[♪♪] WELCOME TO HEALTHY AGING A KET FORUM WHERE WE'LL DISCUSS HOW WE CAN ADD QUALITY TO OUR YEARS THROUGH MORE MOVEMENT AND PREVENTATIVE CARE.

I'M WAYNE TUCKSON.

THIS IS PART OF KET'S INITIATIVE ON AGING CALLED NEXT CHAPTER.

WE ENCOURAGE YOU TO CHECK THE RESOURCES AND INFORMATION WE HAVE ON OUR WEBSITE AT KET.O KET.ORG/NEXT CHAPTER.

TONIGHT WE ARE GOING TO TALK ABOUT THINGS WE CAN AND SHOULD BE DOING TO HELP US TOUGH IT OUT IN OUR GOLD ESPECIALLY YEARS.

OUR LONG DISCUSSION WILL DIVE INTO KEY FOCUS AREAS.

THE IMPORTANCE OF PREVENTATIVE CARE AND SCREENINGS, WAYS TO MAINTAIN STRENGTH AND DIAGNOSING A MANAGEMENT MOVEMENT DISORDERS AN PARKINSON'S DISEASE AND FACTORS TO BE CONSIDERED WHEN SURGERY MAN ONE OF THE TREATMENT OPTIONS OUR PANEL INCLUDES Dr. MISHA RHODE.

AND Dr. ZAIN GUDURU, A NEUROLOGIST SPECIALTYLIZING IN MOVEMENT DISORDERS AT THE UNIVERSITY OF KENTUCKY NEWER ROW SCIENCES INSTITUTE AND A HARDY WELCOME TO OUR STUDIO AUDIENCE.

[APPLAUSE] LET ME START OFF WITH YOU, DOCTOR WE WANT TO LIVE AS LONG AS POSSIBLE BUT WE WANT TO HAVE A GOOD QUALITY LIFE.

WHAT ARE SOME OF THE THINGS THAT WE SHOULD BE DOING AND WHEN SHOULD WE START DOING THEM?

>> MAKE SURE YOU ARE SEEING YOUR PRIMARY CARE PHYSICIAN ON A REGULAR BASIS.

I THINK GETTING AHEAD OF ANY CHRONIC I WILL,S OR DISEASES IS EXTREMELY IMPORTANT.

AND HAVING THAT QUALITY OF LIFE AND THAT LONGEVITY THAT WE ALL WANT.

>> WHAT DOES HEALTHY AGING REALLY LOOK LIKE?

>> I THINK MAKING SURE THAT YOU'RE DISCUSSING WITH YOUR LOVED ONES OR WITH YOUR PRIMARY CARE PROVIDER WHAT MATTERS MOST TO YOU.

HAVING GOALS OF CARE.

MAKING SURE THAT THOSE GOALS ALIGN AND THAT YOU HAVE SOME TYPE OF CARE PLAN WHETHER IT'S EXERCISE, WHETHER IT'S DIET, WHETHER IT'S MANAGEMENT OF AN ILLNESS THAT YOU HAVE AND KNOWING HOW TO BE EMPOWERED AND TAKING CARE OF YOURSELF.

>> TAKING THAT INTO ACCOUNT YOU WORK WITH INTERESTING ORGANIZATION CENTER WELL WHICH CORRECT ME IF I'M NOT WRONG, YOU TRY TO HAVE A HOLISTIC APPROACH IN MANAGING THE OLDER PATIENT.

>> YES.

>> TELL ME ABOUT THAT.

>> WE ARE FOCUSED ON SENIORS AND SO WE ARE PRIMARY CARE ORGANIZATION WITH SENIORS IN MIND.

SO THOSE WHO ARE 65 AND OLDER MAKEUP THE MAJORITY OF OUR PATIENT POPULATION.

AND THE GOAL IS TO LOOK AT A PATIENT NOT JUST FOR THEIR CLINICAL ILLNESSES OR DISEASES BUT LOOK AT ALL THE OTHER FACTORS THAT IMPACT OUR HEALTH.

SO THOSE COULD BE DEPRESSION, SOCIAL ISOLATION, THAT COULD BE TRANSPORTATION, IT COULD BE CAREGIVER BURN-OUT ALL THE THINGS WE EXPERIENCE.

YOU ARE TAKING THAT WHOLE PERSON APPROACH RATHER THAN A CLINIC APPROACH.

>> U.K. WITH THE NEWER ROW SCIENCES AWE GET OLDER DO WE HAVE MORE NEUROLOGICAL DISEASES AND HOW DOES THAT SHAPE HOW YOU ARE EVALUATING PATIENTS?

>> JUST WITH AGING, ALL OF US WE LOSE SOME NEURONS OVER TIME.

THAT'S NORMAL.

THE AMOUNT OF SYNAPSES WHICH NEWER RONES FORM DECREASE IS NORMAL.

IN ADDITION WHEN THERE IS A PATHOLOGICAL PROCESS THAT HAPPENS THAT WHAT CAUSES DISEASES AND A GOOD EXAMPLE IS ALZHEIMER'S, PARKINSON'S DISEASE.

IN MY PRACTICE AS A MOVEMENT SPECIALIST I SEE COMMONLY, ESPECIALLY ABOVE AGE 60 ESSENTIAL TREMOR OUT THERE.

STROKES ARE IS ONE OF THE NEUROLOGICAL DIAGNOSIS WHICH CAN HAPPEN MORE IN AGING POPULATION, TOO.

SO THERE ARE MULTITUDE OF DISEASES AND I AGREE THAT BEFORE THESE SET ON IF YOU ARE A STEP AHEAD AND TRY OUR BEST HOW TO PREVENT THESE THAT SHOULD BE OUR GOAL AND THAT IS WHAT SHOULD BE EDUCATED AND WHAT WE EDUCATE PEOPLE ABOUT.

>> I'M TALKING TO YOU AND I JUST TRIPPED AND I'M STANDING STILL.

HOW COMMON IS IT FOR US WHEN SHOULD WE GET CONCERNED IF SOMEONE LOSES BALANCE OR OTHER LITTLE THING?

IS THAT NORMAL LIFE OR DOES THAT PORTEND SOMETHING ELSE.

>> ABSOLUTELY NOT NORMAL.

YOU ARE ARE LOSING BALANCE, APPROACHING A APPRECIATE PETITION IS DISEF THAT -- PHYSICIAN THAT IS IMPORTANT.

IF YOU HAVE PHYSICIANS YOU SHOULD TELL THEM.

THE POINT WHICH YOU MENTIONED ANY PHYSICIAN NO MATTER WHAT THEY ARE PRACTICING WE SEE THE PERSON AS A WHOLE RATHER THAN ONE DIAGNOSIS.

IF YOU TELL US ABOUT BALANCE PROBLEM WE WILL SEE WHAT NEEDS TO BE DONE AND EVALUATION DEFINITELY NEEDS TO BE DONE FOR THAT WHAT IS THE REASON BEHIND IT, WHAT NEEDS TO BE DONE RIGHT AT THAT TIME.

HOW TO PREVENT THESE.

IT MIGHT BE EDUCATIONAL AND MIGHT BE ABOUT MANAGEMENT OF THAT PARTICULAR PROBLEM.

>> YOU TALKED ABOUT PARKINSON'S DISEASE.

COULD YOU TELL US MORE WHAT IS PARKINSON'S DISEASE AND WHAT DOES IT ENTAIL?

>> SO PARKINSON'S DISEASE IS A SLOWLY PROGRESSIVE, CHRONIC, NEWER ROW DEGENERATIVE PROBLEM WHERE THE DEGENERATION OF NERVE CELLS HAPPEN IN THE BRAIN ESPECIALLY THOSE THAT ARE PRODUCING DOPAMINE A CHEMICAL IN THE BRAIN WHICH LEADS TO MANIFESTATION OF SYMPTOMS WHICH INCLUDES SHAKING, WE CALL IT TREMOR, SLOWNESS, SLOW WALKING, SLOW MOVEMENTS WHICH WE CALL [INAUDIBLE] STIFFNESS OF MUSCLES.

AND FINALLY, BALANCE PROBLEMS.

WALKING AND BALANCE DIFFICULTIES WHICH CAN LEAD TO FALLS.

THESE ARE SYMPTOMS COMMON SYMPTOMS BUT IN ADDITION THERE MIGHT BE OTHER SYMPTOMS TOO, WHICH WE ENCOUNTER SUCH AS SHUFFLING WALKING OR LOSS OF FACIAL EXPRESSIONS OR LOW VOLUME IN THE SPEECH.

WHEN YOU NOTICE THESE THINGS YOU SHOULD APPROACH THE PHYSICIAN.

>> WHEN WE ARE TALKING ABOUT THE GERIATRIC PATIENT AND MOBILITY DISORDERS WHAT ARE SPECIAL CONCERNS GOING ON THERE?

>> RIGHT.

AS I SAID, GOOD NUMBER OF THESE CONDITIONS ARE PROGRESSIVE NEUROLOGICAL PROBLEMS WHICH CAN AFFECT THE BALANCE.

WHEN YOU ARE WALKING WHEN THE BALANCE IS AFFECTED, WHEN THE WALKING IS DIFFICULT, IT PREDISPOSES US TO FALLS THAT IS WHAT CAUSES A FALL WHICH HAPPENS IN A PERSON ABOVE AGE 60, IF IT LEADS TO FRACTURES THE HEALING PROCESS IS TOO DELAYED OR NOT APPROPRIATE AND THAT IS WHAT I MEAN BY SAYING WE SHOULD TALK ABOUT HOW TO PREVENT THESE FROM HAPPENING.

AND IF YOU HAPPEN TO LOSE SOME BALANCE SOMETIME, APPROACH THE PHYSICIAN SO THAT IT WON'T REPEAT AGAIN.

>> WE SEE PEOPLE MOVE, WE GET OLDER.

THE HANDSHAKES A LITTLE BIT LIKE THAT.

YET, OTHER TIMES YOU SEE SOMEBODY SHAKING AND THEY REACH FOR A CUP THERE'S NO SHAKING GOING ON.

HOW DO YOU DIFFERENTIATE THOSE TREMORS VERSUS THE PARKINSON'S?

>> WHEN YOU GET TREMOR, ONE OF THE IMPORTANT ASPECTS WHICH THE PHYSICIAN WILL ASK YOU IS WHEN IS IT HAPPENING?

IS IT HAPPENING WHEN THE HAND IS AT REST OR THE BODY IS AT REST OR NOT DOING ANYTHING?

OR IS IT HAPPENING WHEN YOU ARE DOING ACTIVITY LIKE EATING OR HOLDING A CUP.

SO THE REASON THIS IS IMPORTANT TO DIFFERENTIATE IS BECAUSE JUST BY COMMONALITY IN PARKINSON'S, THE RESTING TREMOR IS MORE COMMON.

EARLY ON.

IN CONTRAST THERE IS A COMMON CONDITION OUT THERE CALLED ESSENTIAL TREMOR WHERE THE SHAKING HAPPENS MORE WHEN YOU ARE TRYING TO RICH AN OBJECT OR TRYING TO DO AN ACTIVITY WHEN IT SHAKES.

DIFFERENTIATING THIS IS ALSO IMPORTANT BECAUSE THE MANAGEMENT IS DIFFERENT.

THE PROGNOSIS IS DIFFERENT.

THE WHOLE TREATMENT IS DIFFERENT.

SOMETIMES FOR ESSENTIAL TREMOR YOU DON'T NEED MEDICATIONS BECAUSE IT MIGHT NOT BOTHER YOU.

SOMETIMES THEY COME TO OUR CLINICS BECAUSE THEY WANT TO KNOW DOC IS THIS ESSENTIAL TREMOR OR PARKINSON'S THAT I NEED TO FOLLOW-UP WITH YOU?

>> MOST PATIENTS AREN'T GOING TO START OFF BY GOING TO SEE HIM.

THEY ARE GOING TO COME TO YOU.

IS IT GOING TO BE THE PATIENT OR THE FAMILY MEMBER THAT INITIATES IT?

SAY, MOM IS WORKING ON HER IPAD, BUT SHE CAN'T SEEM TO HIT THE KEYS PROPERLY OR TRYING TO MAKE A PHONE CALL AND CAN'T SEEM TO DO THAT.

IS THAT WHERE IT STARTS?

>> IT COULD BE BY OBSERVATION OF A FAMILY MEMBER FOR SURE.

I'D SAY IT'S HALF AND HALF, REALLY.

A LOT OF PATIENTS WILL SAY I'VE NOTICED THIS I'VE NOTICED MY HANDSHAKING WHEN I'M SITTING THERE OR I CAN'T USE MY SMARTPHONE, I CAN'T TOUCH THE BUTTONS AND YOU HAVE OBSERVATION BY A SPOUSE OR A FAMILY MEMBER WHO WILL SAY I'M NOTICING IT.

HALF.

>> HALF THE TIME.

SPEAKING OF MOBILITY LET'S TALK MORE ABOUT MOVEMENT.

IS THE OLD SAYING TRUE THAT IF YOU DON'T MOVE IT YOU LOSE IT?

>I GUESS I LOST A LOT.

BRYANT STAMFORD TALKED ABOUT HOW WE CAN STAY MENTALLY AND PHYSICALLY SHARP.

>> THE CLOSEST THING WE HAVE TO A FOUNTAIN OF YOUTH IS EXERCISE THERE IS NO QUESTION ABOUT IT.

>> BRYANT STAMFORD IS A PROFESSOR OF KINESIOLOGY AT HANOVER COLLEGE WHEN OPTIMIZING YOUR HEALTH YOU HAVE TO MOVE IT OR YOU LOSE IT INTEREST THE LESS YOU MOVE THE MORE YOUR BODY SAY WE DON'T NEED THAT IT'S NOT DOING ANYTHING.

WHY BOTHER?

LET'S GET RID OF IT.

ONCE YOU GET RID OF THAT MUSCLE MASS YOU GET WEAKER AND WEAKER.

>> ACCORDING TO THE C.D.C.

EXERCISE CAN REDUCE THE RISK OF DEMENTIA, STROKE AND HEART DISEASE AND CAN IMPROVE BALANCE AND BONE STRENGTH AND HELP ADULTS LIVE INDEPENDENTLY AND LONGER THE TOP THREE EXERCISES MIGHT BE EASIER THAN YOU YOU THINK.

>> I LIKE TO KEEP THINGS REMARKABLY SIMPLE.

WALK, CLIMB STAIRS, CARRY THINGS AROUND THE HOUSE.

>> THE FIRST EXERCISE WALKING IT BENEFITS MORE THAN JUST THE BODY.

>> IT'S GOING TO KEEP YOUR BRAIN ALIVE AND ACTIVE IN SUCH A WAY THAT YOU DON'T DETERIORATE.

>> IT SERVES AS A PHYSICAL AND MEN SHALL EXERCISE.

>> WHEN YOU ARE WALKING YOU ARE ENGAGING YOUR BRAIN IN EARN ITS OF THE CONNECTIONS IN YOUR BRAIN.

WHAT IS WRONG WITH ALZHEIMER'S?

YOU LOSE THE CONNECTIONS THE BRAIN CAN NO LONGER COMMUNICATE IN THE WAYS IT HAS TO COMMUNICATE TO GET SIMPLE THINGS DONE.

WALKING COVERS ALL OF IT, BECAUSE YOU HAVE BO L BOTH SIDES OF THE BODY IN INTRICATE WAYS HAVING TO COMMUNICATE IN HUNDREDS OF WAYS INSTANTANEOUSLY BACK AND FORTH AND BACK AND FORTH.

>> THE SECOND EXERCISE IS CLIMBING STAIRS.

>> IF YOU DON'T CLIMB STAIRS THE DAY WILL COME THAT YOU CAN'T CLIMB STAIRS.

>> THIS IS ONLY SUGGESTED FOR THOSE WHO CLIMB STAIRS SAFELY.

>> HOLD THE RAILING ON THE STAIRS.

CLIMB THE STAIRS, SET A GOAL.

I WILL CLIMB THE STAIRS UP AND DOWN 10 TIMES A DAY.

AND ADD TO IT.

10 TIMES, 15 TIMES, 20 TIMES.

THEY DON'T HAVE TO BE ALL AT ONCE.

HOW DID YOU DO TODAY?

I CLIMBED THE STAIRS 20 TIMES.

IF YOU DID THAT, YOU WOULD BE RETAINING A LOT OF YOUR STRENGTH.

>> THE THIRD EXERCISE IS CARRYING THINGS.

>> GET A BOX.

AND PUT "X" NUMBER OF BOOKS IN IT.

AND PUT IT SOMEWHERE TYPICAL ON THE CORNER OF THE TABLE.

EVERY TIME I PASS IT LIFT THE BOX UP AND TAKE IT AND PUT IT DOWN.

AND THE WEIGHS 10 POUNDS, 15 POUNDS.

AND AS YOU GET STRONGER ADD MORE BOOKS TO IT.

>> WHEN THE GOING GETS TOUGH?

>> WHEN SOMETHING BECOMES CHALLENGING THAT SHOULD BE A HEADS UP CALL TO YOU.

TO DO MORE OF IT.

NOT LESS OF IT.

>> TO KEEP THE TOUGH GOING THROUGH THE GOLDEN YEARS FOR KET I'M KRISTY DUTTON.

>> THANK YOU VERY MUCH KRISTY.

DOCTOR, LET ME ASK YOU, SO WHEN YOU'RE SEEING THE PATIENT AND WE'RE TALKING ABOUT MAINTAINING THAT HEALTH, HOW IMPORTANT IS THE PHYSICAL THERAPY SIDE OF IT AND THE PRESCRIPTION OF EXERCISE WHAT WE HEARD?

>> I THINK HE IS RIGHT.

IT'S CRITICAL.

IF YOU DON'T USE IT YOU LOSE IT.

I THINK MOVING IS IMPORTANT DOING IT SAFELY.

I THINK PHYSICAL THERAPY IS THERE TO HELP MAYBE SETUP GUIDELINES OR GUARDRAILS AROUND WHAT IS SAFE FOR YOU AS AN INDIVIDUAL VERSUS WHAT MAYBE SAFE FOR THE NEXT PERSON.

WE LIKE TO INCORPORATE PHYSICAL TRAINING TO BUILDUP THE PROPER EXERCISE REGIMENT INTO A PATIENT AND FALL RISK IN THE HOME.

THEY WILL GO INTO THE HOME AND LOOK TO SEE ARE YOU AT RISK FOR A FALL.

DO YOU HAVE RUGS AND SMALL PETS THINGS THAT CAN TRIP YOU UP THAT YOU ARE NOT NECESSARILY THINKING ABOUT.

I THINK PHYSICAL THERAPY IS A VERY STRONG PARTNER IN MAKING SURE THAT WE STAY HEALTHY AND ACTIVE.

>> I WANT TO WALK Dr. TAAP WITH THE SAFE HOME COALITION WHAT STEPS SHOULD WE MAKE TO MAKE OUR HOMES SAFER?

>> THANK YOU FOR HAVING ME.

EVERY MANY THINGS WE CAN DO AND MANY ARE FREE.

FIRST, I SUGGEST WE PAY ATTENTION AND TAKE ACTION.

BY THIS, I MEAN FOR EXAMPLE, IF ONE IS ON MEDICATION AND MAYBE FEELS LIKE THEY ARE OFF BALANCE OR HAVING PROBLEMS IT MAY IMPEDE THEIR MOBILITY CONSULT THEIR PHYSICIAN AND FIND OUT WHAT IS GOING ON.

INSIDE THE HOME ITSELF THERE ARE MANY THINGS WE CAN DO LIKE CLEAR THE WALKWAYS AND MAKE SURE THERE'S UNNECESSARY THINGS ON THE FLOOR.

LAMP CORDS WIND THOSE UP AND PUT THEM OFF TO THE SIDE.

PUT A LAMP NEXT TO ONE'S BED.

IN THE BATHROOM ONE CAN MAKE SURE THE FLOOR IS DRY.

SAME AS THE REST OF THE HOUSE.

AND THE BATH TUB HAVE LITTLE STRIPS ANTI-SLID STRIPS AND HAVE HAND HOLDS AS WELL SO THEY DO NOT FALL.

SOMETHING ELSE ONE CAN DO THROUGHOUT THE HOUSE IF YOU HAVE STAIRS WATCH WHAT IS ON THE STAIRS.

PEOPLE LIKE PUTTING PLANTS OR BOXES OF STAIR PLANTERS ON THOSE STEPS NOT A GOOD IDEA IF ONE IS HAVING PROBLEMS IF THEY ARE FALLING.

IN ADDITION TO THE KITCHEN MAKE SURE EVERYTHING IS CLEANED UP.

AND WATCH WHAT ONE IS DOING.

IT'S SUPER BOWL EVENING, WE'RE IN A RUSH TO GET TO THE CHAIR, WATCH THE BALL GAME WE HAVE THE BIG BASKET BUCKET OF DORITOS AND POMP CORN AND SODA IN ONE HAND AND WE ARE RUSHING IN THERE AND WE PLOP DOWN AND MISS THE CHAIR.

PAY ATTENTION AND SLOW DOWN TO WHAT WE ARE DOING.

IF YOU HAVE A PET, AND YOU HAVE TOYS THAT ARE SCATTERED THROUGHOUT THE HOUSE, PETS DO NOT CLEAN UP AFTER THEMSELVES, DOGS, CATS, MAKE SURE THOSE ARE TAKEN CARE OF.

AND OUTSIDE OF THE HOUSE, MAKE SURE EVERYTHING IS BASICALLY TAKEN CARE OF.

DEBRIS IS OFF OF THE STEP WAYS.

AND JUST SLOW DOWN, THINK ABOUT WHERE YOU ARE AT.

AND ONE TIP I WOULD GIVE IS HAVE A FAMILY OR A NEIGHBOR COME BY.

AND DO A SELF CHECK.

LOOK AROUND SEE WHAT ONE MAY HAVE MISSED.

>> ONE THING YOU DIDN'T COMMENT ON WHICH I THOUGHT WAS INTERESTING, CLOTHING.

AND IN PARTICULAR, FOOTWEAR.

THEY ARE CALLED SLIPPERS FOR A REASON BUT SOMETIMES THEY CAN BE TOO SLIPPERY.

WHAT DO YOU RECOMMEND?

BATHROBES AND SLIPPERS?

>> THAT IS A GOOD COMMENT THERE ABOUT CLOTHING.

IT CAN IMPEDE US.

FOR EXAMPLE, PANTS THAT ARE TOO LONG NOT CUFFED AND WE CAN TRIP OVER THOSE.

IN TERMS OF SLIPPERS, ONE THING WE HAVE SEEN IS FLIP-FLOPS CAN BE A CAUSE OF ACCIDENTS AS WELL.

BECAUSE WE'RE RUSHING WE GET FLIP-FLOPS ON THEY ARE NOT SECURE DEVICES ON ONE'S FEET.

BETTER SHOES WITH GOOD TREADING IS IDEAL.

SLIPPERS BEDROOM OR WHATEVER FIT WELL, THEY DON'T SLIDE, THEY DON'T SLIP AND THAT IS ANOTHER REASON TO KEEP THE FLOORS DRY, AND CLEAN OF DEBRIS AND SO ON.

>> WOULD YOU COMMENT FOR ME, YOU'VE HEARD ALL THIS WHAT ABOUT THE PATIENT WHO IS DEVELOPING MOBILITY DISORDERS PARTICULARLY THE PARKINSON'S PATIENTS, ARE THERE ANY PARTICULAR CONCERNS THAT YOU WANT TO MAKE SURE ARE DONE IN THE HOME?

>> RIGHT.

I WOULD LIKE TO ADD TWO POINTS YOU HAVE BROUGHT UP GREAT POINTS.

ONE IS AGAIN, NO DUAL TASKS.

YOU ALREADY HAVE A PROBLEM WITH BALANCE, THERE IS A TENDENCY TO FALL, WHEN YOU ARE WALKING DON'T TALK ON THE PHONE AND WALK.

DUAL TASKS ANYONE CAN CHECK THIS IF YOU ARE WALKING NORMALLY AT X SPEED, IF YOU WALKING AND TALKING IT WILL BE LOWER SPEED.

SO THAT DUAL TASKS SHOULD NOT BE DONE.

SECOND IS WHEN YOU ARE WALKING MAKE WIDER TURNS IN YOU ARE TURNING MAKE WIDER TURNS THAT WILL PREVENT FALLS, TOO.

THIRD, VERY OBVIOUS, IF YOUR PHYSICIAN TOLD YOU TO USE A CANE, USE IT.

DON'T JUST BUY IT AND PUT IT IN THE CORNER.

SO ANY PERSON WITH CHRONIC NEUROLOGICAL PROBLEM WHO IS HAVING BALANCE, ALWAYS WE REFER TO FISH CAL THERAPY ALWAYS.

AS YOU SAID, IT'S ABOUT TEACHING THEM ABOUT WHAT TO DO AND WHAT NOT TO DO AND ALSO ABOUT TEACHING THEM WHAT KIND OF EXERCISES SHOULD BE DONE IN A REGULAR FASHION.

ONCE YOUR PHYSICAL THERAPY IS ENDING IT SHOULD NOT STOP.

THE REGULAR EXERCISES NEEDS TO CONTINUE.

>> THANK YOU VERY MUCH FOR THAT.

JUST AS A QUICK ASIDE WHEN DO YOU RECOMMEND THE FOUR-POINT WALKER?

WHEN THEY CAN'T MOBILITY DROPS DOWN MORE?

>> RIGHT.

I DON'T HAVE A SPECIFIC ANSWER FOR THAT IT DEPENDS ON HOW THE WALKING IS THE BALANCE IS ON BOTH THE SIDES HOW ALERT THE GAIT IS THEIR GAIT LURCHING A LOT OF FACTORS GO INTO THAT.

IF WE AS PHYSICIANS ARE NOT SURE WE TAKE HELP OF OUR PHYSICAL THERAPISTS WHERE THE COMPREHENSIVE APPROACH SHOULD HAPPEN WITH THE PROVIDERS TOGETHER?

I WOULD ADD IT DEPENDS ON WHAT THEY ARE NEEDING THE DEVICE FOR.

SO IF IT'S I HAVE PATIENTS WHO MAY SAY I GET TIRED EASILY.

AND A CANE MAY NOT NECESSARILY HELP YOU IF YOU ARE GETTING TIRED BUT A WALKER WILL.

ESPECIALLY THOSE WITH A SEAT BECAUSE PEOPLE CAN REST.

>> LET'S CHANGE GEARS A LITTLE BIT.

I WANT TO DISCUSS SCREENINGS AND PREVENTATIVE IN YOURS.

BEFORE WE HEAR FROM THE PANEL I SPOKE WITH JOHN WONG WITH THE U.S. PREVENTATIVE SERVICES TASK FORCE.

>> SO I AM A MEMBER OF THE TASK FORCE.

AND PART OF WHAT THE U.S. PREVENTATIVE SERVICES TASK FORCE DOES AND LOOK LONG AND HARD AT THE EVIDENCE FOR THE BENEFIT OR THE HARM FOR SOMETHING THAT MIGHT PREVENT DISEASE, FOR A SCREEN TEST THAT COULD PREVENT DISEASE, OR DETECT IT AT AN EARLIER STAGE.

OR MAKE BEHAVIORAL RECOMMENDATIONS TO HELP PEOPLE IN THIS NATION LIVE LONGER, HEALTHIER LIVES.

>> SO WHEN WE LOOK AT, SAY, A RECOMMENDATIONS FOR SOMETHING LIKE COLON CANCER IT USED TO BE 50 NOW IT'S DROPPED DOWN TO A YOUNGER AGE.

I ASSUME THERE ARE FACTORS YOU TAKE INTO CONSIDERATION TO MAKE ADJUSTMENTS WHEN TO START SCREENING.

>> ABSOLUTELY.

IN FACT WE ROUTINELY LOOK AT THE MOST RECENT DATA WITH THE MOST RECENT TREATMENTS AND SCREENING TESTS.

AND SINCE YOU CALL OUT COLORECTAL CANCER WHAT WE FOUND IS THAT THERE HAS BEEN 15% MORE PEOPLE IN THIS NATION DEVELOPING COLORECTAL CANCER THAT ARE UNDER THE AGE OF 50.

AND AS A CONSEQUENCE OF THAT, WE WERE ABLE TO LOWER THE AGE AT WHICH WE RECOMMEND COLORECTAL CANCER SCREENING TO AGE 45.

IN PART BECAUSE WE ALSO HAD DATA FROM STUDIES THAT DEMONSTRATED THAT SCREENING DOWN TO AGE 45 HAD BEEN SHOWN TO BE BENEFICIAL IN WHAT ARE CALLED RANDOMIZED TRIALS THE HIGHEST LEVEL OF SCIENTIFIC EVIDENCE THAT WE LOOK AT.

UNFORTUNATELY WE DO NOT HAVE SOLID EVIDENCE FOR INDIVIDUALS UNDERAGE 45.

AND OBVIOUSLY AS YOU KNOW IT IS A COLORECTAL CANCER SURGEON WE ARE INTERESTED IN UNDERSTANDING BETTER THE BENEFITS AND HARMS OF SCREENING AT YOUNGER AGES.

>> YOUR CONTINUOUSLY REEVALUATING THE DATA AS IT COMES IN FOR CHRONIC ILLNESSES AND CANCERS AND THINGS?

IT'S NOT SET IN STONE?

>> ABSOLUTELY.

AS YOU WELL KNOW SCIENCE CHANGES.

YOU KNOW.

OUR TESTS CHANGE.

OUR TREATMENTS CHANGE.

AND AS YOU CAN SEE, THE DEVELOPMENT OF DISEASES BECAUSE OF POPULATION BASED BEHAVIORS, OR OTHER FACTORS IN THE COUNTRY, INCREASE AND HOPEFULLY WILL DECREASE THE INCIDENTS OF SOME OF THESE DISEASES.

>> WE ARE AN AGING POPULATION.

AND BECAUSE OF THAT, HOW DO YOU EVALUATE WHEN TO STOP RECOMMENDING A SCREENING TEST?

BECAUSE AS WE GET OLDER WE HAVE BEEN TOLD WOMEN, GET YOUR MAMMOGRAMS, MEN PROSTATE EXAMINATIONS AND BOTH MEN AND WOMEN COLON CANCER SCREENING AND LUNG SCREENING IS THERE A POINT THAT WE NEED TO STOP DOING THIS?

>> YOU KNOW, IT'S A VERY IMPORTANT DECISION THAT WE MAKE.

AND WE THINK ABOUT IT LONG AND HARD.

BECAUSE, AGAIN, OUR GOAL IS TO HELP EVERYONE IN THIS NATION LIVE LONGER, HEALTHIER LIVES.

BUT WE WANT TO BASE OUR RECOMMENDATIONS ON THE BENEFITS AND THE HARMS.

AND WE NEED SOLID EVIDENCE FOR US TO THINK ABOUT THAT DECISION.

SO WHEN WE DO HAVE SOLID EVIDENCE, SUCH AS FOR LUNG CANCER SCREENING, WE SAY GOING UP TO AGE 80 IS APPROPRIATE.

ON THE OTHER HAND, WHEN WE LOOK AT COLORECTAL CANCER FOR EXAMPLE, WE SAY SCREENING UP TO AGE 75 IS APPROPRIATE.

BUT FOR 76-85, THAT SHOULD BE AN INDIVIDUAL DECISION.

WE CALL THAT A GRADE C RECOMMENDATION A CHOICE.

AND WE RELY ON A CONVERSATION BETWEEN A TRUSTED HEALTHCARE PROFESSIONAL AND A PATIENT.

BECAUSE WHEN INDIVIDUALS ARE OLDER THERE IS A CLOSER BALANCE OF BENEFITS AND HARMS.

AND SO THAT MAY DEPEND ON A PATIENT'S SITUATION.

IT MAY DEPEND ON A PATIENT'S OTHER DISEASES THAT THEY MAY HAVE.

AND WHETHER OR NOT FOR EXAMPLE, THEY ARE A CANDIDATE TO POSSIBLY HAVE SURGERY IF A COLORECTAL CANCER IS FOUND.

ON THE OTHER HAND, WE HAVE SOMETHING LIKE BREAST CANCER SCREENING WHERE ALL OF THE TRIAL EVIDENCE THAT VERY TOP LEVEL OF EVIDENCE WE ARE LOOKING FOR TO BE CLEAR ABOUT WHETHER OR NOT WOMEN WOULD BENEFIT FROM MAMMOGRAPHY WE DON'T HAVE THOSE DATA BECAUSE NONE OF THE TRIALS DONE OVER 30 YEARS AGO ENROLLED WOMEN WHO WERE 75 AND OLDER.

SO WE REALLY DON'T KNOW THE BENEFITS AND HARMS AND WE CALL THAT AN I STATEMENT WHERE WE DON'T HAVE THE EVIDENCE TO MAKE A DECISION ABOUT THE BENEFITS VERSUS THE HARMS.

AND WE ARE BASICALLY CALLING FOR ADDITIONAL RESEARCH.

SO WE'RE NEITHER FOR OR AGAINST EXTENDED SCREENING.

AND IN THOSE SITUATIONS, WE DON'T HAVE THE EVIDENCE.

AND WE ENCOURAGE PATIENTS TO HAVE AN HONEST DISCUSSION WITH THEIR TRUSTED HEALTHCARE PROFESSIONAL ABOUT WHAT MIGHT BE BEST FOR THEM IN THEIR CIRCUMSTANCE.

GIVEN THAT WE DON'T HAVE SOLID EVIDENCE.

>> I KNOW YOU DON'T GET INTO THE FINANCING SIDE WHEN YOU ARE MAKING YOUR RECOMMENDATIONS I ASSUME YOU DON'T, BUT ARE WE FINDING THAT SOME OF OUR INSURERS AND OLDER POPULATION, MEDICARE, ARE THEY WILLING TO COVER THE SCREENINGS IN THIS OLDER POPULATION GROUP?

SAY YOU HAVE THAT 75 OR 80-YEAR-OLD FEMALE WHO HAS HAD NEGATIVE MAMMOGRAMS IN THE PAST DO THEY COVER THESE THINGS IN THE FUTURE?

>> JUST TO BE VERY CLEAR, THE TASK FORCE LOOKS STRICTLY AT THE BENEFITS AND HARMS.

WE WANT TO BE A TRUSTED SOURCE WHERE WE'RE THINKING ABOUT HOW GOOD IS THE EVIDENCE.

IS IT SOMETHING THAT YOU SHOULD DEFINITELY DO.

OR IS IT SOMETHING WHERE THE BENEFITS OUT WAY THE HARMS.

SOMETHING WHERE THERE IS A CLOSER BALANCE AND THAT IS THAT CHOICE BETWEEN A CONVERSATION BETWEEN A PATIENT AND A CLINICIAN AND THEN THERE'S OUR D RECOMMENDATIONS WHICH SAY NO, YOU SHOULDN'T DO THAT.

I STATEMENTS ARE FOR AGAIN WHEN WE DON'T HAVE THE EVIDENCE.

WITH REGARD TO INSURANCE COVERAGE, YOU KNOW, WE RECOGNIZE THAT INSURANCE IS AN IMPORTANT PART.

BUT IT'S NOT PART OF OUR RECOMMENDATIONS.

WE VIEW IT AS PART OF LEGISLATORS REGULATE EARNINGS, AND INSURERS.

AND I WILL JUST SAY THAT THINGS THAT WE DON'T HAVE SUFFICIENT EVIDENCE OR THINGS WHERE WE MIGHT CALL IT A CHOICE, DIFFERENT INSURERS WILL CHOOSE WHETHER OR NOT TO COVER IT EVEN THOUGH IT'S NOT IN OUR HIGHEST RECOMMENDATION STATEMENTS.

>> THANK YOU, SIR.

DOCTOR, A COUPLE OF VERY INTERESTING POINTS WERE RAISED.

BUT HOW DO WE CONSIDER OR DIFFERENTIATE CHRONOLOGICAL AGE VERSUS PHYSIOLOGICAL AGE IN DECIDING WHAT WE'RE GOING TO DO.

>> THAT IS A GOOD QUESTION.

I THINK IT STARTS WITH A CONVERSATION WITH YOUR PRIMARY CARE PROVIDER.

BECAUSE THERE ARE PATIENTS OUT THERE WHO COULD BE 75 BUT BASED ON A NUMBER OF CHRONIC ILLNESSES, DISEASES, WHATNOT, MAY ACTUALLY BE PRESENTING MORE LIKE THEY ARE 10, 12, 15 YEARS OLDER AND THEN THE FLIP SIDE OF THAT PATIENTS IN THEIR 90s WHO ARE MORE ACTIVE.

THEY ARE MORE ALERT.

THEY ARE MORE OF EVERYTHING.

ON VERY FEW MEDICINES SO AT THAT POINT IT IS A CONVERSATION BETWEEN MYSELF, THE PATIENT, TO SAY YOU KNOW, IS THE ARE THERE HARMS IN DOING SCREENING?

DO THEY OUTWEIGH BENEFITS OR VICE VERSA AND MAKING SURE WE ARE ALIGNED PROVIDER AND PATIENT.

>> IS THAT A DIFFICULT DISCUSSION TO HAVE WITH THE PATIENT AND THEIR FAMILY?

>> I HAVEN'T FOUND IT TO BE SO.

USUALLY I'M TRANSPARENT ABOUT IT AND MAKE SURE THE MOST IMPORTANT THING IS INFORMATION.

MAKING SURE THE PATIENT IS INFORMED WITH ALL THE UPSIDES AND THE DOWNSIDES, WHAT DOES THIS MEAN.

I THINK A LOT OF TIMES WE TELL EVERYBODY, GET PREVENTATIVE SCREENINGS BUT WE ARE NOT SAYING WHAT HAPPENS IF THEY FIND SOMETHING.

AND I THINK THAT IS THE CONVERSATION THAT HAS TO HAPPEN.

>> PLEASE?

>> I WANT TO ADD ONE EXAMPLE TO THAT VERY, VERY GOOD ANSWER.

WE HAD A 94-YEAR-OLD PERSON WITH PARKINSON'S AND ONE OF THE SURGICAL TREATMENT OPTIONS IS DEEP BRAIN STIMULATION.

SO QUESTION IS IF YOU JUST LOOK AT THE NUMBER AGE NUMBER CHRONOLOGICAL AGE, MAY NOT BE THE RIGHT PERSON FOR THE SURGERY BUT THIS IS A PERSON VERY ACTIVE.

ENJOYS THE LIFE VERY MINIMAL NUMBER OF MEDICATIONS WITHOUT YES, THIS PERSON, THIS PROBLEM IS DEBILITATING AGE IS JUST A NUMBER HERE.

THIS PERSON SHOULD GET IT.

GOT THE SURGERY IS DOING VERY GOOD.

>> WHEN WE THINK OF SCREENING, YOU ARE THINKING ABOUT A DISEASE THAT IS COMMON AND TWO, YOU HAVE SOMETHING THAT YOU CAN DO TO TRY TO HELP THE PATIENT.

AS WE'RE GETTING OLDER MANY OF US ARE CONCERNED WITH ALZHEIMER'S DISEASE.

WHERE DO YOU SEE SCREENING FOR THAT?

IS THAT SOMETHING THAT WE CONSIDER?

OR IS IT YOU WAIT MORE OF DIAGNOSTIC STUDIES?

>> RIGHT.

SCREENING TO BE DONE BY THE PROVIDERS.

WHEN DO YOU GO TO THE PROVIDER IS THE FIRST QUESTION?

THE ANSWER FOR THAT IS IF YOU HAPPEN TO SEE SHORT-TERM MEMORY PROBLEMS OR DIFFICULTIES YOU ARE HAVING DAY IN AND DAY OUT.

SOMETIMES THE PERSON MAY NOT NOTICE ITS IT'S THE FAMILY MEMBER WHO NOTICES IT.

SO GOING AND GETTING SCREENED AND DIFFERENTIATING WHAT IS AGING VERSUS WHAT IS PATHOLOGY OR SOME COGNITIVE PROBLEM.

OR SOMETIMES IT'S MILD COGNITIVE IMPAIRMENT WHERE YOU CAN WAIT-AND-SEE OR DO SOME DIAGNOSTIC TESTS NOT JUMP ON TO MEDICATIONS THAT IS ABOUT MEMORY.

IF YOU ALSO HAPPEN TO SEE ANY SUDDEN CHANGE IN THE PERSONALITY, TOO, THAT IS ALSO A RED FLAG TO GO TO THE DOCTOR.

IF YOU HAPPEN TO SEE ANY ADDITIONAL ABNORMAL MOVEMENTS INVOLUNTARY MOVEMENTS WHICH ARE HAPPENING WITH COGNITIVE PROBLEMS, THEN ALSO YOU GO TO THE DOCTOR.

IF YOU HAPPEN TO SEE SUDDENLY THE MEMORY IS WORSENING AND STABILIZES FOR SIX MONTHS AND WORSENS AGAIN THIS PROGRESSION SOMETHING ELSE IS GOING ON GOING TO THE DOCTORS.

>> DOCTOR, WE'VE SEEN REALLY LEAP FORWARDS IN TERMS OF PROCEDURES FOR HIP AND KNEE REPLACEMENTS.

ALMOST TO THE POINT THAT THESE THINGS ARE BEING DONE AS AN OUTPATIENT.

SOME PEOPLE GO HOME THE SAME DAY.

WHAT ABOUT THAT IN THAT PATIENT?

HOW DO YOU DETERMINE WHEN I'M GOING TO SAY IT'S OKAY FOR YOU TO GO AHEAD AND CONSIDER HAVING KNEE SEVERE CHANGES WHAT IS THE CRITERIA YOU ARE LOOKING AT FOR THE HIP?

>> MAKING SURE WE'VE OPTIMIZED EVERYTHING NONSURGICAL FIRST.

WHETHER THAT IS PHYSICAL THERAPY OR MEDICATION OR EXERCISES, AND THEN SITTING DOWN AND REALLY REVIEWING THE PATIENT'S MEDICAL HISTORY.

SO WHAT ARE YOUR CHRONIC ILLNESSES?

WHAT CHRONIC DISEASES COULD PUT YOU AT RISK TO UNDERGO SURGERY BECAUSE THAT IS MAJOR SURGERY PARTICULARLY IF YOU ARE TALKING ABOUT GENERAL ANESTHESIA.

OPTIMIZE YOU TO BE THE BEST SURGICAL CANDIDATE YOU COULD BE GOING IN.

BUT I THINK ONCE THE MOBILITY IS SEVERELY IMPAIRED OR PEOPLE ARE HAVING PAIN THAT IS THAT BEING WELL CONTROLLED, WITH MEDICATIONS, THEN DEFINITELY.

I WOULD SAY BEFORE YOU GET TO THAT POINT YOU WANT TO START HAVING THOSE CONVERSATIONS.

>> WHO IS THE ONE THAT TENDS TO PUSH MORE FOR THE SURGERY AND WHO IS THE ONE THAT IS SAYING, I DON'T THINK I WANT MAMA TO HAVE THE SURGERY?

IS IT LIKE ONE PERSON IS SAYING YEAH, OR ANOTHER PERSON IS SAYING NO, NO.

>> I THINK WHEN YOU THINK ABOUT THE FAMILY MEMBERS SOMETIMES THE FAMILY MEMBER WILL BE PUSHING FOR IT BECAUSE THEY ARE OBSERVING THE PATIENT HAVING THE DIFFICULTIES AND THE PAIN.

THEY WILL SAY YOU NEED TO GET THIS DONE.

>> SINCE YOU BROUGHT IT UP, LET'S MOVE OUR DISCUSSION AND TALK ABOUT WHO AND WHAT COULD HAPPEN UNDER ANESTHESIA.

BECAUSE THAT IS A KEY PROBLEM.

I HAD A CHANCE TO SPEAK WITH JIAPENG HUANG AND WE TALKED ABOUT THIS VERY SUBJECT.

ARE THERE SPECIFIC COMPLICATIONS AND OR RISK FOR THE ODDER PATIENT UNDERGOING GENERAL ANESTHESIA?

>> THERE ARE QUITE A FEW.

WHEN WE GET OLDER OUR CARDIOVASCULAR SYSTEM IS WEAKER.

WHEN WE ARE YOUNGER YOUR BLOOD PRESSURE IS LOW.

BUT WE WE GET OLDER THE ABILITY DECREASES.

SO WHEN WE PUT AN OLDER PATIENT TO SLEEP THERE IS A HIGHER CHANCE OF LOW BLOOD PRESSURE.

THAT IS ONE THING I WORRY ABOUT.

THE SECOND THING I WORRY ABOUT IS THE LUNGS.

WHEN WE GET OLDER, IT'S MORE DIFFICULT TO BREATHE.

AND WE USE A LOT OF MEDICATIONS TO PUT YOU TO SLEEP ONE OF THE MEDICATIONS.

SO THAT IS A MEDICATION TO CONTROL YOUR PAIN AND CAN REDUCE YOUR CHANCE FOR BREATHING AGAIN.

SO THOSE ARE THE TWO MAJOR RISKS THE HEART AND THE LUNG SYSTEM.

THE OTHER ONE IS CALLED A POST-OPERATIVE COGNITIVE DYSFUNCTION.

SIMPLY PUT SOME ELDERLY PATIENTS AFTER ANESTHESIA THEY HAVE TROUBLE MEMORIZING THINGS.

TROUBLE WITH MEMORY LOSS.

TROUBLE WITH THINKING.

SO WE CALL THAT COGNITIVE DYSFUNCTION.

SOMETHING OUR COMMUNITY HAS BEEN STUDYING QUITE A BIT TO SEE HOW TO REDUCE THAT CHANCE.

BUT THOSE ARE THE THREE MAJOR THINGS, THE HEART, THE LUNG AND THE BRAIN.

THOSE ARE THE THREE THINGS WE ARE CONCERNED ABOUT.

>> ARE THERE ANYTHING THAT WE CAN DO PRIOR TO SURGERY, ESPECIALLY IF YOU ARE TALKING ABOUT AN ELECTIVE PROCEDURE TO TRY TO IMPROVE THAT PATIENT'S CARDIOVASCULAR, PULMONARY AND OR COGNITIVE FUNCTIONING TO LESSEN THE RISK?

>> DEFINITELY.

THAT IS A REALLY GOOD QUESTION.

THE FIRST THING YOU CAN DO IS TALK TO AND AANESTHESIOLOGIST.

AND MOST OF THE TIME, WE WANT TO TALK TO YOU.

STOP BY OUR CLINIC AND WE'LL GET ALL THE INFORMATION FROM YOU.

AND THE BEST THING TO DO IS TO BRING SOMEBODY WHO CAN TAKE CARE OF YOU.

WHO IS YOUR CAREGIVER A FAMILY MEMBER SO THEY MIGHT KNOW MORE ABOUT YOUR MEDICAL HISTORY AND MEDICATION AND OTHER CONDITIONS.

THAT IS NUMBER ONE TALK TO US.

COME TO OUR CLINIC.

AND THE SECOND ONE THAT WE SEE IS FRAILTY.

WHEN WE GET OLDER PEOPLE GET FRAIL.

SO MAKE SURE YOU EXERCISE, MAKE SURE YOU EAT RIGHT.

MAKE SURE YOUR NUTRITION IS GOOD AND THOSE ARE VERY IMPORTANT FOR YOUR RECOVERY.

AND THE OTHER ONE IS STOP SMOKING.

IN KENTUCKY SMOKING IS A BIG ISSUE.

AND IF YOU SMOKE, THAT WILL MAKE THE BREATHING MUCH WORSE.

ONCE WE PUT YOU TO SLEEP WE HAVE TO PUT A BREATHING TUBE TO HELP YOU IF YOU SMOKE AND THE CHANCE FOR YOU HAVING A PULMONARY ISSUES IS HIGHER.

AND THE THIRD ONE IS REALLY EXERCISE OUR BRAIN.

DON'T SIT AT HOME AND WATCH TV WATCH YOUR PHONE ALL THE TIME.

AND GO OUTSIDE, EXERCISE, AND DO SOME WORK PUZZLE.

AND DO SOME READING.

THOSE ALL WILL HELP YOUR COGNITIVE DYSFUNCTION AFTER ANESTHESIA.

AND WE DO A LOT OF THINGS.

WE WE ARE CONCERNED ABOUT YOU HAVE BRAIN MEMORY ISSUES WE WILL DO ASSESSMENT SO WE HAVE A BASE PRIOR TO.

MOST OF THE TIME WHEN YOU COME TO TALK TO US, BEFORE SURGERY, BEFORE ANESTHESIA, WE'LL GIVE YOU DETAILED INSTRUCTION WE WANT YOU TO BE DONE AND FOLLOW THE INSTRUCTION ANDS AND IT WILL REDUCE THE CHANCE FOR ANY COMPLICATION.

>> TELL ME THEN WE ARE AN AGING POPULATION, AND THERE ARE MORE AND MORE SURGICAL PROCEDURES CONSIDERED ELECTIVE.

IF I'M HEARING YOU CORRECTLY, BECAUSE SOMEONE IS OLDER, DOESN'T NECESSARILY MEAN THEY SHOULD NOT HAVE THESE PROCEDURES.

BUT WHAT ARE THE RED FLAGS THAT SAY, HEY THIS OLDER PATIENT MAY NOT BE A GOOD CANDIDATE FOR ME?

>> THAT IS A REALLY GOOD QUESTION.

THERE'S ALWAYS RISK AND BENEFITS ASSESSMENT FOR ANY PROCEDURES.

WORK WITH THE SURGEONS AND WE WILL WORK WITH THE PRIMARY CARE DOCTOR AND WORK WITH YOU THE PATIENT.

AND TO DETERMINE.

AND SOME OF THOSE MAJOR ISSUES, LET'S SAY IF YOU HAVE HEART FAILURE AND ESPECIALLY THE HEART IS NOT CONTROLLED YOUR CARDIOLOGIST IS NOT ABLE TO CONTROL YOUR HEART THAT MIGHT BE DANGEROUS TO HAVE A PROCEDURE.

HOWEVER, YOU KNOW AS I SAID EARLIER ONE OF THE MAJOR PROCEDURES WE DO IS HIP FRACTURES.

IF YOU ARE AT HOME AND YOU FELL YOU BROKE YOUR HIP AND COME TO PROCEDURE, WE HAVE TO FIX THAT HIP WITHIN 24 HOURS.

AND OTHERWISE, THE RISK FOR YOU TO DIE FROM THE HIP FRACTURE IS HIGHER.

IT IS A RISK AND IN THAT CASE ALTHOUGH YOU HAVE HEART FAILURE AND I MIGHT BE ABLE TO TONE YOU UP AND CONTROL YOUR HEART FAILURE AND DO THE PROCEDURE.

THE OTHER MAJOR ISSUE WE HAVE IS COPD, CHRONIC OBSTRUCTIVE PULMONARY DISEASE AND SMOKING IS COMMON IN KENTUCKY IF YOU USE OXYGEN AT HOME FOR YOUR COPD, AND THEN IT WILL INCREASE YOUR RISK MUCH, MUCH HIGHER.

WHEN WE SEE YOU IN THE PREAFTERNOON THEZ YEAH CLINIC THAT IS A RED FLAG FOR ME.

AND THE THIRD IS REALLY IF YOU HAD A STROKE BEFORE.

IF YOU'VE HAD A STROKE THE CHANCE FOR COGNITIVE DYSFUNCTION AFTER SURGERY IS MUCH HIGHER.

WE ARE CAREFUL WITH THOSE PATIENTS, TOO.

AND CERTAINLY OTHER ISSUES SUCH AS SOME PEOPLE GOT BAD DIABETES AND WHEN WE GET OLDER THE CHANCE FOR DIABETES IS MUCH HIGHER AND IF THE FLU KOS IS NOT CONTROLLED -- GLUCOSE IS NOT CONTROLLED THAT IS CONCERNING.

300 AND ABOVE I WILL NOT DO THE PROCEDURE.

>> THANK YOU VERY MUCH.

WE KNOW THAT ANESTHESIA IS SAFE FOR A LOT OF US.

AS YOU HEARD THE DOCTOR MADE A POINT SAYING POST-OPERATIVE MENTAL STATUS CHANGES.

WHAT IS LEADING INTO THAT?

AND IS IT SOMETHING THAT YOU CAN TELL THAT MAY SAY THIS PERSON IS INCREASED RISK?

>> RIGHT.

SO I THINK COGNITIVE RESERVE IS THE ANSWER FOR THAT.

SO TO GIVE YOU AN EXAMPLE, IF A 10-YEAR-OLD KID GETS SOME URINARY TRACT INFECTION IT WILL LIMIT THAT KID WILL NOT HAVE HALLUCINATIONS OR CONFUSION AND YOU TREAT THAT WITH ANTIBIOTIC AND IT IMPROVES WITHIN A DAY.

BUT SAME IS NOT THE CASE IN A PERSON WHO IS HAVING LOWER COGNITIVE RESERVE.

OR THE TIME WITH JUST WITH AGING AFTER 21 OR CELLS START SHRINKING IN THE BRAIN.

AND THE ABILITY OF THE CELLS TO ACT MORE ESPECIALLY WHEN THERE'S MEDICAL ILLNESS GOING ON, IS NOT UP TO THE MARK AND THAT'S WHAT CAN PUSH THE PERSON INTO THIS CONFUSIONAL STATE WHICH WE CALL AS DELIRIUM.

AND IF A PERSON HAS SUCH MANIFESTATION AFTER A SURGERY OR ANESTHESIA, THAT TELLS THAT PROBABLY THERE IS LOWER COGNITIVE RESERVE WHEN THINGS AT LEAST GET BACK TO BASELINE EVENTUALLY THAT PERSON NEEDS TO HAVE THAT COGNITIVE SCREENING SHOULD BE DONE.

SO THE ANSWER FOR THAT IS LOWER COGNITIVE RESERVE THAT PUTS YOU AT RISK FOR HAVING COGNITIVE DYSFUNCTION TRANSIENTLY OR DECREASE OVER THE LONG RUN OR SUDDENLY HAVE DELIRIUM.

>> ONE OF THE THINGS WE SOMETIMES SEE IN OLDER PATIENTS AS OPPOSED TO YOUNGER PATIENTS IS WHAT WE USED TO REFER TO AS SUNDOWNING.

AS THE SUN GOES DOWN, THE PATIENT BECOMES MORE AND MORE CONFUSED.

IS THAT JUST AN INAPPROPRIATE OBSERVATION OR A REAL THING THAT WE SEE?

AND HOW DO YOU RECOMMEND WE COMBAT THIS?

>> RIGHT.

SUNDOWNING IS GENUINE.

IT'S ESPECIALLY YOU SEE THE MANIFESTATIONS OF THAT AGAIN IN A PERSON WITH ANY CHRONIC NEUROLOGICAL PROBLEM.

A PERSON WITH DEMENTIA ESPECIALLY MODERATE ADVANCED DEMENTIA YOU SEE THE PATTERN WITH THE CIRCADIAN RHYTHM YOU SEE THE SUNDOWNING WHICH COMES WITH FATIGUE, WHICH COMES WITH CONFUSIONAL STATE AND CAN HAVE HALLUCINATIONS AROUND THAT TIME.

WHEN THAT HAPPENS, ADDRESSING THE UNDERLYING SLEEP DISORDER SHOULD HAPPEN.

SOMETIMES WE'LL HAVE TO TAKE HELP OF SLEEP SPECIALISTS THERE, TOO.

AND ALSO MAKING SURE THAT THERE'S AMPLE ENOUGH LIGHTING AT THE HOME WHERE THEY LIVE THAT IS ALSO IMPORTANT.

AND IF EVEN THEN WITH THIS NONMEASURES IF IT IS NOT IMPROVING SOMETIMES WE RECOMMEND MEDICATION TO BE GIVEN RIGHT AROUND THAT TIME WHICH ACTS AS A SYMPTOMATIC MEDICATION TO PREVENT THOSE MANIFESTATIONS.

>> AFTER SURGERY MANY OF US WILL HAVE PAIN.

BUT WE HAVE TO BE CAREFUL ON MANAGEMENT OF THAT.

WHAT DO YOU HAVE TO TAKE INTO ACCOUNT AND WHAT DO YOU RECOMMEND FOR PAIN CONTROL FOR THAT PERSON FOLLOWING A PROCEDURE?

>> I THINK WHEN YOU'RE TALKING ABOUT SOMEONE AS THEY AGE AND PAIN CONTROL, YOU DO HAVE TO BE VERY CAREFUL.

BECAUSE A LOT OF THE MEDICATIONS WE USE ARE OPIOIDS.

WE KNOW WHAT THEY CAN DO.

THEY CAN SEDATE YOU.

THEY DEFINITELY MAKE YOU MORE SLEEPY.

DEPRESS YOUR BREATHINGS.

ANDTH THAT CAN LEAD TO FALLS.

IT CAN LEAD TO BEING UNAWARE OF YOUR SURROUNDINGS.

AND IT CAN ALSO CAUSE MEDICATION ERRORS IN YOUR TYPICAL DAILY MEDICATION YOU HAVE TO TAKE THOSE THINGS INTO ACCOUNT WHEN YOU ARE PRESCRIBING.

AT THE SAME TIME, YOU WANT TO HAVE ADEQUATE PAIN CONTROL SO PEOPLE CAN HEAL AND GET UP IF THEY HAVE HAD A SCROINT REPLACED THEY NEED TO BE MOVING.

I THINK THERE IS RECOMMENDATIONS WITH WHEN YOU ARE PRESCRIBING FOR AN ELDERLY POPULATION WHERE DO YOU START?

SO YOU START LOW.

AND YOU RAMP UP SLOW.

VERSUS STARTING AT THE HIGHEST DOSE POSSIBLE AND YOU ARE DOING CHECK INS TO SAY IS YOUR PAIN UNCREDITOR CONTROL ARE YOU HAVING SIDE EFFECTS.

>> IS THAT A DISCUSSION JUST WITH THE PATIENT OR WITH THE PATIENT'S FAMILY AND OR CAREGIVERS.

>> BOTH, ABSOLUTELY BOTH.

FOR THE FIRST COUPLE OF DAYS AFTER ANYONE HAS HAD SURGERY, IT'S THE PERSON WHO IS HELPING YOU THAT HAS THE INSTRUCTIONS.

>> AN INTERESTING EXAMPLE ABOUT A YOUNG PERSON URINARY TRACT INFECTION THEY TAKE ANTIBIOTICS AND IT GOES AWAY.

BUT AS WE GET OLDER, I DON'T KNOW IF I SHOULD SAY, THEY HAVE SOME OTHER CONDITIONS GOING ON, BUT WHAT WOULD SEEM LIKE A SIMPLE PROBLEM IS MORE SIGNIFICANT.

SO HOW DO YOU ADDRESS THAT?

>> I THINK MAKING SURE THAT THE PATIENTS THEMSELVES ARE AWARE THAT AS WE GET OLDER YOU KNOW, THE TYPICAL RUN OF THE MILL ILLNESSES MAY PRESENT DIFFERENTLY THEY MAY LOOK DIFFERENTLY.

A URINARY TRACT INFECTION BURNING WITH URINATION GOING TO THE RESTROOM MORE FREQUENTLY THOSE ARE ARE THE TYPICAL SIGNS YOU SEE.

AS YOU GET OLDER IF YOU HAVE AN INFECTION YOU SEE IT HAPPENING MORE IN MALES AS WELL AS IF FEMALES WHICH IS NOT THE USUAL AND WHEN YOU ARE YOUNGER IS IN FEMALES AND YOU WILL SEE PATIENTS HAVING CONFUSION.

THEY WILL HAVE SIGNS OF DELIRIUM THEY MAYBE SLEEPING FOR HOURS, HOURS DURING THE DAY AND IT'S USUALLY A FAMILY MEMBER WHO WILL NOTICE IT.

BUT I HAVE HAD ON OCCASION A PATIENT SAYING I FEEL FOGGY AND I'M NOT THINKING CLEARLY AND THAT IS THE FIRST STEP TO CHECK A URINE TEST.

>> ANOTHER THING FOR US WE KNOW IN CERTAIN AREAS THERE ARE FOOD DESERTS.

AND THINGS MAY NOT BE ACCESSIBLE FOR CERTAIN PEOPLE TO GET TO IF IT IS A GOOD STORE NEARBY.

AS WE GET OLDER OUR DIETARY PATTERNS SEEM TO CHANGE A LITTLE BIT.

HOW DOES THAT IMPACT NUTRITION AND WHAT DO YOU TELL YOUR PATIENTS?

>> SOME PATIENTS ARE LESS HUNGRY, I HEAR THAT.

I'M JUST NOT AS HUNGRY AND SOME IS DUE TO LACK OF ACTIVITY.

I FIRST THING I SAY WHAT DO YOU DO THROUGHOUT THE DAY, HOW ACTIVE ARE YOU?

AND THE SAME CAN RELATE TO SLEEP, TOO.

I WILL HAVE PATIENTS I'M NOT SLEEPY AND TO BE SLEEPY YOU HAVE TO HAVE ACTIVITY THROUGHOUT THE DAY FOR YOUR BODY TO NEED TO RECHARGE.

WHEN IT COMES TO FOOD, IT IS IMPORTANT SOMETIMES I HATE TO SAY FORCE FEED BUT IT IS IMPORTANT TO I'D SAY EAT THROUGHOUT THE DAY OR GRAZE THROUGHOUT THE DAY VERSUS TRYING TO FORCE YOURSELF TO HAVE THREE LARGE MEALS.

BREAKING THEM INTO SIX SMALLER MEALS MAKES SENSE FOR A LOT OF PEOPLE.

AND MAKING SURE THAT EACH MEAL HAS A GOOD BALANCE BETWEEN YOUR FATS, CARBOHYDRATES YOUR PROTEINS.

SO THAT YOU STAY FULL AND YOU'RE GETTING ADEQUATE NUTRITION.

>> MY FAVORITE WORD GRAZING.

AT NIGHT I LOVE TO GRAZE THAT IS MY PROBLEM.

>> NOT AT NIGHT.

>> YOU ELUDED TO IT WE ARE NOT SLEEPING WELL.

HOW DOES SLEEP OR LACK THEREOF OR THAT CHANGING SLEEP PATTERN WHAT IS GOING ON?

DO WE NEED LESS SLEEP OR MORE SLEEP?

WHY DO WE SEE THIS DISRUPTIVE PATTERN.

>> GREAT QUESTION.

SLEEP.

RECENTLY THERE WAS WE HAD AMERICAN ACADEMY OF NEUROLOGY MEETING AND THEY EMPHASIZED HOW IMPORTANT THE SLEEP IS FOR HEALY FOR HEALTHY SLEEP HAS TO BE GOOD.

THERE ARE A VARIETY OF PROBLEMS WHICH CAN HAPPEN WITH SLEEP ESPECIALLY IN PEOPLE WHO ARE HAVING NEUROLOGICAL PROBLEMS.

SOMETIMES THE PROBLEM IS FALLING ASLEEP OR SOMETIMES THE PROBLEM IS MAINTAINING SLEEP OR SOMETIMES EARLY MORNING AWAKENING AND THOUSAND YOU CAN'T GO BACK TO SLEEP.

THE FIRST ONE IS ACTUALLY COMMON IN TEENAGERS THEY ARE WATCHING TV.

SO THAT BRINGS THE EXAMPLE OF WHEN WE ARE ADDRESSING THE SLEEP PROBLEMS ANY OF THE SLEEP PROBLEMS, MAINTAINING SLEEP HYGIENE IS IMPORTANT THAT MEANS NOT HAVING A TV IN YOUR BEDROOM.

BEDROOM SHOULD BE THERE FOR SLEEPING ONLY AND SO THAT YOU CAN GO TO SLEEP AS SOON AS YOU HIT THE BED.

THAT SLEEP HYGIENE HAS TO BE MAINTAINED.

EVEN THEN IF IT IS NOT HELPING THAT'S WHERE THE VARIETY OF MEDICATIONS INCLUDING SOMETHING WHICH IS OVER-THE-COUNTER AND NATURAL CALLED MELATONIN CAN SOMETIMES HELP.

THAT IS WHERE YOUR PROVIDER CAN HELP YOU FIND OUT WHAT IS THE RIGHT MEDICATION DEPENDING WHEN IS THE SLEEP PROBLEM HAPPENING THAT IS NUMBER ONE.

I WANT TO ADD NUMBER TWO.

SOMETIMES IT'S NOT A PRIMARY SLEEP PROBLEM.

TO GIVE YOU AN EXAMPLE, IF YOU HAPPEN TO SEE A PERSON WITH NEUROLOGICAL PROBLEM OR THE LONG RUN THEY CAN HAVE URINARY PROBLEMS DO.

THE PERSON IS WAKING UP TO GO TO THE BATHROOM THE SLEEP IS DISTURBED AT THAT TIME.

CAN'T GO BACK TO SLEEP.

IN THAT EXAMPLE, ADDRESSING THAT URINARY FREQUENT URINARY PROBLEM ADDRESSING THAT SHOULD BE THE SOLUTION FOR ADDRESSING SLEEP PROBLEMS.

OVERALL, HAVING A GOOD NUMBER OF HOURS AND FULL STRETCH OF SLEEP IS IMPORTANT FOR THE WHOLE HEALTH AND FOR YOU TO FUNCTION FULLY THE FOLLOWING DAY.

>> I WANT BOTH YOU TO TO COMMON, FIRST, WE SEE ALL THIS INFORMATION, DO THESE ELUDED TO EXERCISING FOR THE BRAIN, DO THESE BRAIN EXERCISES CROSSWORD PUZZLES, AND ALL THESE OTHER WONDERFUL THINGS TO EXERCISE THE BRAIN.

ARE WE REALLY GETTING A BENEFIT AND SUPPLEMENTEDS AND IT WILL IMPROVE YOUR BRAIN POWER?

>> RIGHT.

EXCELLENT QUESTION.

>> DO YOU RECOMMEND ANY OF THAT?

>> NO.

I DO NOT RECOMMEND IT.

NO.

SO LET'S TALK ABOUT BRAIN EXERCISES.

THERE HAS BEEN STUDY, STUDIES DONE LOOKING THE THAT UNFORTUNATELY, THEY HAVE NOT SHOWN ANY CLEAR BENEFIT.

THAT SAID, KEEPING YOURSELF PHYSICALLY ACTIVE AND MENTALLY ACTIVE, IS IMPORTANT NOT JUST FOR BRAIN STANDPOINT BUT FOR THE WHOLE HEALTH.

SO SECOND IS OVER-THE-COUNTER VITAMINS MINERALS, ANTI-OX DANTDS, SOMETIMES THERE IS A FULL LIST WHICH IS BROUGHT TO OUR NOTICE.

MY ANSWER FOR THAT IS I WILL TELL YOU A SCIENTIFIC ANSWER BUT MY ANSWER TO THAT IS YOU ARE ALREADY TAKING THESE MEDICATIONS PRESCRIBED BY YOUR DOCTOR, AND YOU ARE TAKING ALL THESE PILLS LESS MEDICATIONS IS THE BETTER APPROACH.

ANY PHYSICIAN WILL THINK IN THE SAME WAY, LESS MEDICATIONS ARE BETTER.

THE SCIENTIFIC ANSWER FOR THAT IS EVERYTHING INCLUDING COHEN SOMETIMES INDEPENDENTLY, ALL THOSE VITAMINS UNLESS THEY ARE DEFICIENT AND CAUSING THAT THEY HAVE NOT SHOWN BENEFIT IN ANY NEWER ROJ CAL PROBLEMS.

>> WHAT DO YOU SAY?

>> I COMPLETELY AGREE.

I THINK BEING ACTIVE WHETHER YOU ARE READING, YOU ARE DOING THE CROSSWORD PUZZLES, YOU'RE SOCIALIZING YOU ARE EXERCISING I THINK THAT IS IMPORTANT FOR WHOLE PERSON HEALTH.

AS FAR AS THE VITAMINS AND THE EXTRA ENZYMES I AM IN COMPLETE AGREEMENT HERE.

I THINK A MULTIVITAMIN A DAY IS WHERE IT SHOULD STOP.

IN ADDITION TO WHATEVER PRESCRIBED MEDICINES YOU ARE ON.

ONLY IF THERE IS A DEFICIENCY IN SOMETHING I WOULD RECOMMEND IT.

>> DOCTOR, FROM THE NEUROLOGISTS PERSPECTIVE WHAT IS THE TAKE HOME POINT THAT YOU WANT US TO HAVE ABOUT WHAT WE NEED TO DO TO KEEP THE BRAIN GOOD AND WATCH OUT AS FAR AS MOBILITY DISORDERS?

>> RIGHT.

TO SUMMARIZE HEALTHY AGING MEANS HAVING A GOOD SLEEP, ABLE TO ENJOY WHAT YOU LIKE TO ENJOY IN THE PAST ABLE TO DO EVERYTHING WHAT YOU WANT TO DO.

THAT IS THE FINAL TARGET.

HOW TO REACH THERE, ONE IS ABOUT WE TALKED ABOUT PREVENTATIVE THINGS, WHAT IS HEALTHY DIET, THE SIMPLE MEANING OF HEALTHY DIET IS YOUR PLATE SHOULD LOOK COLORFUL.

A LOT OF COLORS GREEN VEGETABLES AND FIBER, MEDITERRANEAN DIET HAVE HELPED WITH CARDIOVASCULAR RISK FACTORS LOOK IT UP.

THAT'S GOOD ONE TO THINK ABOUT.

HEALTHY DIET AND SECOND THING WHICH IS IN YOUR HANDS IS REGULAR EXERCISE CAN BE REGULAR WALKING, SO NO EXCUSES LIKE BAD WEATHER YOU CAN DO AT HOME WITH A BIKE AND THAT HAS SHOWN BENEFIT FROM NEUROLOGICAL ILLNESSES STANDPOINT, TOO.

GOOD FOOD, GOOD EXERCISE AND REACH THAT TARGET.

>> ALL RIGHT.

GIVE ME WITHIN A MINUTE?

>> I'D SAY -- >> HE SAID ALL THE GOOD STUFF.

>> MAKE SURE THAT YOU ARE SEEING YOUR PRIMARY CARE PROVIDER ON A REGULAR BASIS.

I THINK HAVING THOSE CONVERSATIONS MAKING SURE THAT YOU'RE DISCUSSING PREVENTATIVE CARE MEASURES AND DISCUSSING DIET AND DISCUSSING EXERCISE.

BUT THAT YOU HAVE SOMEONE WHO IS HELPING AND PARTNERING WITH YOU AND YOUR HEALTHCARE BECAUSE THE GOAL IS TO HAVE THE BEST QUALITY OF LIFE AS POSSIBLE.

>> THANK YOU VERY MUCH.

THOSE ARE VERY, VERY GOOD POINTS.

BECAUSE I THINK AT THE END OF THE DAY WE WANT EVERYONE OUR FRIENDS OUR FAMILY MEMBERS TO BE AS HEALTHY AS THEY POSSIBLY CAN BE.

AND FROM WHAT I'M HEARING FROM YOU TWO THE BIG POINTS ARE EAT WELL, NOT GRAZE.

GET LOTS OF SLEEP.

YOU CLEARLY LIVE IN A QUIET NEIGHBORHOOD AND YOU DON'T HAVE AIRPLANES FLYING OVER YOU.

AND SEEING OUR DOCTORS NOT TAKING TOO MUCH MEDICATION NOT DEPENDING ON A MIRACLE DRUG BE SENSIBLE, EXERCISE, SIMPLE EXERCISES AND ONE OF THE THINGS ALSO IS KEEPING OUR HOMES SAFE.

I THINK WHAT?

GETTING SOMEONE TO COME IN AND TAKE A LOOK AT DO WE HAVE THE THROW RUGS AND THE WIRES AND EVERYTHING KEEP ALL THAT.

SO I THINK WE CAN DO IT.

WE CAN BE AS HEALTHY AS WE CAN BE AND LIVE FOR A LONGTIME WITH GOOD QUALITY OF LIFE.

I LIKE TO THANK YOU FOR WATCHING.

HEALTHY AGING A KET FORUM AND THANK YOU TO OUR PANEL FOR BEING WITH US AND OUR AUDIENCE MEMBERS BEING HERE TODAY.

A LOT OF RESOURCES AND MORE INFORMATION ABOUT KET'S NEXT CHAPTER INITIATIVE THAT FOCUSES ON THE CHALLENGES AND REWARDS OF AGING CAN BE FOUND ON OUR WEBSITE AT KET.ORG/NEXT CHAPTER.

I'M Dr. WAYNE TUCKSON HAVE A GOOD NIGHT, EAT WELL AND WE'LL SEE YOU ON THE NEXT FORUM.

[♪♪]