How to Embrace Aging: A Conversation with a Geriatrician

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani.

Greetings to everyone today joining us for our podcast. You're listening to the Living to 100 Club, and I'm your host, Joe Casciani. You can find this conversation and all past recordings on our website, livingto100.club. Today we'll be talking about geriatric medicine, but before we get started, I want to just remind our listeners of a few items. I'm a public speaker and I present to community organizations and senior groups on topics related to aging well and managing setbacks. I also offer a free 30-minute healthy lifestyle audit. That looks at current lifestyle practices and uncovers age-related challenges that you or a family member may be facing. With the findings from the audit, we can decide if individual coaching would help. If you are interested, set up a free call from the option on my website. I also provide consulting and training on clinical topics like depression and dementia. Now to our podcast where we discuss successful aging, staying positive, and making more informed decisions. Our guest today is Dr. Jeanette Guerrasio, a physician specializing in internal medicine and geriatrics. We will discuss age-related physical changes in our body like heart, kidneys, and lungs. We'll also discuss other Undesirable changes that are common, such as incontinence, osteoporosis, and arthritis. What bodily changes take place as we get older, and what can we expect, and what changes frequently accompany aging but are not part of the normal course of aging? First, a little background. Jeanette Guaracio is a practicing primary care internist in practice at Sundial Medical Center in Denver, Colorado. She graduated from Albany Medical College and completed her residency at the University of Connecticut. She received additional geriatric training at the University of California, Los Angeles. While practicing at the University of Colorado, she became a professor of medicine. In addition to education, she is equally committed to the clinical care of patients with expertise in both adult medicine and geriatric medicine. Geriatrics. Dr. Gracia is a member of the Society of General Internal Medicine and the Academic Hospitals Task Force. He's been a course director for various national meetings, including the Society of General Internal Medicine, Society of Hospital Medicine, Alliance for Academic Internal Medicine, Association of American Medical Colleges, and the Federation of State Physician Health Programs. Most recently, she was awarded the Humanism Award, chosen as the Clinical Sciences Teacher of the Year by the medical school graduating class, and inducted into the Academy of Medical Educators at the University of Colorado President's Teaching Scholars Guild. Dr. Gracia, welcome to our podcast.

Thank you. I look forward to chatting with you.

Great, me too. I'm looking forward to this. I always like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today. I went through a long list of your credentials and achievements, so bring us up to date. How did you get where you are today?

I think I'm going to go back further than you expect, but I actually wanted to be a doctor since I was 6 years old.

Oh wow.

And There are no other doctors in my family, and so a lot of people wondered where that came from. But I have this wonderful father. He is so kind and he's such a giving soul, and he's been a volunteer fireman in our community where I grew up for 53 years. And I just loved watching how he interacted with the public and his dedication to other people and to the community. And I really think that's what fostered my desire to become a physician, not just a physician but a physician that served the community. And by the time I was 18, I was already thinking about going to medical school and I wrote my first application for college. And I remember writing that I wanted to be a physician because I love to listen to people and to learn their stories and to learn from them. And that I felt like often physicians didn't spend enough time listening to their patients. And I really think That's sort of the key of who I am and how I've built my practice. And so, and in the way that I teach learners to learn. So I spend a lot of time listening, and then as I learn, I like to share what I've learned for the benefit of other people. And that's what I hope to do today.

Yeah, well, I love that. I love that because it does take a lot of listening time. With patients. We, we often think we know all the answers or can recommend or prescribe or whatever we're doing, but we really need to hear the person, right? We need to be there present and we need to know what's going on with the whole person, not just their symptoms, right? Not just their complaints. Yeah. So tell me about your current professional work. You're teaching, you, you're in clinical practice. Yeah.

So when I finished residency, I started working at the University of Colorado and I worked at the university for 13 years. And all of my work was done at the bedside, whether it was teaching residents or taking and taking care of clinical patients at the same time. I radiated towards geriatric patients. And so two-thirds of my time was spent with patients that were considered geriatric. And I just wanna stop here for a second because some people say, well, what is geriatric? You know, Classicly means over 65, but, and for some people, 65 is an old age. They have a lot of health problems and they have not done well. But for many people now, 65 still feels young and that geriatric title doesn't seem to fit who they are or how they see themselves. And so a new term has come up called the old old. And so the old old is now for people who are 85 and above. So, A lot of what we talk about in geriatrics really has to do with research and studies and statistics and what works best for over 65. And then there's this whole group of people who are old, old, and that's maybe what most people now want to think is geriatrics.

So people in their 60s or 70s, um, we don't consider old anymore, but, um, I'm sure is the practice of medicine with that age group, this closer to 40s and 50s. Or 80s plus?

I actually think it's in some ways closer to the 80s plus from a medicine standpoint. Even if you feel well, we have to think about things differently from a, from the side of a physician. And I will talk a little bit more about that as we proceed. And so after being at the university for 13 years, I was able to sort of fine-tune my teaching and my practice skills. But I often felt like I didn't have enough time with patients. And we talked about how I like to listen, and I wanted to practice differently. And so I eventually moved into the community, into my own practice, where I could do things in a more custom way. And so although this is unheard of in most parts of the country, I actually do home visits. And we have a lot of— a lot more time with our patients. We basically give them the time they need. It's not based on any sort of set structure. And so I feel like I can provide better care because, you know, starting at 65, as you mentioned, you start having to think about different things. What, what's important to the person? Where are they in their life? What do they wanna be able to do? You wanna make sure you're incorporating their goals for the next 10, 20, 30+ years as you're coming up with their treatment plan in a way that you don't when somebody's 30 or 40.

You know, you, you accept insurance, I take it, health insurance?

So we do, um, we do charge a little bit of an additional fee, okay, because of the time that it takes to do some of the extra things.

That's what I was going to ask about, because with current procedure codes, I mean, there are time allotments. So if you spend the extra time, that, that doesn't necessarily fit within the nice CPT I know.

And I have to say, I felt guilty about that for a long time, that I'm treating people who can afford to pay for it. It's not— a middle-class family can afford it. It's not an extensive amount of money, but I spent 20 years treating underserved patients, and now I feel like I want to be able to provide good medicine that I think people are otherwise not getting.

Right. Yeah, I appreciate that.

I say all the time.

That's good to hear. So what do you enjoy about geriatric practice?

So I alluded to some of this, but there are two things that I love about geriatrics. The first is patients have a wealth of knowledge and life experiences to share. And so, and they're often eager to share their stories for the benefit of others. And so I get to hear these stories. I learn from them. I actually put out a weekly newsletter um, that includes certain medical topics based on patients, what patients want me to write about, but I'll often incorporate stories that patients tell me or, or wanna, uh, contribute to the newsletter for the benefit of other people.

Mm-hmm.

And then the second thing I really like about geriatric care is it's medically very complex.

Mm-hmm.

And so we talked about the fact that you have to not only consider the medical aspects, but all the social aspects that come with disease. But if you look in the mirror, or if I look in the mirror, I'll put this on myself, I see wrinkles and I see gray hair and I see bumps that weren't there when I was 20.

Sure.

And so part of being a trariatrician is understanding that all those things that are abnormal on the outside happen on the inside too. And so if you get a CAT scan with some abnormalities or an MRI or a lab value, you have to figure out what needs to be investigated and what's just a normal part of aging. And does it need to be investigated? Because you don't want to put your patients through unnecessary testing, right?

Right.

So part of what I like is sort of that cognitive challenge of geriatrics. We have so many factors to balance in coming up with a treatment plan. And so that's part of what I like about geriatrics.

Yeah, you, you brought up the complexity, and that is so important because there are so many different systems and normal aging and some age-related decline. I know when I started working with older adults, one thing that really impressed me was that you could not tell what was going on just by looking at the person. Bumped over in a wheelchair, for example, in a nursing home, you know, you might think that they were completely out of it, but on the contrary, they were bright and alert. They were just kind of dozing off, and you can't tell from from the outside what's going on or how healthy, how alert, how intact cognitively the person is just by looking at them.

I went to see a 99-year-old patient this week and at her home, and the daughter was talking a lot and I've known them before and she'd lost some weight, the patient. And I wondered if there was a reason, a cognitive reason that the daughter had taken over the visit. And I said, no, I prefer to talk to your mom first, 'cause she's the patient. And then what she doesn't tell me, I'm going to let you fill in. And then at 99, she immediately perked up and was able to tell me everything I needed to know. So, you know, sometimes you're surprised, just have to give people that opportunity.

Yeah. Yeah. We can't tell just by the looks or if the person is not speaking very much, it doesn't mean anything about what's going on inside. Yeah. So here's a big question that we can just jump right into. Let's talk about normal age-related decline? What, what kind of physiological changes can we expect to see? Systems?

Yeah, this is a huge question. And so I thought this might be best explained through an example. And of course, this isn't going to cover everything, but it'll help explain what happens.

Sure.

So, um, now take this example, and I'm not a golfer, but I've seen this happen so many times. I think this is a great example. Imagine it's August and you decide to take your grandson, or it could be your granddaughter, golfing. Okay? So, your grandson wakes up early in the morning and is later than they expected to be, to wake up, and they're in a rush to get to the golf course. And so, they skip their breakfast, they grab their golf clubs, and they run to the golf course and they meet you there. Now, you, on the other hand, you wake up and you contemplate whether or not you should eat. You're not really very hungry, so maybe you eat a quick little pastry, and then you start to think about how much you should drink because you're not sure if, if you can hold your bladder while you're on the course. And so you don't drink very much, maybe just a few sips of drink while you're taking your pills. And so you're golfing with your grandson and you're having a lot of fun, and then you get to hole 4 and you notice that the day is turning out to be hotter than you expected. And you and your grandson start to sweat a little bit under the sun, and your grandson goes jumping from the golf course— the golf cart— completely unfazed and starts off at the tee. Now you get up from the golf cart and the world starts to darken a little bit. You feel a little wobbly and you start to hope that you don't pass out in front of your grandchild, and you quickly grab a bottle of water. And now what's happening here? Now, this is a very— you're both on the same golf course. In fact, your grandson had nothing to drink. At least you had a few sips of water. How come you're dehydrated and he's not? Or how come you're dizzy and he's not? And so in this just one example, this, I feel like, catches all of what happens to us as we age. Not quite all, but a lot of things. So let's take a look at the cardiovascular system first. So over time we get calcium and we get cholesterol that build up in our blood vessels and that causes our blood vessels to stiffen. And so when you stand up quickly, the blood vessels aren't able to squeeze that blood back up to the brain. And so what happens is the water and the blood pool in your feet and you don't get the oxygen to your brain quick enough and you start to feel a little woozy. Then, when you're young, your heart will beat much faster. So when your heart beats faster, you're able to get that blood to your brain quickly. But as you get older, your maximum heart rate is actually lower than when you're young. And so when you stand up and you need your heart to go faster to pump that blood to your brain, it just can't do it. And why is that? Your heart needs hormones like adrenaline to tell it to go faster, but your adrenal glands don't make as much hormone as they used to. And so your heart can't speed up like it did when you were 20 because you don't make enough of this chemicals that signal for the heart to go faster. And then the last piece of this is people over 65, whether they feel 65 or not, live in a chronically dehydrated state.

Mm-hmm.

So starting at age 65, we lose our ability to sense when we're dehydrated. We don't get as thirsty, we drink less liquid, and our kidneys are not able to concentrate urine as well. And so if I drink a glass of water when I'm young, I'm able to hold onto a lot more of that liquid. Where when you're older, you end up peeing out most of it because you urinate a dilute urine. So it's much harder to hold on to fluid, which means older people actually need to drink more than they did when they were young. But of course, that's not what older people do. They don't wanna have to go to the bathroom, and so they drink less. And so all of these factors compile on top of each other that lead people to feeling more woozy when they stand up or being more dehydrated. And so I could go on to lots of things, but I want to give you a common principle that links everything together, cuz you're not gonna remember what every organ does as you get older. But what happens as you get older, you get one— each organ, individual cells start to die. And when individual cells slowly start to die, they leave behind scar tissue that causes the organ to get stiff. And when it's stiff, it doesn't work very well. Okay. And so imagine you have a big muscle and the muscles when you're young is soft and stretchy. And then over time, you slowly— the cells die and you get little areas of, um, scar tissue and stiffness in the muscle. And so when you get up in the morning, your muscles aren't as loose as they were when you were 20, they're stiffer. And so some of the ways to prevent that is to stay hydrated. Water keeps muscles and your organs from getting stiff, and stretching of the muscles keeps them soft and moving. Now, there are a ton of tips that I could give you on how to help each organ, like, um, in addition to just drinking more fluid, because there's a reason you're not drinking more fluid. You're not drinking more fluid because you're worried about your bladder. Well, did you know there's pelvic floor physical therapy? And I say this because most people don't realize that there's physical therapy for everything. And so there's pelvic floor physical therapy that can help strengthen your bladder so you can hold on to more water and you're not as afraid of drinking too much. Or there are, um, medications and different, um, things that you can use to help with the bladder. There are— some people know about these compression stockings that can help keep the blood where it's supposed to be when you're getting up quickly or out golfing. Um, they used to be really, really hard to put on, compression stockings. Now they make ones with zippers and they make ones with Velcro that are more user-friendly. And so there are all of these— our population is aging, and so fortunately the technology is starting to get so much better to help us manage some of these changes so that people can go on and not experience some of these side effects that come with the changes into our body as we age.

Yeah, yeah. Well, it's funny you mentioned that golf example because I could relate to that. I left my water jug in my car this weekend on my golf outing, and about the 10th hole I said I'd really need that water, and there were no fountains where I was, or no carts with any water on it. So I really noticed that, you know, I'll reserve what symptoms occurred to me, but it's funny you, you mentioned that. So I'm curious about if these changes are taking place— we're living longer— are the changes taking place in later years than they used to, or do they still happen in our 60s but we're managing better or we're coping better with them?

Yeah, so that's another great question and shocks most people as and scare some of my students 'cause some of my residents are in their 30s. But the truth is that all of these changes start at 30, 3-0. And so all this, the cells start dying randomly. This process of fibrosis, it starts at age 30. And so when I have patients who come to me at 50 and 60 and they're afraid of aging, I can tell them, look, you've already been doing it for 20 or 30 years and look how well you're doing. Like, we naturally adapt to our circumstances, especially when the changes are slow and subtle. And look how well you're doing. You've been doing this for 20 or 30 years, and this is going to progress. Now, the reason it gets harder when you're, you know, 70, 80, 90 is because you begin to lose your reserve. And you have a ton of reserve at 30 and 40. At 50, that it's less obvious when you start to have some of this initial cell— these initial cell changes. The question you asked was, why does this happen? Why are we doing so well at 65 compared to, say, decades ago? And I think it's better nutrition. I think it's better exercise. I think it's better medication. I think it's different expectations as well. So I think there's a lot of social factors as well as medical factors that explain why we are doing better. Than generations before us. And, you know, and generations before us, there were lots of people who lived to 90, but we had a very high infant mortality rate. We had a high maternal mortality rate, and a lot of people died of infections that we can now treat. And so I think the— it's not that people didn't live to 90 years ago. It's just that so many more people died younger that the average age was lower. But I think we're seeing more people get through those, um, those initial, like, humps?

So yeah, we are living longer. Of course, a lot of it has to do with healthier lifestyle changes, right? I can see that. So the normal cellular damage or decline may still be happening, but we're able to kind of postpone it or delay it because of our nutrition and activity, physical exercise and all of that. Yeah, yeah, I always like to cite the Department of Health statistic on longevity, and, you know, they found that 30% of our longevity is due to genes and 70%— National Institute of Health, rather— 70% is due to lifestyle in terms of how long we live. And I, I, I love that because it really shows that what we used to think was out of our control really is not out of our control. I mean, 7 out of 10 things we can do are really under our control.

It's true. 7 outta 10 things are under our control. And with the other 30%, there's some great technology out there now that, that will allow us, and that allows us now to detect cancers earlier and that allow us to detect heart disease in a very different way than we had in the past. There are, we've been using a a test looking for DNA fragments in blood, in blood to catch cancers in the early stages. We do a lot more genetic screening of patients to figure out who's at highest risk so we know when to start screening tests. So we're not uniformly testing everybody at the same age for certain cancers. We vary it based on individual. And then the other thing, we have some tests where we look for both soft and hard plaques in people's arteries. So that we can help people sooner. And can I mention what those tests are?

Yes, please.

So CLEARLY, C-L-E-E-R-L-Y, is the test that we've been doing. It's like a CAT scan with dye that looks for both soft and hard plaques, because it's usually not the hard plaques that cause strokes and heart attacks. It's usually the soft plaques that are more likely to rupture. So we've been using that technology to catch these sort of time bombs, so to speak, that are in people's arteries before they have heart attacks. And then the company's GRAIL that makes a test called Galleri that looks for blood tests. Now it doesn't work well for cancers that don't have a great blood supply, but for things like pancreatic and ovarian cancers that previously we had no screening tools for, and that by the time you found them, they were always stage 3 and stage 4, and we didn't have good treatment for. We can now catch in the much earlier stages. And so I think these things too are also helping us decrease people's genetic risks in ways we didn't have the technology 2 years ago.

Yeah, that's good to hear. That's good to hear. I wasn't aware of some of those screenings. So you cited some of the changes that naturally occur, you know, that maybe the physiological changes, the muscle loss, uh, balance, difficulty. Are there some ways to adapt to these changes and how can we best mollify or reduce their impact?

Yeah. So I think the biggest barrier often to physical adaptations is our willingness to change. And I'm not— I'm human too. And your doctors are human too. I unfortunately broke a leg and then a couple of years later broke the other ankle. And I had to stop running, and it was something that I loved to do. And, and, you know, I had to give up running for hiking. Do I miss it? Of course I do. And so, but I've had to let it go. I had to grieve for its loss, and I had to move on. But I can still be outside. I can still be with my spouse. I can still be with my dogs. I can still exercise and explore the trails of Colorado. I just do it differently. And I met new friends along the way. And so I think Um, part of it is this willingness to adapt, and I have a lot, a lot more things to say about this. So I want to pose another question for you because I think often when we ask people to make changes that are not pill-related, so giving them a pill, that they're less willing to adopt some of these changes. So I'm going to pose a question, and, um, this one's for you.

Okay.

Now I'm, I'm not your physician. Just wanna make that clear to the audience. And I know nothing about your medical history, but suppose you'd had a stroke and I said, will you please take an aspirin a day to prevent a stroke? Now that you've already had a stroke, what would you say?

Well, I'd say I have to look at all of the options that I have. I have to understand my decision. I have to understand the benefits, the risks. Yeah. I kind of wanted to learn more about before I can change my behavior.

Absolutely. So you are an educated, um, I hate the word consumer of medicine. You're an educated patient and you would want to sit down and chat with me about why an aspirin would, would or wouldn't be safe for you and what would be your risk of taking it versus your risk of not taking it. And strokes are pretty scary. And a lot of people will find that their risk of having A negative effect from the aspirin is minor relative to taking an aspirin for a second stroke. And they're so afraid of a stroke that they're willing to take the aspirin. And so most people would say yes. Now suppose you were to fall and break your wrist, and it's only a minor fracture, and you're very lucky, you don't need surgery. And so, so then I recommend a few things. And so Here would be some recommendations, and I do this for everybody whether they've broken a wrist or not. Balance exercises. I love balance exercises, and they can be simple, like, can you stand on one foot? And then after you do that, I say, can you stand on one foot while you brush your teeth? So even for the busiest people who don't have time to exercise, they can always find time to brush their teeth. I make my parents do this too, by the way. And then I say, well, let's change your shoes to something either with a thin sole or hard sole shoe, or something that's like an athletic shoe that fits tightly on your foot. Number 3 would be to turn on the lights wherever you go, so make sure you're not bumbling around in a place where you can't see well. 4 is to wear your glasses and your hearing aids if you need them. Um, the 5th one is to utilize any safety devices that you need. So if you're on stairs to use the handrail. If you need a raised toilet seat, use a raised toilet seat. If you need a walking stick, some people call them canes. In Colorado, we call them walking sticks because people prefer to use walking sticks, to use them. If in your house, if you clear the— unclutter paths so that they're 32 inches wide and make sure there's no cords or anything that you can trip on. And the last thing is ask your doctor to review your medications. Most people resist these recommendations.

Mm-hmm.

And, but these 7 recommendations are as effective at preventing falls as an aspirin is at redu— as, as an aspirin is at preventing a second stroke.

Mm-hmm. Yeah. Yeah.

And people don't realize how effective, like even wearing hearing aids, if you live alone, in your home and there's nobody there to talk to, just the act of wearing hearing aids, you're much less likely to fall and end up in the hospital because it helps with balance and your, and your sensory orientation. And it's these little things. Now, easy for me to say. I, you can't see me. I wear glasses. I have transition lenses. I don't, I'm not yet to the point of wearing hearing aids. Um, in fact, I live with my father-in-law who needs hearing aids. So I wear earplugs cuz the TV's often very loud. So I live in the opposite world right now.

Yeah.

But the, so I, I don't always know that understand the full resistance to that, but, but I just wanna say like some of these little things, it's amazing how much benefit you get from them. And I think a lot of times patients don't realize.

Yeah. These are important risk management factors. I had a physical therapist on my podcast just a few weeks ago and she, She talked about these recommendations. And one other point that I hadn't considered was the importance of contrast between the floor and the wall, because when they're too similar, it's very easy to kind of misjudge your orientation. And the better, the more contrast, the better and easier it is to manage that.

I love that you mentioned that. There's so many tips. One of the things that some people will do is they'll take two different color tape, pieces of tape, and they'll put them on stairs. Because when you look down, especially through transition lenses, the stairs can be blurry and you can't see where one stair starts and the other ends. And so they'll put alternating strips at the edge of the stairs so they can differentiate the stairs, like differentiating the wall from the floor. There's so many good tips out there.

Yeah, there is. There's a wealth of—

I can't give in 60 minutes, but we'll check.

There is a lot of information, you're right, at our fingertips. That's the beauty of it. There's There's so much wealth of information. Let's shift into— let's cross over that line from normal age-related change to things that are out of the norm, things that cross over into what we consider— I don't like to use the word abnormal, but disease, not within normal limits. Disease.

Okay, what is normal aging versus what do we consider disease? And I think the one thing that scares people the most is cognitive decline. Like people say, my memory is not as good as it used to be. Do I have dementia? And sometimes I do dementia testing to, to, um, give them some, uh, ease their nerves, to give them some comfort that they don't have dementia, that they're aging as they should. And so we talked about at what age we start of aging, and we said the number was 30. And so I will tell you this: my brain does not work as well as it did when I was 20, and it does not work as well as it did when I was 30. My brain will continue to age. I am not considered geriatric yet, but I'm still not as sharp as I was when I was younger, and that will continue until I'm 80, even if I don't have any diseases. And so by the time you're 80, you're going to notice that there are differences in how quickly you learn and how long it takes to retrieve information, and that is completely normal. And so a lot of people say, okay, then what's the difference between normal aging and diseases like mild cognitive impairment or dementia? And dementia is a sort of a broad category for many things like Alzheimer's or vascular dementia or Lewy body dementia. So if you start asking the same questions over and over again, if you start getting lost in familiar places, if you have trouble following instructions, if you struggle to find words, or you become confused with time, people, or places, doesn't mean you have dementia, but that's the time when you should start talking to your doctor and let them test you. And so don't panic. Because there are reversible causes. So sometimes it could be a vitamin deficiency. Sometimes it can be depression. Sometimes it can be normal aging, which you may not want to hear, but, but it doesn't, it's not necessarily a disease that's gonna proceed quickly. And so what a doctor's gonna do when you see them is they're gonna examine you and they're going to consider your medications, they're gonna consider your supplements, they're going to do some cognitive testing, and there's a few different ones that actually I think they're all equivalent. The Mini Mental Status Exam, there's a Montreal Cognitive Assessment, there's a St. Louis University Mental Status Exam, there's a new one called the SAGE. They're all equivalent, they're just different schools made different ones. And then you're gonna get an, a score based on your education and your age and your functional ability,, and that will give you some sense of how you're doing cognitively. But then they're gonna check your vitamins and your thyroid level and do an imaging of your brain, ideally an MRI. But if not, if you can't get an MRI, they'll do a CAT scan and see if there's anything that's treatable. And just to give you an example, B12 deficiency is very common in older people because as you get older, the stomach doesn't absorb B12 as well. And people tend to eat less things like red meat that contain B12. And so B12 deficiency alone causes confusion. But it's really important that you see your doctor right away because if you don't correct a B12 deficiency right away, you end up with permanent confusion. This is something that needs to be corrected right away. B12 deficiency also can cause you to be off balance when you walk. And unfortunately, I have a patient who had B12 deficiency and she didn't take her B12, and now she's permanently off balance when she walks because she she didn't take her vitamins, which is really sad.

Yeah, good information, Jeanette. That's very good information. I like the point you raised. Some of these signs of cognitive decline are reversible. It's not always a primary degenerative dementia. I mean, sometimes there are nutritional deficiencies or depression, or we used to call it transitional stress, situations for people moving from one location to another that can all— similar signs as dementia, but treatable, reversible. So that's, that's good. And you, you, you really point out the importance of a comprehensive assessment, not just looking— I mean, we look at the mini cognitive exams, but there's also a whole host of other measures that we need to look at and see what can be ruled out, what's part of the picture, what's not part of the picture. We could go on and on. I know we're just touching the surface here. I see that. So, you know, I'm always curious about people's reactions and when they see some of these signs of slowing down or weakness or decline and they get discouraged or, you know, what's the point about aging? You know, who wants to live like this? I wonder, what do you say to the person who is discouraged or feeling depressed about some of these changes?

You know, I think there are people come in two flavors as I see them. There are the people that are mildly bothered. They're the people who just are discouraged or they're embarrassed. They don't like the way their arthritic hands look. And I love to share them a quote with them that from my mother and my mother calls all of these things, her gray hair, her wrinkles, her spots, she calls them trophies of aging.

Uh-huh. Yeah.

And I just love that saying because it It changes your perspective on aging, right? Like, you've earned these, these, you know, like you've earned your gray hair, you've earned your baldness, you've earned all this stuff. And so I just love that perspective. And then there are some people that are more upset. And I think at that point, you really need to acknowledge that aging is hard. And the main reason it's hard is because the longer you're here, the more loss you experience. You lose your youth, you lose function, and you lose friends, you lose love, you lose independence. And those things need to be grieved, and that's healthy. And, but after grieving, people need to be able to move on. And so I encourage when people are feeling discouraged or depressed to think about the things that they can take control of. What can they take control of? How can they contribute? In what ways can they contribute to their community, to the people around them? What this puts their attention on something greater than themselves. I encourage people to celebrate small wins, to learn something new, to hang on to what's most important in life, to sit back and reflect on what's most important to them at that point. The next thing that I often tell people, because I wish my grandparents had done this, is to write down or record stories of your life for the next generation. Leave a legacy. I just think that's so important. Maybe take creative risks. Have you always wanted to learn how to play the piano or to paint? And don't be afraid of making mistakes or not doing it well. Just go at it and give it a try. Spend time outdoors. Enjoy the sun. Find ways to connect with other people, especially people younger than you. Because as you get up there, my 99-year-old patient, if she didn't make friends that were younger than her, she probably wouldn't have any friends because there's a good chance that her, her peers were not going to live as long as her. Practice expressing your emotions. Write, act, dance, sing, exercise, and eat healthy. And then if you need professional help from doctors, therapists, religious leaders, life coaches, don't hesitate to get it. I think it's, it's so valuable and often the best money that people ever spend to take care of themselves.

Good tips. These are all excellent recommendations. I talk about them myself, learning things new. I mean, opening new doors, you know, taking on some new hobbies or interests, languages, musical instrument, writing, whatever it is. I'm going to have someone coming on my podcast in a short while who has created this whole collection of side hustles. Called Side Hustle Nation, and it's loaded with dozens and dozens of different activities, not volunteer, but really employment, kind of income-earning activities, and just great, great ways to not only occupy ourselves and stay stimulated, but to earn a little money on the side. So I, I think he's got a, you know, a huge market of people who are in there senior years and ready to do more things. So these are good recommendations, taking time to get over the losses, but also looking forward to what's next. Yeah, that's great. How can we become more empowered and take charge of our own healthcare? What do you recommend?

Well, I feel like your audience is doing that right now just by listening to your podcasts. So staying informed and being open-minded and willing to, willing to try different things. And so I always used to tell my students and residents to be open-minded to try different things. Not everything is gonna work for you, and that's fine, but hold onto the things that do and let the other ones go, but at least be willing to try something new. Don't be afraid to bring information to your doctors. Don't be afraid to ask questions. The internet has a lot of inaccurate information, so don't be shocked if your doctors shoot the information down that comes up on the internet, but let them at least explain to you why they're concerned or why they disagree. So never, never, your doctor should never be intimidated by questions that you or information you bring to them.

And to be prepared when you have time with your doctor, because it's short and we need to be prepared with our questions and have our list of information available. So yeah, that's good. That's good. So you've written a book. Tell us about your book, Embrace Aging: Conquer Your Fears and Enjoy Added Years. I like that title. Tell us about your book.

So when the pandemic started, I started writing a newsletter for my practice every week to help make the community feel connected, and I alluded to that earlier. And then I realized so many of these topics would make for a great book. And the way the book works is that Each chapter, and there's over 30 chapters, talks about how the body changes based on different organs and different systems. And then it tells you what you can do to help yourself in that arena, and then what a doctor could do for you if you sought help and went to seek help. And so it basically goes through how to prevent falls and how to adapt your home and how to deal with incontinence and how to deal with sexual dysfunction. And I put in topics that I know patients don't like to talk to their doctors about, so they at least had a place to go for information., but it talks about osteoporosis and arthritis and everything that we know, Eastern medicine, Western medicine, supplements. So people had a place to go and it's not boring like a textbook. It includes patient cases and personal stories and family stories. And I just wanted it to be very approachable for people and cutting edge at the same time. And so I think it's very optimistic and practical and makes for a good reference, reference guide for people.

Great. It sounds great. Congratulations. It's a useful, valuable resource for people. So we're just about out of time. What would you hope our listeners take away from our conversation today?

I want to tell one quick story and it'll be quick. So I was talking to a patient one day and she had lost her husband and she said, you know, um, Your life is like a tapestry, and when you lose a spouse, it's like having a hole cut in the tapestry. And she said, and people promised me that the hole would get smaller over time. And she said, that's not true. The hole did not get smaller. She said, but over time I built a bigger tapestry, and so the hole became a smaller portion of my life. And so what I want your listeners to, to hear in all of this is that as you What I want people to know is that as you grow and as you build your years, you know, we talked a lot about loss at the end, is that you can build more of your life and the losses become a smaller portion of your life. And I wanted to give you tools and an understanding. And part of this, there's a lot more detail in the book, but so that you can continue to build that tapestry and continue to enjoy your life and continue to be independent and healthy. And that as I listen to older patients, I want you to listen to your friends because they have a lot of great ideas that you can adapt and continue to listen to this podcast because I've listened to many of the sessions and I really enjoy them. It's just so great to listen to other bright minds and adopt their ideas.

So yeah, well, thanks. Thanks for that. That's a great story too. I mean, it's so true because It can seem so big at the time, but over succeeding months or years, it changes. Our perception changes of these losses. And I love the quote by Dan Sullivan, motivational speaker. He says, "Our future should be bigger than our past." And that's, that's hard to accept sometimes because our past is so great and we have such great memories, but we cannot stay stuck there. There. We have to be ready to look and see what's ahead. It's time to celebrate aging, you know, it's time to look forward and, you know, see our future years in an uplifted way. And that's, to me, that's successful aging, no matter what bumps come along. It's just, it's that perception of staying positive and looking forward to what's down the road. Yeah. Well, this has been a great conversation, Jeanette. Thanks very much.

Thank you for the opportunity.

Yes, you're sure welcome. It looks like we're out of time though, but before we wrap up, I just want to remind our listeners about a co-sponsor for our program, A Mighty Good Time. Are you looking for ways to engage and stay active? Check out amightygoodtime.com. It's a one-stop shop for events and activities for those 50 and over. It's free to search and it's free to post. amightygoodtime.com. And be sure to visit the Living to 100 Club website to sign up for our weekly podcast announcements and monthly newsletters. And while you're there, be sure to download a free copy of my 9 Tips for Living Longer. Lastly, pick up a copy of my book, Living Longer Is the New Normal, all about maintaining a positive mindset in all we do. It's on Amazon as an ebook or hard copy. We've been talking today with Dr. Jeanette Guerrasio. Jeanette, For those who might want to contact you, what's the best way to do that?

So I have a website that's medicinewithinreach.us.

Medicinewithinreach.us. And your book is available on your website?

It's on Amazon or Barnes Noble.

Okay, great. Okay, well, thanks very much for being a guest. It was very informative, and I know our Listeners enjoyed it a lot. Many thanks again, and thanks to everyone for tuning in. Hope to see you next time.

Hi, this is Suzanne Newman, host of the Answers for Elders podcast and radio show. We are the North Star star that guides you through the complicated journey of senior care with trusted experts in money, law, living solutions, and more. So join us on this station, your favorite podcast channel, or just go to answersforelders.com. Meet the wayshowers who will help your journey go a lot easier.