Featured Guest:

Gabrielle Ruff, M.D., MPH

• Special interests: Geriatric/Senior Health Medicine
• Medical School: The Ohio State University, Columbus, OH
• Residency & Fellowship: Summa Health System
• Board Certifications: Internal Medicine, Geriatric Medicine

Transcription:

Scott Webb (Host): Caring for an aging parent can be challenging for caregivers trying to navigate the growing needs of their loved ones. And joining us today is Summa Health Geriatric Medicine Specialist, Dr. Gabrielle Ruff. She's here to answer some of the most commonly asked questions that she gets from caregivers who are seeking support for health and social needs for their aging loved ones.

This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Gabrielle, it's so great to have your time. We're going to talk about senior healthcare and when we should possibly consider moving to higher levels of care and supervision and so on. So we've got a lot to cover today. Just as we get rolling here though, how do we know when it's time to seek senior healthcare and is that different than other types of care?

Dr. Gabrielle Ruff: I'm gonna actually answer that by saying there really is no wrong time to seek senior care. We have patients that come in because they have a specific issue, like memory loss or concern about their medications. But we also have patients that come in because they just want to get a comprehensive senior assessment and establish a baseline level of either cognitive or physical status, as well as just figure out how they can age well. And that's why I say there's really no wrong time to seek senior healthcare because there are a lot of reasons people come to us and they are all appropriate. We work really closely with a lot of primary care providers in the area, so primary care and senior healthcare are not mutually exclusive. We co-manage with these primary care providers for a variety of senior health needs.

Scott Webb: Yeah. And so when seniors and or their families come in for that baseline, what types of health assessments do you provide?

Dr. Gabrielle Ruff: We provide what I like to call a multi-domain assessment. Senior healthcare is at its core, a very collaborative practice, so we are working with a multidisciplinary team of social workers, advanced practice providers and pharmacists. We actually tend to have longer appointment slots, and this additional time allows us to provide a more in-depth assessment of patients that we're working with.

And we know that the environment surrounding the patient is just as important as the physiologic processes happening inside, and we know it takes time to delve into that. That's a little bit of difference that you may see between our practice and maybe a primary care practice. But that multi-domain assessment we provide includes looking at not just the medical components, but the mental, physical, environmental, and spiritual components as well.

We may look at things like weight and nutrition, making sure that someone is maintaining a healthy weight. We look at medications and ensure that the medications a senior patient is on are actually appropriate for their age and the changes in physiology that happen as we all get older. We look at cognitive status.

Sometimes we're just again looking at someone's cognitive status for a baseline that we can later compare to if we need to, or sometimes we're actually diagnosing a change in cognition and giving our patients and their caregivers tips on how to navigate those changes. We also look at emotional status, mood, functional status, fall risks, living environment, and most importantly, what matters to the patient when it comes to quality of life.

So goals of care conversations are also a type of assessment that we do in our practice.

Scott Webb: Yeah, there's some buzzwords in medicine over the last few years, multidisciplinary being one of them. So I love hearing that and just love of hearing that you really listen to prospective patients and their families. And my wife is sort of confronting this with her dad. He wants to stay home, right?

He's not interested in going someplace else, which I'm sure is a common theme, but I think she's a little bit concerned about his safety, and I'm sure others have those same concerns. So what can we do, you know, if we've got those seniors in our lives that we care for and we love, and we want to keep them safe, what can we do to keep them safe?

Dr. Gabrielle Ruff: This is a discussion that is never going to go away and it is an appropriate conversation. Again, I'm sure your wife wants the best for her, for her father, and I think comes, sometimes that struggle comes because we try to balance autonomy and dignity with safety, and that's not always easy. Trying to respect an individual's right to live in the environment that makes them the happiest, but to also make sure that environment is safe.

So the first thing I would recommend for anyone facing this dilemma is have that conversation with your loved one about what your specific concerns are. I think you will find you will get much further in making a plan for safety if you start with that. Because when you start with a conversation, you're letting that individual know that you love them, you respect them and you realize that they have a part in this discussion and they are part of this decision process.

After you have the conversation and share what your specific concerns are, it really depends then on what the safety concerns might be. For some of our patients, just fall hazards are the biggest concerns. So looking through the home, looking for fall hazards. Throw rugs are lovely for décor.

Scott Webb: I thought you might say, uh, yeah, I thought you might say throw rugs. That'd be at the top of my list, right?

Dr. Gabrielle Ruff: Yes, yes. Horrible fall risk. The throw rugs. So looking for things like that and removing them. That is definitely gonna be already improving the safety environment of your loved one. A medical alert device is another great way to increase the safety of someone at home. Sometimes individuals may fall on their home, they're not near a phone or a, a device that allows them to call out for help. Having a medical alert device on their person, gives them the opportunity to push the button or even just have the device detect a fall and have help contacted. In some unique situations, some of our patients families have actually placed cameras in the home.

That is not something I recommend for everybody. Again, that is for very unique situations. Other things include using a pill box. It's a great way to make sure that you took a medication and you're able to see if you missed a medication. Your loved one can actually show that to you when you come over and you can make sure that they are indeed getting all of the doses of their medications appropriately each day.

Also, something that we don't talk about a lot, but is weapons. Some people have guns in their homes. Making sure that those are stored appropriately. That's also a way to increase safety in the home. And lastly, I'd like to say driving. If you are in a position where you live near your loved one and you're able to just occasionally, ride along with them to the store or a doctor's appointment, to just kind of keep an eye on how they're doing with the rules of the road, and if you feel that their driving is still safe and that it's something that they should continue.

Scott Webb: Yeah. There's a lot of layers here. You know, it's like sometimes we're dealing with folks, you know, uh, seniors in our lives who were the ones who taught us to drive, right? And so who are we to criticize their driving? Uh, there's a yeah, there's a lot to unpack here. And just great suggestions. And you know, I think that one of the difficulties is how do do we know?

So you say there's no bad time to come in, but you were mentioning like, you know, pill boxes. I'm 54 and I use a pill box because I sometimes go, wait, did I take my medication or did I just think about taking my medication? You know? And so I go to the pill box and I go, oh. Okay. I took it good. So pill boxes, uh, you know, all great suggestions, but how do we know when it's time to transition to a higher level of care and supervision and how, this is the million dollar question, how do we convince our, the seniors whom we love that it's time?

Dr. Gabrielle Ruff: Well, let me just say, I've been doing this for a long time, Scott, and I don't know that I, I am able to convince people all of the time. But, uh, we do the best that we can with that. I would like to answer that question by saying something that we talk to our patients about is the five M's. The five M's stand for money, mobility, meals, medication and medical care. And we've touched on a little bit of those throughout this conversation, but when we're looking at money, we're looking at someone being able to manage their bank account, pay their bills successfully, not get behind on bills, not be scammed out of money that they need to care for themselves as they get older. Meals. We want to make sure that someone consistently has food in the refrigerator. Someone is eating on a regular basis. That their weight is not unintentionally dropping. Mobility. We want to make sure in addition to driving, like we mentioned earlier, that someone is not having lots of falls in their home and we're not aware of that.

Medications, we talked about the pill box. We talked about making sure that we use that so we can know when we took a med, when we didn't and medical care. Making sure that a loved one is getting to doctor's appointments, making sure that they remember what's being said in those doctor's appointments and that someone is aware of any changes to medications or tests that have been ordered.

We kind of summarize those by calling them the five M's. And I would say that the answer to when you should transition to a higher level of care or supervision is when someone can no longer safely maintain the five M's in their current environment. I think that's the most simple answer to that question.

There's a lot of nuance to that, but when someone is no longer able to maintain a safe level of function in their current environment, that's when it's time to consider the next level of care or supervision.

Scott Webb: Yeah. One of the things that drives my wife crazy about her dad is that he doesn't have a home phone. He only has a cell phone, and the cell phone is often not where he is. So he doesn't know that she's trying to reach him. He doesn't know that he has messages to call her back. And as you say, there's a lot of nuance to this. And I know there's a lot of nuance when we think about memory loss as well, and it can be a very difficult thing dealing with seniors as they begin to lose their memory a little bit, whether that's a natural part of aging or something else that's going on. So how do we have those conversations?

How do we communicate with a parent or a loved one who's clearly suffering from some memory loss?

Dr. Gabrielle Ruff: Well again, these are all great questions. The first key that I would say for communicating with someone who has memory loss, is patience. We live in a society that you know, patience is not always at the top of our list of virtues. But when it comes to dealing with someone who has memory loss, patience has to be at the top of the list of virtues, because not being patient with someone who may already be aware of the fact that they are not remembering things like they used to or like they would like to, is going to cause frustration.

So it may seem that it makes sense to say, oh, you just said that, if someone's repetitive. Well remember I already asked that, you answered that question. But the truth is that's just going to frustrate the individual. So sometimes just answering the question again and not acting like you heard it, you know, the second time or the third time or the fourth time that day, is the best way to approach someone who is dealing with memory loss.

And I think that will go back to that concept we talked about of protecting dignity in someone who may have a process that they cannot control when it comes to their memory decline. You also mentioned Scott, that there's this question of is it normal to have memory loss or not? I like to say that I have a job because it's difficult to tell sometimes whether memory loss is just normal aging or it's something else.

And I encourage anyone listening to this to never assume that memory loss is just normal aging. If you are noticing memory loss, you should definitely speak with your primary care provider who can do an assessment or even point you in the direction of a senior healthcare specialist like myself who can do the assessment that will let you know one way or the other.

Scott Webb: All great advice today and as we get close to wrapping up here, how do we help our parents, our seniors, our loved ones, really prepare for the future; whether we're thinking about financial exploitation or other concerns, how do we best prepare them for, you know, the twilight years if you will.

Dr. Gabrielle Ruff: I like to say that one of the things about my job that I enjoy, is the ability to give people the tools to do just what you asked, control the future. We have so little control over the future. Looking, ahead, I would recommend that any family working with an aging parent, decide who the decision maker is going to be in the event that parent has either a medical reason or some other reason why they are unable to make decisions.

Best case scenario is that never happens. But in the event that it does, you do want to be prepared for that. So making sure that you have filled out a healthcare power of attorney form is crucial. Making sure that you've filled out a financial power of attorney form is also crucial. And what this does is, it doesn't take decision making power away from the parent. It only kicks in when that individual does not have the ability to make those decisions for finances or healthcare. I would also recommend talking to an elder law attorney. Oftentimes, those attorneys can help families get all of the things together that they need to be prepared for the eventualities of the future.

Again, best case scenario is we never have to use these things, but it's better to be prepared than unprepared.

Scott Webb: Yeah, it's difficult to have these conversations because you start talking about end of life care or hospice care, or power of attorney, and, you know, those conversations can be uncomfortable and you're just trying to do the best thing you can for our loved ones and prepare for the future so that we don't butt heads later or there's indecision later.

But it's difficult because mortality is not something that most people are really comfortable talking about. So glad we had this conversation today. Just hearing your compassionate approach, and encouraging all of us to have these conversations and while we're doing it and having those conversations to be patient, right?

To be proactive, and that everybody just needs to know that we're just trying to do the best for our loved ones, and hopefully we can convince them of that as well. So thank you so much for your time today, and you stay well.

Dr. Gabrielle Ruff: Thank you. You too, Scott.

Scott Webb: And to make an appointment with a Summa Health Senior Health Specialist, call 330-375-4100 or visit summahealth.org/seniors to learn more. And if you found this podcast to be helpful and informative, please share it on your social channels and be sure to check out the full podcast library for additional topics of interest. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. Stay well, and we'll talk again next time.