Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Today, I'm sitting down with internal geriatric medicine physician, Dr. Sakeitha Crowder, and we're going to be talking about healthcare and which type of doctor you should see in your senior years. Thank you so much for being here. Before we get started, I would love to know how geriatric care became a passion of yours and what made you want to become a physician?

Dr. Sakeitha Crowder: Lengthy story made short. My mother participated in a lot of care of older people within our church and our community. And so I sort of grew up with a lot of older people around me. At an early age, I saw a lot of health disparities with our older population, and just to be honest, developed a love and a care for our older population.

So in medical school, when I learned about geriatric medicine, I did my first rotation and that's about it.

Host: And why is it important to have an established primary care physician?

Dr. Sakeitha Crowder: So as I like to tell my patients, it's important to have that personalized care. The difference with just a regular provider that you see one time versus your primary care provider, is that they get to know you personally. And in knowing you personally, they can provide the best in preventive care based on your family background, your lifestyle, sometimes even your job, things that we consider, as well as your acute and chronic care.

Host: Dr. Crowder, as patients get older, when should they consider seeing an internist or geriatrician?

Dr. Sakeitha Crowder: Good question, Maggie. So, the time to consider switching maybe from your regular family medicine practitioner to an internist or geriatrician is when there are more complex medical conditions. So, I have oftentimes have patients that are referred to me, because of conditions such as dementia or Parkinson's or other, what we call geriatric syndromes.

That's a good time to maybe consider switching because an internist or a geriatrician, we are a little bit more familiar with complex medical conditions. And we serve, I always call it, we kind of serve as your central point. So we're the ones when there are several specialists that are involved in a person's care, we sort of make sure that all aspects of their care are recognized and accounted for and not just that specialty.

Host: I think most patients thought they were so called good if they got their annual physical. Can you explain what an annual wellness visit is and who qualifies?

Dr. Sakeitha Crowder: So an annual Medicare wellness visit does differ from the regular CPE or complete physical examination. It is for all patients that have Medicare benefits. So those that are 65 and above or that were able to get Medicare benefits earlier due to complex medical conditions. So it is a once a year examination and when we say examination, it is not so much a physical exam as much as it is a health risk assessment.

It also includes mental health screenings, social determinants of care, and other factors that differ, advanced care directives are also discussed. And of course we always review the medications, the list of specialists that a person sees as well as their medical conditions. It does not include, however, a physical examination, And it may not include labs. So it is different. It's a lot of questionnaires.

Host: And what are some of the most common questions you receive from patients as they age?

Dr. Sakeitha Crowder: I think the most common is, Doc, help me age well. So, very general, broad in terms, but, you know, realistic. So, I have patients that start having the discussion in their 50s. And what we're looking for is how can you age appropriately? So we see those that have declining health status, particularly functional, mobility wise, and how can we prevent a decline?

And so we work a lot on health risk assessments. So a part of the Medicare wellness is our fall assessment. So we, you know, how likely is it for you to fall? What things are in the home? We even ask, do you have rugs? You know, on the floor, because we know that the most common location for falls are in the bathroom. So the rugs that we love, they're plush, but they're also fall risk.

Host: It is amazing how many people we all know who fall and it just takes so long, the older you are, it seems to heal from that. So prevention is worth everything, right?

Dr. Sakeitha Crowder: It is key. And there are so many things that we can put in place once we realize that there is a fall risk potential. Number one, we can maybe activate the team approach such as physical therapy. So, strengthen the muscles that are weak, that is putting the patient at risk. Medication review, as we call it, medication reconciliation. Dizziness, are there problems with blood pressure changes? What can we do so that we can reduce the risk of an event occurring in the first place? So, we prefer to interact prospectively versus retroactive, meaning after an event has occurred. So, that is our preference.

Host: That sounds like a good plan. Dr. Crowder, we've all heard stories about how patients get referred to specialists and quote lost in the system. How do you do things differently at Novant Health? Is it truly a team approach?

Dr. Sakeitha Crowder: Yes ma'am. It is definitely a team approach. One way our electronic medical record system has a lot of things that help to remind us that there are preventive care issues that are missing. So we have a care coordination team behind the scenes that help to assist our team in making sure that we meet the needs of our patients.

 There is active interactions between our specialists. So oftentimes our specialists, if that is not their specialty, and there's a new problem that arises, every day I have messages saying, Hey, this patient has this concern. Can you help us? So it's a team approach that we all sort of circle back, and at the end of the day, we try to take care of the patient.

Host: And what's your best advice for our more seasoned listeners? Do you have any tricks to make aging easier? Please share.

Dr. Sakeitha Crowder: I definitely, I think the biggest is staying physically active. So a lot of times when my patients are retiring, my next words are congratulations on your retirement. Now tell me how we're going to stay active. So physically, physical activity is key. You must start an exercise routine. If you're a smoker, stop smoking.

Making sure that you have a primary care provider, and if nothing else, that you at least get your Medicare wellness visit every year. And kind of follow the recommendation, healthy living, so making better dietary choices. So, of course, less of the fast food, less of the processed foods, more fruits and vegetables, and water.

I think this summer, particularly, we had a very hot summer here in North Carolina, and, remaining hydrated was very pivotal, it was key. It's key to the health of a lot of patients.

Host: That's a good one for, I guess, every day of the year, but especially in the summer.

Dr. Sakeitha Crowder: Every day of the year, but especially in the summer. We had several patients who presented with what we call orthostatic dizziness, and really it was just dehydration.

Host: Well, finally, can you share a little bit about what an advanced care directive is? Some people refer to them as living wills. Why is having one so important?

Dr. Sakeitha Crowder: Yes, ma'am. I'll be glad to discuss that. So a advanced care directives is a formal or legal document, which allows a patient to state their care or their desires, in the event that they are unable to do so. So, number one, most, our advanced care directives, it includes, the healthcare proxy, or what we call the healthcare power of attorney.

So, if you're unable to make your own decisions, who would you prefer us to talk to? Okay, this should be a close person, a friend, a family member, whomever you have had that sit down one on one conversation and said, hey, if you're not able to breathe, would you want a breathing, you know, a mechanical ventilator?

Would you want CPR? You know, all the details. Next is the living will portion, and it's where you can communicate your wishes directly to the physician. So some patients, prefer DNR or DNI, do not resuscitate, which means no CPR and no intubation. Or DNI, which means, no intubation only, CPR is fine.

You know, in the, in the event that they have passed away. The Living Will allows you to decide or delineate step by step in certain conditions, if you'd want a feeding tube, would you want IV hydration? Or you know, all the details or how long you would want those things used if they're utilized.

So, as I tell patients, I know we don't like to have the discussions about end of care or in a life, but this allows you to be an active participant. You lead us, you guide us, not we as physicians making the decision for you or your family members. So what it allows is it gives your family members comfort at the end that the decision that they're making is actually not their personal decision, but it is that person, their mom, their dad, their loved one, their spouse. It allows them to say, I'm following their wishes.

Host: It's so crucial. And maybe do it sooner than later because you never know. I mean, to wait till you're older, is that a good idea?

Dr. Sakeitha Crowder: We recommend that you should at least start by age 65. So as I mentioned earlier, it is a component or aspect of the Medicare wellness. You know, it's a questionnaire that we ask, do you have one? And if not, we have them in our clinics. I always like to remind patients that the last page, you get it notarized and it is a legal document, just plain and simple. So in our discussions during our Medicare wellness, this is a great time to bring up questions or to go through it or even schedule a separate appointment just for the advanced care directives.

So no, do not wait. And you can review it. So I tell patients, maybe at 65, their desires are a little different than 95, you know, as far as what you would or would not want at the time of end of life. And so yes, you can modify it. You can update it.

Host: Well, thank you so much for sharing your expertise. All this information is so useful. We really appreciate it.

Dr. Sakeitha Crowder: Yes, Ma'am.

Host: Again, that's Dr. Sakeitha Crowder. To find out more, please visit novanthealth.org/healthy-headlines. To find a physician, visit novanthealth.org. And for more health and wellness information from our experts, you can visit healthyheadlines.org.