Heroes of Healthcare
Heroes of Healthcare

Episode · 1 month ago

Geriatrics: Enabling a More Age-Friendly Healthcare System

ABOUT THIS EPISODE

The number of older adults is expected to double over the next 30 years.

That’s why it’s critical that the healthcare system undertakes measures to ensure that care becomes more age-friendly.

In this episode, Dr. Ugochi Ohuabunwa, Professor of Medicine at Emory University, shares insights into how geriatric care works and how it continues to evolve as the elderly population grows. 

We discuss:

  • Why geriatrics is becoming increasingly important
  • The overarching goal of geriatric care
  • How geriatric care differs from primary care
  • When it’s time to switch to geriatric care
  • The 4 M’s Framework 

To hear this interview and more like it, subscribe to Heroes of Healthcare on Apple Podcasts, Spotify, or wherever you listen to podcasts.

Listening on a desktop & can’t see the links? Just search for Heroes of Healthcare in your favorite podcast player.

Our goal has really been beyond theconsult but to make sure that there are good processes of care that actually establishedas part of the guidelines of care of the older adult. You're listening toheroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcareindustry focused on transforming lives in their communities. Let's get into the show. Welcometo the heroes of healthcare. Dr Aboumois, thanks for joining us.Thank you so much for having me. Ted, glad to be here.Yeah, and and and. So I don't make the mistake, and Iknow we talked about this before, I'm going to refer to as Dr Oh, that's fine. Okay, very good. Well, thank you for joining us. I'm very interested in today's conversation. Something new for our show, andI know that there are a lot of people in as a generations likemyself, are aging and getting into our retirement years or older years, andthere's lots of folks retiring. Jerry atrics is becoming a very big, importantpart. Many of my friends and myself are are dealing with aging parents andthings like that. So I think this episode is going to be immensely informationalfor our listeners and one that's been maybe arguably overdue. So we're excited tohave you today. If you don't mind, if you can, we can justtell the listeners a little bit about yourself and where you come from andwhat got you into medicine. I always know that that helps enlighten the peopleabout your background. Sure, absolutely so. I'm originally Nigerian. Wanted to bea physician right from when I was a child, you know, whenI would go to the hospital for anything, I would admire the physicians that werethere. Also, at some time, at you know, at some pointin my childhood, wanted also to be a police officer. So thinkabout you know, like wanting to be a physician and wanting to also bea police officer. Very service, service minded, right. That's right.So that's you know, those were some of the think, my thoughts asto how I wanted to be of service to humanity. So as I grewup that I followed the path of becoming a physician and that's something I'm forevergrateful that I did. Follow that dream to be able to help mankinds.That's that's great. And tell us all bit about your education where you wereeducated? Sure, absolutely. I did do my medical school in Nigeria.Also did my completeed my residency there, came over to the United States,did another residency and then also did my fellowship at emery and then I stayedon a spot called yet and unvesty. And what made you what drew youto Jerry attricks? What drew you to...

...that? That's set specialty or subspecialtyof primary care. What was the attraction for you to that discipline? Sofor me there was a pool more towards older adults and those who are terminallysick. I had that pool to both. I thought about either being a criticalcare doctor, which was more of focused on taking care of patients whowere critically ill and I felt that at the point at which I'll seeing them, I couldn't really make much of a difference except, you know, totreat them. Also thought about being an oncologist, also somewhat of a terminalultimately, I felt and then I was also drawn towards geriatrics and I feltthat geriatrics was more of what I wanted to do because I would be ableto make a difference early in helping people age gracefully, but in addition tothat, be able to help frail older adults. So that was where finallyI decided on. Hey, you know, want to make a difference in thecare of older adults. So even as a young lady, you stillcouldn't get that service minded and how to help people, you know, outof the decision making process. So well, thank you. Thank you for theservice, and that's great. Let's jump in a little bit too exactlywhat you so you made the decision geriatrics was the path you wanted to getto. What makes you passionate about geriatrics and what are you seeing currently intreatment of elderly? A lot the elderly population is growing too numbers that aremore than they have been historically. And what's what are you seeing and whatare you trying to change and what improvements are are we seeing in the ingeriatrics? Absolutely so. One of the major things that has formed the phasisfor my passion is the fact that older adults, the number of older adultsI expected to double in the next thirty years. That's what the data shows, and so it's very critical that we are well equip, the health caresystem is well equipped to take care of older adults. Just in the sameway that there's a passion to make sure that children are well taking care ofand you have pediatricians who take care of this children. The same way forolder adults, their care is also peculiar. You're dealing with a population that's muchmore vulnerable that the dose of medications that you would give a younger adultis different from the dose of medications that you would give an older adult,that an older adult can come into the hospital being able to walk. Bythe time they are living the hospital, they aren't able to walk. Somultiple things can potentially go wrong in the care of an older adult and thathas formed the basis for my desire to help make a difference in the careof older adults, to make sure that...

...we have good care processes and systemsof Kre in place, that health cap provide us, whether they had Jerryattritions or not, know about the peculiarities of older adults and know how tocare for them. And health care provide us, ranging from you have thenurses, you have the Rehab Therapists, you have the physicians, you haveall members of the health care team, social work. Everyone knows how totake care of older adults and what makes their care Backus, makes them difference. Yeah, I loved on our precall you talked about, you know,geriatrics and pediatrics just being part of primary care, but a specialty, pediatricsbeing more known, which is for the children, and geriatrics obviously being forthe elderly. But, as you said, it's a community. It's not justthe how the physicians deal with it, it's how the nurses deal with them, it's how the medical text deal with them and so on. Whatares if you can, put you on the spot a little bit, butif you can, what are some of the specifics are you can you giveus an example of something that if maybe an elderly person came into the emergencyroom and the normal course of treatment might be something, how would you wantit to be approached, given and that somebody might be a more senior intheir age? Absolutely so, even though the time that patients day in theemergency room is technically a short period of time, but for an older adultthings could potentially go wrong within that short period of time. They could becomemore delirious in the emergency room just because of that atmosphere. Right it's muchmore fast paced. You may not quite get the attention that you need,you may not have the kind of lighting that you need and so on.That would help prevent or optimize your care. And so you find that older adultsin the emergency room, multiple things can go wrong. Let me giveyou another example. Pressure, all says, can happen just by someone laying inbed for two hours putting pressure on the same spot. So you couldhave that F real older adult whose skin is already fragile, being in theemergency room laying on that, you know, that cat, laying on that onthat Gurney, and then ultimately they develop a pressure also on an areabecomes, you know, at higher risk for pressure, all says, orthey become weaker. Right, the more someone stays in bed, then theycould become we can so that time, even though it's a short period oftime in the emergency room, multiple things would go wrong. So the goalis really in the emergency room to identify those older adults who are at veryhigh risk for developing complications, medications. They could be at supposed handful medicine. So ultimately the best kind of care that you can provide to an olderadult is to identify those older adults who had high risk for these hazards andto implement care processes to improve their care. And the American College of Emergency PhysiciansActually came out with guidelines on how...

...to care for older adults in theemergency room with an awareness of, you know, some of these hazards thatpotentially could happen to improve their can the emergency room. That's great and Iguess that's part of what your department is doing, is making sure that thatthose standards are being educated to the emergency room position so that they know howto adjust the level of care accordingly based upon the the the stage of thatelderly person. Absolutely, and so that's why it's, you know, teamworkright. You're not likely to have enough Jerry attricians everywhere. That's why thegoal is really to make sure that all health care provide us, irrespective ofthe setting of care, know how to care for an older adult in thatsetting to make sure that they get the optimal care. So let's talk aboutit. If you can a little bit deeper, let's talk about that.So how do you and your team in that in your department? How doyou go about doing that? Is that where you're called in for a consultwhen somebody is over a certain age or that you review the treatment, orif an emergency room physician or a hospitalist says I'm not really sure what orI'm not getting response, when do you guys get called in and what's thatprocedure? Absolutely so there are. Right now we are calling for consules,but our goal has really been beyond the consult but to make sure that thereare good processes of care that are actually established as part of the guidelines ofcare of the older adults. Right so they could call a Jerry attrition andthe geriatriation would come in to see that older adult, but that wouldn't makeas much of a difference if the staff in that emergency room and not trainedto care for an older adult. The nurse needs to know this patient isat risk for delirium and so would implement care processes to help prevent delirium fromhappening. The pharmacist in the emergency room would take a look at the medicines, know which medicines are high risk for older adults. You know, callthe team and say hey, we think this medication is a little too highrisk for an older adult. So the goal is really to have and that'swhat we've been walking on to make sure that they are good systems in place, you know, to identify those high risk older adults and make sure that, irrespective of what I have a Jerry attrition or not, but those standardsare in place to get the patient out of bed as earlier as possible whilethey're in the emergency room, prevent false prevent delirium, have good care processin place in addition to calling a Jerry attrition or having a multidisciplinary team thatevaluates the patient while they are still in in my density department. Okay,so it is it's a team work and it's making the awareness is it iscritical. So if I were to bring my father into the emergency room andthey're trying some different things and trying to evaluate him, should I request agery attrition be included, or is that just something that's the normal course ofaction, that that's a a? I'm...

...assuming they've been trained or be Ican make that request and have somebody like yourself, who I know is overoverseeing some of the care. So you could request for a Geriatriction, buttypically what the providers who are in the emergency department would know a patient whowould benefit from the Kelva jerryatriction. Just in the same way as they callingthe attention of a cardiologist because a patient presents with a certain symptoms, arecalling a neurologist the same way they would, you know, recommend that a geriatricianbe involved in the care of the patients. Okay, makes sense,of perfect sense. So one of the things that I've I've heard of andI loved it for you to share and it seems like a simple thing,but a lot of problems with elderly manifest themselves due to dehydration. I rememberwith my mother, you know, she would start to you know, shesuffered cognitively and as a result, it was hard to get her to consumeenough water to stay hydrated. And then we would see her decline and weused to bring her to the check her into the hospital and they would giveher an IV and all of a sudden it was like she'd spring back tolife and be much better and more cognitively better, and things like that.Is that I within for GERIATRICIANS. Is that an ongoing issue with the elderly? It is, and it just highlights again the point that very little thingsthat wouldn't matter in a forty year old matter in an older person. Sosimple things that stay hydration could make that person more delirious, could make theperson much more weak, could contribute to fall. So dehydration is a major, major problem amongst older adults that you know need to be paid attention toand it's sometimes difficult, even though funily, members are trying to encourage the personto drink more water, take more fluids, but sometimes, you know. So that's also part of the education of older adults to make sure weknow to drink and all. Yeah, I know. Used to say tomy mom you have to drink more water and she'd say I am you,just keep refilling the glass, but she hadn't had any, but because ofher cognitive state she believed that she did. So it was it was a challenge, but I do know that she did better when we could keep herher hydrated it and I've I've seen that with my father now and I've seenthat with lots of I've heard that affirmed by friends saying it's something so simpleand it can prevent a lot of problems. As you're continuing to work with them, what are some of the things that you and your team do differentlywhen you're screening a new patient. So a new patient might come in,maybe not through the emergency room, but just as a normal course of things. What are some of the things that are different that a Gerry attrition islooking for versus maybe just a primary care...

...doctor or Pedi attrition for that catthat matter? Absolutely so we as Jerry attritions, either in the clinic settingor when the patient is admitted to the hospital. We do a few thingsthat are additional to the usual things that our colleagues would do. One iscognition. We tend to do an assessment of the person's cognition. We wantto pick up on those contiff deficits early so that they are addressed early,and that's part of the comprehensive geriatric assessment. We also do a functional assessment tosee what the needs of the patient are, needs, you know,which we get to. Are they able to do some of the basic ideals, bathing, dressing, cooking, you know, cleaning, just being ableto do those, and then trying also to determine what their social support systemis, because that makes a difference. Right. So you could have someoneand who lives alone and yet functionally they don't have the functional capacity to copeby themselves and that ultimately could make them become a malnourish, they're not able, they fall and all kinds of hazards. So those are all some of thethings that we do. So a good social history, a good functionalhistory, a good cognitive assessment and then medications. That's huge for us,trying to make sure that you know the medications that are patients are taking appropriatefor their age and have, you know, less side effects. That's great.So obviously we all he'll we hear statistics that people are living, we'reliving longer, quality of life is going longer, life expectancy is going longer. Are there certain things that you feel have been advances in in geriatrics thathas contributed to that, or is it just the across the board advances withinhealthcare, in cardiology, in neurology and all of the alogies that are helpingpeople live longer and live in many ways more better quality of life? Yeah, I think it's across the board, but they're, you know, somebasic things in general that would help. Right. So things, how functionalis the person? So you hear about exercise, how much exercise helps,that's really very true, and starting early to do that and maintaining your physicalfunction. True exercise is very helpful in determining how you would do as youget older. So those are some of the things I would think would havecontributed to, you know, people living longer. Diet also there's much moreemphasis on the kind of food that you eat right. So eating the rightkind of food would determine how your body does ultimately and how much longer youlive. So a few of the things that certainly would help. But butthe interventions in the healthcare system in general has helped to prolonged lives in generalgreat. So one of the other things...

...we had talked about before was,you know, when should a person change from maybe a primary care doctor toa Gerry attrition? So I've been with my primary care doctor, been withthem for many, many years, but I may now getting into my olderyears and I say, Oh, maybe I should switch. There's certain thingsthat we see physically or is there an age recommendation? When or even forthose of us who are caring for our elderly parents, is a time whenwe say, let's it's time to maybe switch. So in general and with. You know what you had said earlier about people living longer. You rightnow it's also a concentration as to what should be the cutoff for geriatrics.Right. So currently we have it at sixty five. Anyone who is sixtyfive and oldest considered to be part of geriatric population. But people are livingmuch longer and I'm much more functional. If you have someone who is reallyvery functional, the pressure may not be as much to see a Gerry attrition. But even with that, the few things like medications, you know thata Gerry attrition. Some advantages to having a Gerry attrition. See the person. But besides that, when you have family members who are developing cognitive deficits, that's one of the indications for you to think about seeing a Gerry attrition. Or you find out that they're not. They are becoming much weaker, youknow, their physical function is declining or maybe they're beginning to fall.Those are some indications for you to consider having a Gerry attrition. We alsohave what's called failure to thrive. So you have the functional decline, cometip decline. nutritionally, they are not eating well as much. That's alsoanother indication that I should consider having a geratrician see the patient. Sometimes,you know, you could have someone who is really doing fairly well but isa multiple medications. That's one of the rules of a Gerry attrition. Oneof major rules is to address polypharmacy where someone is on multiple medicines and welook at medicines very critically to make sure that they're of high benefit and lowrisk. That's our goal, you know, to our patients to make sure thatthey're not suffering from the adverse effects of medication. So that's also anothera potential indication to consider. Great man, this is very good, great information. Yeah, because I mean no different again, I go back tomy the pediatriction analogy. At certain age I don't go to I grow up, I don't go to the pediatrician anymore. Right, I go to the familycare doctor and within geriatrics, you know, I often hear there's confusionaround the difference between Palliative care and hospice and geriatrics. And you know thereare many people who say well, hospices end of life, but yet youhear about people graduating out of hospice sort of situations. You know, canyou go through that a little bit for...

...the listeners and for myself and selfishly, but I do think that there's some confusion there. You know, whendo I seek palliative care, when do I seek hospice, and what shouldmy expectations around that be? So let me start with hospice. So hospiceis usually for those who have been estimated to have less than six months tolive, and that's based off of setting diagnosis. Can says, or hadfailure. That at end stage, or chronic obstructive at way disease. That'salso end stage. So you have diseases when it's more terminal, when clinicianevaluates the patient and things that they have less and six months to leave,then hospice is a properate in the sense based off of the goal. Soit's also dependent or what the family wants, right. So, because the goalof hospice is really to Provide Comfort, make sure that the patient's goals aremet, make sure that that period of the end of life period isas comfortable as possible and and their needs and whatever their desires are met.Paltive case also, you know, in that also, I would say,directed towards the same goal. So you have palliative care and hospice. You'rethinking about, you know, multiple, let's say, multiple core morbidities,more heading towards end of life. Again, pain, that intractable. That wouldneed to be addressed. So again more of comfort measures. But theperson may not necessarily be at the point of I'm terminal. I have lessthan six months to leave, but it's beginning to keep in view what thegoals of care are and addressing and trying to make sure again that that personis comfortable or keeps in view what the goals of their care are and haveas much support as possible quality of life as you move towards the end.That's right. So you're thinking about the quality of life. Is Very criticaltowards that. And then just in general, geriatrics is just, you know,caring for older adults irrespective of time. That's well. As a geriatrician youcan care for your patient through out the span as they have gotten older. You can walk with their palliative care doctor, it's a team based care, or with their hospice doctor also. Okay, that's great. You know, one of the things you mentioned earlier, I want to come back to ita little bit, and it talks about cognitive or things like that.But you called it failure to thrive, and maybe explain a little bit moreabout what you mean by that, because I do see again with the olderpopulation that loss of purpose, meaning what do I have to live for?Her to people hunt anymore? Or I don't feel like I've got anything tolive for. My children are grown, I don't have the grandchildren, youknow, whatever it might be. I...

...don't have my professional career, Idon't know. I'm not able to do my hobbies. I used to loveplaying tennis. I can't do that anymore. Whatever those things might be, thereis a bit of loss of purpose and a lot of times that's thecognitive or the mental behaviorals part of it that you just see. Sometimes thatdecline begins to accelerate due to that loss of purpose. Absolutely so you findthat depression is very common as people get older, and the reason being whatyou said about. You find that older adults are often alone, don't haveas much support as they would need. Children are all grown, have theirown lives, have their own families, and so that older adult is essentiallyleft by himself or herself, and so that contributes to the sadness, rightand and so it's one of the major goals would be to try as muchas possible to make sure that there is still some purpose, something to livefor, or family members providing much more support for that older adult and engagingthem as much as possible. Otherwise. So dementia is different from depression,right. So someone the content deficits that are speaking about more related to dementiarather than depression. So that loss of purpose would make one to become alittle bit more depressed and a little more depressed and and ultimately they may notdo well right and they begin to fail to thrive. Dementia by itself isyou know, you have that decline, the aging the brain. You knowthey are changes in the brain that have contributed to certain areas of the brainnot working as well as they should. And then the person begins to developlike contip deficits, but in general, failure to thrive can be contributed tobuy a number of these conditions were ultimately that person declines, becomes more depressed, develops cognitive deficits, their physical function declines, they don't eat as wellas they should, they begin to lose weight. So it's a whole syndromeof multiple things that contribute to the filial to fly. But where the cognitivedementia may not be as treatable, the depression could be a little more treatable. So that's when you're doing that cognitive assessment, you're trying to determine isthis a deterioration of the brain, which we might be all treat might notbe able to treat, or as a depressive situation which we might have abetter opportunity to impact you. So you absolutely correct. So sometimes a patientmay not necessarily have dementia but they are beginning to forget things. You know, they may have some manifest certain cognitive deficits and it may be as aresult of depression, and so it's really very important to try to distinguish whetherit's actually depression that you're dealing with all...

...its actual dementia and you know sothat if the patient is becoming more depressed, then you're able to address that's somethingthat you can address easily. With the cognitive deficits, they're actually muchmore permanent. It's a progressive thing, but it's important that it's picked upon early so that certain medications can be given to help slow that cognitive declinedown. Depression also could be treated with medications or psychotherapy or just and evenengaging one a little bit more and trying to find purpose in life. No, absolutely, and you know that. How you know that optim is theor that how we feel or all of that sort of stuff can be canbe so important. I often talk on the show about my father because I'min that world with him and you know, I do see, I do seethe times when he's tired of fighting the medical issues that he has,his his congestive heart failure, his other things like that, and he justhe's just, it just gets we all get worn down from it after awhile. So it can lead to depression and and loss of appetite and allof those sorts of things where then it just becomes this this self fulfilling prophecy, this downward spile spirals, so to speak. So as we're as we'rekind of coming up, you know, wrapping up here on a and whatare some of the advances you're seeing? You know, to me, whenI hear you talk, and correct me if I'm wrong, geriatrics is amore of an application of a process of treatment where like, because you saidearlier, we're aging longer because of advances in cardiology, neurology, nephrology,all the different things that are the are major organ pieces that contribute. Geriatrics. Is More of this, and I'm asking you to correct me because I'mprobably not saying this right, but it's kind of a course of care lookingat all of the different aspects of the human physiology that the person would needneed to do. So is it fair to say with this, and againI don't probably not be very articulate here, but is it fair to say thatthere is advances in geriatrics? There are new things that we're learning,there are things that are coming out that are exciting to you about advances beingmade in geriatrics? So I would say advances in medicine in general right,overall, that's correct. Advances in medicine that's helping to prolonged life, andwith that there has to be a preparedness of the healthcare system. So theadvances in let's say cardiology, would help. You know, like you have thedifferent relator, you have those advances that help in prolonging people's lives.But as they get older you would find that some of the basic things,like the cognitive deficits, the functional deficit would still happen down the line,and so it's important that there is a preparedness of the healthcare system to beable to take care of those older adults...

...for some of those deficits that arehappening because they are living longer. Right so, the number of people thatwould have dementia with people living longer, it's expected to increase because people areliving longer, you have many more older adults and so you would definitely havemore more people coming down with dementia or manifesting with dementia or the functional decline. And so the goal, let me put it this way, the goalof geriatrics has been to make sure, and I know I've said it,you know a few times, but it's really too equip the health care systemto know how to care for older adults because of these deficits that will becomemuch more manifest with people living longer, because they would happen down the line. So, and I would say that the advances in geriatrics are more focusedon trying to create these systems of care. Let me give you an example.In the past we didn't have things like a geriatric emergency department. Rightnow we have geriatric emergency departments as a goal of trying to improve care ofolder adults in the emergency department. Right in the past, you know,years ago, maybe let's say in the S, we did not have specialunits for older adults. Now we have special units for older adults, theacute care for the elderly units where older adults who are hospitalized I cared forto make sure that that whole health care team provides good care, you know, to the older adults. Tho, there are advances in geriatrics, alltargeted towards improving the care of older adults, irrespective of a setting or even inthe out patients setting. Also, there are advances things that you know, like knowledge is increasing on how to you we would care better for olderadults. Well, that that well, that's good and we're happy to hearthat. I know you. I know you and I talk. Last timewe said that there's not enough Jerry Attrition's coming out of that school. Sothere's a shortage of them, especially and I think more of the well,obviously probably not no difference between urban or suburban or rural areas for that matter. There's just a shortage across across the board. But obviously for any ofthe medical students listening. We have a lot of aging people. I thinkyou said what there was a what was the number you said? I've apologize, I thought I wrote it down. Thirty percent increase. Know the numberof older adults is going to double in the next thirty years. Double inthirty years. Yeah, so if you you know, if you want somejob security, I think you're going to Jerry attricks. Okay, so,as we're going to wrap up here, just one last kind of question.What it? What is your hope for the evolution of Jerry attrics within thehealth care system? So one of the goals of every Jerry attrition is thathealthcare systems become much more age friendly. The goal is really to build capacityamongst members of the healthcare team so they have the knowledge and the skills tocare for older adults, taking into account...

...the fact that there are not enoughJerry attritions. So the goal is really to build capacity and make healthcare systemsmuch more a friendly. The instead of healthcare improvement over the last few yearscame out with the framework to encourage health systems to become more a friendly,and it's called the four ends, which are considered to be the most importantthings in the cave and older adult one of the N is what matters tothe patient. So making sure that in whatever care that we're providing to apatient, we take into account what really matters to them, what they aregoals are. The second end is mentation, so making sure that an older adult, even if they're in the hospital for something as simple as a ran attract infection, paying attention to their mentation and having care processes in placeto maintain that. The third one is mobility, right, so trying tomake sure that you keep older adults as mobile as possible, because once they'reimmobile they are likely to decline functionally and that would affect their trajectory. Thenthe fourth one is medications, making sure that the medications that are provided tothem as safe and appropriate for them. So that's my hope that ultimately mosthealthcare systems would become age friendly and, you know, have the knowledge andskills to care for older adult and adapt the forums and and apply and applythem and always use that as kind of the are we doing that in thissituation? That's great. I love that and I like that it makes itsimple and easy and and I'm sure for an emergency room doctor who's very busyhandling multiple patients, that's something that they can easily say is okay, I'vegot an elderly patient here. Am I applying the forums here as I'm approachingthem? That's right, absolutely, that's great. Well, others, I'veloved our time together. Thank you so much for your time. Dr Oh, really inside ful not something that we hear in the MAINSTREAMM information around healthcare. So I'm so privilege that we were able to steal some of your timeto be able to bring this to our listeners. As we always wrap upour heroes of healthcare podcast, we love to ask a question of our guests, which is, so, who is your hero, or who is yourhero as you've been going through your career? I would say my dad. He'sbeen my hero. He's the he's kind and I think that that's acritical component of healthcare. Kind Nets and compassion, and so my dad hasbeen my hero as a result of that, because of the person he is.Yet yeah, he modeled that for you, which gave you the passionto go into the service side of medicine. Well, thanks again so much foryour time. Thank you for your service and continuing to pioneer the rightsand the and the health of the of our elderly. We need to continueto preserve them. They are the history that the future. I love hearingstories from the older folks, and so...

...thank you for continuing to do thegreat fight with you and your team. Thank you so much for having me. You've been listening the heroes of healthcare for more. Subscribe to the showin your favorite podcast player or visit us at heroes of healthcare podcastcom.

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