Heroes of Healthcare
Heroes of Healthcare

Episode · 5 months 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 the consult but to make sure that there are good processes of care that actually established as part of the guidelines of care of the older adult. You're listening to heroes of healthcare, the podcast that highlights bold, selfless professionals in the healthcare industry focused on transforming lives in their communities. Let's get into the show. Welcome to 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 I know 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, and I know that there are a lot of people in as a generations like myself, are aging and getting into our retirement years or older years, and there's lots of folks retiring. Jerry atrics is becoming a very big, important part. Many of my friends and myself are are dealing with aging parents and things like that. So I think this episode is going to be immensely informational for our listeners and one that's been maybe arguably overdue. So we're excited to have you today. If you don't mind, if you can, we can just tell the listeners a little bit about yourself and where you come from and what got you into medicine. I always know that that helps enlighten the people about your background. Sure, absolutely so. I'm originally Nigerian. Wanted to be a physician right from when I was a child, you know, when I would go to the hospital for anything, I would admire the physicians that were there. Also, at some time, at you know, at some point in my childhood, wanted also to be a police officer. So think about you know, like wanting to be a physician and wanting to also be a police officer. Very service, service minded, right. That's right. So that's you know, those were some of the think, my thoughts as to how I wanted to be of service to humanity. So as I grew up that I followed the path of becoming a physician and that's something I'm forever grateful 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 were educated? 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 stayed on a spot called yet and unvesty. And what made you what drew you to Jerry attricks? What drew you to...

...that? That's set specialty or subspecialty of primary care. What was the attraction for you to that discipline? So for me there was a pool more towards older adults and those who are terminally sick. I had that pool to both. I thought about either being a critical care doctor, which was more of focused on taking care of patients who were 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, to treat them. Also thought about being an oncologist, also somewhat of a terminal ultimately, I felt and then I was also drawn towards geriatrics and I felt that geriatrics was more of what I wanted to do because I would be able to make a difference early in helping people age gracefully, but in addition to that, be able to help frail older adults. So that was where finally I decided on. Hey, you know, want to make a difference in the care of older adults. So even as a young lady, you still couldn't get that service minded and how to help people, you know, out of the decision making process. So well, thank you. Thank you for the service, and that's great. Let's jump in a little bit too exactly what you so you made the decision geriatrics was the path you wanted to get to. What makes you passionate about geriatrics and what are you seeing currently in treatment of elderly? A lot the elderly population is growing too numbers that are more than they have been historically. And what's what are you seeing and what are you trying to change and what improvements are are we seeing in the in geriatrics? Absolutely so. One of the major things that has formed the phasis for my passion is the fact that older adults, the number of older adults I 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 care system is well equipped to take care of older adults. Just in the same way that there's a passion to make sure that children are well taking care of and you have pediatricians who take care of this children. The same way for older adults, their care is also peculiar. You're dealing with a population that's much more vulnerable that the dose of medications that you would give a younger adult is 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. By the time they are living the hospital, they aren't able to walk. So multiple things can potentially go wrong in the care of an older adult and that has formed the basis for my desire to help make a difference in the care of older adults, to make sure that...

...we have good care processes and systems of Kre in place, that health cap provide us, whether they had Jerry attritions or not, know about the peculiarities of older adults and know how to care for them. And health care provide us, ranging from you have the nurses, you have the Rehab Therapists, you have the physicians, you have all members of the health care team, social work. Everyone knows how to take 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, pediatrics being more known, which is for the children, and geriatrics obviously being for the elderly. But, as you said, it's a community. It's not just the 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. What ares if you can, put you on the spot a little bit, but if you can, what are some of the specifics are you can you give us an example of something that if maybe an elderly person came into the emergency room and the normal course of treatment might be something, how would you want it to be approached, given and that somebody might be a more senior in their age? Absolutely so, even though the time that patients day in the emergency room is technically a short period of time, but for an older adult things could potentially go wrong within that short period of time. They could become more delirious in the emergency room just because of that atmosphere. Right it's much more 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 adults in the emergency room, multiple things can go wrong. Let me give you another example. Pressure, all says, can happen just by someone laying in bed for two hours putting pressure on the same spot. So you could have that F real older adult whose skin is already fragile, being in the emergency room laying on that, you know, that cat, laying on that on that Gurney, and then ultimately they develop a pressure also on an area becomes, you know, at higher risk for pressure, all says, or they become weaker. Right, the more someone stays in bed, then they could become we can so that time, even though it's a short period of time in the emergency room, multiple things would go wrong. So the goal is really in the emergency room to identify those older adults who are at very high 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 older adult is to identify those older adults who had high risk for these hazards and to implement care processes to improve their care. And the American College of Emergency Physicians Actually came out with guidelines on how...

...to care for older adults in the emergency room with an awareness of, you know, some of these hazards that potentially could happen to improve their can the emergency room. That's great and I guess that's part of what your department is doing, is making sure that that those standards are being educated to the emergency room position so that they know how to adjust the level of care accordingly based upon the the the stage of that elderly person. Absolutely, and so that's why it's, you know, teamwork right. You're not likely to have enough Jerry attricians everywhere. That's why the goal is really to make sure that all health care provide us, irrespective of the setting of care, know how to care for an older adult in that setting to make sure that they get the optimal care. So let's talk about it. 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 do you go about doing that? Is that where you're called in for a consult when somebody is over a certain age or that you review the treatment, or if an emergency room physician or a hospitalist says I'm not really sure what or I'm not getting response, when do you guys get called in and what's that procedure? 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 there are good processes of care that are actually established as part of the guidelines of care of the older adults. Right so they could call a Jerry attrition and the geriatriation would come in to see that older adult, but that wouldn't make as much of a difference if the staff in that emergency room and not trained to care for an older adult. The nurse needs to know this patient is at risk for delirium and so would implement care processes to help prevent delirium from happening. The pharmacist in the emergency room would take a look at the medicines, know which medicines are high risk for older adults. You know, call the team and say hey, we think this medication is a little too high risk for an older adult. So the goal is really to have and that's what 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 standards are in place to get the patient out of bed as earlier as possible while they're in the emergency room, prevent false prevent delirium, have good care process in place in addition to calling a Jerry attrition or having a multidisciplinary team that evaluates 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 is critical. So if I were to bring my father into the emergency room and they're trying some different things and trying to evaluate him, should I request a gery attrition be included, or is that just something that's the normal course of action, that that's a a? I'm...

...assuming they've been trained or be I can make that request and have somebody like yourself, who I know is over overseeing some of the care. So you could request for a Geriatriction, but typically what the providers who are in the emergency department would know a patient who would benefit from the Kelva jerryatriction. Just in the same way as they calling the attention of a cardiologist because a patient presents with a certain symptoms, are calling a neurologist the same way they would, you know, recommend that a geriatrician be 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 and I 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 remember with my mother, you know, she would start to you know, she suffered cognitively and as a result, it was hard to get her to consume enough water to stay hydrated. And then we would see her decline and we used to bring her to the check her into the hospital and they would give her an IV and all of a sudden it was like she'd spring back to life 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 things that wouldn't matter in a forty year old matter in an older person. So simple things that stay hydration could make that person more delirious, could make the person 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 to and it's sometimes difficult, even though funily, members are trying to encourage the person to drink more water, take more fluids, but sometimes, you know. So that's also part of the education of older adults to make sure we know to drink and all. Yeah, I know. Used to say to my 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 of her 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 her her hydrated it and I've I've seen that with my father now and I've seen that with lots of I've heard that affirmed by friends saying it's something so simple and 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 differently when 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 is looking for versus maybe just a primary care...

...doctor or Pedi attrition for that cat that matter? Absolutely so we as Jerry attritions, either in the clinic setting or when the patient is admitted to the hospital. We do a few things that are additional to the usual things that our colleagues would do. One is cognition. We tend to do an assessment of the person's cognition. We want to 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 to see 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 able to do those, and then trying also to determine what their social support system is, because that makes a difference. Right. So you could have someone and who lives alone and yet functionally they don't have the functional capacity to cope by 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 the things that we do. So a good social history, a good functional history, 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 appropriate for 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're living 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 that has contributed to that, or is it just the across the board advances within healthcare, in cardiology, in neurology and all of the alogies that are helping people 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, some basic things in general that would help. Right. So things, how functional is 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 physical function. True exercise is very helpful in determining how you would do as you get older. So those are some of the things I would think would have contributed to, you know, people living longer. Diet also there's much more emphasis on the kind of food that you eat right. So eating the right kind of food would determine how your body does ultimately and how much longer you live. So a few of the things that certainly would help. But but the interventions in the healthcare system in general has helped to prolonged lives in general great. 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 to a Gerry attrition? So I've been with my primary care doctor, been with them for many, many years, but I may now getting into my older years and I say, Oh, maybe I should switch. There's certain things that we see physically or is there an age recommendation? When or even for those of us who are caring for our elderly parents, is a time when we 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 right now 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 sixty five and oldest considered to be part of geriatric population. But people are living much longer and I'm much more functional. If you have someone who is really very functional, the pressure may not be as much to see a Gerry attrition. But even with that, the few things like medications, you know that a 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, you know, 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 also have what's called failure to thrive. So you have the functional decline, come tip decline. nutritionally, they are not eating well as much. That's also another 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 is a multiple medications. That's one of the rules of a Gerry attrition. One of major rules is to address polypharmacy where someone is on multiple medicines and we look at medicines very critically to make sure that they're of high benefit and low risk. That's our goal, you know, to our patients to make sure that they're not suffering from the adverse effects of medication. So that's also another a potential indication to consider. Great man, this is very good, great information. Yeah, because I mean no different again, I go back to my 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 family care doctor and within geriatrics, you know, I often hear there's confusion around the difference between Palliative care and hospice and geriatrics. And you know there are many people who say well, hospices end of life, but yet you hear about people graduating out of hospice sort of situations. You know, can you 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, when do I seek palliative care, when do I seek hospice, and what should my expectations around that be? So let me start with hospice. So hospice is usually for those who have been estimated to have less than six months to live, and that's based off of setting diagnosis. Can says, or had failure. That at end stage, or chronic obstructive at way disease. That's also end stage. So you have diseases when it's more terminal, when clinician evaluates 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. So it's also dependent or what the family wants, right. So, because the goal of hospice is really to Provide Comfort, make sure that the patient's goals are met, make sure that that period of the end of life period is as 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're thinking about, you know, multiple, let's say, multiple core morbidities, more heading towards end of life. Again, pain, that intractable. That would need to be addressed. So again more of comfort measures. But the person may not necessarily be at the point of I'm terminal. I have less than six months to leave, but it's beginning to keep in view what the goals of care are and addressing and trying to make sure again that that person is comfortable or keeps in view what the goals of their care are and have as 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 critical towards that. And then just in general, geriatrics is just, you know, caring for older adults irrespective of time. That's well. As a geriatrician you can 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 it a little bit, and it talks about cognitive or things like that. But you called it failure to thrive, and maybe explain a little bit more about what you mean by that, because I do see again with the older population 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 to live for. My children are grown, I don't have the grandchildren, you know, whatever it might be. I...

...don't have my professional career, I don't know. I'm not able to do my hobbies. I used to love playing tennis. I can't do that anymore. Whatever those things might be, there is a bit of loss of purpose and a lot of times that's the cognitive or the mental behaviorals part of it that you just see. Sometimes that decline begins to accelerate due to that loss of purpose. Absolutely so you find that depression is very common as people get older, and the reason being what you said about. You find that older adults are often alone, don't have as much support as they would need. Children are all grown, have their own lives, have their own families, and so that older adult is essentially left by himself or herself, and so that contributes to the sadness, right and and so it's one of the major goals would be to try as much as possible to make sure that there is still some purpose, something to live for, or family members providing much more support for that older adult and engaging them as much as possible. Otherwise. So dementia is different from depression, right. So someone the content deficits that are speaking about more related to dementia rather than depression. So that loss of purpose would make one to become a little bit more depressed and a little more depressed and and ultimately they may not do well right and they begin to fail to thrive. Dementia by itself is you know, you have that decline, the aging the brain. You know they are changes in the brain that have contributed to certain areas of the brain not working as well as they should. And then the person begins to develop like contip deficits, but in general, failure to thrive can be contributed to buy 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 well as they should, they begin to lose weight. So it's a whole syndrome of multiple things that contribute to the filial to fly. But where the cognitive dementia 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 is this a deterioration of the brain, which we might be all treat might not be able to treat, or as a depressive situation which we might have a better opportunity to impact you. So you absolutely correct. So sometimes a patient may 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 a result of depression, and so it's really very important to try to distinguish whether it's actually depression that you're dealing with all...

...its actual dementia and you know so that if the patient is becoming more depressed, then you're able to address that's something that you can address easily. With the cognitive deficits, they're actually much more permanent. It's a progressive thing, but it's important that it's picked up on early so that certain medications can be given to help slow that cognitive decline down. Depression also could be treated with medications or psychotherapy or just and even engaging one a little bit more and trying to find purpose in life. No, absolutely, and you know that. How you know that optim is the or that how we feel or all of that sort of stuff can be can be so important. I often talk on the show about my father because I'm in that world with him and you know, I do see, I do see the 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 just he's just, it just gets we all get worn down from it after a while. So it can lead to depression and and loss of appetite and all of 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're kind of coming up, you know, wrapping up here on a and what are some of the advances you're seeing? You know, to me, when I hear you talk, and correct me if I'm wrong, geriatrics is a more of an application of a process of treatment where like, because you said earlier, 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'm probably not saying this right, but it's kind of a course of care looking at all of the different aspects of the human physiology that the person would need need to do. So is it fair to say with this, and again I don't probably not be very articulate here, but is it fair to say that there 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 being made 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, and with that there has to be a preparedness of the healthcare system. So the advances in let's say cardiology, would help. You know, like you have the different 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 be able to take care of those older adults...

...for some of those deficits that are happening because they are living longer. Right so, the number of people that would have dementia with people living longer, it's expected to increase because people are living longer, you have many more older adults and so you would definitely have more 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 goal of 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 system to know how to care for older adults because of these deficits that will become much 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 focused on 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. Right now we have geriatric emergency departments as a goal of trying to improve care of older adults in the emergency department. Right in the past, you know, years ago, maybe let's say in the S, we did not have special units for older adults. Now we have special units for older adults, the acute care for the elderly units where older adults who are hospitalized I cared for to make sure that that whole health care team provides good care, you know, to the older adults. Tho, there are advances in geriatrics, all targeted towards improving the care of older adults, irrespective of a setting or even in the out patients setting. Also, there are advances things that you know, like knowledge is increasing on how to you we would care better for older adults. Well, that that well, that's good and we're happy to hear that. I know you. I know you and I talk. Last time we said that there's not enough Jerry Attrition's coming out of that school. So there'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 of the medical students listening. We have a lot of aging people. I think you 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 number of older adults is going to double in the next thirty years. Double in thirty years. Yeah, so if you you know, if you want some job 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 the health care system? So one of the goals of every Jerry attrition is that healthcare systems become much more age friendly. The goal is really to build capacity amongst members of the healthcare team so they have the knowledge and the skills to care for older adults, taking into account...

...the fact that there are not enough Jerry attritions. So the goal is really to build capacity and make healthcare systems much more a friendly. The instead of healthcare improvement over the last few years came 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 important things in the cave and older adult one of the N is what matters to the patient. So making sure that in whatever care that we're providing to a patient, we take into account what really matters to them, what they are goals 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 r an attract infection, paying attention to their mentation and having care processes in place to maintain that. The third one is mobility, right, so trying to make sure that you keep older adults as mobile as possible, because once they're immobile they are likely to decline functionally and that would affect their trajectory. Then the fourth one is medications, making sure that the medications that are provided to them as safe and appropriate for them. So that's my hope that ultimately most healthcare systems would become age friendly and, you know, have the knowledge and skills to care for older adult and adapt the forums and and apply and apply them and always use that as kind of the are we doing that in this situation? That's great. I love that and I like that it makes it simple and easy and and I'm sure for an emergency room doctor who's very busy handling multiple patients, that's something that they can easily say is okay, I've got an elderly patient here. Am I applying the forums here as I'm approaching them? That's right, absolutely, that's great. Well, others, I've loved 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 time to be able to bring this to our listeners. As we always wrap up our heroes of healthcare podcast, we love to ask a question of our guests, which is, so, who is your hero, or who is your hero as you've been going through your career? I would say my dad. He's been my hero. He's the he's kind and I think that that's a critical component of healthcare. Kind Nets and compassion, and so my dad has been my hero as a result of that, because of the person he is. Yet yeah, he modeled that for you, which gave you the passion to go into the service side of medicine. Well, thanks again so much for your time. Thank you for your service and continuing to pioneer the rights and the and the health of the of our elderly. We need to continue to preserve them. They are the history that the future. I love hearing stories from the older folks, and so...

...thank you for continuing to do the great 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 show in your favorite podcast player or visit us at heroes of healthcare podcastcom.

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