The future of geriatric care
Deborah Kado is a geriatrician who believes her field is misunderstood.
Her interest in the science of aging began with a childhood encounter in a nursing home but recently resulted in intriguing work in which Kado linked microbes in the gut to vitamin D metabolism and poor sleep. Kado refuses to blame aging alone for health problems, advocating for better care regardless of age. It’s never too late to strive for better health, Kado tells host Russ Altman on this episode of Stanford Engineering’s The Future of Everything podcast.
Transcript
[00:00:00] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. I thought it would be good to revisit the original intent of this show. In 2017, when we started, we wanted to create a forum to dive into and discuss the motivations and the research that my colleagues do across the campus in science, technology, engineering, medicine, and other topics. Stanford University and all universities, for the most part, have a long history of doing important work that impacts the world, and it's a joy to share with you how this work is motivated by humans who are working hard to create a better future for everybody. In that spirit, I hope you will walk away from every episode with a deeper understanding of the work that's in progress here, and that you'll share it with your friends, family, neighbors, coworkers as well.
[00:00:48] Deborah Kado: People are getting diseases all across lifespans. It's just how we think about it. We, we tend to more maybe expect it. Oh, it's, I'm getting X because I'm old. It's what happens. Our body falls apart. But that's not what I say, so, uh, to all my patients, regardless if they're 92 or 35, uh, it's, it's not necessarily your fault. We're trying to understand it. And I have had the experience of learning from so many of my patients over the 25 plus years that I've been a geriatrician, that you can overcome so much no matter what age you are, and you'll defy even more expectations if you have to be, happened to be 95.
[00:01:36] Russ Altman: This is Stanford Engineering's The Future of Everything, and I'm your host, Russ Altman. If you're enjoying the show or if it's helped you in any way, please consider rating and reviewing it. We love to get a 5.0 if we deserve it. Your input is extremely valuable and will help us spread news about the show across the internet. Today, Deborah Kado from Stanford University will tell us about the medical specialty of geriatrics. It's very important, it turns out, that both you and your physician don't just blame aging on your medical problems but get down to the bottom of things. It's the future of geriatrics. Before we get started, a reminder to rate and review the show, particularly if you have found it useful or interesting.
[00:02:24] While we're all getting older, and as we get older, it seems like we get more medical problems. There's a specialty in medicine, geriatrics, which are doctors who take care of the elderly, and they have a special challenge. After living on the earth 50, 60, 70, 80 years, things accumulate. But you don't wanna just blame aging for all your medical problems. And in fact, this can be a failure mode for both patients and their doctors. Geriatricians are trained to get to the bottom of things and to not assume that it's just your chronological age that has caused you to get cancer or back pain or muscle spasms or anything. Well, Deborah Kado is a professor of medicine and epidemiology and population health at Stanford University. She's an expert at gerontology, the study of aging, particularly bones and how they relate to your sleep, to your vitamin D and calcium levels, and to many other aspects of your health.
[00:03:22] Deborah, what led you to focus your, your professional work on aging and the elderly?
[00:03:29] Deborah Kado: I have to think about the seminal moment, and it actually was when I was 10 years old. My mother was PTA president and as part of that, she organized our classrooms to go to a local nurse, nursing home where the students would get paired with a nursing home resident to help them with a weekly art project. So I developed a relationship with one of the residents. His name was Ralph. And, uh, it was a very pleasant, I really liked Ralph. I think he had probably some dementia and I helped him with his art projects. And one week I returned, but as I was trying to follow the directions on how to help him do the art project, I made a mistake and I yelled in the art room, Ralph, I'm getting as senile as you are.
[00:04:30] Russ Altman: Oops.
[00:04:31] Deborah Kado: Uh, so the day went on and my mother upon driving me home, dropping off all the other kids says to me, do you realize what you just did? Which I had not. Until she pointed that out to me, and I was horrified that I was ageist at age 10. Uh, and I think the rest of my time, uh, I was not really encouraged to pursue aging or geriatrics in residency, the chief resident told all of us in the room, don't bother to study for the MKSAP in geriatrics. That's the study guide that a lot of internal medicine doctors use to pass the internal medicine boards. So, and he said, all you need to know is that older people fall down, become incontinent, and they get demented.
[00:05:19] Russ Altman: Oh, isn't that lovely?
[00:05:20] Deborah Kado: Yeah. So I actually followed that direction because you have to read a lot to be able to pass the boards. My score was 4%. And, uh, I think, uh, even before that in medical school when, uh, the internal medicine doctor was trying to encourage people to pursue internal medicine as his specialty said, don't worry, you're not only seeing old people. So there was a lot of negative bias that I was picking up, and I think that, uh, at the end of the day, I, I wanted to really reconsider our attitudes, and that old people are people too, and deserve respect and dignity and care. So I think that's what got me there.
[00:06:04] Russ Altman: It, it's a great, it's a great origin story. Uh, and, and there's so much in that story in terms of what Ralph was experiencing, what his caregiver was experiencing and then your journey. Okay, so let's, let's do some basic definitions. Um, I think many people are familiar with geriatrics, that's, those are doctors who, um, take care of the elderly. Uh, and, and you've, uh, written about the, there's a difference between geriatrics and gerontology and you actually do both. So can you just give me a quick set of definitions?
[00:06:34] Deborah Kado: Sure. So gerontology is the study of aging, the process of aging, uh, from a lot of different ways, social, uh, psychological, medical, um, health policy wise. Whereas, uh, geriatricians are clinicians. They are trained to, to care for older people as they age, to keep them as healthy as possible.
[00:06:58] Russ Altman: So how would you characterize our understanding of aging? I, you know, we all, I think everybody knows that the population is aging in the US and, and globally in, in many places. Um, and, and that we need to understand this process because many, many of us have family members or friends who are reaching into their 80's, 90's. I mean, I spent the weekend with a, with a 90-year-old, uh, who, you know, beat me at Bridge. So what, what is the issue? Um, uh, and where, where are we focusing our attention in terms of learning more about taking care of the, the aging population and the elderly specific individuals?
[00:07:33] Deborah Kado: Yeah. So, um, it's interesting because it's a semantic thing. If you think about aging, I think most people focus on old. But in fact, we begin aging almost upon conception, right? But we don't focus on it because development and growing, that sounds positive, but as we get older, it's, it's, it's, I think most people consider it a natural and universal process, but it has been over decades, um, kind of made equivalent to loss. Loss of physical, mental, uh, health, uh, uh, independence. And it doesn't necessarily need to be that way, but I think that's what all of us kind of think about. And then we think, oh, well then what happens next? You know, you kick the can, you know?
[00:08:34] Russ Altman: So, so, so, um, do we, so, but, but, and yet I know that when people come to you, they're, I'm guessing, and I'm, this is part of, this is from personal experience, just stuff happens. You know, things happened to me at my age that weren't happening to me 20 years ago. I've, I've learned that I can wake up in the morning with a random new problem that didn't, wasn't, that at least I wasn't aware of when I went to sleep and now, I'm waking up. And so, um, how do you approach a healthcare plan with one of your patients? Um, 'cause I'm sure they want, they wanna have, they have their goals, they have their communities, they want to engage fully and then just stuff happens that kind of can be considered, look like a barrier, uh, that didn't exist before. Uh, how do you manage that? What's the, what's the, uh, uh, the appropriate kind of mindset when you're going into an interaction with one of your patients?
[00:09:26] Deborah Kado: Yeah, so it's a great question. It's actually the same across the ages. So when I, uh, started the Bone Clinic at UC San Diego, I started seeing people at age 18 all the way up beyond a hundred. And it, stuff happens all along the spectrum. It's just that when we're younger, we tend to brush it off or not take it as seriously. Or if we have a pain, we ache, but then we, we assume it's gonna get better. However, our own expectations as well as the clinicians who see us, tend to put the, uh, they tend to make equivalent, the fact that they're having a symptom with the fact that they're old. So in fact, last week I had just had a, a patient advocate speak to my medical students who said he's suffering from cancer. And he basically said when he went to the doctor, the oncologist who said, you have cancer, and he said, I wanna know why. I was a cycler. Everything was fine. And now I found this spot. And the oncologist's answer was, oh, it's because you're getting old. Uh, and is that really true?
[00:10:42] Russ Altman: Yeah. And it's not very satisfying.
[00:10:45] Deborah Kado: No, and it's, it's actually, it's a cop out in my opinion. People are getting diseases all across lifespans. It's just how we think about it. We, we tend to more maybe expect it. Oh, it's, I'm getting X because. I'm old. It's what happens. Our body falls apart, but that's not what I say. So, uh, to all my patients, regardless if they're 92 or 35, uh, it's, it's not necessarily your fault. We're trying to understand it. And I have had the experience of learning from so many of my patients over the 25 plus years that I've been a geriatrician that you can overcome so much no matter what age you are, and you'll defy even more expectations if you have to be, happen to be 95 and get through something.
[00:11:33] Russ Altman: Okay, great. So you mentioned, um, you mentioned, uh, you know, learning and, and, and having a kind of a whole view of the patient. And one of the great things about your scientific work is you're connecting parts of physiology that I don't think people normally consider, uh, connecting. So I know you look at bone health, but I also know that you look at the microbiome, the various bacteria that are living in the gut, and you look at how that can interact with the brain. So now I'm thinking about bones and brains. I'm, I didn't always think about those as totally connected, gut and brain, gut and bones. Tell me about how you've kind of landed on this interesting set of interactions. Uh, how did you make these connections and what do you think they mean about our understanding of health?
[00:12:19] Deborah Kado: Uh, that's a great, uh, some of it is serendipity, kind of the resources that I had available to my fingertips by working with amazing other scientists in the area who are willing to collaborate. I think one thing great about geriatricians is that we really have kind of a big picture take on things and, and that we realize that nothing is simple. We wish it were, but it's just not. And, and so when we see something, we think about multifactorial causes. So when I, I've been working with this, uh, population of about, uh, in, in 2000, there's 6,000 men who were recruited from different areas across the United States, 6 different clinical sites.
[00:13:01] And they were recruited to study the effect of, you know, what are the risk factors for fracture in older men. But they answered a number of questionnaires. They underwent physical function, cognitive function testing, and have been followed over the years. And in 2014 they happened to, uh, agree, a 1000 of them or so to give their stool samples. Which I thought was amazing. I didn't think they would, but they were, because they had already been followed every 4 months from 2000, they were dedicated. So when we asked, do you mind giving us a sample of your poop? You know, it means,
[00:13:35] Russ Altman: No problem. Here you go. Here you go.
[00:13:37] Deborah Kado: They did it, right? And, and so, uh, the person who thought to ask them for stools circulated an email, do you have any questions that you'd like to ask about this? We are, we're thinking there could be something going on with microbiome and bone. That's why he did it. But for me, I was thinking, well, in clinic, all my patients come into me and they say, doc, I know that uh, you need vitamin D to absorb your calcium and how much calcium should I take? And then I was thinking on the other side, well, we know that there are vitamin D receptors all throughout our body and specifically in our gut, and we know that there are millions of bacteria in their gut. There, there must be some kind of interaction. So that was kind of how it came about. It was my patients asking me these questions and me thinking, well, huh, I believe that the microbiome is important and it's probably doing something in there. And that's, and the, and then the,
[00:14:34] Russ Altman: So what did you find? What did you find? What was the connection or the association at least?
[00:14:38] Deborah Kado: Yeah, so the association was, uh, blew my mind actually, uh, because what, uh, we did is we measured the vitamin D levels, the kind that the doctor level, um, would measure in the clinic, uh, 25-hydroxyvitamin D, which is supposed to be the stable, uh, storage measure of vitamin D. Are you sufficient? Are you deficient? What's going on? This is what everybody is measuring. And you hear a lot about vitamin D in the public media.
[00:15:07] Russ Altman: Of course. Yes. And it's added to a lot of the milk.
[00:15:10] Deborah Kado: And added to a lot of milk and people take a lot of supplements, but uh, it's actually the 1,25-dihydroxyvitamin D that's the active form.
[00:15:21] Russ Altman: Yes. That and that's different.
[00:15:24] Deborah Kado: Right, that binds the receptor, vitamin D receptor in the gut that allows you to absorb your calcium, et cetera. And what we found by studying the, the microbiome of these men was that there was absolutely zero, a flat line relationship between the storage level vitamin D, the 25-hydroxyvitamin D, and the, the health of the gut microbiome. And by health, I mean that there's a good variety, a healthy ecosystem within your own GI tract.
[00:15:58] Russ Altman: Yes. Yeah. So we, we know that like for, for health, let's just call it healthy poop, has a certain distribution of bacteria that we expect to see and that we know is associated with pretty much healthy, um, and, and, and, and you, you were not seeing a correlation between whether it was the nice looking bacteria or the problematic bacteria. That didn't seem to affect the long-term storage of vitamin D.
[00:16:22] Deborah Kado: But it did affect the active hormone. Which with, what we saw was the more healthy, the more diverse, these older men's, uh, microbiomes were the, the better the, the 1,25-dihydroxy active vitamin D hormone was. And that was true looking at different ratios of vitamin D metabolites showing, what would make sense?
[00:16:49] Russ Altman: Yep. So would the prediction be that those, um, people with the good circulating levels would be less prone to fracture? Would that be the hypothesis?
[00:16:58] Deborah Kado: That would be the hypothesis, yes, uh, for sure. Although we haven't seen it in the data, but what we did see is we looked at ratios of metabolism. So those who were, uh, you know, metabolizing well were more, also had health, healthier gut microbiomes. And that was associated, that has been associated with a reduced risk of fracture.
[00:17:22] Russ Altman: So there you go. And, and it's a, a pretty much direct line between kind of bone health and what kind of, uh, bacteria in your poop. Now if I, if I'm not mistaken, 'cause I did look at some of your work, you also were looking at things like sleep. Am I, am I right?
[00:17:36] Deborah Kado: Yeah, because these men were amazing. Thank you to all MrOS participants because, uh, they really stuck with us. And I'll just mention the 6 cities that, or areas they're from.
[00:17:47] Russ Altman: Sure, sure.
[00:17:48] Deborah Kado: Uh, so San Diego where I was, Palo Alto area, Oregon, uh, Portland, Oregon, uh, Minneapolis, Minnesota, Pittsburgh, Pennsylvania, and Birmingham, Alabama.
[00:18:00] Russ Altman: There you go. Yeah. That's a nice slice of Americana.
[00:18:03] Deborah Kado: Yeah. Yeah. And so these, these, um, men also answered questions about how they sleep. And they're standardized questionnaires, about 20 questions, um, and then they also wore armbands and even sleep actigraphy monitors over the 20 years that they've been followed to kind of get a sense of what are their sleep patterns, what's going on. So, uh, they had sleep studies done too over time. And so I decided to look at that. 'Cause I was thinking, you know, you know, sometimes my stomach wakes me up at night, whatever.
[00:18:35] Russ Altman: Yep, yep.
[00:18:36] Deborah Kado: There must be some kind of association, and certainly, again, we can't attribute causality because we're measuring these things at the same time. But there's certainly strong correlations. Those men who self-reported better sleep had more diverse gut microbiomes.
[00:18:56] Russ Altman: You know, it's, I, I have to say that as a physician myself, one of the remarkable things I learned very early as a physician is when you ask somebody, how's your poop? Which is a ridiculous question, and like, nobody teaches you how to answer that, but almost every patient knows in their heart they'll say, no, my poop is good, or, no, I'm having problems. And I'm always amazed at the ability of humans to character, I mean, it's one of the great privileges of being a doctor is that you can ask that question without getting arrested. But I, but I, but now you're, you're putting a little bit of science into it, is that you know that that's gonna affect their sleep. It might affect their bones and maybe their fracture risk. It's quite amazing.
[00:19:36] Deborah Kado: Yes. The other, I wanna talk about objective measures also to finish that off because sometimes people say, you know, you might be biased, self-report isn't very good. Men always report that they're taller than they actually are, et cetera. So, so the idea is these men wear these actigraphy monitors or armband monitors, and what, uh, was really interesting to see is that, uh, those men who had more regular sleep patterns, like consistent, go to bed, wake up, at the same time, their gut microbiomes were also healthier.
[00:20:10] Russ Altman: Wow. And, and then now, and you mentioned that this is not causal and it, but it raises these great questions about is it the sleep that helps cause a good bowel, bowel or is it the bowel that helps good sleep or is it more complicated? And so this is really exciting.
[00:20:27] This is The Future of Everything. I'm Russ Altman and will have more with Deborah Kado next. Welcome back to The Future of Everything. I'm Russ Altman. I'm speaking with Deborah Kado from Stanford University. In the last segment, we got some definitions of geriatrics, gerontology, and we heard about some of Deborah's fascinating work linking bone health to the microbiome, your poop, as well as sleep and other measures of health in the elderly. In this segment, we're gonna talk about what's the status of geriatrics training in the United States, and what are things that physicians should know, and patients should know to make sure that they don't make bad assumptions about the causes of their diseases.
[00:21:20] I wanted to start out by asking you about medical education. You're a professor at a medical school. How is the and, and you made some mention, uh, uh, that even early in your career you weren't always hearing about geriatrics, and you were told in kind of dismissive ways, don't worry about it. It's not that complicated. Uh, and yet your own work has shown that it is complicated and fascinating. What's the status of medical education for our young doctors? And do they, are they getting a better, um, bit of information than you got in your training?
[00:21:50] Deborah Kado: Well, that's an outstanding question because since coming to Stanford in 2021, it really dawned on me that instead of an parallel increase in our aging population and doctors who are specialized in taking care of older people, it's been the, actually the opposite. That when I started there were 10,000 or so board certified geriatricians in the United States. And when I got to Stanford in about 2021, there's 7,000 or under 7,000.
[00:22:18] Russ Altman: Well, that really is going in the wrong direction.
[00:22:20] Deborah Kado: Yeah, right. So then I thought, well, why? What is happening? What happened? And, and, uh, in fact, only about 4% of medical schools has been published offer any curriculum in geriatric medicine. Uh, so maybe it's no surprise 'cause there's not enough people to teach geriatric medicine, but also, I think there's, uh, a lot, uh, a lack of, uh, understanding of that this might be important for all doctors. Because unless you're a pediatrician, you by definition, will be taking care of someone who's older. And they're just not, I mean, we have six weeks of pediatric, mandatory inpatient, outpatient exposure as all medical students for many, many years now. And yet, uh, that that's not mandated in most medical schools. Yeah.
[00:23:08] Russ Altman: Wow. I, I think there is a fallacy, I remember from my own training that it is true that in general medicine you do have a lot of elderly patients, but that doesn't really mean that you've been trained on the special challenges of those folks. And, and once I was exposed, I actually took, uh, geriatrics rotation, uh, and I loved it. And I but, but what I, the number one thing I learned from it was that there was a whole bunch of things that were useful and specific to that population. And an approach that is a little different from, um, how you might approach a 30-year-old. And, and so I'm wondering, um, how do you get, how do you drill this into the medical students or how do you gently coax them to understand that there's, that there are, um, special, special ways that you can manage these patients and interact with them?
[00:23:55] Deborah Kado: Yeah. Well, um, being now involved a bit in medical education, even when I got here, it became really apparent that to get a medical student's attention is a competitive process. There are, so I, I'm excited for our students, but at the same time, kind of horrified because the amount of information that they have to absorb by in the four years is mind blowing. And so it's a matter of getting the people who are in charge of the medical school curriculum to, to say, this is important. We will allow you face time with the medical students. And even though the, um, ACGME or the American College of Graduate Medical Education now has 27 core competencies that every medical student who graduates should know about general principles of geriatric medicine, um, there's no, there's no, um, way to assess if medical students are actually achieving that. But fortunately for me, there is one medical student here at, uh, at Stanford who was very interested in geriatrics, and we have embarked in this project along with the Stanford Longevity Center to assess what is a state of, at least Stanford medical student graduates. You know, they're pretty good students, right?
[00:25:15] Russ Altman: Yeah, yeah.
[00:25:16] Deborah Kado: Uh, so we, we created a, a, we used an old questionnaire. We asked them about, uh, these questions that seem pretty basic for medical students, and they scored under the passing level for, for what Stanford considers a passing level on exam. But more interestingly, we also had this geriatric attitudes questionnaire, and we looked at how the attitudes towards aging correlate with how they did on the exam. You wanna guess what we found?
[00:25:47] Russ Altman: Well, I mean, I guess I would guess that if you don't care, then you don't know.
[00:25:53] Deborah Kado: Exactly. It was, this was a small sample. We only had something like a 39% response rate in a class of 87, and yet it was so statistically significant, the line. The, the more positive aspect of views you had about aging, the better you did on the exam. But what is even more exciting as of yesterday, we have now expanded our collaboration and are using a validated questionnaire developed by my Harvard colleague, Andrea Schwartz, and have, are administrating to this year's, uh, graduating class, not only at Harvard, at Stanford where we now have a 59% response rate, which I'm really excited about. Uh, University of Washington and the University of Texas, uh, Texas has already sent us back, they got something like 132 responses in their class. Our class is smaller, but the sneak peek is we're replicating the results about attitudes and score and only 25% of the students would pass the exam if we used the cut rate of 65%.
[00:26:53] Russ Altman: But, you know, the great thing, uh, part of me as an engineer and one of the things that engineers say is that you, if you can't measure it, then you can't intervene. So you guys are making the incredibly important first step of measuring where you are and, and where the problems are. And then you'll, I'm sure, you'll design educational interventions to try to raise that, raise those boats.
[00:27:14] Deborah Kado: Exactly. So it was a roundabout question, but we couldn't change anything until we raised, like you guys say, from the ACGME this is what the expectation is and failing miserably.
[00:27:24] Russ Altman: So we're in, later in a, in a minute, I'm gonna get to some advice for, for patients and for non-doctors about how they can manage their aging. But what would be a couple of the key signals that you would send to a medical professional about what they need to know about geriatrics. And I know, you said there's 27, it's your whole career. It's totally unfair for me to ask you to, but what would be two of the top things you would want other physicians to be aware of that you, that you suspect they might not be aware of?
[00:27:54] Deborah Kado: Well, I can think of a top one and maybe as I answer that, I'll be able to count the second.
[00:27:57] Russ Altman: Great. I'll take the top one.
[00:27:58] Deborah Kado: The top one is, don't attribute whatever you're seeing to aging. So I can give you very specific examples. I treat patients at the VA. I have a 76-year-old vet. He comes in and he used to walk 5 miles a day around his beautiful property in the Santa Cruz mountains. And he's not really a complainer, right? But he just kind of says, I'm not doing that anymore. And it's basically, um, kind of, I guess bypassed by a lot of different people who may have seen him. And uh, and, then in addition, and I just came off of medical grand rounds where they talked about the importance of bedside, uh, exams, clinical exams.
[00:28:45] I actually listened to his heart because I actually didn't have a resident with me at the time. So I went and I did my own exam, and I said to the man, um, have, has anybody told you have a heart murmur? And he says, no. And then I say, well, um, okay. Uh, so I send a note to the primary care physician that I detected a heart murmur. I think, you know, I would suggest that it gets it worked up and he is having a decrease in his physical, uh, usual physical activities. and turned out, uh, not only did he have an aortic stenosis murmur, which was not actionable on that, I mean, but, uh, he had, uh, evidence of a reversible cardiac lesion. So he went to catheterization and got a stint.
[00:29:31] Russ Altman: Wow. And, and it would not have been correct to say, oh, he's just getting older. That's why he can't walk around his beautiful mountain.
[00:29:38] Deborah Kado: Yeah. It's just aging. And that, you know, this happens again and again. And I think that people, and I have another story, uh, so over the,
[00:29:46] Russ Altman: These are great, these are money. These stories are good. So let's hear it.
[00:29:49] Deborah Kado: Yeah. So the other story is, uh, I sometimes take care of the parents of my colleagues who are doctors. And one time I see a, a patient's, uh, mother, I'm sorry, a doc, a fellow doctor's mother, and the mother complains to me of back pain. So I happen to see the colleague and I say, oh, I saw your mother. It was so great to see her. She has a back pain. Uh, she's told me she had back pain today. And, and then the colleague says, oh, well she's, she's getting old. And I thought,
[00:30:23] Russ Altman: This is a fellow physician?
[00:30:24] Deborah Kado: Yeah. And I, and I really didn't say anything, but it's something that stuck in my mind for so long. Because I'm thinking, well, I don't know, for me, maybe I shouldn't assume too much. Maybe her mom always complains about back pain, and she's just tired. Or maybe it's like the story about the orthopedic surgeons where the kids say, oh, I have this arm pain, and they're like, forget it, don't worry about it because, you know, it's so usual. But I, it just stuck in my mind that I see a lot of that.
[00:30:51] Russ Altman: No, that, that, I think that one piece of advice is probably the best one. So let's, let's move over to patients. If, if, I'm a person, I'm, I'm, I'm living my life. Uh, I'm aware that I'm getting older. Uh, what are some things that you would advise to, um, make sure that you have a kind of positive experience as you age and you can't make sure, but to increase the probability that you have a positive experience as you age?
[00:31:16] Deborah Kado: Yeah, I love to try to first talk about what we consider in geriatric medicine important as to really listening and understanding what matters for that particular patient. Because different thing matters, different things matter differently, depending. Um, but once I get an understanding of where their goals are, then I usually talk about work, uh, because anything, most things that are really worthwhile in your life you've worked for. And it's not like pie outta the sky and then, oh, everything is all cheery and happy. I mean, those things can give you temporary happiness and joy, but the things that are really durable are things that you've worked hard, and you know that you, you feel that you deserve. So, uh, and then I tell them, I feel like no matter where you start, whether you've had a cancer diagnosis or a stroke, or a loss of multiple family members, that you have agency to have a positive outcome, that it can start at any point, but you have to believe that, and that's where the hope part comes in.
[00:32:23] Russ Altman: Great. So hope is great. And then agency is a, and when you say agency, I think what you mean is like taking control and not feeling like you're, other people are always making decisions for you, but to say, I'm gonna make some decisions about how I spend my time, how I do things.
[00:32:40] Deborah Kado: Yeah. So this is a good point because what I notice often when I'd get feedback from my geriatrics patients or patients who have seen other doctors, but they come to you for consultation and sometimes they're no longer able to drive, or they may have some mild cognitive impairment or even more, the things that they really appreciate about seeing a geriatrician is a geriatrician knows who's the patient. So no matter where that is, it's the patient who you're taking care of and, and to talk only to the person who's driving or, you know, managing the medications is not really respectful. So I feel that if I were gonna give another, the second piece of advice,
[00:33:23] Russ Altman: Good. There you go.
[00:33:24] Deborah Kado: Is to pay first and foremost attention to the, your patient. Uh, and it's amazing that people can understand even if you think they can't.
[00:33:33] Russ Altman: Yeah. That's fantastic. And it actually, it turns into a piece of advice for the patients. Those two things you had for your colleagues as physicians is the patients should make sure they're being talked to as the primary patient and not the people who are around them when they make a visit and see if they're detecting a doctor who's kind of giving up on them and saying, well, you're just old versus, let's get to the bottom of this. And those are two things that many people would be able to perceive.
[00:34:01] Deborah Kado: Yes.
[00:34:02] Russ Altman: Thanks to Deborah Kado, that was the future of geriatrics. Thank you for tuning into this episode. Don't forget that we're pushing almost 300 back episodes in our catalog so you can spend all day and all-night listening to The Future of Everything. Please remember to hit follow in whatever app you're listening to so that you'll be notified of new episodes, and you'll never miss the future of anything. You can connect with me on many social media platforms @RBAltman, or @RussBAltman at LinkedIn, Threads, Bluesky, Mastodon. You can also follow Stanford Engineering @StanfordSchoolOfEngineering, or @StanfordENG.
