04-16-2015, Geriatrics

>> AS TIME GOES BY, GERIATRIC ISSUES, COMING NEXT “ON CALL WITH THE PRAIRIE DOC.” >> GOOD EVENING, AND WELCOME TO “ON CALL WITH THE PRAIRIE DOC.” THE AGING PROCESS CAN BRING MANY JOYS, SUCH AS GRANDCHILDREN, NEW HOBBIES, AND MORE KNOWLEDGE AND EXPERIENCE, BUT IT ALSO BRINGS ON MEDICAL PROBLEMS 80% OF OLDER ADULTS WILL BATTLE AT LEAST ONE CHRONIC CONDITION OR ILLNESS SUCH AS HEART DISORDERS, ARTHRITIS, OR SKIN CANCER, AND 50% OF OLDER ADULTS WILL BATTLE AT LEAST TWO GERIATRICS IS THE BRANCH OF MEDICINE THAT DEALS WITH THE PROBLEMS AND DISEASES OF OLD AGE TONIGHT WE HOPE TO ANSWER YOUR QUESTIONS ABOUT THE AGING PROCESS TO HELP ANSWER ALL OF YOUR QUESTIONS, AND I’M REALLY HOPING WE GET QUESTIONS TONIGHT, I AM JOINED BY DR. ELLEN PINHOLT OF THE REGIONAL MEDICAL CLINIC ASPEN CENTER IN RAPID CITY. DR. DAVID SANDVIK, WHO IS THE DIRECTOR OF THE GERIATRICS FELLOWSHIP AT THE SANFORD SCHOOL OF MEDICINE IN SIOUX FALLS AND RAPID CITY WE ANSWER YOUR QUESTIONS AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL GET ‘EM IN EARLY. CALL IN YOUR QUESTIONS AT 1-888-376-6225. OR SEND US AN EMAIL SO, TODAY WE HAVE THIS CADRE OF GERIATRIC SPECIALISTS, ELLEN PINHOLT, TELL US A LITTLE BIT ABOUT YOU. >> WELL, I STARTED GERIATRICS IN THE LATE ’70s, ACTUALLY AND I GRANDFATHERED IN GERIATRICS — >> WITHOUT DOING THE FELLOWSHIP >> IN THOSE DAYS, THE FELLOWSHIP WAS JUST STARTING. >> RIGHT >> BUT YOU TAKE THE EXAMS AND THEN I CONTINUED MY EXAMS THROUGHOUT THE TIME AND I ENDED UP IN THE MILITARY AND A LOT OF PEOPLE THINK THE MILITARY DOESN’T HAVE GERIATRIC PATIENTS. >> BUT WE DO. >> WE DO. WE HAVE RETIREES AND SOMETIMES DEPENDENTS OF ACTIVE DUTY THAT END UP NEEDING OUR CARE. SO I ENDED UP EVENTUALLY AT THE END OF MY CAREER, THE CHIEF OF GERIATRICS AT WALTER REED AND THEN I RETIRED AND CAME TO SOUTH DAKOTA. >> SO YOU’RE FROM WHERE ORIGINALLY? >> WATERTOWN, SOUTH DAKOTA >> I KNEW THAT, YOU KNOW. I MET YOU WHEN YOU WERE A NURSING — PRENURSING STUDENT, RIGHT? >> RIGHT. >> DID YOU DO YOUR NURSING? >> NO, I DIDN’T COMPLETE IT. >> YOU DID YOUR PREMED >> I SWITCHED TO PREMED. >> THEN YOU WENT TO WHERE? >> USD SCHOOL OF MEDICINE, THEN I DID MY RESIDENCY IN HONOLULU, HAWAII, AT TRICKLER ARMY MEDICAL CENTER >> THEN DID YOU GO IMMEDIATELY INTO — WELL, DID YOU — THEN YOU DID GERIATRICS, HOW SOON AFTER THAT? >> IT WAS AFTER MY FIRST THREE YEARS IN THE MILITARY, THEN I CAME BACK TO SAN ANTONIO, THAT’S WHERE I DELVED IN GERIATRICS. >> GREAT. AND, DAVID, YOU’RE NOT ONLY A GERIATRICIAN, YOU’RE THE HEAD OF THE FELLOWSHIP PROGRAM. TELL US A LITTLE BIT ABOUT, WHERE DID YOU START, BY THE WAY? >> IN COLTON. [ Laughter ] AND I’M ENDING UP THERE >> AND YOU’RE ENDING UP IN COLTON. BUT YOU WERE A MINISTER. >> NO. >> YOU DID THE MINISTRY >> NO. >> YOU DID SOME TRAINING IN MINISTRY? >> I HAD A ROCKEFELLER THEOLOGICAL FELLOWSHIP, AFTER COLLEGE AT St. OLAF IN PHILOSOPHY WENT TO COLUMBIA UNIVERSITY IN UNION THEOLOGICAL SEMINARY. >> SO YOU FINISHED IN THE SEMINARY. >> NO, NO, I FINISHED WITH A MASTER’S IN LITERATURE AND RELIGION OF THE BIBLE >> OH. >> MOSTLY OLD TESTAMENT. SO — >> THAT’S VERY INTERESTING. >> THEN AFTER THAT YOU TAUGHT — >> I TAUGHT — >> — GRADE SCHOOL? >> WELL, MIDDLE SCHOOL IN THE BRONX >> DID YOU KNOW THAT? >> NO. >> FOR ABOUT NINE MONTHS, I WAS A NEW YORK CITY SOCIAL WORKER IN WEST HARLEM. >> I BET THAT WAS AN EXPERIENCE. >> IT WAS VERY INTERESTING I REMEMBER BEING SENT TO A BURNED-OUT BUILDING TO PROTECT MY PARTNER, A WOMAN SOCIAL WORKER AND FOUND OUT LATER THAT IT WAS THE STREET IN NEW YORK CITY WHERE THE MOST ASSAULTS ON SOCIAL WORKERS — AND WE WERE OF BIRACIAL GROUP AT THAT POINT I THOUGHT, WHAT HAVE I GOTTEN INTO? SO I WENT TO MEDICAL SCHOOL >> AND YOU’VE BEEN HEAD OF THE FELLOWSHIP IN GERIATRICS FOR FOUR YEARS OR SOMETHING LIKE THAT? >> SINCE 2010. >> AND THIS HAS BEEN — GERIATRICS IS KIND OF A DYING FELLOWSHIP, ISN’T IT? I MEAN, IT’S BEEN, NO PUN INTENDED OR ANY JOKES OR ANYTHING, BUT, I MEAN, IT’S NOT BEEN GROWING VERY WELL >> NO, IT HASN’T. >> STRUGGLING TO EXIST. >> WE’VE HAD DECREASING NUMBERS >> AND THE MAJOR REASONS ARE? >> WELL, I THINK THE MAJOR REASONS ARE THAT WE HAVEN’T

THOUGHT ABOUT IT VERY WELL. IF YOU LOOK BACK, ELLEN AND I AND YOU, DR. HOLM IS ALSO A GERIATRICIAN, HE’S A LAPSE GERIATRICIAN. >> I PASSED THE BOARDS BUT THEN I — YOU’RE WANTING ME TO — >> I WANT TO TAKE HIM AND TEACH. >> I KNOW YOU DO. >> AND I’VE TAUGHT, TOO PEOPLE IN THE LAST MONTH INTO RETAKING THEIR BOARDS. SO WE MAY SEE A RESURGENCE BUT DURING THOSE YEARS WHEN YOU COULD GRANDFATHER IN FROM THE PRACTICE ARM WITHOUT A FELLOWSHIP, WE PRODUCED ABOUT 8,200 GERIATRICIANS. AND FROM THERE ON, THE NUMBERS HAVE BEEN GOING DOWN BECAUSE THE FELLOWSHIP WAS REQUIRED. >> AND THAT’S A TWO-YEAR EXPERIENCE? >> IT WAS A TWO-YEAR, AND NOW IT’S A ONE-YEAR, SINCE, OH, SINCE ABOUT THE FIRST TWO YEARS THEY REQUIRED A FELLOWSHIP. >> AND WE HAD THREE FELLOWS. >> WE HAD THREE FELLOWS AND I THINK WE NEED TO TURN BACK TO THOSE PRACTICING PHYSICIANS WE ALL TOOK THE EXAM BECAUSE WE WANTED PROFESSIONAL DEVELOPMENT AND WE THOUGHT WE COULD DO A BETTER JOB TAKING CARE OF OLDER PEOPLE. RIGHT? >> YEAH >> AND THAT’S EXACTLY HOW PRACTICING PHYSICIANS STILL FEEL SO EVERY TIME I BRING THIS UP TO A GROUP OF PRACTICING PHYSICIANS AND SAY, WE ARE OFFERING A PART-TIME FELLOWSHIP, IF YOU WANT TO KEEP PRACTICING, THEY GO, TELL ME ABOUT IT. >> SO, MY THOUGHT — ANY COMMENT ABOUT WHAT HE JUST SAID? >> WELL, I THINK WE’LL NEVER HAVE ENOUGH GERIATRICIANS ANYWAY BECAUSE OF THE AGING OF OUR POPULATION. >> OF THE BOOMERS. >> YEAH. THEY’RE GOING TO OVERWHELM US SO I THINK JUST YOUR IDEA OF GETTING THE PHYSICIANS THAT ARE PRACTICING PRIMARY CARE MORE SKILLED IN THE GERIATRICS FIELD IS PERFECT. >> WELL, THERE’S A GREAT DEAL OF SPECIAL INFORMATION YOU NEED TO KNOW TO CARE FOR THE VERY ELDERLY >> CORRECT. >> AND I THINK IT’S — THE TAKE-HOME I HAVE ON IT IS WE USE TOO MANY MEDICINES AND WE DON’T CONSIDER THEM EVEN WHEN THEY HAVE DEMENTIA AS VALUABLE, LIKE WE SHOULD. I MEAN, THERE’S SOME THINGS THAT YOU CAN LEARN AS YOU CARE FOR PEOPLE IN NURSING HOMES OR HELPING KEEP PEOPLE OUT OF THE NURSING HOME >> YEAH. >> AND, YOU KNOW, THE OTHER PART OF DOING GERIATRICS IS THAT IT’S A DIFFERENT WAY OF THINKING. SO, LET ME GIVE YOU AN EXAMPLE WE HAVE GERIATRICS SYNDROMES. AND THOSE ARE THINGS THAT HAPPEN THAT YOU DON’T HAVE A SINGLE MEDICINE FOR. BUT PEOPLE GIVE SINGLE MEDICINES FOR IT FOR EXAMPLE, I KNOW THIS GENTLEMAN WHO WAS INCONTINENT, AND NORMALLY IF HE WERE TO GO TO HIS PRIMARY CARE PHYSICIAN, HE WOULD GET A DRUG FOR INCONTINENCE, SOMETHING TO HELP HIM HOLD URINE. HE HAD BEEN AN ENGINEER, AND HIS DAUGHTER WANTED TO ALWAYS HAVE HIM LOOK PROFESSIONAL. SO SHE MADE HIM WEAR BUTTON-UP PANTS, LEVIs, KHAKIS AND HE COULDN’T UNZIP OR UNDO HIS TROUSERS. SO HE WAS ALWAYS INCONTINENT AND FINALLY HER SIBLINGS — >> BUTTON-UPS. >> IT WAS REALLY A PROBLEM OF — >> MEDICATION. >> NOT DRUGS. DRUGS IS NOT THE ANSWER. >> YEAH. SO THE OTHER SIBLINGS FINALLY TALKED HER INTO ALLOWING SWEAT PANTS. AND HIS INCONTINENCE IMPROVED BY 40% [ Laughter ] >> THINK ABOUT THOSE THINGS. >> VERY QUICKLY, WHAT AGE GROUP IS GERIATRICS? AT AGE 60? 65? 75? WHEN DO WE START CALLING IT? DO WE HAVE AN AGE? >> OH, I THINK 65 BUT, YOU KNOW, MORE IT’S COMPLEXITY. >> MORE — YEAH. >> YEAH. >> AND ACTUALLY IT’S GETTING MORE TOWARDS 75, DON’T YOU THINK? >> OH, I THINK SO, BECAUSE — WELL, I WON’T TELL YOU EXACTLY WHY I THINK THAT. [ Laughter ] >> I BET I UNDERSTAND >> IN 1969, BOB BARTLING AND OTHER BROOKINGS COMMUNITY MEMBERS STARTED A RUNNING CLUB TO EMPHASIZE THE IMPORTANCE OF PHYSICAL FITNESS >> WE HAD ELEMENTS FROM ALL OVER BROOKINGS, MEANING WE HAD HIGH SCHOOL ATHLETES, WE HAD COLLEGE ATHLETES, WE HAD COACHES AT BOTH LEVELS, AND WE HAD — WE HAD JUST CITIZENS AT DIFFERENT AGE LEVELS AND, SO, THERE WERE 10, 12 OF US AT THE INITIAL MEETING AND WE ORGANIZED THE CLUB. AND, OF COURSE, THE CLUB HAS PROSPERED. WE HAD DIFFERENT — WE HAD DIFFERENT GOALS WITH OUR CLUB AND ONE OF THEM EARLY ON WAS TO INCREASE OUR MEMBERSHIP TO INCORPORATE MORE PEOPLE IN THE COMMUNITY TO JOIN OUR CLUB AND TO ALSO REAP THE HARVEST FROM

OUR CLUB BY JOGGING AS THE MAIN PURPOSE FOR ACQUIRING A NEW FITNESS LEVEL WE HAD VERY VERY FEW TURNDOWNS. AND LOOKING UP THE OLD MINUTES IN OUR NEWSLETTERS, WE REACHED A HIGH OF OVER 900 MEMBERS. BUT OUR MISSION, OUR GOAL MISSION OF THE CLUB WAS THE PROMOTION OF RUNNING FOR PURPOSES OF FITNESS AND HEALTH I GOT DOWN TO FOUR MINUTES AND 52 SECONDS, BUT THAT NUMBER, THE FIRST NUMBER’S THE IMPORTANT NUMBER, FOUR, SEE, IN OTHER WORDS, YOU COULD ALWAYS TELL SOMEBODY, I CAN BREAK FIVE MINUTES, YOU DIDN’T TELL THEM BY JUST A LITTLE BIT. SEE? AND NOW I’M AT THE LEVEL OF 15 TO 20 MILES A WEEK. SO, AGAIN, YOU COULD EXTRAPOLATE AND GET YOUR YEARLY MILEAGE AND IT WOULD BE PATHETIC IF I CAN HIT 900 MILES OR 1,000 MILES A YEAR, WHY, I’LL BE PERFECTLY HAPPY MY FAVORITE IS THE GOLF COURSE. IN OTHER WORDS, A SOFT SURFACE TO LAND ON AND THEN FROM THERE I LIKE TO GO GRAVEL, BECAUSE THAT’S NEXT SOFTER THEN BLACKTOP AND THEN CEMENT IS THE LAST RESORT. AND YOU CAN — YOU SEE THE BEAUTY OF JOGGING IS YOU CAN DO IT ANYWHERE AT ANY TIME WITH HARDLY ANY EQUIPMENT YOU’VE GOT TO COME UP WITH WHAT YOU ENJOY DOING AND WHAT YOU’LL STICK WITH DOING AND THAT’S THE KEY TO THIS WHOLE THING. AND IF IT ISN’T JOGGING, IT CAN BE WALKING, IN THAT AREA, BUT YOU TAKE SWIMMING AND YOU TAKE BIKING AND THEY’RE TERRIFIC. SO YOU CAN COME OUT WITH THE END RESULT OF BEING FIT WITH ANY BODY’S MOVEMENT [MUSIC] >> WELL, BOB BARTLING HAS BEEN A FRIEND OF OURS FOR A LONG TIME AND WHAT A JOY TO HAVE HIM ON OUR SHOW. YOU KNOW, I THINK WHAT HAPPENS, HE AND I THINK IT WAS SCOTTIE ROBERTS, A DOCTOR FROM BROOKINGS, WHO’S NOW PASSED AWAY, SCOTTIE ROBERTS AND BOB BARTLING AND ANOTHER I THINK OR TWO, IT MIGHT NOT BE SCOTTIE, BUT I THINK SO, STARTED UP THIS RUNNING CLUB AND THEN THEY COULDN’T GET SHOES, SO BOB PUT A SHOE STORE IN THE BASEMENT OF HIS FURNITURE STORE, AND THEN HE’D SELL THEM AT COST TO GET PEOPLE, AND WHEN YOU BOUGHT SHOES, YOU’D GET A REDUCTION IN THE PRICE IF YOU JOINED THE RUNNING CLUB, WHICH IS WHAT GOT ME IN THE RUNNING CLUB AND NOW I’M A PERMANENT MEMBER BECAUSE THAT WAS MY 50th BIRTHDAY PRESENT FROM MY WIFE AND, SO, ANYWAY. I JUST HAVE TO SAY THANK YOU TO BOB BARTLING, A PERFECT EXAMPLE OF A REGULAR EXERCISE PROGRAM. I’M CRAZY ABOUT EXERCISE I THINK IT’S VERY VERY IMPORTANT. I TRY TO RUN ABOUT 20 MILES A WEEK I’M NOT IN BOB’S AGE BRACKET. BUT I THINK IT’S VERY VERY IMPORTANT WHAT IS YOUR TAKE ON IT, ELLEN? >> I THINK THAT’S VERY COMMENDABLE. BUT I WANT TO SAY TO ALL THE PEOPLE OUT THERE THAT IT DOESN’T HAVE TO BE THAT COMMITTED. IT REALLY CAN BE AS SIMPLE, AND WE CAN USE THE TERM PHYSICAL ACTIVITY — >> LET’S NOT SAY EXERCISE BECAUSE PEOPLE DON’T LIKE THAT WORD. SO PHYSICAL ACTIVITY. >> ACTIVITY AND THAT JUST MEANS YOU CAN WALK, YOU CERTAINLY CAN WALK, YOU CAN DO STATIONARY BICYCLING, SWIMMING. >> YEAH. >> ALL VERY GOOD. AND THEN SHOULD I PUT MY PITCH IN? >> YES, LET’S HEAR YOUR PITCH. >> THEN FOR THE NATIONAL INSTITUTE OF HEALTH, THERE’S A FREE EXERCISE GUIDE AND ACTIVITY. >> PHYSICAL ACTIVITY GUIDE. >> YES AND WHAT’S GREAT IS IT HAS ORDINARY PEOPLE DOING CHAIR EXERCISES AND SUCH TO HELP WITH BALANCE, TO PREVENT FALLS. I THINK THAT’S WHERE WE’RE MOST COMMITTED TO PHYSICAL ACTIVITIES TO HELP PREVENT FALLS AND GET BETTER BALANCE. >> ISN’T THAT TRUE, THE STRONGER YOU ARE, THE LESS YOU FALL? I MEAN, ISN’T THAT — THAT’S THE MAIN EXERCISE, THAT’S STRENGTHENING. I MEAN, IS THERE AN IDEAL EXERCISE, DAVE? WHAT’S THE IDEAL EXERCISE? >> I THINK JUST STAYING ACTIVE. THERE WAS THIS BOOK, “THE BLUE ZONES,.” >> YEAH, LET’S HEAR THAT. >> — A RESEARCH FROM NATIONAL GEOGRAPHIC, I’M BLOCKING ON

HIS NAME RIGHT NOW, TOOK A BLUE PEN AND MADE MARKS ON THE WORLD MAP FOR WHERE EACH PERSON OVER — LIVING OVER 100 CENTAURIAN LIVED. AND THE AREAS THAT TURNED BLUE HE CALLED BLUE ZONES. WE HAVE ONE IN THE UNITED STATES, IT’S LOMALINDA, CALIFORNIA, WHERE THE SEVENTH DAY ADVENTISTS LIVE AND THEY HAVE A PRETTY STRICT DIET BUT THOSE PEOPLE HAD NO — I MEAN, WE’RE TALKING ABOUT — >> WE’RE TALKING GYMS, ARE WE, WE’RE TAKING ACTIVITY. >> WE’RE TALKING ABOUT COSTA RICA, AN ISLAND OFF THE COAST OF ITALY BUT REMOTE AREAS. AND THE MAIN ACTIVITY THAT THEY DID WAS TO RAISE THEIR OWN FOOD AND GARDENING >> SO IT WAS RAISING YOUR OWN FOOD THAT REALLY KEPT THEM BEST >> PROBABLY ON BOTH ENDS. >> EATING RIGHT AND EXERCISING RIGHT. WELL, I KNOW THAT WE HAVE — WE HAVE LONGEVITY IN SOUTH DAKOTA. >> IN SOUTH DAKOTA, ABSOLUTELY >> I THOUGHT WE WERE THE EPICENTER RIGHT HERE. >> WE’RE NEAR — >> IT USED TO BE? >> NO, WHAT HAPPENED WAS WE ARE A STATE WITH SOME OF THE HIGHEST PERCENTAGE OF ELDERLY, BUT IN LARGE PART IT’S BECAUSE PEOPLE HAVE MOVED OUT. >> THE DENOMINATION. >> THE YOUNGER PEOPLE >> SO WE’VE GOT A LOT OF OLDER PEOPLE. I’M NOT SURE THAT WE’RE ACTUALLY THE LONGEST, THAT’S IN LOMALINDA. >> AND IS IT THEIR DIET OR IS IT THEIR ACTIVITY? >> YEAH. >> THERE WE GO SO WE HAVE A QUESTION, A 60-YEAR-OLD MAN FROM WESTERN, SOUTH DAKOTA, HOW DOES GRAPE JUICE AND OTHER ANTIOXIDANTS SLOW DOWN THE AGING PROCESS? ELLEN, DO YOU THINK GRAPE JUICE HAS ANYTHING TO DO WITH IT? >> I DON’T THINK THAT’S REALLY KNOWN. IT’S CERTAINLY POPULAR TO TAKE ANTIOXIDANTS. AND CERTAINLY FRESH FRUIT, YOU KNOW, THEY DO BLUEBERRIES AND THINGS LIKE THAT I MEAN, CERTAINLY FRESH FRUITS ARE ALWAYS GOOD. BUT I DON’T THINK TAKING ANTIOXIDANTS CERTAINLY IN A PILL FORM IS NECESSARILY KNOWN. >> AND OTHER ANTIOXIDANTS. >> IT HAS BEEN STUDIED. THE PILLS HAVE BEEN STUDIED NEVER FOUND ANY DIFFERENCE. BUT THE FOODS WITH THOSE VITAMINS IN ARE — >> HAVE MADE A DIFFERENCE? >> YES. >> I THINK THERE’S — IN A WOMAN’S STUDY, SOMETHING LIKE 30,000 STRONG, OVER TEN YEARS OR LONGER THAN THAT, THEY FOUND THAT PEOPLE WHO DRANK A CERTAIN AMOUNT OF ALCOHOL, NOT TOO MUCH, LIVED LONGER. AND I DO KNOW THAT THEY FOUND WHEN THEY WERE STUDYING MICE THAT VITAMIN E OR THAT THE ANTIOXIDANT ISSUE WAS REAL AND THEY SAW THAT VITAMIN E WAS IN THERE AND THEY FIGURED IT WAS THE THING AND ALL OF A SUDDEN ALL THE RESEARCHERS WERE TAKING VITAMIN E AND THE BIG RESEARCH, INCLUDING YOU, AND WHEN IT ALL CAME DOWN, THERE WAS NO DIFFERENCE. >> RIGHT. >> AND, ACTUALLY, THERE WAS A DIFFERENCE THERE WAS, LIKE, ONE OUT OF EVERY 350 PEOPLE WHO TOOK MORE THAN THE DAILY REQUIREMENT OF VITAMIN E WHO DIED OF CARDIAC DISEASE. >> AND IT’S THE SAME THING WITH CALCIUM I MEAN, THERE’S SOME CARDIAC DISEASE WITH TOO MUCH CALCIUM. SO, DO YOU — LET ME ASK YOU BOTH, IS THERE ANY PARTICULAR VITAMIN OR SUPPLEMENT THAT YOU RECOMMEND, ELLEN? >> NO. >> NO? >> NOT PARTICULARLY. I MEAN, I END UP, IF THEY AREN’T EATING A REGULAR DIET OR HAVE TROUBLES, I SOMETIMES JUST DO THE MULTIPLE ONE A DAY WITH CALCIUM AND VITAMIN D CERTAINLY IN SOUTH DAKOTA, WE DO HAVE A LOT OF VITAMIN D DEFICIENCY DURING THE WINTER >> DON’T HAVE ENOUGH SUN. >> NOT ENOUGH SUNLIGHT DURING THE WINTER MONTHS SO I THINK SUPPLEMENTING THAT, BUT NOT OVERSUPPLEMENTING. >> RIGHT YEAH, I TAKE A VITAMIN E — NOT AN E — A D, I DO 2,000, PARTICULARLY THE WINTER, THE TWO SEASONS THAT ARE LESS SUN THAN NIGHT. DAVE, DO YOU TAKE ANY SUPPLEMENTS? >> NO, I DON’T. AND I THINK IF — IF YOU HAVE A REASONABLE DIET, YOU DON’T NEED A SUPPLEMENT NOW, THERE’S ONE EXCEPTION, AND THAT’S IF YOU ARE IN AN INSTITUTION. EITHER ASSISTED LIVING OR NURSING HOMES. THEN EVERYBODY SHOULD JUST BE DIAGNOSED AS BEING OSTEOPOROTIC AND YOU SHOULD BE ON CALCIUM AND VITAMIN D TO DECREASE THE NUMBER OF FALLS AND FRACTURES >> AND ACTIVITY. >> ACTIVITY. >> THERE WE GO. >> ALL RIGHT. >> ONLY 4% OF PEOPLE OVER 65 YEARS OLD ARE IN NURSING HOMES, WHICH MEANS THE REST EITHER LIVE ON THEIR OWN OR MOVE IN WITH A FAMILY MEMBER. LUCY KEPHART RECENTLY MOVED HER MOTHER INTO HER HOME AND

ALLOWED US TO COME IN AND FIND OUT WHAT THE TRANSITION HAS BEEN LIKE. >> AND I KIND OF NOTICED, STARTING IN NOVEMBER, THAT SHE BEGAN TO SOUND KIND OF MORE ANXIOUS AND WHEN I WOULD CALL HER AND WORRIED AND MORE PESSIMISTIC, WHICH WAS NOT LIKE SHE NORMALLY WAS ORDINARILY MY MOM IS THE QUEEN OF OPTIMISM. AND HAS A WONDERFUL, SUNNY DISPOSITION, AND ALWAYS HAS BEEN VERY VERY OPTIMISTIC. BUT THAT KIND OF CHANGED IN NOVEMBER, AND I WORRIED ABOUT HER. SO I CALLED HER MORE FREQUENTLY. AND SHE WAS HOSPITALIZED JUST FOR A BRIEF PERIOD OF TIME, AND I WENT DOWN TO CHECK ON HER AFTER THAT. AND IT WAS APPARENT TO ME THAT, YOU KNOW, SHE JUST KIND OF NEEDED MORE HELP AND SUPPORT THAN SHE WAS GETTING LIVING ON HER OWN WE DIDN’T KNOW IF IT WOULD BE A LONG-TERM STAY OR A SHORT-TERM STAY MOM WASN’T REALLY — >> MOVE IN. >> YEAH. SHE WASN’T REALLY READY TO MOVE IN AND STAY WITH ME, AND THAT WASN’T OUR INITIAL PLAN. OUR INITIAL PLAN WAS, COME VISIT FOR A WHILE, SEE HOW YOU ARE, GET YOUR HEALTH BACK, SEE HOW THINGS ARE GOING, AND THEN WE’LL KIND OF MAKE DECISIONS AS WE NEED TO. WE HAD HAD THE PLAN STARTING YEARS AND YEARS AGO THAT IF MY MOM EVER NEEDED MORE HELP AND WASN’T ABLE TO BE INDEPENDENT THAT SHE WOULD COME TO WHEREVER I LIVED. NOT NECESSARILY MOVE IN OUR HOUSE WITH US, AS IT HAPPENED, BUT SHE WOULD COME TO MY TOWN. AND, SO, IT MADE SENSE THAT SHE CAME UP — THAT SHE WOULD COME UP HERE AT THAT TIME. AND YOU HAVE A COMPANION THAT COMES TWO AFTERNOONS A WEEK. >> AND SHE’S MY WALKER. >> SHE WALKS WITH YOU IN ADDITION TO THE EXERCISE GROUP. SO, YEAH, SO I FOUND SOME PLANNED ACTIVITIES, YOU KNOW, SOME SERVICES THAT WE HAVE AVAILABLE IN BROOKINGS, SENIOR CITIZEN CENTER AND THEN ALSO A PAID SERVICE TO HAVE SOME IN-HOME COMPANIONSHIP. SO THAT HELPS. MY MOM HAS SAID THAT THAT’S ONE OF THE THINGS THAT SHE’S BEEN AWARE OF THAT’S BEEN MORE CHALLENGING AND IT’S CERTAINLY ONE OF THE THINGS THAT I’VE SEEN IN GERIATRIC CARE, TOO, IS I NEED TO, YOU KNOW, HELP MAKE SURE THAT MY MOM KEEPS HER MEDS STRAIGHT, THAT SHE TAKES THEM EVERY MORNING, TAKES THEM EVERY EVENING SO, I’M COGNIZANT OF THAT. I COME HOME AT LUNCH, CHECK AND MAKE SURE, MORNING MEDS ARE GONE, AND IN THE EVENING, EVENING MEDS ARE GONE ALL THROUGHOUT MY LIFE, SHE’S BEEN MY MOM. I’VE BEEN HER KID AND WE’VE HAD THAT RULE. AND THAT HAS SHIFTED A LOT. SHE’LL OFTEN REFER TO ME AS MOTHER IN A JOKING WAY, OF COURSE. BUT I THINK THAT’S ONE OF THE WAYS THAT WE ARE SUCCESSFUL IN OUR RELATIONSHIP NOW, IS SHE’S BEEN ABLE TO UNDERSTAND THAT, YOU KNOW, BECAUSE OF HOW HER MEMORY IS RIGHT NOW, THERE ARE CERTAIN THINGS THAT SHE NEEDS HELP WITH, AND I’M HERE TO HELP HER. AND, SO, SHE’S WILLING TO LET ME MAKE DECISIONS AND DO THINGS FOR HER [MUSIC] >> NOW, WEREN’T THOSE TWO BEAUTIFUL LADIES TO PROVIDE THAT TO US THANK YOU VERY MUCH, LUCY AND LUCY’S MOM FOR SHARING THAT INFORMATION WE TALK ABOUT ASSISTED LIVING AND NURSING HOME. WHEN IS IT THE RIGHT TIME OR MAYBE BETTER YET TO JUST MOVE IN WITH THE KIDS? I THINK THE OLD WAY WAS THAT YOU WOULD MOVE IN WITH YOUR CHILDREN OR THEY WOULD BRING YOU — OR THEY WOULD MOVE IN WITH YOU WHAT’S HAPPENED AND WHAT DO YOU THINK THE FUTURE BRINGS, DAVE? >> BOY, THAT’S A BIG QUESTION >> IS THERE ANY SUPPORT FOR FAMILIES TAKING THEIR — TAKING CARE OF THEIR ELDERLY? >> I THINK THERE IS. IT’S A REALLY GOOD REASON TO HAVE LONG-TERM CARE INSURANCE AND IF YOU DO GET LONG-TERM CARE INSURANCE, YOU SHOULD MAKE SURE THAT YOU GET SOMETHING THAT COVERS HOME CARE. AND MAYBE CARE BY RELATIVES. AS WELL AS INSTITUTIONAL CARE BUT THERE ARE TIMES WHEN YOU SHOULD GO IN TO A NURSING HOME >> WHEN IS THAT? >> IF YOU GET HOSPITALIZED AND VERY WEAK FROM WHATEVER REASON THAT YOU WENT IN AND NEED TO HAVE SOME STRENGTHENING, SOME REHABILITATION BEFORE YOU CAN GO HOME OR TO A DIFFERENT LEVEL OF CARE, IF YOU ARE UNABLE TO DO THREE HOURS A DAY OF THERAPY, YOU CAN’T GO INTO A REHAB HOSPITAL, REHABILITATION HOSPITAL, FREESTANDING ONE. SO YOU NEED TO GO TO THE NURSING HOME THAT’S YOUR TICKET HOME. NOW, YOU SHOULD BE IN CHARGE OF WHAT HAPPENS TO YOU AND SAY, MY GOAL HERE IS TO GET HOME AND IT’S YOUR JOB TO GET ME THERE. >> YUP >> THAT’S MY DOCTOR, MY THERAPIST, MY SOCIAL WORKER, MY NURSE, EVERYBODY WHO’S A TEAM MEMBER HERE, YOUR JOB IS TO GET ME BACK HOME. >> RIGHT. NOW, THAT’S NURSING HOME

OPTIONS. AND THAT’S NOT EXACTLY THE REASON FOR SOME OF THEM, BUT FOR MANY OF THEM, AFTER A FRACTURED HIP, I GET THEM TO THE NURSING HOME. WHAT ABOUT THE ASSISTED LIVING, ELLEN, WHY NOT THE ASSISTED LIVING? WHAT’S THE DIFFERENCE BETWEEN ASSISTED LIVING AND A NURSING HOME? >> WELL, A NURSING HOME, LIKE DAVE WAS SAYING, IS SKILLED CARE SO YOU HAVE SKILLED THERAPISTS, YOU KNOW, PHYSICAL THERAPISTS, NUTRITIONISTS, THINGS LIKE THAT AND NURSING, YOU NEED WOUND CARE OR INCISIONAL CARE, YOU KNOW — >> A LOT MORE HELP. >> YOU NEED A LOT MORE ONE-ON-ONE CARE. ASSISTED LIVING SOMETIMES JUST ENDS UP BEING, YOU KNOW, A STEP THAT WHEN YOU CAN’T GET SOCIALIZATION AT HOME, WHEN YOU CAN’T DO YOUR CHORES, YOUR DAILY CHORES AT HOME AND YOU JUST CAN’T COMPLETE THEM, OR YOU USE SO MUCH ENERGY DOING YOUR DAY-TO-DAY ACTIVITIES THAT YOU DON’T GET TO GO HAVE FUN WITH YOUR CARD-PLAYING FRIENDS BECAUSE IT JUST — THE DAILY LIVING CHORES JUST WEIGH YOU DOWN. AND SOMETIMES THAT’S ACTUALLY A TIME WHERE YOU CAN SAY, MAYBE I SHOULD GO TO A SENIOR COMMUNITY OR AN ASSISTED LIVING. >> RIGHT. >> BECAUSE THEN YOU HAVE SUPPORT AND YOU GET TO ENJOY COMPANY AND YOUR RELATIVES, WHEN THEY COME TO VISIT, ARE MORE VISITING INSTEAD OF, YOU KNOW, MAKING SURE YOU WENT TO THE DOCTOR’S OFFICE, YOU GOT YOUR SHOPPING DONE, YOU GOT YOUR COOKING DONE. >> IT’S A RELIEF OF A BURDEN. I THINK THERE’S A LOT OF FEAR OF ASSISTED LIVING AND NURSING HOMES BY ALL OF US BECAUSE, OH, I DON’T WANT — BECAUSE THEY’RE ALL DEMENTED IN A NURSING HOME, WHICH IS NOT TRUE. AND I JUST DON’T WANT TO GET DEMENTED AND, THEREFORE, I DON’T WANT TO GO TO THE NURSING HOME I MEAN, I THINK THAT’S THE FALSE IDEA. >> AND THE LAST THING, IF YOU ARE OVER AGE 65 OR ANY AGE, THE LAST THING YOU SHOULD DO IS MAKE YOUR CHILDREN PROMISE THEY WILL NEVER SEND YOU TO A NURSING HOME. >> THAT’S THE WORST THING TO DO. >> BECAUSE THEY MAY — YOU MAY GET TO A POINT, MY PARENTS BOTH GOT TO A POINT WHERE THERE WAS NO WAY THAT WE COULD TAKE CARE OF THEM AT HOME. >> WHY NOT GO TO THAT FIVE-STAR HOTEL? AND LET THEM TAKE CARE OF YOU A LITTLE BIT. SO, LET’S MOVE ON TO SOME QUESTIONS MY DAD IS 65, SHOULD HE STAY WITH HIS FAMILY DOC OR GO TO A GERIATRIC SPECIALIST? >> YOU KNOW, WE HAVE A MYTHICAL BEAST IN SOUTH DAKOTA CALLED THE JACKOLOPE, WHICH IS A MIXTURE BETWEEN A JACK RABBIT AND AN ANTELOPE. >> THERE ARE REAL, AREN’T THEY? >> MOSTLY YOU SEE THEM IN — >> WALL DRUG. >> TAXIDERMY SITUATIONS IT’S ALMOST EASIER TO FIND A LIVE JACKALOPE THAN A GERIATRICIAN. [ Laughter ] >> STICK WITH YOUR PRIMARY CARE DOC. >> YES. BUT THERE ARE TIMES WHEN YOU SHOULD SEE THEM. FOR EXAMPLE, EVERY PHYSICIAN SHOULD ASK THEIR PATIENTS IF THEY’VE FALLEN ONCE OR TWICE IN THE LAST YEAR. AND IF YOU’VE FALLEN TWICE OR MORE AND YOU ARE LIVING INDEPENDENTLY IN THE COMMUNITY, THERE ARE MANY THINGS THAT CAN BE DONE TO MAKE SURE — TO DECREASE YOUR CHANCE OF FALLING AGAIN BUT IT INCLUDES THERAPY, IT INCLUDES EVALUATION OF YOUR MEDICAL SITUATION AND YOUR MEDICATIONS AND THAT SHOULD BE DONE BY A GERIATRICIAN. >> ALL RIGHT. QUESTION FOR SANDVIK 68-YEAR-OLD WOMAN WOULD LIKE TO KNOW IF THERE’S AN ALTERNATIVE FOR AMITRIPTYLINE SINCE IT DIMINISHES SEX DRIVE. SEX DRIVE IS AN IMPORTANT PART OF ANYBODY ANY AGE, OR AT LEAST FROM 18 OR 14 OR WHATEVER IT IS, UP TO A CERTAIN AGE. DOES IT GO AWAY FOR EVERYBODY WHEN YOU GET OLD? WHAT’S THE STORY ON THAT? WHAT SHOULD WE DO? ELLEN? >> OH, YOU SAID IT WAS A QUESTION FOR HIM. [ Laughter ] >> WELL, WE’LL PUT THAT QUESTION TO YOU, DAVE. >> OKAY. >> AMITRIPTYLINE, WE’RE TALKING ABOUT MEDICATION. >> I DON’T WANT TO EMBARRASS ANY OF THE YOUNGER PEOPLE IN THE ROOM HERE, BUT SEXUALITY REMAINS IMPORTANT ALL THROUGH LIFE. FOR MANY PEOPLE AND FOR MANY PEOPLE IT REMAINS UNIMPORTANT. >> IN THE BEGINNING TO THE END >> IT PROBABLY DOESN’T CHANGE AN AWFUL LOT THROUGHOUT LIFE. BUT AMITRIPTYLINE IS AN ANTIDEPRESSANT, IT’S AN OLDER ANTIDEPRESSANT, IT HAS A LOT OF SIDE EFFECTS IF I WERE ON IT RIGHT NOW, I WOULDN’T PROBABLY BE — I WOULD PROBABLY BE TALKING LIKE THIS BECAUSE MY MOUTH WOULD BE VERY DRY. [ INDICATING ] AND I MIGHT BE DIZZY WHEN I STAND UP AND I MIGHT NOT BE ABLE TO URINATE AND A NUMBER OF THINGS. >> PEOPLE ARE SWITCHING TO NORTRIPTYLINE IN VERY LOW DOSES, RIGHT? >> NORTRIPTYLINE IS AN OLDER DRUG, VERY INEXPENSIVE, BUT THERE ARE OTHER NEWER ANTIDEPRESSANTS THAT ARE GOOD. >> I DON’T EVER USE IT FOR ANTIDEPRESSION I USE LOW, LOW DOSES FOR CHRONIC PAIN. >> IT MAY BE THAT THIS IS FOR CHRONIC PAIN THAT’S MOSTLY WHERE YOU SEE IT. YOU DON’T USUALLY SEE PEOPLE USING IT FOR DEPRESSION

BUT ANY OF THE ANTIDEPRESSANTS CAN HAVE EFFECTS ON SEXUALITY. >> RIGHT IN FACT, ALMOST EVERY DRUG SEEMS TO DO THAT. BLOOD PRESSURE MEDICINES, LETTING THE DIABETES RUN AMUCK, IS ANOTHER STORY THAT CAN CAUSE TROUBLE WITH SEXUALITY SMOKING IS A BIG THING THAT PEOPLE DON’T TALK ABOUT ENOUGH ELLEN, TELL US MORE ABOUT GERIATRICS AND SEXUAL ISSUES. >> I DON’T — >> VIAGRA. >> OH, OH, WELL, I MEAN, IT’S — WE DO HAVE A LOT MORE HELP FOR PEOPLE, AND I DON’T KNOW IF GERIATRICS IS ALWAYS SO INVOLVED I HAVE TO SAY UROLOGY TENDS TO BE MORE INVOLVED AT TIMES AND GYNECOLOGY REMAINS IMPORTANT BUT I THINK PEOPLE ALSO HAVE TO JUST WONDER WHAT THEIR TAKE IS AND WHAT DO THEY REALLY MEAN BY IT. CERTAINLY JUST CLOSENESS IS SOMETIMES ALL THAT PEOPLE REALLY WANT >> I HAD A 87, 88-YEAR-OLD LADY WHO’S DYING OF CANCER AND SHE WAS IN HER — IN THE ROOM, I WASN’T CARING FOR HER, THIS WAS YEARS AGO, AND SHE SAID, MOST AMAZING THING THAT EVER HAPPENED TO ME, RICK, I GOT TO TELL YOU THIS STORY. AND SHE SAID, AND I HAD — I HAD A COLLEGE STUDENT SHADOWING ME, THIS YOUNG, KIND OF PETITE GIRL AND SHE SAID, IT’S AMAZING, I MET THIS FRIEND AT THIS DANCE THING THAT WE WERE DOING, AND I DECIDED TO COOK SUPPER FOR HIM. SO HE CAME OVER FOR SUPPER, WE HAD SUPPER AND THEN WE TOOK OFF OUR CLOTHES AND JUST HELD EACH OTHER AND, OF COURSE, IT WASN’T WORKING FOR HIM, HE WAS 90. BUT WE JUST — WE TRIED AND WE JUST HAD A WONDERFUL TIME. IT WAS JUST AMAZING. AND THE NEXT WEEK HE CAME OVER FOR SUNDAY DINNER, AND THE SAME THING HAPPENED, THE THIRD WEEK, THE SAME, AND THEN HE DIED >> IF SHE DIES, SHE DIES. >> HE DIED LAST WEEK. AND WE HAD JUST DID THAT, IT WAS JUST — IT WAS SO WONDERFUL. I’M JUST SO HAPPY ABOUT IT. I JUST WANTED TO TELL YOU THIS AND LIKE TWO WEEKS LATER SHE DIED. >> OH. >> AND I THOUGHT TO MYSELF, WASN’T THAT A JOYOUS STORY? THAT GIRL STANDING IN THE ROOM, HER MOUTH — >> YEAH. LET ME SAY THAT IF YOU ARE HAVING SEXUAL ISSUES, YOU REALLY OUGHT TO DISCUSS IT WITH YOUR DOCTOR PEOPLE ARE AFRAID TO BRING THOSE SORTS OF THINGS UP, BUT POSTMENOPAUSALLY A LOT OF WOMEN HAVE DIFFICULTY WITH SEXUAL PERFORMANCE, SO DO MEN. MEN HAVE GOT MEDICINE FOR IT THERE IS NOT A GREAT SOLUTION FOR WOMEN. BUT YOU OUGHT TO TALK TO YOUR DOCTOR >> LOOK AT THE DRUGS THAT YOU’RE ON. >> YES. >> AND THE DRUG FOR DRYNESS OF URINE, KILLS THE SEX. THE URINE SLOW DRUGS FOR, YOU KNOW, FOR PROSTATE, MANY OF THEM KILL — >> RIGHT. >> ELLEN? >> I WAS GOING TO ADD, THOUGH, BUT WHAT’S INTERESTING IS THE FASTEST RATE OF H.I.V. IS IN THE ELDERLY POPULATION. BECAUSE — >> OF VIAGRA AND THE LIKE. >> WELL, BECAUSE THEY THINK, WELL, OF COURSE, I’M NOT GOING TO GET PREGNANT, SO THEY DON’T THINK ABOUT SEXUALLY TRANSMITTED DISEASES. AND IT WAS QUITE ASTOUNDING WHEN THAT STATISTIC STARTED COMING OUT. >> RIGHT. >> WHAT’S ALSO INTERESTING, WE WERE TALKING AT NOON CONFERENCE A COUPLE OF DAYS AGO, IN THE FELLOWSHIP, ABOUT GYNECOLOGIC ISSUES AND THE RECOMMENDATION IS THAT WOMEN HAVE HAD PAP SMEARS, I THINK, FOR FOUR TIMES, EVERY THREE YEARS APART, YOU DON’T NEED TO CONTINUE THEM BUT A LOT OF PEOPLE GET TO MEDICARE, WOMEN GET TO MEDICARE, AND THEY GET THEIR FIRST PAP SMEAR AND YOU FIND THAT — YOU FIND — A NUMBER OF CERVICAL CANCERS. BUT THEN YOU’RE FACED WITH THE QUESTION OF, YOU KNOW, SHOULD I DO PELVIC EXAMS AND PAP SMEARS? AND WHAT I’VE TOLD WOMEN IS THAT, I THINK YOU CAN TAKE THIS HOME, TOO, THAT IF YOU’VE HAD NEW SEXUAL PARTNERS, YOU SHOULD HAVE PAP SMEARS AGAIN. >> YEAH. >> THOSE THREE OR FOUR PAP SMEARS EVERY THREE YEARS >> AND NOW WE’RE NOT TALKING JUST 65 OR OLDER, WE’RE TALKING 40s AND 50s AND 60s AND ALL — >> ALL ALONG. AND YOU TELL ME WHETHER I NEED TO DO A PAP SMEAR YOU DON’T NEED TO TELL ME DETAILS, JUST TELL ME WHETHER I NEED TO DO A PAP SMEAR >> YEAH. >> I WAS GOING TO SAY, I MEAN, PAP SMEARS DURING THE 40s STILL CONTINUE TO BE A RECOMMENDATION. >> RIGHT. AS WE GROW OLDER, OUR TASTES AND DESIRES CHANGE WHEN IT COMES TO DIET. HOWEVER, THERE ARE ALWAYS BETTER CHOICES WHEN WE PLAN OUR DAILY MENUS. >> THE BEST MENU FOR BOOSTING

MEMORY AND BRAIN FUNCTION ENCOURAGES GOOD BLOOD FLOW TO THE BRAIN, MUCH LIKE WHAT YOU’D EAT TO NOURISH AND PROTECT YOUR HEART. A RECENT STUDY FOUND THAT THE MEDITERRANEAN DIET HELPS IN KEEPING AGING BRAINS SHARP. STRENGTHEN YOUR RECALL BY ADDING THESE FOODS TO YOUR DIET ROTATION. EAT YOUR VEGGIES, EATING AT LEAST ONE OR TWO SERVINGS AT EACH MEAL OF COLORFUL, CRUNCHY VEGETABLES, ESPECIALLY FROM THE CRUCIFEROUS GROUP WILL HELP YOU GET PLENTY OF THESE IN YOUR DIET THE MORE COLOR IN YOUR VEGETABLE SELECTIONS, THE MORE ANTIOXIDANTS AND NUTRIENTS FOR YOU BE SWEET ON BERRIES AND CHERRIES. BERRIES, ESPECIALLY DARK ONES, ARE A RICH SOURCE OF FLAVONOIDS THAT CAN BOOST MEMORY FUNCTION. GET ADEQUATE OMEGA 3 FATTY ACIDS, ESSENTIAL FOR BRAIN HEALTH, THESE MAY HELP IMPROVE YOUR MEMORY IN HEALTHY YOUNG ADULTS SEAFOOD, ALGAE AND FATTY FISH ARE SOME OF THE BEST SOURCES OF OMEGA 3 FATTY ACIDS WORK IN WALNUTS. WALNUTS NOT ONLY HAVE A POSITIVE IMPACT ON HEART HEALTH, BUT ALSO CAN HELP TO IMPROVE MEMORY. ADD A HANDFUL TO YOUR DAY FOR A MID-AFTERNOON SNACK [MUSIC] >> WELCOME BACK. THE QUESTION WE TALKED ABOUT EARLIER WAS, WHICH SUPPLEMENT SHOULD WE TAKE? AND, AGAIN, WE BOTH, WE ALL THREE OF US TOTALLY AGREE, THE BEST SUPPLEMENT IS FOOD RIGHT FOOD, BALANCED FOOD. >> GIVE ME ICE CREAM. WHEN I NEED A SUPPLEMENT >> SO WE’VE GOT SOME QUESTIONS. THIS ONE IS ABOUT SUPPLEMENTS. FEEL FREE TO — 68-YEAR-OLD WOMAN FROM RAPID HAD A HIP AND KNEE FRACTURE IN THE PAST FOUR YEARS SHE DOESN’T HAVE OSTEOPOROSIS. WOULD THE EXPERTS RECOMMEND CALCIUM AND VITAMIN D SUPPLEMENTS? >> I THINK BY DEFINITION, SHE DOES HAVE OSTEOPOROSIS. >> IT DEPENDS ON HOW SHE FRACTURED >> RIGHT. >> AND WHY IS SHE FALLING? I MEAN, THAT’S THE OTHER THING. >> RIGHT >> IF SHE FRACTURED WHEN SHE FELL. BUT IF SHE FRACTURED WITH VERY LITTLE STRESS, SHE, BY DEFINITION, DOES HAVE OSTEOPOROSIS. AND THEN IT’S UP TO SOMEBODY TO DECIDE WHAT TO DO >> I CHECK VITAMIN D LEVELS BEFORE I START PEOPLE ON THEM. BUT I ALMOST — IF THEY DON’T WANT THAT, THEN I’LL JUST START THEM ON IT AND — BUT I’M RELUCTANT ABOUT THE CALCIUM WITH THE VITAMIN D. BUT YOU GUYS PROBABLY FEEL DIFFERENTLY WHAT DO YOU THINK? ELLEN? >> I THINK YOU NEED BOTH. BECAUSE OF THE VITAMIN D HAS TO HAVE CALCIUM, ENOUGH CALCIUM IN THE DIET TO WORK. >> RIGHT IF YOU’VE GOT THE D, THOUGH, AND YOU’RE EATING A BALANCED DIET OR EVEN CLOSE >> IF YOU HAVE ENOUGH CALCIUM, YEAH. >> DAVE, YOU HAVE ANY COMMENTS ABOUT THAT? >> YOU MIGHT WANT TO GO WITH A DIFFERENT MEDICINE THAN JUMPING TO CALCIUM AND VITAMIN D YOU MIGHT WANT TO GO TO SOMETHING THAT MORE AIMS AT PREVENTING FRACTURES. YEAH SO YOU REALLY NEED TO TALK TO YOUR DOCTOR ABOUT THAT. BUT YOU SHOULD BE SCREENED FOR OSTEOPOROSIS, AGAIN, ALMOST BY DEFINITION, YOU PROBABLY HAVE IT. >> OKAY SO, TELL ME ABOUT THE IDEA OF FEEDING TUBES IN DEMENTED PEOPLE THAT’S A QUESTION THAT I HAVE. AND I WANT TO ASK MY FOLKS, MY PROMPTER JUST WENT OUT, SO YOU NEED TO GIVE ME ANOTHER SOURCE OF QUESTIONS. GO AHEAD. WHAT ABOUT THE IDEA OF FEEDING TUBES? >> WELL, FUNNY YOU SHOULD ASK, WE JUST HAPPEN TO HAVE THESE SHEETS OF PAPER HERE, ABOUT CHOOSING WISELY, WHICH IS SOMETHING THAT THE AMERICAN BOARD OF MEDICAL SPECIALTIES HAS BEEN DOING OVER THE LAST FEW YEARS. SO, THERE ARE NOW TEN THINGS TO THINK ABOUT IF THEY’RE RECOMMENDED TO YOU, TEN THINGS FROM THE AMERICAN GERIATRICS SOCIETY AND TEN THINGS FROM THE SOCIETY FOR POST ACUTE AND LONG-TERM CARE MEDICINE THERE WERE FIVE OF EACH OF THOSE THAT CAME OUT A FEW YEARS AGO AND IN BOTH OF THEM THERE’S DON’T RECOMMEND PERCUTANEOUS FEEDING TUBES IN PATIENTS WITH ADVANCED DEMENTIA. >> TRY TO FEED THEM. >> TRY TO FEED THEM. AND AS I SAY, GIVE ME ICE CREAM >> WELL, IT’S MUCH MORE — TO HIS POINT, YEAH, IT’S MUCH MORE ENJOYABLE TO THE PERSON TO HAVE SOMETHING IN THEIR MOUTH AND ALTHOUGH IT MIGHT NOT BE ENOUGH, BUT AT LEAST IT’S THE HUMAN INTERACTION, IT’S THE TASTE AND IF THEY LIKED ICE CREAM BEFORE, GIVE THEM ICE CREAM. >> STARVING THEM TO DEATH. >> AND THAT WAS, YOU KNOW, THE ETHICAL ISSUES IN THE PAST. THINKING THAT WE’RE — WE NEED TO GIVE THEM FOOD AND WATER

BUT, ACTUALLY, WHEN PEOPLE WITH DEMENTIA, THEIR BRAIN IS GETTING SMALLER AND THEY’RE SHUTTING DOWN AND THEY DON’T GET HUNGRY AND THIRSTY AS IF I STOPPED YOU FROM EATING >> RIGHT. NO, WE DON’T PUT FEEDING TUBES, HARDLY AT ALL, IN THIS COMMUNITY WE REALLY BELIEVE IN — AND IF THEY’RE IN SEVERE DEMENTIA, YOU DON’T DENY THEM FOOD, YOU PUT THEM UP TO THEIR LIPS BUT IF THEY DON’T TAKE AND CAN’T EAT AND DRINK, THEN THE QUESTION IS TO THE FAMILY. DO YOU WANT US TO FORCE FEED THEM? AND THEY DON’T DO WELL. >> LET ME READ WHAT THE RECOMMENDATION WAS HERE CAREFUL HAND FEEDING FOR PATIENTS WITH SEVERE DEMENTIA IS AT LEAST AS GOOD AS TUBE FEEDING FOR THE OUTCOMES OF DEATH, ASPIRATION, PNEUMONIA, FUNCTIONAL STATUS AND PATIENT COMFORT. FOOD IS A PREFERRED NUTRITION — NUTRIENT AND TUBE FEEDING IS ASSOCIATED WITH AGITATION, INCREASED USE OF PHYSICAL AND CHEMICAL RESTRAINTS AND WORSENING PRESSURE ULCERS AND AS I RECALL ALSO PNEUMONIAS SO YOU AREN’T DOING ANYTHING GOOD AND YOU’RE DOING A LOT OF THINGS THAT ARE NOT SO GOOD >> HARMFUL. >> YEAH, I THINK THIS LIST WAS FABULOUS. THE ISSUE OF SLEEPING PILLS, IT TALKED ABOUT AVOIDING LIPID-LOWERING DRUGS WHEN YOU’RE OLDER THAN 60 BECAUSE THE DATA DOESN’T SAY THAT IT SUPPORTS. >> I THINK IT’S OLDER THAN THAT, PROBABLY, WHEN THEY’RE LESS THAN TEN YEARS OF LIFE EXPECTANCY >> ANTIPSYCHOTIC DRUGS, WE TALKED ABOUT THAT, BLOOD PRESSURE MEDICINES, DIABETES MEDICINES, STOP CANCER SCREENING, THERE’S A TIME YOU QUIT THESE THINGS >> AND THERE’S ONE BIG ONE THAT OCCURS ON BOTH THESE LISTS ALSO AND THAT IS, DON’T GIVE ANTIBIOTICS FOR URINARY TRACT INFECTION, IF YOU DON’T HAVE ANY SYMPTOMS OF A URINE PROBLEM. >> IF YOU DID A URINALYSIS ON EVERY NURSING HOME LADY THAT I HAVE IN MY NURSING HOMES, THEY’RE GOING TO ALL BE ABNORMAL >> ABOUT HALF OF THEM WILL BE POSITIVE. SO, THEY GO IN TO THE EMERGENCY ROOM FOR A SORE ELBOW AND THEY GET TREATED FOR A URINARY TRACT INFECTION. >> WHICH GIVES THEM VAGINITIS, C-DIFF, DIARRHEA, ALL SORTS OF PROBLEMS. THERE’S A CALLER THAT ASKS, WHERE CAN YOU GET THE EXERCISE BOOK YOU PROMOTED? >> IT’S THE NATIONAL INSTITUTE ON AGING, AND THE WEBSITE HAS GO, G O, THE NUMBER 4, AND THEN LIFE, AND THEN ORG >> GO4LIFE.ORG. >> AND IT HAS A D.V.D. OR A C.D. OR A BOOK, AND IT’S — >> HOW MUCH IS IT? >> IT’S FREE. >> COOL. >> YOUR TAXPAYER DOLLARS >> TAXPAYER DOLLARS BEING USED. THAT’S GREAT. THAT’S GOOD 60-YEAR-OLD FROM PIERRE. WHAT KIND OF RESPITE CARE IS THERE FOR CAREGIVERS? SEE, CAREGIVERS. >> THAT’S A VERY GOOD QUESTION. >> THAT’S AN IMPORTANT ISSUE I MEAN, WHAT HAPPENS WHEN WE ARE BURNED OUT BY CARING FOR OUR ELDERLY FAMILY MEMBER? DAVE, ANY COMMENT? >> YEAH, ACTUALLY, THERE’S PROVISION FOR THAT. AND YOU CAN CALL THE OFFICE OF ADULT SERVICES AND AGING IN THE DEPARTMENT OF SOCIAL SERVICES IN SOUTH DAKOTA. AND THERE ARE MONEYS TO HAVE THE PERSON THAT YOU’RE GIVING CARE TO IN DAY CARE OR MAYBE A NURSING HOME STAY >> RIGHT. >> SO THERE ARE SOME POSSIBILITIES THERE. >> RIGHT SO RESPITE, YOU CAN PUT THEM IN FOR A DAY KIND OF A THING, COME UP, PICK THEM UP AT NIGHT, THOSE KIND OF THINGS. >> I HAD A FRIEND, TWO DAYS EVERY WEEK HE WAS ABLE TO PUT HIS WIFE IN A DAY CARE. >> HOME DAY CARES. >> THEN HE COULD GO HAVE HIS OWN PERSONAL TIME. >> YEAH. 71-YEAR-OLD WOMAN FROM SIOUX FALLS, WOULD LIKE TO ADDRESS SUPPLEMENTS, IS THERE SUCH A THING AS TAKING TOO MUCH? YOU KNOW, WE’RE GOING TO DO A SUPPLEMENT SHOW. AND I WANT TO SAY THAT AND PREPARE THE AUDIENCE THAT THAT SUPPLEMENT SHOW WILL BE COMING UP IN MAY. AND IT’S GOING TO BE REALLY INTERESTING. AND MY ANSWER IS, YES. AND I THINK THE BIG STUDY THAT STICKS IN MY MIND IS THAT 30,000-WOMAN STUDY THAT LOOKED AT THE TEN YEARS, AND THE WOMEN THAT WERE TAKING A MULTIVITAMIN VERSUS THE WOMEN WHO WERE NOT TAKING A MULTIVITAMIN, THERE WAS NO DIFFERENCE IN GROUPS I THINK THERE’S A DANGER — >> WE’VE CERTAINLY SEEN SYNDROME IN PEOPLE WHO HAVE TAKEN TOO MUCH CALCIUM, IN THE DAYS BEFORE WE HAD ANYTHING ELSE TO TREAT ULCERS >> RIGHT. 84-YEAR-OLD FROM BROOKINGS, FEELS EXTREMELY TIRED, EATS WELL WOULD A PROBIOTIC CAPSULE HELP WITH DIGESTION? I KIND OF LIKE THOSE BUT THEY CAN BE SPENDY. >> I GUESS YOU HAD THAT ON YOUR SHOW LAST WEEK, RIGHT? >> YEAH. >> I DON’T KNOW IF IT HELPS ENERGY, PER SE. IT CERTAINLY HELPS DIGESTION

>> I HEARD A PRESENTATION YESTERDAY, AND VERY CAREFUL STUDIES HAVE NOT SHOWN ANY DIFFERENCES IN OUTCOMES. >> SO, WE’VE GOT SOME QUESTIONS THAT WE’RE GOING TO ANSWER LATER. ON THE COMPUTER. WHAT WOULD BE YOUR MOST IMPORTANT TAKE-HOME MESSAGE, DAVE? THAT YOU WOULD WANT PEOPLE TO MAKE SURE TO REMEMBER >> OH, BOY. >> ANY COMMENT ABOUT MAKING SURE THAT YOU GO TO THE DOCTOR IF YOU’VE GOT DEMENTIA? DEMENTIA WOULD BE ONE PARTICULAR TOPIC >> DEMENTIA WE HAVEN’T TOUCHED TOO MUCH ON. IT’S VERY VERY DIFFICULT I’D SAY PROBABLY SOMEWHERE ALONG THE LINE SHOULD SEE SOMEBODY WHO SPECIALIZES IN NOT MEMORY PROBLEMS BUT THINKING PROBLEMS. MUCH OF THE TIME PEOPLE WHO HAVE THOSE PROBLEMS KNOW THEM THEMSELVES. BUT WE HAVE ALMOST — WE HAVE THE FELLOWSHIP CLINIC, ACTUALLY, THAT YOU COULD CONTACT AND WE COULD DO EVALUATIONS ON PEOPLE WITH EARLY MEMORY PROBLEMS, BUT ALSO NEUROLOGISTS AND PSYCHIATRISTS. >> WELL, GENERAL PRIMARY CARE. >> AND YOUR GENERAL PRIMARY CARE >> YOU NEED THE C.A.T. SCAN ONE TIME AND NEED THYROID AND B LEVELS AND A GENERAL WORKUP. >> WE JUST PUT IN A GRANT TO TREAT PRIMARY CARE AND GERIATRICS. AND WE SENT OUT A SURVEY TO CLIENTS OF THE ALZHEIMER’S ASSOCIATION IN SOUTH DAKOTA AND 40% OF THEM SAID THEY DID NOT FIND WELL-TRAINED PROFESSIONALS TO HELP THEM SO, IT’S DIFFICULT. >> WE NEED TO HAVE SOME TRAINING TO TAKE CARE OF THE ELDERLY ELLEN, WHAT WOULD BE YOUR MOST IMPORTANT THING? THERE’S A BOOK THAT YOU’RE RECOMMENDING? AGING WELL. >> YEAH, AGING WELL. I THINK WE TEND TO DO KIND OF DOOM AND GLOOM FOR AGING, BUT, ACTUALLY, THERE’S SUCCESSFUL AGING AND THE LESSONS IN THE BOOK BY DR. VALIANT WAS ON THE HARVARD LONGITUDINAL STUDY, AGING WELL, AND HE MOSTLY EMPHASIZED THAT IT’S NOT THE BAD THINGS THAT HAPPEN TO US, IT’S THE GOOD THINGS — GOOD PEOPLE THAT COME ALONG AND HAPPEN TO US. IT’S A GRATITUDE JOURNAL IT’S FORGIVENESS FROM PAST EXPERIENCES. I MEAN, IT’S TRYING TO SHOW PEOPLE THAT ALTHOUGH YOU HAVE A LOT OF LOSSES ALONG THE WAY OF YOUR FRIENDS, YOU HAVE TO GATHER NEW FRIENDS AND THAT’S WHY SOMETIMES MOVING TO ASSISTED LIVING, FOR INSTANCE, YOU END UP BECOMING FRIENDS WITH YOUR — WITH THE AIDES THAT HELP YOU, YOU END UP BECOMING FRIENDS WITH YOUR TABLE MATE. I THINK IT’S A PROCESS WHERE YOU ADD TO YOUR GROUP INSTEAD OF KEEP SUBTRACTING AS YOU AGE. >> SPEAKING OF AGING WELL, YOUR MOM AND DAD ARE DOING GREAT. AND I LOVE TO SAY A SHOTOUT TO YOUR MOM AND DAD, I KNEW THEM VERY WELL WE’LL BE RIGHT BACK AFTER THIS. >> READY TO QUIT? GREAT! WE’RE READY TO HELP. CALL THE QUITLINE TO SET UP A QUIT TAKE. TAKES ABOUT 15 MINUTES NEXT TIME WE TALK, WE’LL REVIEW FREE MEDICATIONS, TRIGGERS, COPING, WITHDRAWAL TAKES ABOUT 30 MINUTES. CHECK IN FOR TWO MORE SUPPORT CALLS AND WE’LL GO OVER CHALLENGES HOW TO HANDLE SLIPS. AND DON’T WORRY, IF YOU’RE STRESSED OR THINGS GET ROUGH, JUST CALL THEN, BAM! YOU’RE TOBACCO-FREE. SO TAKE A DEEP BREATH. YOU CAN DO THIS >> BABY BOOMERS ARE COMING-OF-AGE, RETIREMENT AGE, THAT IS, AND MANY ARE WONDERING WHAT’S GOING TO HAPPEN. STARTING ABOUT NINE MONTHS AFTER SOLDIERS RETURNED HOME FROM WW II, THERE WAS A BIRTH RATE BOOM COMING ALMOST AS A CELEBRATION OF SOLDIER SURVIVAL, AND THIS HAS PROFOUNDLY AFFECTED OUR CULTURE BABY BOOMERS, AND I’M ONE OF THEM, ARE THOSE BORN FROM 1946 TO 1964 DURING A SUCCESSFUL POST-WAR ECONOMY. THIS VERY LARGE GROUP OF KIDS WERE THE MOST PRIVILEGED OF ALL TIME OFTEN RAISED WITH A SOLDIER-DISCIPLINED FATHER AND A NOT-ALWAYS-HAPPY WORK-AT-HOME MOTHER, WE GREW UP WATCHING TOO MUCH TV, LISTENING ON TRANSISTOR RADIOS TO BEACH BOYS AND BEATLES, AND FACING A NEW AND REAL THREAT OF ATOMIC WARFARE STILL, LIFE WAS QUITE IDYLLIC FOR BOOMERS DURING THOSE FIRST 18 YEARS BUT AFTER GRADUATING FROM EASY-&-PERFECT-BOOMER HIGH, WE WERE SLAPPED INTO REALITY BY THE DRAFT, VIETNAM, AND A NEWLY REALIZED INEQUALITY HAPPENING BETWEEN SEXES AND RACES. THIS GENERATION, OFTEN LABELED AS ONE OF SEX, DRUGS, AND ROCK-N-ROLL, GREW INTO AN ANGRY GOVERNMENT-DISTRUSTING COUNTER-CULTURE THAT FOUGHT FOR SOCIAL JUSTICE, FOR CAUSES LIKE FEMINISM, CIVIL RIGHTS, AND THE VIETNAM WAR. THESE ALL REFLECT THE BOOMER ETHIC: THE RIGHT OF SELF-DIRECTION. IT IS NO SURPRISE THIS GROUP

HAS ALSO ACHIEVED THE MOST WEALTH. ACCOUNTING FOR 24% OF THE TOTAL U.S. POPULATION, BOOMERS HOLD ONTO SOMETHING LIKE 80% OF OUR COUNTRY’S WEALTH, ACCOUNT FOR 80% OF ALL LEISURE TRAVEL, AND DOLE OUT 50% OF CONSUMER SPENDING 76 MILLION BOOMERS IN THE U.S. ARE A HUGE CULTURAL DEMOGRAPHIC LIKE A PIG SWALLOWED BY A PYTHON, THE BIG BUMP IS MOVING THROUGH THE SNAKE AND IS NOW COMING TO RETIREMENT AGE. AS WE BECOME VERY ELDERLY, SICK, AND DISABLED, THERE WILL BE A SMALLER CADRE OF YOUTH TO CARE FOR US. WILL WE BECOME A HUGE SOCIETAL BURDEN? FIRST OF ALL, THE ELDERLY ARE USUALLY NOT THAT BURDENSOME RESEARCH FINDS 75% OF THOSE AGED 85 OR OLDER STILL DRIVE, 70% ARE NOT DEPRESSED, 60% DO NOT EXPERIENCE SIGNIFICANT MEMORY LOSS, AND ON AVERAGE THE ELDERLY ARE AS HAPPY AS ANY AGE GROUP WHEN BOOMERS TURN 85, ALTHOUGH POTENTIALLY A DEMANDING GROUP, I PREDICT WE WILL FIND THE RESOURCES TO CARE FOR THOSE WHO NEED IT, AND SOME MIGHT STILL BE ACTIVE ENOUGH TO EVEN PHYSICALLY HELP. MORE IMPORTANTLY, MOST BOOMERS WILL HAVE AN ADVANCED DIRECTIVE, BYPASSING FUTILE EFFORTS AND REDUCING THE RISK FOR A PROLONGED, EXPENSIVE, AND PAINFUL DEATH AND, OH, IN THESE NEXT YEARS AS BOOMERS HAVE MORE TIME ON THEIR HANDS, EXPECT INTOLERANCE TO SOCIAL INJUSTICE, AND AN INCREASING DEMAND FOR THE PRIVILEGE OF SELF-DIRECTION [MUSIC] >> THIS BRINGS US TO THE END OF OUR SHOW THIS EVENING. FOR MORE THAN 35 YEARS OF CARING FOR OLDER PEOPLE, I HAVE HEARD IT SAID MANY TIMES, AND BELIEVE IT’S TRUE, “GROWING OLD IS NOT FOR SISSIES.” LIFE CAN BE TOUGH, BUT I KNOW THAT THE ONES GROWING OLD WITH GRACE ARE THOSE WHO STAY ACTIVE AND INTERESTED, WITH A SENSE OF BLESSING AND HUMOR. MAY WE ALL STRIVE TO DO IT THAT WAY I SINCERELY THANK OUR FANTASTIC GUESTS TONIGHT, ELLEN PINHOLT AND DAVID SANDVIK THANK YOU SO MUCH. FROM ALL OF US HERE AT “ON CALL WITH THE PRAIRIE DOC,” UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE