I am a massive proponent of using pill boxes of some kind. Most people can't take one medication correctly. It is not easy to take . If you have a single antibiotic for an earache and your doctor tells you to take this thing two or three times a day for 10 days, most people will miss a dose. It's not easy. So could you, before we get off of medications, I'm, I'm kind of intrigued by this. What, do you have a favorite type of pill box ? Is it just, is it the kind that are in a, a circle or is it, does it make any difference? Just go buy one?

Speaker 3: 14:54

It doesn't make any difference. My favorite pill box is the one that works for a patient. So , so pick one you like and that you think you'll use 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 of trouble with your memory and thinking, have a family member or friend double check it just to make sure that everything's in the right place.

Speaker 2: 15:12

Yeah. Really good tips, Gary , about medications . Some of them are so important and, and so I don't wanna minimize the importance. Some of your medications are critically important, so I'm not suggesting that people just start stopping them, but it is good to make sure that you know what you're taking and that you're taking them correctly and that you need them all. Let's talk about the fifth m, which is matters most. And I want to , I wanna focus on that a little bit 'cause I, I think it is so important, and it's something that maybe is the hardest. One of all of these things 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 mind mobility, multi complexity and medications, we really wanna center the care plan and what matters most to an older adult and their family. So for example, if getting to the hair salon every week is important to you, or if minimizing the number of medications is important to you, that's something we wanna focus on. And make sure that the treatment plan is focused on 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 that conversation with you. You can also talk about it with other members of the care team. So if you're in connected with a social 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 want your last years and time to be?

Speaker 3: 16:30

We encourage patients and families to talk about plans early and talk about them often. It's always great if you can talk about what you want and what you're hoping for while you're able to have those conversations. And it can also help your family in the future because it can give them certainty that what they're doing is consistent with what you would want. There are a lot of great tools online that can help you have these conversations. Some of them are five wishes, honoring choices or the National Institute on Aging also has some great resources.

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 these websites. And these are just websites that you go that kind of 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 to start 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 wills then were advanced directives and then healthcare power of attorneys. There's a whole bunch of mumbo jumble words. What is the most important thing for people to have done in order to have the best chance of getting the end of their life be according to their wishes?

Speaker 3: 17:39

We talk a lot with patients about assigning someone to make decisions for you if you're not able to. There are a lot of parts of advanced directives are living wills, but that's often considered the most important piece. And then once you've identify that individual, if possible, have a conversation with them about what you want, that will really help them make those decisions if they are ever, if they ever need to make those.

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, my healthcare decision maker and daughter says, mom wouldn't want this, so we're not gonna pursue this course. Then long lost brother from Sacramento shows up and says, wow , no, I want to do that. How, how do you recommend we approach that? I mean, or family members approach that? Do you just, do you , do you make sure all your kids have a conversation or, or is it all just up to one person? What do you think? Yeah,

Speaker 3: 18:35

That's a good question and I think it will depend a little bit on everyone's family and sort of the dynamics in that family. Writing down your wishes can really help with that. You know, if there's a document that everyone can see that can help if there's any conflict at the time, decisions need to be made. I will say we don't see this very often, but if you have a family member you don't want involved in the decisions, you can also state that.

Speaker 2: 18:57

Yeah, boy , I never thought of that. Just straight up say no , you know, Joey from Sacramento doesn't get to be a part of it. I guess that that makes , um, some, some sense. I wanna ask you about when decisions need to get made that are so difficult for an older adult who's still cognitively intact and making decisions. But for instance, living situations, families are all the time talking about, well, maybe it's time for mom to move to an assisted living, or maybe it'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 do we avoid an unsafe living situation? But at the same time, honoring the integrity of elders. People don't, you know, I think sometimes we start to talk to our older adults like they're five again, no, these are elders deserving of respect and they have their own agency and yet hard decisions have to be made.

Speaker 3: 19:51

It can be, it can be really challenging for a lot of families. So let's say if this's something you're currently going through, you're not alone. There is a range of care available and sometimes that can be helpful. So it ranges from in-home care with, from someone like a personal care assistant or a home health aide all the way to a skilled nursing facility or a nursing home where someone's gonna be getting help with daily tasks such as dressing, bathing, and eating. In terms of talking with a loved one about it being time to make a transition. It can be a great time to talk about what matters most. And often when someone moves to a place like an assisted living facility, getting help with things like meals and maybe medication management actually makes them more independent in other areas of their lives . So I like to talk about the benefits and how sometimes getting help with a couple parts of life can really help you focus on the things that are important to you.

Speaker 2: 20:41

I'm gonna shift just for a minute about the current state of academics in geriatrics. I happen to know that Dr. Sheets is a , a researcher in, in the care of older adults and in the science of 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 for longer. And really thinking about , um, promoting independence later in life.

Speaker 2: 21:11

So, so important. That is really cool that that is being done. The science of geriatrics is being advanced at Hennepin Healthcare where both Dr . Sheets and I work and has been for decades. We train geriatricians 25 years of a fellowship in geriatrics that we've doing here. We have internationally known researchers such as Dr. Murray, who was on that episode in season two, episode 16 about dementia. We have active researchers like Dr. Sheets right here at Hennepin Healthcare , who are providing what I would call some of the best quality care for older adults. 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, if you could leave , uh, a thought with, with people listening today, what would that be?

Speaker 3: 22:04

I would be to think about what matters most to your loved one and your family and really 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 and care of older adults. Listeners, many of us will have to deal with aging parents eventually, as I'm sure some of you out there already are. So I hope you found today's episode both interesting and helpful. Please realize you don't have to navigate this issue alone. There are plenty of professionals and resources to help you along the way. Thanks for listening and be sure to join us again in two weeks time for another great episode. And in the meantime, be healthy and be well.

Speaker 1: 22:43

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. Got a question or a comment for the show, email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota and engineered and produced by John Lucas At Highball Executive producers are Jonathan, CTO and Christine Hill . Please remember , we can only give general medical advice during this program, and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well.