Myths About Aging: What’s Real?

[Music] good evening everyone welcome so nice to see you all I see some familiar faces I'm Anna Chodos on the co-chair of the course and currently an assistant professor in the division of geriatrics in the Department of Medicine here and I'm very pleased to present this evening with my colleague dr. Linda Mackin just briefly like to introduce her she's gonna present with me we're gonna go back and forth to talk this evening with you about missive aging also just briefly Linda is a nurse practitioner and PhD nurse in our School of Nursing and an experienced educator and professor here at our University so it really a pleasure to to present with her we had a lot of fun putting this together I hope it's really enjoyable and informative so I'm gonna get us started this is our menu for the evening these are the myths we're gonna talk about it's probably somewhat obvious but I just wanted to restate what a myth is a myth is a wild widely held or wildly as well but widely held but false belief or idea so most of what you're seeing here is actually false and that's what we're gonna talk about so the first myth is that older people are either super healthy or super frail we kind of have these two images of what it's like to be an older person the second is that you are completely responsible for how well you aged we learned a little bit about the aging biology last week and so maybe you can draw on some of that but we'll talk a little bit more about sort of what's true and what's not about that third is older people will eventually lose their memory fourth is most older people will end up in nursing homes and fifth is there's nothing to look forward to in older age I didn't create these widely held beliefs I am stating them here so I thought I would get started actually with a little bit of why we decided to include this topic there's been some really important work in the last three years done by a group called the frameworks Institute in collaboration with multiple organizations that do aging research and aging policy and they were hired there a MacArthur Genius organization awarded for their work in framing and understanding cultural issues and in this case they were asked to work on Aging and so they have multiple reports on reframing aging and how it's time to reframe the way we think about aging and I just wanted to share some of their insights there's multiple publications on this they're all incredibly interesting unfortunately it turns out it's not super easy to just reframe aging it's actually a little complicated involved mostly what they've done is produce a set of communication tools that we can use to talk about aging differently so that people's views shift a little bit that the paradigm shifts a little bit and how we think about and communicate about aging but one thing they did that I thought was really interesting is talk about the swamp so they identify cultural norms and ideas and then characterize that as a swamp the reason they characterize that as a swamp is that there are some beautiful lush things about a swamp but there are a lot of hiding and not always visible at the surface dangerous things lurking below and they use this image of a swamp to remind us that when we're communicating about aging or other issues they use this this framing in other areas as well but when you're communicating about aging what's in that swamp so what do you want to try not to put your what snapping alligators do you want to try to avoid basically and what's fascinating is they do a lot of interviews and they do a lot of cultural analysis media analysis to understand what are the dominant ideas in this swamp so what they found when it comes to aging is that people when you talk to them have at once so I'm gonna start over here on the top left they at once have ideas about Aging excuse me that are both idealized and what they perceive to be real and there's some what they clash a little bit so a lot of the idealized views of aging that are out there are about the fact that older people have a lot of accumulated wisdom that they can be self-sufficient and active and that they've earned their leisure that they're spending time at the Country Club or whatever because they've earned it so those are some of the ideal versions of Aging that people think about and look forward to on the other hand when you ask them what they think people are actually experiencing an older age they've deteriorated physically they don't have as much control over their lives they're dependent upon others and their this is a determined outcome there's not a lot they can do about it at the same time they put a lot of emphasis on how individual how individuals really own the aging process and how their lifestyle choices and maybe their financial choices affected how they were able to experience older age and how they're able to live in older age they see threats in our modern life to the experience of Aging so families aren't as close physically people live on fixed incomes economics is harder and the really predominant view that Social Security is doomed and that's a that's a looming threat for older people there's consistently and us-versus-them kind of talk so older people are other dairy much they're not part of the rest of us there's a zero-sum meaning it's us against them so other generations are sort of in conflict with the older generations and there's a real us or versus them in the digital world that older people are really incompetent in technology and digital device what are some of the solutions that people think are possible that better that individuals can make better choices and plan better that's one way they could have control that they could learn more and be better educated so that's something we could do as a society to help them and but actually a lot of times it's a really fatalistic view there's nothing you can do to really improve the way your people are gonna age I'm not saying any this is true I'm saying this is the cultural analysis and I actually only had to look at one magazine to find examples of all of this so I just want to share with you some magazine covers from Time magazine in the last 30 or 40 years so 1970 growing old in America the unwanted generation so that's a very fatalistic that's a very us versus them zero-sum that's a very dependent or unwelcome message I would say old age how to help our parents again dependency of the ring it just makes me wonder like is nobody who's an older person reading their magazine that's that what they think and now for the fun years Americans are this 1988 Americans are living longer and enjoying it more this is the urns leisure idea but who will foot the bill so again this us versus them generations are warring and I don't know what dole was doing but he's on a roll in 1988 now we get to the sort of immortal wishful thinking that there's not anything we can do but science is going to help us not age right so we're gonna stay forever young says the supermodel who in 1996 is their example of science searching for ways to keep us forever young I think they're also alluding to the Fountain of Youth here she's in a pool of water can Google solve death so I don't know how many of you have read articles about Google's efforts they hired I believe a really prominent UCSF scientist don't work on some of this I think it's calicoes their venture to focus on the science of the anti-aging science this was very recent and how to live longer better so this says the anti-aging supplements experts take I don't take any supplements I just want to say pray the benefits the health benefits of faith the world's healthiest places so there's been a lot of focus on areas in the world where people live longer than others often called blue zones and then and the asterisks how to live longer better and still have fun so obviously that wasn't nobody assumed that that was included originally and getting older see a 10 put an asterisk there and then actually this from the future may 28th and this is Steven Brill he's putting out a book and I can actually can't remember the title about how the baby boomers and their the way that they've now structured economic life and political life have broken America and I also enjoy that right under his next generation leaders reshaping the world so it's always a focus on young people reshaping the world which they do it's wonderful or next generation leaders I guess I shouldn't say they're all young but it's like this additional subtle other ring or distinction between older people and the baby boomer generation and people are actually changing the world apparently so I just want to is this just an introduction into why we wanted to talk about some of these myths they're really out there actually as a field we're trying really hard to use what we know and what we do and working with older people and the research that we do to counter some of these myths and I forgot I can never resist the silver tsunami so that one is super popular it's everywhere it a million news articles start with you know as the silver tsunami approaches and so this is one article from May 7th startups the opportunity and silver tsunami as boomers retire Valley businesses brace for the silver tsunami so I it's it's literally making us terrified of old people getting older that this is a natural disaster and there's nobody who says hey there's a tsunami coming let's all hug and hug the tsunami it's let's run the other way so as an image the silver tsunami is a really unfortunate one so let's get to the miss some information about these myths and why they're wrong so older people are either super healthy or super frail so this was an article I saw a couple years ago about a gentleman Charles I actually can't say his last name properly probably you just sir the greatest British sprinter you've probably never heard of currently holds World Records and the 200-meter indoor 400 meter outdoor Sprint's as well as British records and a 60 meter indoor 100-meter outdoor and 200 meter outdoor a couple of weeks ago he narrowly missed out on the world record for the 60 meter sprint after pulling his hamstring halfway through he's still won the race to become European champion it's an impressive record given that the man by pretty well established standards shouldn't be able to cross a road without help let alone run he is 96 years old so yes a remarkable human being this is exactly the the folks that newspapers love to report on people love to do stories on of course this is remarkable at any age to be a world champion and this gentleman was incredibly athletic most of his life with long life so various 20 year hiatus is but his life story is very interesting and he actually had wonderful things to say about getting older and how he's been treated as an older person but it's just to point out that here he is you know here he is this great accomplishment and they have to they want to celebrate his age at the same time kind of take a dig and point out that other ninety six year olds apparently can't cross the street and I just frankly I haven't seen that study so what do we know about older people are they either super frail can't cross the street or competing in European Championships actually no so this is a growth chart for kids so what do you do with kids you follow you track their growth and that's you know if they're on track there is no such thing for older people so the thing that really sticks out about older people is header what we call heterogeneity they're incredibly different for a chronic illogic age we do not focus on age because it isn't that helpful so this is the guy on the left is a San Francisco resident and he's a beneficiary of a program here that was working with him and he agreed to have his picture taken and on and so that's a local gentleman and on the right are people roughly 20 years older who do swimming in cold water every day and and he's actually basically homebound so I think at 20 years their junior so that is to say that if I'm looking at an age I don't know if you are I thought that tells me nothing about how you can get through a day and what what you're capable of physically and cognitively I need to know more about you as a person and the the main thing is that really we cannot chart where you're supposed to be based on your age and we're really trying to understand better how to categorize who really needs certain interventions in terms of some of the anti you know sort of anti disease or Pro function interventions versus just you know doing cut-offs by age so for example you could imagine that one thing that really gets complicated for us is cancer screening so cancer screening is usually based on age cut-offs and the problem is age cut-offs don't actually tell you about how long that person will will likely get benefit from the intervention you're giving them especially as they get older the heterogeneity gets bigger so we often like to know more about our folks and I'll get to that a little bit more the other thing we know is that especially here we have a bigger diversity of older people than we ever have before so not just heterogeneity meaning there's a difference in function and health and socio-economic circumstances but actually just cultural background so what this graph shows is as our older population grows grows grows grows grows this is a total number going up to 2060 the number of native-born will get quite a bit smaller over time and kind of almost flattened and the foreign-born will become a larger proportion so they are growing at almost 300 percent between 2015 and 2016 whereas native-born older adults as part of our population are growing about 76 percent so it's just a greater diversity and more fun to work in geriatrics and but why are people so different so why is why do you really want everybody to be the same by a number of key markers when they're three and you have no idea how they're doing functionally or in terms of their health when they're 80 just based on age it's really because if you think about it when you're older you're really experiencing cumulative effects of multiple things that affect your health and well-being so the things that most commonly affect how you're doing when you're older are how you're functioning and things that may help or hurt your function like do you live on a big Hill do you have 45 stairs do you have a really really small kitchen do you have caregiving responsibilities that has a big impact on people's lives and function what's your social network social network changes a lot over a lifetime life events these are unpredictable things like partners dying or major illnesses chronic conditions that you have to deal with every day economic opportunities that may have been in your control may not have been especially women have a lot of coming in and out of the workforce or the women who are older now I have had a lot of Economic Opportunity variability over a lifetime and then what was your access to health care over a lifetime so all of these things when they meet a person who's an individual person has a different genetic makeup and and health makeup and susceptibility to different illnesses or ways that your well-being might be affected when it comes into contact with all these things all these different variables over a lifetime people gonna look very different at 80 and have different function and abilities and again health so just briefly to sort of address this idea if we are gonna lump all older people together are they mostly healthy or mostly not and mostly they're healthy so this was an it is a National Health Interview Survey it's not it's not a direct survey but it's a it's a phone survey that's done every year that is about available but the most recently where they sort of aggregated people over 65 in terms of chronic illnesses and healthy most reported being healthy the other is here in California most older people 72% have reported that their health is good - excellent which is the same as as middle-aged roughly the same and so I guess I just wanted - to sit for a minute with the fact that we really try to focus on not necessarily the list of chronic conditions or the list of medicines but how people feel that they're doing and how they're able to get through their day so how do we sort of quantify how people get through their day and how well they're able to I keep using this word function and so I wanted to find it for a second so this is a little detour function for us in the health world where we and this often in the social services world when we're working usually with older people is to ask about these things and these are sort of basic I think most of you're going to think these are pretty basic if I'm asking how well you're functioning during a day but we split it in two and forgive me for not spelling this out instrumental activities of daily living that iadls and activities of daily living so the iadls are usually as people start to need maybe need some help or lose some function as they get older if they lose any function these tend to be impacted earlier because they can be a little more complicated or have more moving parts but I also now sort of think of these as the app functions so your phone has an app for a lot of these things at this point but taking medicines doing housework actually preparing food doing your finances doing shopping using a phone and using transportation or driving these are all considered instrumental activities of daily living so these are really things you need to be independent outside of your home activities of daily living are often impacted much later in a disability course or later in life and these often although it depends on on what particular conditions you might have because you could imagine you would have like a oh you know bad shoulder or something like that that might affect some of this but these are the things that you need to be independent in your home so if you could get an app to bring you all of this or to get you around and did you help you do your bills and remind you to take your medications this is what you would need to be independent like behind your front door safely so that is bathing dressing being able to toilet independently or maintain hygiene if you're incontinent transferring from a bed to a chair chair to chair to standing and then feeding yourself so a lot of people do really well to have a good quality of life even if they're impacted in a lot of their ideals and and are independent in their home but once somebody has a disability and ADL I'll just say it's usually my focus to make sure I know that they're getting some assistance with that to maintain independence in a community it doesn't mean you know they need to leave the home it just means I you know you want to make sure they have some assistance but how many people actually have this disability so really it's about a third of folks have we usually say around thirty percent have a self-care difficulty like a activity of daily living and so this is sort of an aggregate of different ones they didn't this is the American Community Survey and they didn't actually parse it out by the ones I just showed you they added a couple more but but in between ambulation and self-care and some independent living difficulty it's usually about a third have some disability over age 65 about 9% have a cognitive difficulty vision 7% hearing 15% and that's actually probably a low estimate if it's probably including only severe hearing difficulty but these are all the things that these to me don't seem like barriers to living in the community it's just something you want to detect and know about because you can do something about it but it is by no means the majority of older people the other thing too is what I find really interesting when we think of how are people super healthy or super frail or how do we think about older people in our communities the working and being older is increasingly common so it's really important to think about older people and their ability to adapt to work environments and be accepted and integrated into work environments and so people over 65 are the fastest growing sector of the labor force and part of that we know is economic that people don't feel like they can retire as early but part of that is definitely that people are robust and want to be working and are working however what does it mean to work as an older person I think I just wanted to highlight some really interesting examples particularly of late well one that I always love is Betty REITs oskins you know her yeah of course okay she's a celebrity but she's our 96 year old park ranger in Richmond at the rosie the riveter park do you guys know this gentleman I'm gonna totally botched his name it's mata Mata here Muhammad he was he's just been elected the Prime Minister of Malaysia he had a long run in the 80s and I think to 2000 as their prime minister and now he's 93 I was just elected a couple weeks ago as their prime minister and these folks are anonymous they are a Google search but the point is they are in my mind working there providing childcare there's a lot of support that increasingly people receive from other generations not parents but grandparents or even above great-grandparents I have some patients who has great grandparents are taking care of their great-grandchildren and I think not seeing them in the labor force is one thing and that's certainly increasingly common like technically post retirement age but then also the fact that many older people do a lot of work in the you know for our community for a society even as as post retirement okay so dr. Americans gonna take over here for a few minutes so I'm gonna handle myths number two three and four so number two is that you are completely responsible for how well you age by race of hand how many people here think that's true okay all right okay we got we got a few hands here and on what basis is anybody want to throw it in it yes okay all right so I just need to repeat this for the recording the audience member said that a lot of people's illnesses are related to lifestyle choices so habits and environment and maybe things that they've done during their life right and so that therefore makes you responsible for how well you age or not anybody else have anything else to add to that yes okay okay good thank you so the comment was to keep yourself sharp you wanted every day try to learn new things and try to incorporate more knowledge into your fund of knowledge that you have and that keeps you more vigorous yes good I agree with that yes so I'm gonna talk about myth number two relative to longevity and I'll tell you the reason why is that I had four family members who were part of the New England centenarian study so I know quite a bit about that study and the results from it anybody here in the room have any family members or anyone that's associated with the New England centenarian study no so my grandmother and three of her siblings were all enrolled they have all since passed away but my grandmother lived to be a hundred and five her baby sisters were 103 and 102 respectively when they passed and their brother was a hundred and one when he passed he was actually the first one to enter the study and then when he entered the study the coordinators of the New England centenarian study reached out to him and said do you have any siblings well yes I do at that point he was the oldest so all of the the sisters were still in their 90's but they enrolled everybody and as part of the enrollment blood was drawn so that they have banked genetic tissue and blood composition and and information on all of the people that were enrolled in these studies and the New England centenarian study started collecting data around 1994 and what some of the major things that have come out of the centenarian study is that genetics is probably the most important factor in predicting or determining if you're gonna make it to a hundred or not and in fact I I meant to put this on the slide on in the New England centenary and study website there is a little side box where you can click a survey that will tell you what your chances are of making it to a hundred I actually do it in my classes with my nursing students and we have a lot of fun then we report back to each other about how we were doing and we feel sad for those that say they're not going to make it to a hundred did you have a question sir yes yes yes yes probably very very close to it so I just want to repeat what this gentleman said is that there was an article in the paper today about a woman who's 113 years old who's still very much together cognitively and and functionally and and looked great you said yes great good thanks for sharing that so they're a really unique group of people but they have found that there are actually genetic signatures so they have looked at all this genetic data that they've collected through the years of data collection for the centenarian study and they have identified sort of clusters or patterns of specific genes that seem to help people to better achieve that goal if that's your goal or to achieve an age of 100 so they call those the genetic signatures to contrast this in my own family with what this gentleman said about lifestyle and environment my family members sort of demonstrated the effect or not of that so as I said all four of them made it to be over 100 my grandmother 105 was the longest living and I can remember growing up she was making her own yogurt long before anybody ever even thought to sell yogurt in the grocery store and as a kid we were all gagging I didn't want to eat grandma's yogurt and in fact if she was a member at the Olympic Club and played golf there until she was around 96 or 97 and she would pick mushrooms off of that golf course and said that she knew better than anybody else which ones were poisonous and which weren't but whenever grandma prepared a salad for the family nobody wanted to eat it if it had mushrooms in it for obvious reasons so we weren't really certain that she knew exactly what she was doing with selecting her mushrooms but she did not die from mushroom poisoning so she she didn't know what she was doing she also used to put a wheat germ in everything that she baked so she would bake like Grandma oatmeal cookies but had wheat you're a minute and as kids we bite into it and we're thinking this is gonna be nice and buttery and juicy and it was like eating sawdust so anyhow she was very much into nutrition she also swam almost every day so she made it to 105 in contrast her sister who lived over in Oakland passed away just shy of 103 and she called herself a couch potato hated exercise didn't want to have anything to do with exercise and literally lived office Stouffer's frozen dinners and could talk for hours about which ones were the best she made it over a hundred - and then the one sister lived in Portland she's the one that made it to 103 she was driving until I think she was like a hundred and apparently she drove one of those Cadillac DeVille that was like a block long and I guess she knew how to park it which you know tells you something about her function right and then the brother who loved to be a hundred and one he had a pacemaker and I didn't have a lot of contact with him during my life but he I believe he got married a few times in one time or the last time was in his 90s and he was quite vigorous up until the moment that he he passed at 100 Malone's so there's kind of a wide range just with my own family of the effect of their their lifestyle and their habits so it kind of comes back to the genes and that's what they're seeing from the centenarian study in doing some reading in preparation for this presentation I came across two concepts here that I want to share with you because I think it kind of helps to tie some things in here particularly around the value of function and the importance of function so a scientist down at Stanford James Freese came up with the compression of morbidity hypothesis and this was back and I think in the 1990s and his hypothesis was that people who made it to advanced age were able to shorten the period of their life where they actually had chronic illnesses that affected their function and longevity the folks who have contributed to the research that's in the centenarian study took that hypothesis and worked it a little bit more to call it compression of disability and what they have found is that people who make it to over a hundred have just the same amount of chronic illness as younger people if you sort of compare people that make it to a hundred and those who don't it's not like the people over 100 have fewer illnesses they have many of the same illnesses that younger people who don't make it to 100 also have but they are able to compress the disability associated with those illnesses until very very late in life therefore they're able to function more independently and they came up with three sort of labels for these people relative to the compression of disability and one is the survivors so so these are people that have had chronic illness that was evident before age 80 the delayers of the people that had the chronic illnesses starting in their 80s but they were able to delay the compression of the disability or the impact that it had on their function until later and then the escapers are people in their 90's who didn't really seem to have much disability related to their illness at all and another interesting thing that they found in the centenarian study is that at age 93 90 percent of the people in their cohort that they were studying were functionally independent 90 percent of the 93 year olds so that again really supports this notion that it really is all about function and for all the years that my family members were enrolled in the study while they were still alive there was an annual interview and a survey that was completed and it had to do with how well are they doing how much help do they need with things like the ADL's and the iadls there were some measures of their memory function and where they were living and how much help they needed to get through the day as well as medications chronic illnesses hospitalizations things like that so they have a really rich database and I think some really interesting things have come from that and I think we have a lot more to look forward to going along with our myth is to debunk this myth that oh you're responsible for your own aging right more older adults are doing activities so this is a graph showing self-reported activity both aerobic activity on the left hand side and muscle strengthening activity on the right and the dark blue represents people who responded to the survey between year 2000 and 2002 the light blue is later people who responded between 2013 and 2015 and you can see across the board the the respondents in the later time cohort are self reporting more but as we age it does sort of decline in terms of the percentage of people who are reporting aerobic activity and muscle strengthening activity including in the oldest old cohort which are people 85 and up for the most recent data from muscle strengthening less than 10% or around 10% are doing that right now so there's a lot of room for boosting these the height of these bar graphs in here to help support function okay it is a myth that older people will eventually lose their memory and if you look into this a little bit you'll find a lot of sort of statements out there but the one that I use the most is at age 85 half of the people will have some cognitive impairment that's doesn't it's not equivalent to dementia and half will not so I've seen that number the age sort of move up and down but in that's kind of a ballpark figure so memory loss is common in aging but I really want to emphasize that it's not normal and this is something that I try to remind my students because I think it's easy when you work with older people to fall into this rut of thinking while everybody has some cognitive impairment and that that's just part of Aging when it is not so it's memory loss is common as I said about the 85 year olds 50% will and 50% will not but it is not a normal part of Aging and there are some expected cognitive changes and I put a short list here but these are the ones that are most commonly described there is a decline in processing speed meaning that you're not able to process thought as quickly as you would when you were younger there is also a decreased ability to multitask and an activity of daily living that's very important that requires multitasking is driving so that's why it's important to be aware of these changes with older drivers or family members that are aging and driving because there's also a reduction in reaction speed from a neurological standpoint that can impact driving safety as well the ability to learn is preserved but it may take a little more effort it may take a little more time to get things to sink in but one can always learn and just as I had mentioned this dividing line at age 85 half-half cognitive impairment half do not we have this other dividing line when we talk about people that have memory or cognitive impairment and we have sort of two very broad categories one is called mild cognitive impairment or MCI and then we have a global term of dementia and Alzheimer's disease being the most common form of dementia but the term dementia actually has many many different types of cognitive impairments underneath that umbrella and the thing that differentiates mild cognitive impairment versus dementia is in mild cognitive impairment there may be some memory problems that are detected through some assessments or screenings but the impairment does not interfere with the person's function they can still perform their activities of daily living they are still fairly independent with their activities in terminal activities of daily living whereas with dementia there are functional impairments and quite often they are in the activity of daily living category the toileting the transferring those of which I like to think of those as needing a warm body to help you to perform those and I love what you said Anna about the app side for the iadls so I think that's an important thing to keep in mind is that when memory impairment impacts function then we're talking about something under the category of dementia and not just mild cognitive impairment does anybody want to guess at what is represented in the picture that's an early hearing aid yes and thank you to the few people that laughed I love to include this picture but I hardly ever get anybody laughing at it but I think it's pretty funny but it does remind me to say that if you ever need to improve your hearing instantaneously just pull your ears forward like this like he's doing and it really improves your hearing that's what elephants do and so we can do it too we can use our own hands to do it so a really important thing to think about when somebody as they age for all of us who are aging but particularly if somebody seems to be having some cognitive or memory impairment is are there some things that can be fixed from a Sun sensory standpoint so hearing being one I've seen a number of people in my practice who have been sort of labeled as having cognitive impairment when actually it's just that they cannot hear and similarly people that they don't have good vision correction or they have problems with cataracts that have not been treated that will influence their ability to perform some of these assessments that we do in order to determine if there is any indication of memory impairment so we always need to be aware that sensory function does decline as we get older hearing ability does decline as we get older it's probably a normal part of Aging and there are normal changes that occur with vision as well some of which we can correct some we cannot but if we want to optimize somebody's cognition and ability to participate in their life we need to make sure that the sensory function is intact another thing that turns out to be helpful in being able to maintain a good cognitive function is dependent upon how big your personal fund of knowledge is so to put it very generally if you are somebody who is fairly knowledgeable educated then it's going to be longer before your cognitive losses are going to have a significant impact on your function and also may make any cognitive problems less detectable to other people because you are working with so much knowledge to begin with illness burden so we know that older people often will start collecting chronic health problems so it's not uncommon for older people to have high cholesterol or high blood pressure or diabetes and I see in older adults that sometimes all of these diseases start to gang up on you because one sort of kind of feeds into the other one so that can also impact your your memory function and cognition as well as the medications that we use to treat some of these problems can do that as well and then as we've talked about a little bit habits and lifestyles do influence our memory so if just for a very general example we know that drinking alcohol is not good for the brain neither is it good for our liver but it's not good for the brain and so smoking is the same because it has all of the negative effects with our vascular system so when I'm thinking about memory I think it's useful to know what the risk factors are for memory impairment and cognitive impairment and look at the list of risk factors although recognized that we can't do anything about any of them except maybe protecting younger people from head injury but age is the biggest risk factor for developing dementia or cognitive impairment there are some forms of dementia that ran in Wrentham families there are some specific genes that are associated with the development of dementia and then as I mentioned about head injuries but there are some factors that can help reduce the risk and those are really well exemplified by the folks who are in The Wizard of Oz story so I was thinking about this last night I don't think and you can help me if I if I'm not getting this right I don't think along there yellow brick road trip they ate anything does anybody remember that I don't remember that so we're just gonna because they were able to complete their journey that they ate a healthy diet they did not smoke or drink during their journey however they did fall asleep in a field of poppies do you remember that and I don't remember if it was the whole group or if it was just one or two of them but so they did they did have some exploration with that we can give them that they got plenty of exercise for their bodies as they journey along the yellow brick road and they probably did their heart and brain a lot of good through that exercise but they also had members of this group that were seeking heart and brain and which one of the characters is the one that wanted a heart the tinman wanted a heart he did not have one yes and who needed a brain desperately the Scarecrow right and so this gives me the opportunity to say that in health care and particularly then talking about maintaining health we say whatever is good for the heart is good for the brain so a heart healthy diet and lifestyle with exercise avoiding smoking controlling cholesterol watching the salt intake eating a you know Mediterranean - diet is beneficial not only to the heart but also to the brain and then finally coming back to our our Wizard of Oz characters they all benefited from the social support that they got from each other and we know that that's something that's helpful for all of us but particularly as we age and helping to keep our cognition and our armed memory working as best as it can through social support and we'll move on to myth number four most older people will end up in nursing homes and I was thinking as as Anna was going through all of these you might not believe it but we actually tried to work these in a more positive way we had a different list that was even more of a downer than what we have on this right Anna you have to sort that out the other night this is a myth fortunately most older people will not end up in nursing homes but I have some information just about who does live in nursing homes most of the residents in long-term care are older adults about 63% but a good portion more than a third of the people that are recipients of long-term care are under the age of 65 and just keep in mind for this particular study long-term care included hospice care nursing home people who are receiving home health nursing and people who resided in residential care communities which I'll talk a little bit about in a moment according to data collected in 2010 only 13% of Americans aged 85 or older resided in an institution so that might be a nursing home or a residential care facility and only 1% of people in a younger age cohort and then I just have to kind of laugh at this stat says 25% of people admitted stay only a short time which is to find just three months or less that sounds like a long time to me to be in an institution so I guess that we should be happy it's only 25% but three months or more sounds long to me the lifetime risk of needing a nursing home varies depending upon what age cohort you're in but in the younger cohort about half of those will spend at least one night in a nursing home over a lifetime now here's another thing that's kind of amusing about this stat is I don't know if anybody that's ever spent one night in a nursing home so III think we can sort of question these stats a little bit I mean the last slide just said you might be there for three months and that's not very long so I don't know we'll just sort of take it for what it is we had somebody help us with the research stats on this I have to say I'm not totally clear on it but but the lifetime risk of being in a nursing home is at about 43 percent so almost half and people aged in the younger age cohort have a 10% chance of spending three years or more in a nursing home and a 5% chance of spending more than four years so I should educate myself more about this study because there's some sort of interesting findings in there so you probably can read that up there I was hoping maybe you couldn't but raise your hand if you think that Medicare pays for long-term care and assistance with daily living well nobody's going to do it now I should have rearranged this slide a little bit you're you're very on the ball with your knowledge here but about half of the people polled thought that that Medicare will pay and and Medicare does not there's very specific things that Medicare will pay for under kind of the umbrella of long-term care and it's not much and then these pie charts show on the one on the Left says does a typical health insurance plan pay for ongoing care in a nursing home and these were people that were 40 years and older and more than half said no so they were correct on that and then does a typical health insurance plan pay for ongoing care at home by a licensed home health aide and about half said no and they were correct on that too so it appears that people increasingly are beginning to understand that Medicare does not pay much for long-term care particularly for custodial care they do not pay for that so I want to talk a little bit about different kinds of living settings for older adults just so we all have kind of a common understanding of that we've talked a little bit about nursing homes that's again sort of an umbrella term underneath that might be a skilled nursing or a subacute might be sort of categorized underneath a nursing home but they actually have different levels of service that's provided but really people that reside in a nursing home are kind of a small slice of the pie what's very becoming increasingly more common in expanding all the time are residential care communities and the data that I was was kind of old from 2014 they said there was 30,000 of these in the country reflecting 1 million beds and more than 3/4 of a million people living in these facilities and in general these are assisted living facilities of which they pop up all over the place these are for a large part corporate owned so some of the brand names are like sunrise and atria and Silverado and then we have also boarding care homes which are typically homes in a residential community a single-family home has been converted to accommodate about 6 residents and there'll be staff in the home at all times to provide personal care and assistance and and medications assisted living and board and care are things that Medicare does not pay for in very limited situations medical may help support somebody who needs to live in a board-and-care home or if somebody needs to live in a boarding care home and they're getting social security insurance they may get a little bit more in their monthly SSI in order to cover the cost of a boarding care and then the third and again Medicare is never going to pay for this active adult communities and so these are the communities where you typically buy your own home or you buy equity into the community there's 151 of these in California and there's 15 in the Bay Area and I'm going to show you an example of one in a minute but I wanted to step away from this topic for just a second to just share an interesting stat here so according to the US Census the oldest county in the United States is Sumpter County Florida where the average age is 66 point 6 years so if you want to move somewhere where you're going to have a lot of company in your your later decades that's where you want to go and part of the reason why they are on top is because that's the home of the villages retirement community have you heard of the villages so the the villages retirement community is this community in Sumter County Florida and it's one of the original active adult communities and they dub it the Disneyworld for adults and that is largely why that County comes out with the highest average age is because this is such a big draw in that County and this is kind of a petri dish for older adult research because they have so many people there in this community just little travel log information for you and then I'm kind of skipping around a little bit but I didn't want to miss the opportunity to tell you a little bit about a couple of resources that may be helpful if you or a loved one are facing selection of a nursing home Medicare has a national database called nursing home compare that's updated monthly and you can look up any nursing home in the country and see how they're doing in terms of staffing inspections what if they've been in trouble for things like that and then in California we have a really great advocacy group called can our California advocates for a nursing home reform they have a really great website and they take very seriously the importance of advocating for long-term care individuals and also to make sure that that families and patients are supported if they find themselves needing to use long term care ok I'll hand it back to Anna thanks for allowing me to return I will say actually briefly about camera I'm a huge fan I use their resources all the time I will say they have actually I think an important website in terms of it's just not very user friendly or it's a little messy but and their name is a little bit terrible because they do everything they do all elder law and they're just actually a great resource if you need an elder law attorney or any sort of just generic information about resources or nursing homes or any kind of legal assistance and they have links to lawyers so I use them all the time actually there are a terrific resource so our last one there's nothing to look forward to in older age except maybe you know not having to live through too many more elections I don't know but it turns out this is a myth thank goodness for all of us so debunks happiness there was a Pew Research Center did a study asking people of various ages a total of about 3,000 people would you say that you are very happy pretty happy or not too happy and frankly across the ages it was pretty similar perhaps some people once they were middle-aged and above there was a there was a certain higher number that were would report not too happy but most people were very happier pretty happy that doesn't change that much very interesting also in the same survey was what people under 65 expected about aging and what people over 65 reported about what they were experiencing and aging so this speaks to our earlier myth but over 57% of younger people or 57% thought that their memory loss was a feature of being older and about 25% were actually experiencing that that's actually high so probably some of those people weren't that you know technically didn't have memory loss again not able to drive having a serious illness not being sexually active feeling sad or depressed not feeling needed being lonely trouble paying bills and being a burden and in all of these that the number of people actually reporting that was much lower and then what about if you actually ask people about their well-being so this is an interesting way to get at well-being is asking people if you're on a ladder for that the bottom is 0 and 10 is the top and you're thinking about your best possible life at the very top and the worst possible life at bottom where are you on that ladder and actually it's sort of dips in middle-aged but people are pretty satisfied they report pretty good well-being as they get older these are all just different ways to getting at it so when you actually and this was sorry this was three hundred and forty thousand people were surveyed in this so it's a pretty robust survey I shudder to think how they were able to complete that survey so there's a lot to say that people in there who are older aren't reporting being unhappy I think there's some real challenges with growing older that people who are older also speak to and so I I want to touch on these briefly just do people know Donald hall he's a he's a poet he's still an active writer now mostly writes prose and he published a book about essays after 80 and really he sort of describes which with what at one point he describes as a ceremony of losses that's what that's what these essays are about so it's not to discount the fact that in later years there can be a cumulative effect of multiple losses in his case he suffered physical disability and was having trouble with mobility and ended up using a wheelchair too for his mobility he had several chronic health conditions that were seriously impacting function he lost his wife actually what somewhat interesting about him he lost her many years earlier but he writes about it as if it's a very present thing she was understandably very important to him and he wrote a great essay where he outlined how he lost respect of his community and this is where I want to start to pivot what we're talking about but what we can do is we get older and what we can do as individuals to affect how we age in our experience of aging and to think a little bit also about what our community can do what we as a community can do for older people that can maybe improve the experience of aging so he talks about going to a museum with a colleague I believe who was pushing his wheelchair for him to make it a little easier to get around the museum and here he is poet laureate distinguished writer of an incredible intellect and the one of the museum staff sort of crouched down and looked him in the eyes and said did you have a nice nice Dindin and you know just yes exactly I'm sure he wanted I think essentially he smacked them in this essay and let them know what he thought about you know and his thoughts expressing it in this essay but just the fact that you know this the phenomenon I think of treating older people as as infants at times was really painful for him and so there is a phenomenon that that is increasingly being studied about loneliness and that was one of the things that was asked about in the Pew study so I want to bring it up because it is notable in older age and it's a increasing focus and so we know that compared to prior generations more older people live alone than they used to and it's particularly true for women so women over 75 are more often live alone than don't and so that of course doesn't mean you're lonely by any means but it's a risk factor and in some studies up to 43% of people in the community who are older have reported feeling lonely so over 65 so that's feels like a pretty high prevalence so this made me wonder however because we do focus on it a lot and we focus on the health outcomes of loneliness such as mental health consequences health consequences and actually higher mortality rates and people who say they were lonely compared to those who don't but I was like well alright is that just a feature of older age just cuz we talk about it all the time in older age and there was a study that looked at this was a German study so I don't know how similar we feel to Germans but or how much we want to compare ourselves to Germans but when they asked people across the lifespan so from their 20s to a hundred years old about loneliness it looked in the raw scores that they were reporting more loneliness in older age but then when they controlled for all the variables like function and health just a way to sort of even it out there's actually sort of peaks of loneliness in life so in thirties sixties and then in older age but it's not necessarily that much higher when you're older however that doesn't mean it's not important and in fact looking across the large lake of the Atlantic Ocean in England they have a campaign against loneliness so they're a little ahead of us on this but they really focus on the health impacts of loneliness and again in my interest in sort of pivoting us to think a little bit about community solutions they have a framework by which they're trying to address loneliness as a community so that framework includes thinking about the structure of the community so what our neighborhood approaches community development approaches volunteer approaches that can impact aging sorry loneliness we know transportation and technology improving those access to those for older people impacts loneliness direct interventions for people as well helping them make new connections build stronger existing relationships and then foundational services for all of us which is just trying to reach out to older people understand their what they're going through and support them appropriately but that the fact that there's a lot of societal and structural parts to this intervention I think is really important because I really think we're getting to the point where we understand that's really health wise function wise you know yes life planning there's lots of things you can do to improve your experience of aging overall and maybe the age better or whatever that means to you or to live longer if that's important but we there's a there's a trend now towards acknowledging and trying to plan aging and disability friendly communities and cities so it's a movement and you can get certified and I just wanted to plug and to say that San Francisco is engaged in that and they currently have an implementation workgroup for an aging and disability friendly City so that involves the tech council Muni community organizations of social services that have access to food and housing turns out housing is a tough problem in the city I don't know if you guys have heard about that but that that is unfortunately a really tough one but but they point out things like you know to also to just focus on disability and aging is undercutting what they're doing because a city that's an inclusive and accessible how it really helps everybody so if you can read signs better if they're clear if the streets are easier to navigate if the curbs are better and technology is more easily accessible that actually just helps everyone so it's not even necessarily entirely all of its it's an all age friendly strategy in some ways and so to point out some examples in the Age Friendly cities as I mentioned things they really focus on our transportation accessibility will see how to what degree Oberer and lyft want to start helping out its access to technology and intergenerational programs which are growing in the city access to health in different settings so there's a huge movement to health in the home so forget nursing homes forget hospitals all of that should be done in the home so there's like a hospital at-home movement there's home-based primary care of course that's a appropriate in some settings and others well home-based primary care Lynda does hombres primary care but we are increasingly are admitting and realizing that clinics hospitals nursing homes are built for the people who work in them and not the people who are supposed to benefit from them so taking those factors out of the actual healthcare we're trying to provide making the city's accessible San Francisco has a lot of challenges around that but making it aging and disability friendly and then this is one of my favorites in the Netherlands they have a program where because of housing crises for students who can't afford housing actually setting up programs where they can live with older adults who might need some some amount of assistance and either getting really discounted or free housing if they live with an older person and you know respectfully provide help occasionally but also companionship and there's a lot of really cool things as usual they're way ahead of us and that's that's what I'm gonna leave things many of you may not know but we're in older Americans month right now and there's a website at the administration for community living ACL gov for older Americans month and I will say that it's really focused on the stuff that you can do so if you're looking for ways to engage and health in learning more about security financial security volunteering and just general info tip sheets this is a good resource so I want to make sure you saw it since this is older Americans month and they may have resources for you but I think finally we're ready to take and there and take your questions which I know we're really looking forward to so yes I'm so sorry yes Oh a.m. dot a CL gov all right I'm so grateful for your attention thank you really looking forward to your questions yes sir yes I'll make a brief comment so the question was how do things like Outlook or work on mindfulness and outlook and and positive thinking and you had a different term which was a good one but things like that how does that impact aging or how's that been looked at aging the the basic thing I will say is obviously mindfulness is really gaining steam there's so many good resources for it things like resiliency building resiliency those things are all in terms of skill sets and way that we ways that we can build our skills oh and gratitude you mentioned gratitude which is a beautiful one and a really important one there's no reason to think that you cannot do those in older ages no reason not to work on those I don't specifically know of research or work that has worked focused only on older people but I would I have seen some research that has shown that outlook does have some impact on resiliency at like physicals like physiologic resiliency in really stressful situations but actually a lot of the data shows that resiliency is higher in older people because cumulatively they've been through more things so actually resiliency is almost like a trained skill that a lot of older people have so and okay so let's yes sir so thank you you've just asked my favorite questions the first is our medicines so like number of medicines associated with getting older basically our increasing age oh yeah so basically we like to take your age multiply it by 2/3 and then make sure you're on at least that many prescriptions i we know it's really it's it's really unfortunate what we caught we call it prescribing cascade and prescribing inertia so the new term all the buzz is D prescribing though that's our number one mission when we work with older people is to see what extraneous harmful or no longer necessary medications are there the promise people get started on medications or they get certain medications by multiple providers who aren't talking and those stay on so you should always be reassessing every single year if not more often what medications you're on if they're necessary and then the main thing I look for is can we get rid of the medicine if we can't get rid of medicine can we go down on the dose or the how often that person's taking that medicine because the lower pill burn and the better and medications the number is associated just a simple number not even the type with a lot of really unfortunate things like Falls decreasing function so we really try to minimize medications but is absolutely true that older people are on most medicines and then the second question was we should all of these excuse me graphs are obsolete because 65 is an absolutely unuseful number for saying when somebody's old I spent the whole time saying how chronology is not that helpful we want to know how people are doing functionally and overall in terms of well-being and you know daily activities so I could not agree with you more but unfortunately we have inherited this cutoff of 65 and there's some utility to it clearly some things are associated with being 65 or older but it does it's not as meaningful as we're pretending it is and I think we would have to agree with you on that yes ma'am yeah so the book I am blanking on the authors while happiness is a choice if I'm not mistaken that's the same gentleman who he published these profiles or at least some of them in the New York Times these are all New Yorkers older old so over 85 New Yorkers and sort of their stories and it is a I read a lot of them or some of their profiles in the paper and yet these are just remarkable people it's completely wonderful to learn from them and his stories are really good and I I think absolutely I think it speaks a lot to the resilience and I think that's a wonderful recommendation and the long weekends coming up so we've got the time to read this story and if you buy your prescription your subscription not prescription to the New York Times maybe you can find it there yes sir yes the question is does is there a decline in immune function as we age and yes there is the term for that's called immune senescence and so what it means is that as we age our immune system is not able to mount as vigorous of a response when they when the body's faced with an infection for example it doesn't mean that the body cannot respond but the response is not as strong and it may be somewhat delayed so a clinical example of that is is that older adults may not develop a fever even if they have pneumonia whereas a younger person would so that's a good question I'm gonna let an answer that one I got the easy part so the question was is there anything that can be done to strengthen the immune system so I think some things are already done so just one quick example clinically as well vaccines for older people the flu vaccine and the zoster vaccine for shingles will be a higher dose than they are for younger people to be sure to stimulate a response I know there's no clear road to improving the immune system specifically is gonna sound a little strange but in some ways it's actually a gift because a lot of damage from the immune response is avoided so pneumonia isn't as painful urinary tract infections aren't as painful so you want a good clinician to be able to detect if you have a problem and help you get treatment but in in some regards it's also adaptive and that it's not the vigorous immune response that you normally get you know isn't quite as damaging either so now we know there's this sort of balance between their needing the immune system to help you get rid of infections or even cancers things like that and then not hat and then the damage it does and leaves behind when it goes you know guns-a-blazing so yeah I think I think we're not but we don't actually have targeted therapies for that so the question in the follow-up question was you know actually can preserving the immune system or strengthening the immune system actually help with avoiding eating some of the medications we need to combat disease and I'm gonna have to punt again I'm not actually sure what we can do I mean I think the basic things we do to preserve mewn system are really it's gonna be a little bit embarrassing ly simple but like good nutrition sleep you know regular exercise those things actually do are shown and then Oh hand-washing well you've it or not you know just to prevent infection in the first place doing all those standard things are helpful there's but it's a good question I'll actually follow up with I don't know if you're her last week but I'll follow up with dr. Newman who who may have some additional information that's a good question does autoimmunity too kind as you get older because obviously all the autoimmune response is the unwanted attack of the immune response on our own body unfortunately no we have a different we see different autoimmune diseases and older adults but we still see autoimmune disease like rheumatoid arthritis doesn't get better you know things psoriasis is autoimmune has an autoimmune component there are things like different kind of inflammation and blood vessels that actually we see more skin diseases that cause blisters that are even more common in older people so I'm not sure that unfortunately we do see a decline in autoimmune disease which is a bummer yes sir so a great question the question was here in San Francisco we have a great infrastructure of public health infrastructure where we have a lot of nurses and those folks are frontlines to provide health care to older people I'm gonna let the nurse answer this question but it would be it would be my vote that absolutely we need a front line workforce yeah I'm gonna let I'll say very briefly because I don't think it's my role to make all the comments but we definitely are a little prideful in geriatrics that we're very interprofessional we are not we're not into having the physician as the center of the universe or even the primary provider like the nurse practitioner as the center of the universe we actually work put a lot of emphasis on social work you know home health workers you know we consider all those people our team the community pharmacists we're trying to work more directly with community pharmacy so this is it's a team effort all the way and I think that is actually a core teaching of geriatrics because the medical stuff actually often needs to get de-emphasized to improve health and well-being because we run the risk of what you call iatrogenic cysts like our health care being the problem not the solution or causing more harm than good but I would love Linda to talk a little bit about this I'll just make one self-serving comment is that one of the things that I really enjoy about being a nurse is the definition of Nursing is the diagnosis and treatment of human responses to illness and I feel like being a nurse and working in geriatrics that comes to its full fruition but I totally agree with what Anna was saying is that geriatrics is really I think one of the best areas for interprofessional collaboration because it takes a team to provide really good care to older adults the other thing we're putting a lot of emphasis on and actually my time here this evening or I should say my time to prepare the talk this evening was funded by a grant from the federal government to Train frontline folks in geriatrics principles but not necessarily be specialists because we're not gonna have enough specialists so that that ship has sailed already so we have about 7,000 geriatricians in the country with the large increase not natural disaster tsunami but large increase in older people that we're gonna have in our country we know that that that's a huge shortfall by at least at least lowball estimate 23,000 if you wanted a geriatrician to provide care to every older person or even every older person that had who's over 85 or you would say had geriatric needs so that that ship has sailed so that's exactly what we wanted to do what I would call that is decentralization we want the frontlines to really hold the knowledge and the skills so that is actually what we have a grant to do and we're and we're working on so Linda's part of our grant and that's how we get to work together and doing education yes sir yeah this gentleman's coming and it's gonna be our last comment and then we'll wrap up and we will definitely stick around for a more discussion if you have time and interest but his comment was really you know we all have lapses in memory sometimes and you know why so much emphasis on that and that the brain is a sort of a more complex organ than that and I would just completely agree it was a little simple for us to focus on memory there's a lot of cognitive domains in the brain and we're learning so much including how things like music or dance or other kinds of body movement can access parts of our brain that were otherwise seemingly flagging in general interaction I want to thank you so much for your time and I really look forward to seeing you next week and look forward to speaking more with you this evening thank you [Applause] [Music] you

Channel: University of California Television (UCTV)

Views: 16,682

Rating: 4.5636363 out of 5

Keywords: Geriatrics, aging, senior health

Id: sCBW9AZ78tQ

Length: 81min 9sec (4869 seconds)

Published: Mon Aug 13 2018