Prakash Chandran: In today's world, so many of us fear getting old. No one wants to lose their teeth, their memory, and most of all their independence. But with the right care plan, could there be a way to age in a healthy way? We're gonna discuss it today with Dr. Anne Wakamiya, an outpatient physician practicing both internal and geriatric medicine at Northern Inyo Healthcare District. Dr. Wakamiya is going to talk to us about caring for older adults and promoting healthy aging. This is Mountain Medicine, the official podcast of Northern Inyo Healthcare District. My name is Prakash Chandran, Dr Wakamiya thank you so much for joining us today. I really appreciate your time. You know, I said it a couple times in the introduction, aging in a Healthy Way, what exactly does that mean?

Dr. Anne Wakamiya: Aging in a healthy way. You know, I think that really, is such a personal question. I would say generally aging in a healthy way is, being able to do the things that you wanna do in your life as you get older, and to be able to do those things as long as you can. And to be able to spend time with people you love, doing the things that you love as long as you can. And so maintaining that quality of life, and for different people, that's gonna mean different things. When we put that into medical context, there's a lot of, chronic diseases that age is a risk factor for and diseases tend to come on as we age.

And so another aspect of healthy aging is to manage those diseases so that they, impact your life as minimally as possible. So I think that what we would call the functional aspect of life, being able to do the things that you wanna do, as well as the medical aspects, minimizing any impacts of disease that does come on with age. I think those are two important parts of healthy aging.

Prakash Chandran: Yeah, and I hear a lot about this term, quality of life and I know that that's encompass of kind of what you're saying, like being able to do the things that you want when you want. Is that also something that you think of about, when you think about aging in a healthy way?

Dr. Anne Wakamiya: Yes, absolutely. And I think my question when I, see patients in the offices is, what aren't you doing that you wanna be doing and how can we get you there? And sometimes, it's not possible maybe to get all the way there, but we'll try our hardest and I want people to live as long as they can, as well as they can. Then I think both of those are equally as important.

Prakash Chandran: So when should a person start thinking about healthy aging for either themselves or a loved one?

Dr. Anne Wakamiya: that is also a great question. I, personally think it's never too early to start thinking about healthy aging. And I think the care that we take when we're younger and we're at kind of less risk for disease and we're still in the preventative stages, I think that that is the time to start the process of healthy aging. And I think a lot of that is with lifestyle. So, with exercise, with physical activity, with nutrition that we provide ourselves, with the social friendships and social circles that we maintain, and kind of help maintain our emotional health. I think all these are really important, from early on, I would say it's never too early to consider these things.

Some people might ask, when should I start going to the doctor? Or, that might be a question that we get to a little bit later. In terms of thinking about healthy aging in a clinical context , in the doctor's office, I would say things to be looking for, it's not too early to monitor your blood pressure. To work with your doctor to occasionally get lipid panels, to check your cholesterol and your blood sugar, and also to start cancer screenings at the recommended times. And I would say for a person who's really not having any significant medical problems that they know of, those are things that can be done, preventatively, to help with healthy aging.

Prakash Chandran: Yeah. So you know, a lot of what you just talked about was helping people as they get older, you know, in their thirties and forties and thinking about ways to start to take care of themselves. But what about people that are, in their eighties and nineties, they've been dealt their hand, maybe they are already dealing with a lot of different medical issues. How should they be thinking about things?

Dr. Anne Wakamiya: So, Kind of coming back to the issue of quality of life again, we kind of take stock at what's important and again, we're troubleshooting. So we're figuring out what would this person like to be doing that they're not doing? And how can we get them to be doing that thing? How can we maintain independence as long as we can? And whether a person's goal is to stay in the home, or whether they have plans to move, , whether it be to another home or to, a more supportive environment. I think we're thinking about how do we achieve those goals. I'm also starting to weigh the risks and benefits of everything we do.

Every medication, every procedure, every move we make, when we're thinking about a person's landscape of medical problems and medications are on, everything we do has both risks and benefits. And so I'm thinking, How, what we're doing gonna add to and work towards the goals that a person has? What benefits is it gonna bring them? And I wanna make sure that what we're doing, that they're not gonna incur the risks or the harms of what we're doing. And so that really means weighing very carefully medications that we're using and procedures that we, decide to move forward with. I also start to think about what is likely to be this person's biggest problem?

When I think about that, and when I think about, what problem rises to the top. that's the problem that we're gonna try to manage. Because I'm thinking about what problem is going to affect this person's quality of life and maybe limit their life the most. And that's what we're gonna talk the most about and work on, preventing more problems coming up.

Prakash Chandran: Yeah, that makes a lot of sense. You know, leading up, I guess to the later years in life, I know you said it's never too early to start thinking about it, and there's so many different facets, right? Like you mentioned, there's physical health, mental health, there's specific nutrition. health, right? Like making sure that socially you're connecting with people still. How do you advise people to, I guess, start, a framework around, checking in with themselves or their loved ones to make sure that those things are actually tended to as they start to age?

Dr. Anne Wakamiya: I think it depends a little bit on the stage, that one is in. And I think a person who is in the 30 to 40 year old range, is starting to find out when a person is due . For cancer screenings, and should start getting cancer screenings. And maybe having some of that baseline blood work done. And maybe connecting with a physician, who you might get to know in case you were to have a problem. And then I think, As one ages and as maybe that same 30 or 40 year old. Thinking about one's parents, who are aging, I think a common concern would be, memory. And memory changes.

Another common concern might be falls noting, changes in a parent's balance and maybe physical activity. It's really helpful to make sure there's no developing medical cause. My approach is to make sure there's no lab abnormality, thyroid problems, or other, like a concrete medical problem causing those issues. And then to take kind of a more holistic approach to things like balance, memory other common problems that come up might be related to urinary or bladder issues, both men and for women.

Prakash Chandran: You know, one of the things that I wanted to address is that sometimes we might have a loved one in our lives that is aging in an unhealthy way, and they're kind of stubborn, right? They don't see all of the signs that they should, and I know. For myself, I'm 41, I have an 80 year old dad. It's something that I, think about a lot, right? Like, how do we be a good support and how do we encourage them in way when they're still very independent and they still want do their own thing? And sometimes it feels like we know better. It feels like we're like, look, we kind of see. You becoming a little bit more fragile. We kind of see those facets that we were talking about, that, physical nutrition, mental health, these things aren't being cared for. So, it's always like interesting to figure out how to approach them in the right way.

Dr. Anne Wakamiya: Definitely. And I think one aspect of it is, sometimes. you know, the person that you're encouraging to come in, they might think that there's nothing to be done about a certain problem. And that's where I really like to sit down and just have a conversation about what the issue is. And basically problem solve and troubleshoot. And so that's how I like to hopefully get people to start coming back. Is that every appointment we're troubleshooting, how can we make life better? What can we do to keep the quality of life or even improve quality of life?

 It may not be a medication, it might be part of the conversation. It might be reassurance. It might be some exercises. and it might just be checking in every three to six months, and making sure we're on track. So I think just taking more of a troubleshooting approach, it can be really helpful and kind of get people engaged that we're trying to problem solve and make things better. And that's the ultimate goal.

Prakash Chandran: Yeah. So, you practice both internal and geriatric medicine, and today we're talking about navigating options for care in the later years. Tell us about like the patients that you see and how they can think about the options for care as they start to age.

Dr. Anne Wakamiya: I think it's really an intimidating topic for a lot of people. As a person ages, it's inevitable that we all, lose some of our capabilities and particularly, I think big ones are mobility, decline in mobility, whether that be physical mobility, the ability to drive ability to navigate around the house, to move from bed to chair to toilet. Those are changes that, prompt questions of how are we gonna get through this? And there's a spectrum of options, , for extra help. And I think this is another topic that's really difficult between adult children and their parents. Essentially I guess what we're approaching here is kind of loss of independence, whether that be from a physical mobility perspective or from cognitive change.

 A lot of people might be really hesitant to use a cane or a walker. However, if somebody's willing to adopt the use of a walker, that might prevent a fall and that might ultimately allow them to live in their house much longer if they were to fall and injure themselves. So I always say you, you gotta give a little, but you get a lot. And so by giving up a little bit of independence through things like assistive devices, it can actually enable a person to stay in their home longer. The options for where, one is receiving care.

Most people kind of are starting in their homes and if it gets to be too much for a person to be at home on their own, they're not able to potentially get around their house or do the things that they need to do, like cook, or kind of manage the. there's a couple different options. One which is a family member could move in with that person, and help them, or they could have some help coming in. a caregiver, for example, coming in to help them. And that could be anywhere from two hours a week, all the way to full-time, 24 hour care.

So that would be a person who is remaining in the home. The other kind of places along the spectrum. So if a person is not able to remain in their home. They need a little bit more help. There's not necessarily somebody who's able to come help them. Family member, caregiver. A more supportive environment would be assisted living. And assisted living is often a setup is where a person has their own living space. But there's common areas for meals which are prepared. And there's often a lot of activities. There are maybe buses that wil l take people shopping or , out to the movies. And it can be a pretty social environment.

 Assisted livings are not medical facilities. So that's one thing to keep in mind is that there are no, nurses on site. At the most, there's a person who's able to give a resident medications and help with giving, medication administration, but not with really any nursing care. And we'll contrast that in a second to nursing home care.

Prakash Chandran: Before we get into care, I can personally attest to the fact that my grandmother-in-law went kicking and screaming into assisted living, and it turned out once she got there to be like she basically completely transformed as a person. She had her independence still. She created better social circles. She was, I'm telling you, busier than we were on the weekends and during the week, and she even said, I didn't realize that assisted living could be so fun. You, it's something that I think is so feared, but for her, it really gave her a new lease on.

A lot of people that were, you know, in her age demographic, had her similar interests and similar dispositions were able to be together. So I can definitely attest to the value of that assisted living arrangement, and I'm sure you hear that yourself as well. Right?

Dr. Anne Wakamiya: Yes, absolutely. That is really common feedback. And so actually kind of one unfortunate thing is we did have an assisted living facility in Bishop that actually closed about a year and a half ago. And so there's currently not assisted living in Bishop where we are and I think that's, been really hard on the community and has kind of made it tough to take out that intermediate option for people. One other thing I just wanna point out about assisted living, it's usually not covered by insurance, unless somebody has a long-term care insurance that might pay for it. But it's not covered by Medicare or any of the major insurance companies. It's usually out of pocket and usually it runs around three to $4,000 a month.

Prakash Chandran: So so it is an expensive, option there. Not everyone can access that for sure.

Dr. Anne Wakamiya: That's right. We're talking about these different options, but we can't talk about them without, Talking a little bit about cost and who's paying for these options, because that often is a driver for where people do, end up, whether they are staying in their home or they've moved to assisted living or even to a nursing home.

Prakash Chandran: I am so Glad you brought that up. I do wanna, you talk a little bit about nursing homes. Tell us about what they are and what's the difference between that and assisted living?

Dr. Anne Wakamiya: So nursing home is, kind of at the other end of the spectrum from a person who's staying at home. The nursing home , it's a much more clinical environment wher e the residents vital signs are monitored and they receive extensive. From nurses who are on staff and onsite, 24 hours a day. , a lot of times these residents are more debilitated than people who would be in assisted living, although I have seen that assisted living is they're offering a lot more services and support to people who do have mobility issues and cognitive issues.

And so, actually people can stay in assisted living a lot longer. Which is I think pretty neat. And then back to the nursing home setting. The nursing home is regulated by Medicare and Medicaid and Medicaid is actually the largest payer for the nursing home. I should say there's two parts of nursing home care. There's, what we call short term rehab, which is somebody who's coming into the nursing home following an operation or a hospitalization where they're expected to rehabilitate and return home. And then there's long-term residents of the nursing home who plan to reside in the nursing home indefinitely.

 The short-term residents of the nursing home, their stays are covered by Medicare, for the first a hundred days. And the long-term residents of the nursing home initially, they pay out of pocket, for their nursing home room. unless they meet, , the qualifications for Medicaid in which medicaid will pay for the nursing home room. And this is really important because the nursing home room monthly, , cost runs are about $10,000. So much more expensive than assisted living.

Prakash Chandran: We are, just as we start to wrap up, I wanted to give you a chance to share anything else that was, important to the audience. And maybe as a prompt, I would love for you to maybe give your best advice, like one piece of advice to an audience member that's taking care of their elderly loved one, just anything that you might have them say or do?

Dr. Anne Wakamiya: Sometimes we have ideas about how we wanna help our elders, and I think it's just really important that we're asking them what's really important to them and how they want , their aging process to be, and how they want their lives to look like. And I think if we start with what they want and we, propose ways. Them meet their goals and support them. I think it makes it a very collaborative process. I think that the message is that we want to support people in aging, in the way that they would like, and we wanna help them achieve their goals.

 And help their lives be the best that they can be, and in according to their values and their hopes, and what they like to do and who they wanna spend time with. And so I think from a medical perspective, from a support perspective we need to really ask our loved one, , what's really important to them and how we can help them, , keep that central as long as we can.

Prakash Chandran: Yeah, think that's wonderful advice in the perfect place to end. So Dr. Wakamiya, thank you so much for your time. I truly appreciate it.

Dr. Anne Wakamiya: Absolutely. Thanks for having me.

Prakash Chandran: That was Dr. Anne Wakamiya, an outpatient physician practicing both internal and geriatric medicine at Northern Inyo Healthcare District. For more information, you can call 760-873-2602 or visit our website at nih.org. If you found this podcast to be helpful, please share it on your social channels or check out the entire podcast library for topics of interest to you. again for listening. My name is Prakash Chandran. Be well.