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Welcome to our insightful podcast episode featuring Rosanne M. Leipzig, a renowned geriatrician and author of the enlightening book, Honest Aging: An Insider’s Guide to the Second Half of Life. Join us as we delve into the key to aging well, exploring the attitudes and responses necessary for embracing old age with a positive outlook, regardless of your current age. Rosanne shares her wisdom and expertise, debunking stereotypes, and empowering listeners to face the inevitable changes that come with aging. Discover how resilience, adaptability, and flexibility play a crucial role in finding growth, meaning, and happiness in this new stage of life. Rosanne provides eight practical practices for a happier old age, from resisting ageism and right-sizing expectations to redefining independence and embracing change. Get ready to be inspired and equipped with valuable insights to enhance your well-being and navigate the second half of life with grace and joy.
Rosanne M. Leipzig is a geriatrician.
She shares her story and discusses her book, Honest Aging: An Insider’s Guide to the Second Half of Life.
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome Rosanne Leipzig. She is a geriatrician, and she’s the author of the book Honest Aging: An Insider’s Guide to the Second Half of Life. Rosanne, welcome to the show.
Rosanne M. Leipzig: Thank you for having me.
Kevin Pho: We’ll get into your book in a little bit. First off, briefly share your story and journey to where you are today.
Rosanne M. Leipzig: That’s a long journey. I’m currently a professor of geriatrics and palliative medicine at Mount Sinai in New York, but I didn’t start out that way. I started out at the University of Michigan, getting an MD and a PhD, and my doctoral work was in pharmacogenetics, in particular why people given the same dose of the same medication respond so differently to it. I did my residency at the University of Rochester, where there were nascent geriatrics and clinical pharmacology programs, and they were interested in the same questions as I was.
So I ended up in New York City almost 40 years ago. It was supposed to be a two-year gig, but I love the city. I did a clinical pharmacology fellowship, and I realized that it was in geriatrics that the questions I was most interested in were most important, and that clinical geriatrics was the most complex and interesting work I could ever imagine doing. I’d also be remiss if I didn’t mention my grandmother. If you’re in geriatrics, there’s always a grandparent, and she showed me how to age well despite what life throws at you.
Kevin Pho: You mentioned that clinical geriatrics is some of the most complex and interesting work that can be done. Why is that?
Rosanne M. Leipzig: You have to know what you would do for any patient regardless of age, what the current state of the art is. Then you have to work with the patient and family to figure out what matters to the patient, what should be done based on what they want, and then how you would have to change it based on the fact that as you get older, you don’t tolerate medications in the same way, or procedures in the same way, and your whole psychosocial milieu is really important in how you will respond to interventions. So I love it for that reason.
Kevin Pho: Now, for those medical students and doctors in training who may be listening to you now, what kind of questions should they ask themselves if they were to consider a career in geriatrics?
Rosanne M. Leipzig: Number one, do they like old people? Number two is, do you like stories? Because there are amazing stories that you will hear. Number three, I would say, is being a detective, because when I was in training, I was taught that when you’re coming up with a diagnosis, no matter how you pinch and squeeze, it’s got to fit just one disease in terms of the signs and symptoms. When you’re 80 years old, you’ve got 80 years’ worth of things going on, any of which could be causing the sign or the symptom. So you’ve got to be open to that and want to be creative. The other reason you need to be creative is that older adults are often not included in clinical trials, so you really need to figure out what’s the best treatment for your patient without necessarily having the evidence base you’d like to have.
Kevin Pho: All right, let’s talk about your book. It’s titled Honest Aging: An Insider’s Guide to the Second Half of Life. I see an image behind you there. Now, tell us about the events that led you to write this.
Rosanne M. Leipzig: Well, let me start by saying I’m 72 right now, or I will be in a few days, and I’ve been going through a bit of this myself. But my entire career, whenever anybody heard what I did, I got questions, whether it was on the airplane or wherever I happened to be: “Is this normal? Is that normal? Is this not normal? What can I do about this?” I realized that there is an awful lot out there that people can do for themselves if they were empowered, and if the people who love them are empowered.
So this is kind of a brain dump, which I tried to put together like the book What to Expect When You’re Expecting, for pregnancy. I’m trying to do that for aging, and it’s really to get people to know what to expect, and when not to accept, “What do you mean? You know, at your age, what do you expect?” which is unfortunately what a lot of patients hear. I want them to be able to go to their doctors, because we don’t learn enough about the differences between 80-year-olds and 60-year-olds in our training. So I really want them to be armed with information they can take to the doctor and say, “What about this? Could we do that?”
Kevin Pho: Now, for those who may not be familiar, what are some of the major differences between 80-year-olds and 60-year-olds?
Rosanne M. Leipzig: Some of the major differences, as I mentioned before, are the reactions to medications. They’re so much more likely to benefit from medications, but also to have adverse events, and the adverse events don’t necessarily look like they do in younger people. Their diseases don’t necessarily present in the same way. We talk about typical presentations and atypical presentations. If you’re 80 years old and you have a heart attack, 50 percent of the time you’re not going to have chest pain or pressure, and that’s atypical for a 50-year-old, but it’s absolutely typical for an 80-year-old. So there’s understanding that you’re going to get up to go to the bathroom more often at night, and it’s not just people with prostates. Antidiuretic hormone plays a game, which isn’t fair, so that you put out less than you should, less than you did when you were younger. I can go on and on.
Kevin Pho: All right, so what are some of the main messages in your book? One of the things that you wrote was your KevinMD article, “8 practices for a happier old age.” So go into some of the tips that you share in your book.
Rosanne M. Leipzig: Well, the first is to recognize that we live in a world that is absolutely ageist, and we also live in a world that’s sexist and racist. Most people will not change their sex or their race during their life, but they will get older. We have this perception of aging that we carry with us: Older people are incompetent, they’re not quite with the program, they are cranky, which I guess is a good word that you hear sometimes. If you feel that way when you’re younger, you’re going to carry that with you into your old age, and the way that you respond to your old age really determines how satisfied you’re going to be with your old age. So you’re kind of prejudiced against your future self. So the first thing is to resist ageism wherever you see it, whatever age you are. Just stand up against it.
A second is that as you get older, you need to right-size your expectations. Things do change. A friend of mine’s father went back to the gym in his 70s, and he was ready to quit in a few days, because what he was able to do was not what he could do before. I said to Bill, “You know, there are 80-year-olds who win their age category in the Boston Marathon, and there are 20-year-olds who win, but the difference is a couple of hours in their speed. These guys are in the best physical condition they can be in.” So you definitely can get into better condition, but you’ll never be doing what you did when you were 20, and that’s OK.
A third is redefining the term “independent.” We have a country which is based on independence, autonomy, self-control, all of those things, and if you’re not independent, you’re dependent, which nobody wants to be. I think we need to flip the way we look at this, to what really matters. What is it you really want to do, and what do you need to do to be able to do that? So if you need to have somebody with you, if you need to be wearing hearing aids, if you need to be using a walker, it’s in service of your getting to do the things you really want to do. So it’s a flip in the way that we look at these things.
And probably the two that I’d end with are, number one, laugh more. We need to laugh at ourselves, we need to laugh at this crazy world we’re living in, and comedians in general live long, if they don’t overdose. And we need to start hanging out with people of different ages. A friend of mine calls it social insurance: people who are younger than you and people who are older than you, that you can do things for, that you become a family with. So that’s just a set of them.
Kevin Pho: Now, you mentioned older people going to the doctor’s office, and some ways that they need to empower themselves and advocate for themselves in a primary care office, especially since their primary care physicians may not be geriatricians. What are some ways they can do that?
Rosanne M. Leipzig: The first is to take a look at how your physician is treating you. If you feel like you’re being brushed off, if you feel like you’re not being listened to, you probably aren’t. You have two choices: You can say something, or you can leave and find someone else. But you certainly should not have a doctor that you don’t think takes you seriously. So that’s the first thing.
The second is to help people out by thinking about what’s most important for you at that visit. What is it that you really want to talk about? Because doctors have lots of lists now; we have checklists and scores, and that doesn’t always match with what’s important for my patient. So oftentimes I will give them this: “What are the three things you want to accomplish today?”
Always give your doctor the opportunity to take medications away. I have friends who feel like it wasn’t worth it to go to the doctor if they didn’t get a prescription, but the older you are, the more medications you take, and the more likely you are to have an adverse event. So make sure you’re taking the ones you need. Medications can be lifesaving; I’m not forgetting that. But I have patients who come in who can’t tell me the indication for certain medications, because there is no actual indication for it. So help your doctor get rid of medications, and think about nonpharmacologic ways to deal with things as well as pharmacologic ones. So those would be a couple of my suggestions.
Kevin Pho: I think we talked offline; I’m internal medicine, primary care, and I see patients of all ages. Now, for those primary care physicians, again, who may not be geriatricians, and see an older patient in the exam room, what are some non-obvious questions that they should be asking their patients, that patients may not be able to ask themselves?
Rosanne M. Leipzig: One has to do with memory, which is very important to everyone, and to get a sense as to whether they are concerned about their memory, and if so, get some examples of what that is, so that you can figure out if it’s just senior moments in normal aging or really something to be concerned about, dementia. So that’s one thing.
The second thing is to talk about hearing, because a lot of people don’t want to talk about hearing. They don’t want to wear hearing aids, although I have to tell you, you walk down the streets of New York, and everybody’s got something coming out of their ears. I think hearing aids are going to become the norm going forward. But being able to hear is really being associated with decreased risk of dementia. Now, we don’t know if hearing aids are going to make the difference, but clearly you can’t remember something if you didn’t hear it to begin with. So it’s really important to think about the use of hearing aids. I have to say, I got mine several years ago, and what was wonderful about them is that I was able to not put so much energy into trying to hear. It gave me a lot of energy for doing other things.
Ask about incontinence. Nobody wants to ask about incontinence, and there are things that you can do. You don’t have to use Depends always, so help people get through that.
Falling. Everybody is afraid of falling. Everybody knows a terrible story, and of course we’re putting more and more people on anticoagulants now, and the stroke from AFib is a major one, so it’s really a risk. But you don’t want someone to fall and hurt themselves, so there are things that can be done to improve falls. Falls is a nice example of what we call a multifactorial disease. There are so many risk factors in so many areas. There’s your vision, there’s getting your cataract out, there’s physical therapy that can help, and there are medications that are fall-risk-inducing that you can get rid of or switch to something else. So there are things that you can do, and oftentimes people don’t think there are. So as a primary care doc, you can get folks on the road to improving these areas that they’re not comfortable talking about.
And last but not least, older people do have sex. So ask; don’t just skip that part when you’re talking to them.
Kevin Pho: One of the things that you mentioned about memory was the differentiation between a senior moment versus something that’s more insidious, like dementia. What are some keywords or key phrases or key signs that would tip us off toward one or the other?
Rosanne M. Leipzig: If it’s what’s called the tip-of-the-tongue phenomenon, where they just can’t get the word, they can’t get the word, the name of the person, but once you get it, you have it, then it’s not dementia; it’s a senior moment. The big difference that we’re talking about here, and of course this is a generalization, is the storage of a new memory, or something that you’ve now learned. If you store it, then it’s not dementia. The problem with the senior moment is recalling it, getting it out of storage.
So in the tests that we do, the MoCA and all of that, we ask people to freely recall five totally unrelated words, and people cannot remember them at all, even though they were able to say them back to you earlier. But if you give them a cue, or show them a list of words and they can tell you that that was the word, then it’s not dementia; it’s a senior moment. Again, it’s very simplistic, but it’s a good way to think about it. It also helps because people then realize that paying attention is really, really important, and getting a good night’s sleep, because that’s when you consolidate the new knowledge, is really, really important to your memory.
Kevin Pho: We’re talking to Rosanne Leipzig. She’s a geriatrician, and she’s the author of the book Honest Aging: An Insider’s Guide to the Second Half of Life. Rosanne, who is the ideal audience that should read your book?
Rosanne M. Leipzig: I think anybody who’s thinking about growing older: older people in particular, and people who love them. I actually have a section in each chapter that’s addressed to loved ones, because there are a lot of contentious issues that can come up as you get older, and you need to have the words to have the right kinds of conversations that bring you closer together and not further apart. Also, some of the doctors that I know have read the book and find a lot of information in there that they can give to their patients as suggestions. In the back of the book, I actually have checklists, or things for patients and families to fill out before they come to the doctor if they have geriatric problems like falls, memory, incontinence, and vision problems.
So obviously I think everybody should read it, but it’s not a novel. You don’t start at the beginning and get to the end. It’s really a reference book. The first five chapters are kind of looking at the big picture of what’s different when you grow older, and then there are very specific things. Then at the end, I talk about hard decisions: how to decide who’s going to speak for you if you can’t speak for yourself, how to decide if you should move, stopping driving, and making medical decisions.
Kevin Pho: And my final question, Rosanne. Tell us some of your take-home messages that you want to leave with the KevinMD audience.
Rosanne M. Leipzig: Well, I think the first take-home message I would have is that aging isn’t all downhill. I’m loving it. I’m saying things that I would never have said before. Some people will tell you I always did that, but not to the extent that I do now. You can be over 80, you can be on the cover of the Sports Illustrated Swimsuit Issue, you can be running for president of the United States. People are really doing lots of things at 80 that we didn’t think they could. But even if somebody’s in great shape, 80 is not the new 60. That’s the take-home message.
There are going to be physiologic changes that occur. You need to learn what the important differences are in your field and prioritize what we call the geriatric 5Ms with your patients. Those are knowing what really matters to them, recognizing the multicomplexity that I spoke about at the beginning, and optimizing mind, mobility, and medications.
Kevin Pho: Rosanne, thank you so much for sharing your time and insight. Thanks again for being on the show.
Rosanne M. Leipzig: Kevin, thank you so much. It’s been a pleasure.
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