Successful Aging with Dr. Ardeshir Hashmi

Podcast Transcript

Nada Youssef:   Hi, thank you for joining us. I'm your host, Nada Youssef and you're listening to Health Essentials Podcast by Cleveland Clinic. Today we're broadcasting from Cleveland Clinic, main campus here in Cleveland, Ohio, and we're here with Ardeshir Hashmi. Dr. Hashmi is the Director of the Center for Geriatric Medicine at Cleveland Clinic, and today we're talking about aging well. Thank you so much for being here today.

Dr. Ardeshir Hashmi:  Thank you so much for having me on.

Nada Youssef:   Sure thing. And please remember this is for informational purposes only and it's not intended to replace your own physician's advice. So before we jump into topic, I'm going to ask you maybe some personal questions, so we get to know you better.

Dr. Ardeshir Hashmi:  Sure.

Nada Youssef:   All right. So first of all, what is the best place to be on a Friday night in Cleveland in your opinion?

Dr. Ardeshir Hashmi:  Well, the disclaimer I'll put is we have a two and a half year old at home. So the furthest we can venture out is a meal with family out and about, but that's very rewarding.

Nada Youssef:   Good. So maybe Chuck E. Cheese, maybe-

Dr. Ardeshir Hashmi:  It's trending towards that now. That's exactly right.

Nada Youssef:   How about your best travel destination?

Dr. Ardeshir Hashmi:  Best travel destination is South Africa.

Nada Youssef:   South Africa.

Dr. Ardeshir Hashmi:  A lot of history, a lot of beauty. Have always been wonderful visit and never tired of sort of going back and-

Nada Youssef:   So you're back soon?

Dr. Ardeshir Hashmi:  Oh, I hope so.

Nada Youssef:   You hope so? Good, excellent. You should. And then the best meal you've ever had.

Dr. Ardeshir Hashmi:  Best meal I've ever had is again with family, I'm a very big fan of seafood. All seafood. So anything seafood appeals to me and very spoiled, in the Cleveland area, I think there are a lot of really great celebrity chef restaurants and just great eating places in and around us.

Nada Youssef:   Perfect, amazing. Great. Thank you. All right, well, let's get into topic. So most people know that geriatrics has something to do with the elderly. But beyond that, there's a lot of confusion of what it is, how it can help how it's different maybe from seeing a primary care physician.

Dr. Ardeshir Hashmi:  Sure.

Nada Youssef:   So let's talk about what is a geriatrician.

Dr. Ardeshir Hashmi:  So a geriatrician is a doctor who is a successful aging specialist. So they have additional training, they have given specialty certifying exams in successful aging. So not just treating diseases of the elderly but also preventing diseases of the elderly. And the interesting thing is that a lot of trends that we're hearing about, throughout healthcare now, which are just commonsensical things, moving early, exercise, and also working in teams, seeing a patient, following them wherever they are in their home, in the office, in the clinic setting, in the hospital, in the rehab setting. These ideas have been part of geriatrics DNA for a long, long time. And so it's amazing and encouraging to see that we're part of very exciting times in health care, a lot of those successful aging concepts of geriatric concepts are being embraced by the larger community. And our training is exactly in that.

So I think it is as much to be a healer, for a lot of these challenges that we face as we get older, but to really keep people in great shape. I think people are living longer but they're living better, and so we are the biggest advocate for each one of us as we get older.

Nada Youssef:   Great. So you mentioned the term successful aging specialist.

Dr. Ardeshir Hashmi:  Yes.

Nada Youssef:   That's the same thing as a geriatrician?

Dr. Ardeshir Hashmi:  Absolutely the same thing, one in the same. And a lot of the times, I mean, I think very naturally, patients and families will have a lot of conceptions about what it takes to be sort of older and no one wants to be geriatric. I don't want to be geriatric, either. But do I want eight successfully? Absolutely. I want to be physically and mentally fit for many, many years to come.

Nada Youssef:   And when you say you age successfully, and just like you mentioned earlier, prevention sounds like that's key. Because you're not just seeing the specialist after you're sick, but you get to see them to make sure that you're healthy and live a longer life.

Dr. Ardeshir Hashmi:  You honed on it perfectly. Prevention is the key word.

Nada Youssef:   Okay. So how old do you need to be to see a successful aging specialist?

Dr. Ardeshir Hashmi:  So it's interesting. By really conversations with our patients and families. That can be anyone above the age of 50.

Nada Youssef:   Okay, so 50-

Dr. Ardeshir Hashmi:  And we can talk more about why 50 and up. I mean, again, as I said, not anyone wants to be aging where you're certainly geriatric, but in terms of successful aging, you can never start too early.

Nada Youssef:   That's true.

Dr. Ardeshir Hashmi:     Right? And so that's part of it. And the other part of that is as we are getting older, but we're also taking care of our loved ones who are getting older, we need help as well in doing that. And so a lot of the conversations around caregiving happened very early on, and many of those individuals are above the age of 50. I think, something for all of us to look forward to in terms of more support.

Nada Youssef:   Great. So let's say you are a patient, and you're about to see your doctor, Dr. Hashmi, what's involved in that visit? Because I know you've mentioned there's a lot of different components that you get involved in with the patient.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   So what does that first visit look like for our patients?

Dr. Ardeshir Hashmi:  Yeah, and I think it's an excellent question. I think also, to include a lot of times we get asked, "Well, how is it different from my visit in my primary care physician?"

Nada Youssef:   Right, exactly.

Dr. Ardeshir Hashmi:  So it is very distinct and unique. I mean, it would not help us if it was duplicating anything that your primary care physician does. If I go in to talk to my primary care physician, I want to talk about them with diabetes or hypertension and things that I've been sort of dealing with for a long time. The advantage obviously, of that is that your primary care physician knows you well, you have a relationship with them that's been built over time. And we very much want you to have that, but we want you to have in addition, it's not or, it's an addition, would be to come and see your successful aging specialist at least once a year, sort of and not more often. And we will talk about issues that might not come up in conversations with your primary care physician.

Nada Youssef:   Like what?

Dr. Ardeshir Hashmi:  Four things mainly. I think, you want your brain health to be top shape throughout your life. You want your physical health and strength and endurance to be preserved throughout life, would be the second thing. Third thing would be to really look at your lot of your medications, and see which ones are really helping you and which ones were started a long time ago, but really now, they're not really helping as much as our bodies change, and which ones could be potentially even harmful in interacting with a lot of other medications?

So a lot of the conversation centers around getting off of any medications that are potentially harmful or that are no longer helping. And I think the thing that is right at the core of this is really always starting ... We start each visit with, "What matters most to you? What's most important to you in your life, as well as your health care?" Because if we know that, then everything else that we do works towards achieving that goal, right? So it's putting that goal first.

All of this takes time. Right? And that is true of healthcare. I think it's just the pressures that we all face of trying to see a doctor and how long we have to wait. And when we do go and see a primary care physician, you got a limited amount of time, you've got about 20 minutes there, right? So there's a lot to cover. And then we ... Not because anyone wants to but just because of the time available, you're forced to prioritize. So the successful aging visit then allows the luxury of time. You can spend more like an hour initially, with not just your successful aging specialist, but as they say, it takes a village. It's an entire team of individuals that comes together, and talks to you about whatever their level and area of expertise is in.

So the pharmacist would talk to you about the medications, if you are looking for your vision or hearing, our team can do that, they can do those screenings right then and there. And then the audiologist will test your hearing and sort of give you an assessment there. So it's again, the team concept, I think you are getting a lot of services all in one place. A lot of the times our patients will say, "Well, normally when I go to see my usual doctors, either I make a list and then I deal with the top three, and then the other things on the list keep on getting differed to the next visit."

Nada Youssef:   Sure.

Dr. Ardeshir Hashmi:  And so those conversations maybe sometimes never end up happening.

Nada Youssef:   I see.

Dr. Ardeshir Hashmi:  Or I get referred to five different specialists in five different places and or five different days and now my daughter or my son has to take me to time off from work. And so trying to really co-locate a lot of those things, so that when you go for your visit, you get your money's worth. And we can make it as high quality and cost effective for you as possible.

Nada Youssef:   And that just like you said, it's customized, if he needs something to do with vision, if you need nutrition, if you're traveling and need something maybe with physical body. So you get to see these specialists all in one.

Dr. Ardeshir Hashmi:  Absolutely.

Nada Youssef:   That's phenomenal. I had no idea that was actually the visit you get to see everyone. So it's really one specialty that has more than one specialty within.

Dr. Ardeshir Hashmi:  Yeah, actually it's a team. It's a team that you-

Nada Youssef:   Yeah, it's definitely a team. Okay, so you talked about our bodies aging.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   In our 60s and 70s, 80s. And maybe starting in 50s. How do our bodies age? Is there ... I know everybody's different.

Dr. Ardeshir Hashmi:  Right.

Nada Youssef:   But are there things you can talk about how our bodies age in those years?

Dr. Ardeshir Hashmi:  There are a lot of different ways. And this, I'm talking about when they change these are natural changes, these are normal changes that happened there about 52 different ways between the age of 50 and 80 that our bodies change. And so it'll take a long time to sort of go through all of them. But certain things that I will mention which, some things are more obvious, our eyesight or hearing, our memories, all of that starts to change a little bit. It's more difficult to hear you or I'm now using glasses for near visions, certainly for reading and then also sort of why did I come into this room? That sort of thing in terms of forgetfulness, and a lot of that could be completely normal. But to differentiate what's normal and what's not, those are the conversations that we have.

Nada Youssef:   We should be having.

Dr. Ardeshir Hashmi:  Things that folks may not know about, and I want to mention the top three really is, one is the importance of staying well hydrated.

Nada Youssef:   Okay.

Dr. Ardeshir Hashmi:  In the summer, but also during the winter. So our early warning system for our bodies telling us, "Hey, you're dehydrated." Is our thirst. And we just don't get as thirsty, that sensation diminishes over time.

Nada Youssef:   The sensation, but your body still needs it.

Dr. Ardeshir Hashmi:  Your body still needs it.

Nada Youssef:   Your body needs it just as much.

Dr. Ardeshir Hashmi:  Your body still needs it as much, exactly. So you almost have to take it regularly, proactively to sort of make sure, "Now it's time for me to take more fluid in and keep track of that." Knowing that you won't feel as thirsty but your body may be getting dehydrated, which can lead to a lot of different things in terms of confusion, falls and leading to actual people getting admitted to the hospital, which we want to obviously stay out of as much as possible.

Nada Youssef:   Sure.

Dr. Ardeshir Hashmi:  Other things in terms of like eating right, so I think it's what does that mean? I think that changes a lot as our bodies change over time. A lot of our muscle tissue gets converted to fat tissue. And so while we may not look any different, but we feel sort of more tired, more weaker, and that's why that's happening. And so the emphasis on eating and eating right then gravitates towards protein intake and making sure that there is muscle build up. And then I think the third thing that I'll mention is, which is a big one is again, coming back to the medications. The kidneys and the liver are responsible for clearing a lot of these medications. As we get older, the body's ability to clear them well diminishes over time. So the same medicine may stay in your system for an extensive amount of time. So we don't account for that, well then the doses don't come down, and we don't get off the medications that are staying in the body and causing harm, potentially.

Nada Youssef:   Right.

Dr. Ardeshir Hashmi:  So when we have those conversations, it's much about awareness, right? And you want to feel empowered to know what's changing with your own body, so that you can can take charge of your own health and make these adjustments that, I always say it's like a marathon. So you've got to pace yourself. The more you pace yourself, the more you make these adjustments of natural changes that are happening, the longer that marathon will go for very, very successfully.

Nada Youssef:   And then so if your bodies are changing that 50, 60, 70s, are you still also changing the customized care for these patients as they get older? So maybe in their 60s, maybe they're focusing less on nutrition, more on let's say therapy, let's say someone's going through depression, mental, you said brain health.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   Is that also would be involved, you would get therapy involved in there? And   customize it as you go?

Dr. Ardeshir Hashmi:  Absolutely. And so the team is modifiable, it keeps on growing. It's a very dynamic sort of team that we work with, tailored as you absolutely and eloquently said, to the needs of that individual patient. So I am different than the next person, and so it should be right? I mean, that's the joy of diversity.

Nada Youssef:   Exactly.

Dr. Ardeshir Hashmi:  We should celebrate that. But in celebrating that I think we need to tailor our visits, each visit as you're coming through these different decades of life, to how your body is changing and what your needs are. And so yes, the team absolutely changes. I'll also say you mentioned brain health and physical health, I think intervening early, listening to your body and having those conversations. There is a whole host of things that can be done. If we pick things up early, especially with brain health and physical health. The longer you wait, the narrower the list of options are, right? And then you're more sort of in a reactive approach, rather than proactively saying, "Hey, we picked this up early, we can really nip this in the bud." Prevention is better than cure, I always say.

Nada Youssef:   Right, of course.

Dr. Ardeshir Hashmi:  And so that, again, to your point about how we customize it, those are the conversations that we have.

Nada Youssef:   Okay, so with the population 50 and up, they're listening to this. Who would have received the greatest benefit from treatments and care from a successful aging specialist? Should every 50 year olds come and see a successful aging specialist or who is going to benefit from this the most?

Dr. Ardeshir Hashmi:  So my answer would be two part. My first answer would be one word. Yes. I think everyone should come in, for different reasons. Remember, we said, I mean, that is helping you as a patient with your own health, as much as your role as a caregiver, you're helping out someone else as we had said before. But those needs and those conversations change over time. Who would benefit really the most is also people who are very interested in making sure that they retain their brain health and their physical health and people who don't want to take a ton of medications. And to my mind, when I sort of think about that, I mean, that pretty much includes everyone including myself.

Nada Youssef:   Sure. All right, so even if someone is let's say 65 or older and does not have let's say just any diseases or serious diseases don't take a lot of medications, they should still see.

Dr. Ardeshir Hashmi:  Yeah, and then it's an excellent question, right? And we get asked this a lot by a lot of our patients, sort of, "I'm having this conversation, but I feel pretty good." And we would say two things, we'd say, "Look, that's great." We want to make sure that that keeps on going. Right? And so a lot of the times we feel great, but do we know what is it about what we're doing in our day-to-day lifestyle that is keeping us great?

Nada Youssef:   That's making you that way.

Dr. Ardeshir Hashmi:  Right? And so there is a lot of talk about what we call the Blue Zones concepts. And this is the areas of the world that have the longest living people, but the lowest blue zones-

Nada Youssef:   You said blue zones?

Dr. Ardeshir Hashmi:  Blue zones, yes. This came out of actually it's a movement now, but it came out as a National Geographic article or expedition, defined the areas of the world that had the longest living people, people above the age of hundred with the lowest rates of disease.

Nada Youssef:   Okay.

Dr. Ardeshir Hashmi:  And they were hoping to find one culture, and so that we could all learn from it. They found five different cultures as diverse as Okinawa, Japan, to Costa Rica, to Sardinia in Italy, to a group of seven Day Adventist out in Loma Linda, California.

Nada Youssef:   California?

Dr. Ardeshir Hashmi:  That's right. And now they were stuck. So they were like five different cultures, what's common amongst these things, I mean, we were hoping to find just one. The deeper that folks have looked at this, they found that there are a lot of commonalities. And it is focused on exactly what we just talked about, eating right, mediterranean plant-based, right? I told you I'm a fan of seafood. And so again, that's good for the health overall, brain health, cardiac health. Physical health, aerobic exercise that is built into your daily routine, sense of purpose and socialization. And it's interesting that the research now is catching up. Every single month, we see articles coming out that are proving what these Blue Zone principles, sort of these cultural, enduring things over centuries.

Science is now catching up and proving that all of those things are actually how we can help people age gracefully and successfully, and look and feel much younger than their chronological age would suggest. So that's one thing, sort of the secret sauce. Let's define the secret sauce, and what's that secret sauce for you? And how can we do more of the great work that you're doing? And then the other thing is, a lot of the times the body is giving us a lot of signals, right? They are very subtle. My tendency, just sort of human level, all of our tendencies very naturally is, nobody wants to be sick.

So we tend to sort of ignore it. "Well, this is changing, but it probably means nothing." Right? It's causes a lot of anxiety internally, people talk to us about these entities. And our thing to them is like, "Look, we are like your early warning system, we want this to be on our radar very squarely." Because again, as we said, we don't want to wait until a time where all of these things have come together, and they're 10 different things. And now you're in trouble, and the next thing you know, you're in the hospital, and there's hospitalization after hospitalization. We want to actually intervene where that thing was just at that one percent and we nip that in the bud, and we just take care of business right then and there.

Nada Youssef:   Sure.

Dr. Ardeshir Hashmi:  So it's really a great learning experience. And I will say that we learn as much from our successful aging individuals that we see, as they do from us, sort of we're all, as we're living longer, we get those principles from them. And our job is to really share it with a larger community, so the next patient that comes in will say, "Well, Mr. X just came in, or Ms. X just came in, and we talked about these great things that they're doing, maybe we can sort of connect you with each other. And so we connect them with that community and those principles.

Nada Youssef:   And that's the sense of belonging and socialization that you were talking about?

Dr. Ardeshir Hashmi:  That's absolutely right.

Nada Youssef:   That's the secret sauce.

Dr. Ardeshir Hashmi:  Absolutely.

Nada Youssef:   Blue zones. I need to read more about that. Because it's very important to look at research-

Dr. Ardeshir Hashmi:  Absolutely, and I will say, there is a book out there about the Blue Zones, there's a TED talk. And so I think the more we all learn, the better we can help her own healths and feel empowered.

Nada Youssef:   Yes, definitely. Great. All right, so can a successful aging specialist help the patient or family members figure out how long they can remain in their own homes safely without assistance? And what kind of services would you recommend for someone that maybe needs an extra help?

Dr. Ardeshir Hashmi:  Absolutely. So we've talked a lot about, early navigation system and warning system. And I think one of the things that we talk about, and I think sort of those who are listening to this and watching this, I'd like to emphasize this is, daily living, activities that we do in our day to day lives, and we group them into basic activities of daily living and instrumental activities of daily living. So the instrumental activities of daily living are the more sort of things that we, you and I take for granted every day, but can change over time.

So our ability to manage our finances, to manage our medications, to be able to drive, to do things like grocery shopping and cooking, how do we prepare meals, do some household chores, and things around the house, do laundry, and also very basic activities of daily living that we don't, remains natural to us, we just don't even think about it. Eating, bathing, dressing, going to the bathroom.

These such things that can change over time, they change very subtly, especially the instrumental activities of daily living, as I said, the finances, the medications, the driving. And as those things change, that is a red alert for us to sort of say, "Well, this can pose a counter to your ability to stay independent in your own home." I have never met a single patient or family member or any individual, for that matter, who says that there's any place better than home. All of us want to stay at home, independent, we love and celebrate our independence, and rightly so.

And so as we talk about these things, how is it going in your day-to-day life with these activities? And are there any changes that you know, do we sort of say, "Well, if it's changing, what can we do about it from a health perspective?" But if you're needing a little bit of help, remember I said it's a marathon, right? It's not a sprint, it's okay to accept that help, right? And then we work with our community partners, and we have many of them now.

Such as Benjamin Rose Institute on Aging, Alzheimer's Association, there are a lot of not-for-profit at no cost to the patient. Entities that can actually help with home safety modifications, or services in the home setting, right? And how does insurance cover that? How do I apply for that? Do I qualify for those benefits? And so all those conversations in a very practical level, just like you and I would have a conversation, the same thing we're talking to people who want to stay independent in their homes.

Our job is to connect them to all the richness of resources. And I will say in our area, we are very fortunate in the greater Cleveland area, in Northeast Ohio, but really with the Cleveland Clinic everywhere at all of our locations. Partners who have been doing phenomenal work out in the community, helping people stay independent in their homes, but our awareness of it is the thing that we have to really work on.

Nada Youssef:   Sure.

Dr. Ardeshir Hashmi:  And so absolutely, that's a big part of that visit.

Nada Youssef:   Okay, well, I'm going to actually jump on to the next question I had, which was about palliative care, and living well discussions power of attorney. That's something that you would also bring up to your patients then, because it sounds like you don't just see the physical mental, you're also working on the stuff that usually I would think about when then I go home. The finances-

Dr. Ardeshir Hashmi:  Absolutely. And I think so crucially important, and really under the umbrella of what matters most to each one of us, right? And so, I mean, I think if there has been a great deal of emphasis on having conversations about end of life and goals of care and sort of how we'd want to be treated, our wishes to be respected, and in that phase of life. And who knows about it, right? Do our family members know about it? Do I have someone who can represent me? A health care representative or power of attorney who knows me and my wish is well enough so that if I can have a conversation I have a backup, right? But also what those wishes are, and where is that documented? Does my primary care physician, do my specialist, or do all my doctors know about it?

And as I go in, God forbid, into a hospital for an urgent need, does the hospital team know about that? Right? And so we not only have those conversations, but try to see how those conversations, those preferences can change and should change over time as our bodies change. But it's much bigger than that, right? So it's our emphasis now, as successful aging specialists, or geriatricians is to have the conversation about not only how do I want to be treated at the end of my life, but how do I want to live? Not just how I wanted to die, but how I want to live?

Nada Youssef:   Yes.

Dr. Ardeshir Hashmi:  And Atul Gawande talks about this, or describes this very eloquently in Being Mortal, right? It's how we want to live. That is what matters more than anything else. And so starting off with that every single visit, every single time really helps to find that conversation, and also brings family members into the conversation too, right? I mean, you talked about part of this is financial planning. And if you are needing more help, or you're needing a different setting, or level of care, how do families plan for this? Right? How to be talk about the insurance? And so there's a lot of support for caregivers as well. And I think that's something that our caregivers should know more about, and increasingly, we have those conversations about difficult conversations.

One of them is this goals of care of thing. But the other conversations are behavioral changes that are happening, things that are different changes and personality that family members will notice, but might be hesitant to bring up and how do I bring that up? How do I bring up with a loved one that their memory is changing? I love them, I care about them. But how do I bring that into the you conversation with them? And driving, that's a great part of our independence, right? If that's changing, well, the earlier you intervene, the more help you can have and how we can support you to stay safe out there. But how do you have those conversations with family members?

Nada Youssef:   Right.

Dr. Ardeshir Hashmi:  And what sort of impact is that having on their own health? On the caregivers own health. We always say, I'm taking care of myself, but I'm also taking care of an older loved one. If I'm not doing well with my own health, then that's twofold, right? It's a double whammy. Now I'm not doing well and I'm not able to provide that care. So the person that I'm taking care off, their health is going to suffer too. So it's, we say when you go in the plane, they always say sort of, "The oxygen drops down, help yourself first, before you help other folks." This is the same concept, you have to help yourself to help other people.

Nada Youssef:   Okay, so you read my mind, that was going to be my next question. So my next question was going to be how can a successful aging specialist help a caregiver to the elderly? And to add to that, I want to ask, do caregivers go with, let's say, the parents, to these, especially if it's a single parent, maybe. Do they go to these appointments? Do you get to actually say everything in front of them? Do they get to bring up things? What do you suggest for caregivers that are taking care of elderly?

Dr. Ardeshir Hashmi:  So I think the conversations that we've just talked about, and how to have those difficult conversations, how to plan in terms of finances, how to connect them to these resources that may need to have? How do they take care of themselves? Right. And so the way the visit is structured, to your initial point was, so you come in for your 60 minute visit. So, prior to that visit, as you you as an individual are going through screening with our other team members, and sort of how your brain health is and physical health is, we are actually in another room dedicated to the caregiver, and sitting down with them and having that conversation for a full half an hour just talking about these issues. How are they taking care of themselves? What are their concerns about their family member? How can we help? What are the resources that are available to them?

There are 40 million families out there nationally, that are taking care of an older dependent, with little to no help from any sort of formal help, that they're aware of. It's not that those resources don't exist, they exist, but it's if you don't have those conversations, and if you don't connect them with members of the community that we had mentioned, yes, how would we know about it? Right? And then again, to the Benjamin Roses of the world, the Alzheimer's Associations of the world, those not-for-profit agencies of the world, sort of A Place for Mom is one of them, and no cost to the patients and families imagine, in finding a place that is going to be safe for them and promote their wellness. So as our emphasis grows on building this team, people who benefit are our patients and our family members.

Nada Youssef:   So the caregivers are not just involved, they're almost a part of their treatments or of the visit-

Dr. Ardeshir Hashmi:  Part of that treatment.

Nada Youssef:   They're driving.

Dr. Ardeshir Hashmi:  Absolutely. And I will draw this parallel of the other phase of life, the beginning of life, pediatrics.

Nada Youssef:   Yes.

Dr. Ardeshir Hashmi:  When we take our children to the doctor, children are not just smaller adults, right? I mean, otherwise, we would take them to our primary care physician, we don't. Women's health is a big thing. Why does women's health exist? Because it deals with issues that are very specific to promotion of wellness and health issues, very specific to you our female patients. And so who do they meet? They meet women's health specialist. Similar to the situation here, right? So what's different about the pediatrician that's, you know, taking care of your child is, they are well-versed with the physiological changes that we've talked about. Similarly, the successful aging specialist is well-versed with those physiological changes, you want to have that conversation, you want to have that distinction, that uniqueness, you cannot reproduce that with any other physician that you see.

So I think, for families as the roles are reversed, and now they're taking care of not only their children, but an older person in their family as well, an older loved one, it's the same sort of thing, you're taking your child for a wellness visit, so that they get the vaccinations that they need. You're taking your older family member that you care for and love to a visit so that we can talk about what are the vaccinations that you need? Should you be still getting your colonoscopy? Or is it dangerous after a certain point? Should you be getting that shingle shot? How long should we be doing mammograms for? Should we be getting a bone density scan? So these are issues that are incredibly important to patients and family members. We're trying to help them. And if the family member can take time off and have those conversations in one visit setting, with an entire team, "Boy, you just save me five different visits, five different co-pays and time off from work."

Nada Youssef:   Yeah. And you know what, people usually honestly just go and Google everything. So I'm glad there's one person we could just come talk to. I think that's very, very important. So you said earlier, the secret sauce, but by practicing good health habits now, so baby boomers can maybe enjoy a more enjoyable, healthy old age, you mentioned quality of life. Can you talk about some proactive steps or habits the older adults should adopt for prevention? Just for the people that are listening or watching?

Dr. Ardeshir Hashmi:  Yeah. I mean, I think that's incredibly important. I think what's good for your heart is good for your brain health.

Nada Youssef:   Yes.

Dr. Ardeshir Hashmi:     So eating wisely in that situation, sort of low cholesterol diet, low fat diet, but really emphasis on protein and muscle building. So that as you are taking care of your brain health, you're also taking care of your physical health, right? And rebuilding a lot of that muscle that you're losing, eating regularly and well, importance of staying hydrated, well-hydrated, we talked about how thirst goes away. And then building in that exercise, and I would really put a big plug for aerobic exercise, and a little bit of resistance, sort of strength training, but a lot of aerobic exercise like walking or swimming. Anything that fits your lifestyle or your interest into your daily routine. And it's not about how much you do, it's about how regularly you do it. So even if you did 10 minutes of aerobic exercise every single day, the every single day part is what's going to keep you well.

We mentioned the Blue Zone principles. And so I always mentioned the Sardinian. So Sardinia, rocky terrain, fabulous Island, wonderful people, the roads are too narrow for a lot of automobiles to go through. So what do you do when you want to go and see your friend? You walk or you get on your bicycle and you bike there. And so those are things that are naturally part of the day-to-day life. For the Japanese, it's sort of culturally, they sit on the floor and have meals together. So that sense of community. But every time that they sort of get up to greet someone, that getting up and down off the floor. So it's sort of inbuilt into those cultures, and to those routines. So that's the sort of thing and that sense of community and social engagement. There's a lot of social connectivity, I think, in the power of social media and internet. But FaceTime, I think, has taken a backseat, right? And those sort of connections and family connections.

And the thing that I enjoy doing with, with my family and my two year old and my wife is meals together with the family and how important those conversations are, to really distress, take the stress off. I will say another big thing, sense of purpose. And as we retire, society really celebrates the young, the beauty of youth and sort of the working class, but who's to say that we retire at 65 anymore, right? I mean, and if we do, who's to say that now we have time to do the things that we've always wanted to do. So taking charge of that schedule, and really scheduling the things that you've always wanted to do. Having that sense of purpose, and really volunteering your time. This is another part of the secret sauce, the more you volunteer your time, the health benefits of this are immense. They're significant. Makes you feel good all day, you help someone else out and then maybe you even help someone out, who is similarly going through the same phase of life that you are.

Nada Youssef:   Yeah, relating to you.

Dr. Ardeshir Hashmi:  And relating to you, yeah.

Nada Youssef:   So mindfulness seems to be a new trendy thing in the secret sauce nowadays.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   Do you talk about meditation with your elder patients or anything like that?

Dr. Ardeshir Hashmi:  Absolutely, incredibly important, incredibly so. And I think taking that time out for yourself, where you are really focused on your body and you sort of even your breathing and sort of in a very quiet sort of space, which is sort of free of the constant technology intrusions of cell phone's going off, and emails coming in just time for yourself. Taking a step back and sort of saying, "Hey." We talked about the pace of things, that marathon thing, part of that pace is slowing things down, it's okay to slow things down. So to take time in your day-to-day life for those things. And again, as I said, it takes a village. And so nutritionists can talk to you incredibly about your diet. Similarly, a lot of our care coordinators and health coaches and primary care coordinators who actually work with us as specialty coordinators, they sit down and have those conversations, "How can we make your life easier?"

And so each one of those individuals to the best of their expertise. They talk to a pharmacist, talking about your medications. And so as you go through these, you four or five, really even many visits, sort of in addition to the FaceTime that you have with us, it really gives it a completely different perspective and a lot of renewed energy to sort of saying, "Life doesn't have to be this way, I'm in charge of my own health, and I should be the one who should be calling the shots here." We just put a team behind that and sort of say, "You're not alone, we're going to advocate for you."

Nada Youssef:   We're here for you. Perfect. Speaking of pharmacists.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   So often as we age, the number of medical problems are going to increase, and with this number of medicines will increase. So with the side effects of drug interactions, can you talk about the medication management that you've mentioned before, and how you can help with that?

Dr. Ardeshir Hashmi:  Absolutely. I mean, I'll give you the example of blood pressure and diabetes.

Nada Youssef:   Okay.

Dr. Ardeshir Hashmi:  Throughout our lives, we're being told to sort of control the blood pressure, control the diabetes as much as possible, right? But we've heard about too much, if a good thing can be bad for you, the same sort of thing here, intense diabetes control, intense blood pressure control, where your blood pressure is too low now, or your diabetes is like too low so that you have low blood sugars, that can lead to a lot of confusion, a lot of falls, sort of a lot of impact on your health overall, leading to a lot of hospitalizations. And so there's a balance, it's always a matter of balance, right? This is just a matter of common sense that our bodies feel. They don't feel well when our blood pressure or our sugar levels are too high. They don't feel well when those levels are too low. Right?

And so the silver lining that not a lot of people talk to you about. But our team talks to you about. The successful aging specialist, but our successful aging pharmacist, if I can call her that, is you're on three different blood pressure medicines right now. But your blood pressure is too low, or you're three different diabetes medicines, but your sugar levels are too low. Do you really need to be on those three medications? Or can we start reducing the doses of this, right? Very judiciously. Very deliberately, not just sort of taking people off. But in a very measured way, as people come down on those doses, because your bodies are changing, because the silver lining there is the body does not need as much medication as we get older. Physiologically, it needs less and less to get better and better.

Not to say that they don't need medications, but the medicine that you're taking, should be helping you. Because if it's not helping you anymore, well, the only thing that it's doing in your body is it's causing harm, and it's causing side effects. And it's interacting with the rest of your medications. So my healthiest 90-year old patients are those people who came to us on 15 different medications. All started with the best of intentions over time. Now at the age of 90, and they look like they're 30 years younger. Why do they do that? Because now they're taking three medications. And they can tell me are you or anybody else, why am I on those three medications? How is that helping me. And they will be more than happy to tell you the story of how they got off the medications and how good it made them feel.

Every time they walk through that door for that successful aging visit, whether it's annually or more frequently than that, we see a different person walk through the door. And they have done that by working with us and getting off of these medications.

Nada Youssef:   And they bring all medications, you're taking from heart to diabetes, every single medication?

Dr. Ardeshir Hashmi:  Absolutely.

Nada Youssef:   And you will get to work with their pharmacists-

Dr. Ardeshir Hashmi:  Absolutely. And we always encourage to sort of bring in the medication bottles, including supplements. That supplement world is out there is this good to help me with my successful aging. And I will say that we talk through those things, and we say well, some things are much better than others. There are other things that could have contents and then that are potentially harmful. And you want to be able to, you know, avoid those. Just going through that exercise is a big eye-opener for patients, but also for family members when they see those 15 medication bottles in that visit on that table top, nobody wants to take that much.

Nada Youssef:   Sure. You know what's funny, my brother is a pharmacist and he mentioned that ... We were talking today. And he mentioned to me one of the issues that he sees is that the doctor, let's say cardiologists will give you some heart medication. They'll tell you, "Take this twice a day." And you go home and then you have the diabetes doctor, "Take this once a day."

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   So which one do you take first? Are you taking in the morning? Are you taking at night? There's so many things that come with it that maybe people are not aware of about but what you're mentioning in your field, as a successful aging specialist, you would take all of this, kind of compound everything and kind of work through what's the side effect? Why you're feeling that way? And you're able to call the shots on what's to completely stop taking? Correct.

Dr. Ardeshir Hashmi:  Absolutely right. And I think, I will take a step back and sort of say when you see your brother next, say big thank you to him. Pharmacists are the cutting edge, as one of ... Including our other team members, like our physical therapists and our nutritionists and our social workers and the care coordinators. But we don't emphasize this enough, that they are really ... This is the future, their role is as important as my role as a successful aging specialist because they're part of that successful aging team.

To your brother's point, and every single pharmacists on our team will echo exactly what your brother has very astutely pointed out, is there's no cross-communication here, right? So your specialist on the right hand doesn't know what the left hand is doing. And so I'm the one who's taking all these medications, right? And so I'm going to listen to all these specialists, but the timing of these medications ... And are there alternatives within those medications, can be have you on a medication that is more long acting so that you don't have to take this medication three times a day.

Nada Youssef:   Right, exactly.

Dr. Ardeshir Hashmi:  Maybe you can just take it once a day, there's a formulation that's there. Is there a medication that I sort of I'm being guided to over the counter that has some harmful effects? And you don't want to take that, right? And so to have that conversation, when you go to your successful aging visit. And I would say, to your point about so many medications, how do I sort of time this? Cost is a big issue here, right? And so does it have to be that brand name? And I will say 100% of time, "Absolutely not, doesn't have to be that brand name at all."

Nada Youssef:   Could be generic, it's-

Dr. Ardeshir Hashmi:  Can be generic, right? And nationally, I will say, again, as I said, there are a lot of successful models in successful aging and in geriatrics. And I think healthcare in general now is learning from those models, and I think it is about time, and we're very happy that that's happening. But those models are part of the same thing, working as a team, and sort of working on improving the quality of care, but lowering the cost of care, which we always talk about. And in terms of just the medication. So if you're taking fewer medications, and there's less cost to that, anyways, you're taking the generics, even better yet. And if you're staying out of the hospital, and you're staying out of the emergency room, and you are not going to five different visits, and you're reducing those copay. All of that is a financial benefit to you, right?

I mean, you have saved and worked very hard throughout your life, for your own retirement and to be there for your loved ones. And to make sure that they have enough, you don't want to be spending that on reactively waiting until you're in trouble. You want to be spending it on low cost things or even things that are free, right? Which is sunshine and aerobic exercise and eating right.

Nada Youssef:   Good nutrition.

Dr. Ardeshir Hashmi:  Doesn't cost a thing. But is it saving a lot of costs to our patients and families? Oh, absolutely.

Nada Youssef:   Yeah. Because just like you mentioned, I mean, that literally was going to be my next question, but you answered it, and to have someone going through retirement or going to go through retirement, their income decreases.

Dr. Ardeshir Hashmi:  Yeah.

Nada Youssef:   So they start thinking, "Do I need to see a specialist or can I cut this in half?"

Dr. Ardeshir Hashmi:  Plus, you want to save up those dollars to go to South Africa, what I want to keep on going to, right?

Nada Youssef:   Yes, I'd travel if I was retiring.

Dr. Ardeshir Hashmi:  I wouldn't want to keep on going into the hospital and sort of doing that, and spending all my energies and money really on that. And I think it's worthwhile seeing a financial planner, there are very expensive, specific dedicated individuals who work with our team, and we can connect you to them through the successful aging visits and our successful aging team to help you plan that. How do you plan for that? It's all part and parcel of the same thing. Unfortunately, I think we have gravitated towards talking about these things in five different conversations in a very solid way. But when talking about things practically just for our own selves, we don't make any distinction, right? I mean, these things are all going to support our health.

Nada Youssef:   Exactly.

Dr. Ardeshir Hashmi:  Including financial planning, including the home that we live in, and how do we continue ending up living there? So there's a lot of richness in that content.

Nada Youssef:   And this is not a very frequent visit to a geriatrician or a successful aging specialist, correct?

Dr. Ardeshir Hashmi:  It's at least once a year.

Nada Youssef:   At least once a year.

Dr. Ardeshir Hashmi:  And I think beyond that, it all depends upon your needs and what are the things that come up in those conversations. There's no limit to how many it can be, sort of its ... But it should be incredible beneficial to you. So I would say, at least once a year, and when it saves you those five other visits well then, it's interesting, a lot of our ... So we hear from caregivers and family members. In fact, this thing of, we have a successful aging program now, it said, "When can we come in and see?" This thing about actually using the age of 50 has actually come from our families and caregivers. They actually would come to us and say, "I'm dealing with all of these things."

Nada Youssef:   "Can I come in?"

Dr. Ardeshir Hashmi:  "Can I come in? Can I talk to you?" You're spending a lot of time with me. It's as much my visit as it is yours. Our response to them is, "Absolutely, our desire is to be more inclusive rather than exclusive."

Nada Youssef:   Sure.

Dr. Ardeshir Hashmi:  And more to spreading the word about this.

Nada Youssef:   So the successful aging program, you just mentioned that. That's a Cleveland Clinic program that helps adults ages 50 and older, achieve their health and life goals. So is there anything else that you wanted to talk about with that program a little bit?

Dr. Ardeshir Hashmi:  I think access. I think our CEO talks about access, and how we want to touch as many lives as possible. I heard him on NPR yesterday and he echoed the same thing. And in perfect alignment with that, I mean, I think what the Successful Aging Program does is connects you to a board-certified expert in your aging and a team of specialists, with the time that you need. We also would emphasize that getting into see a successful aging specialist. So how long does that take? Within the same week or next week is our promise to you.

Nada Youssef:   Wow.

Dr. Ardeshir Hashmi:  Just in terms of the novel scheduling system that we have in place, and probably sort of the best kept secret of the clinic. But we don't want it to be a secret anymore. We want it to be out there and available to people so that you can come in and spend that time with us, that is your time.

Nada Youssef:   So you're saying if someone calls in for an appointment, or to get into this program, they only have one or two weeks, until they get in?

Dr. Ardeshir Hashmi:  And wait time. So what helps with that is that we are at nine different sites across Northeast Ohio, we're out in the region. And so that helps a lot. So you don't have to ... You can go closer to where you live. And that opens up a lot of access and a lot of slots to come in and be seen as long as you call a sort of specific number. And as long as you call that number we can guide you and look forward to seeing you.

Nada Youssef:   I'll give the number out for you right now. So if your age is 50 and up, and you want to learn more about the Successful Aging Program, you can call 216-444-5665 to schedule your visit. Well, it's been an amazing conversation. Thank you so much for your time. It's been a pleasure.

Dr. Ardeshir Hashmi:  Pleasure is all mine. Thank you for having me onboard.

Nada Youssef:   Thank you so much. Thank you. And if you are ... Just like I said, I'm going to say it again. But if you'd like to make an appointment with a successful aging specialist, you can call 216-444-5665. 50 years and up, again quality of life and caregivers along. And thanks again for our listeners and viewers for joining us today. We hope you enjoyed this podcast. To listen to more of our Health Essentials podcasts from our Cleveland Clinic experts, make sure you go to clevelandclinic.org/hepodcast. Or you can subscribe on iTunes. And for more health tips, news and information, don't forget to follow us on Facebook, Twitter, Snapchat and Instagram @ClevelandClinic just one word. Thank you. We'll see you again next time.