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Melanie Cole (Host): Welcome to Back To Health, your source for the latest in health, wellness, and medical care. Keeping you informed, so you can make informed healthcare choices for yourself and your whole family.

Back To Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

Today's special episode is part of our Women's Health Wednesday series, which features in-depth conversations with Wild Cornell Medicine's top physicians on issues surrounding women's health throughout the life course. Listen here for the information and insight that will help you make the most informed and best healthcare choices for.

I'm Melanie Cole. And joining me to highlight healthy lifestyles for aging women, we have a panel today with Dr. Emily Fessler, she's an Assistant Professor of Clinical Medicine at Weill Cornell Medical College Cornell University, and an assistant attending physician at New York Presbyterian Hospital Weill Cornell Medical Center; and Dr. Emily Coskun, she's an Assistant Professor of Clinical Medicine at New York Presbyterian Hospital Weill Cornell Medical Center.

Doctors, I'm so glad to have you join us today. This is a great topic. And as an aging woman myself in my late 50s, which is unbelievable for me to even think to say, Dr. Fessler, I'd like to start with you. What is geriatric medicine and how do geriatricians approach the care of older adults differently from other types of physicians?

Dr Emily Fessler: First of all, I definitely just want to thank you so much for having us here today. I think we're actually the first geriatricians to be on this podcast series. And we're just really excited to chat and to talk a little bit about what we both love to do. Geriatrics is a specialized field of medicine, where we really focus on care for older adults. And I'll say that's typically defined as adult 65 and up, but in practice for us and most of our patients are really in their late 70s and even up until their 100s. I think one unique thing about geriatrics is that we are trained to work across multiple care settings, so that includes outpatient primary care, in the hospital and also in institutions like assisted living, nursing homes, rehab facilities. And then because our patient population is unique, we do have a somewhat unique way of approaching overall care and that's by framing our assessment using this age-friendly model called the four M's.

So the first of those M's that we're always thinking about as geriatricians is medications. And we know that older adults are at a really high risk of polypharmacy or taking a lot of medications, including some that can cause harm. So we're always really mindful about reviewing meds carefully at every interaction with every patient. The second M that we think about is mind, which includes both cognitive function, as well as mental health, so depression, anxiety. The third M is mobility. Because as we get older, you know, we're all much more likely to face challenges in day to day function, increased risk of falls, difficulty with walking, so we're really always looking out for anything that could get in the way of function either now or in the future for our patients. The goal is keeping people as mobile and it's independent for as long as possible. And then, the fourth M which honestly is probably the most important, stands for what matters most. So it's a really critical, honestly for all patients at any age, but I would say particularly for older adults to take your values and priorities and goals into account in your own medical care. And I would say, the more I practice and the more patients I see, I've realized that there is absolutely no sort of one-size-fits-all approach to caring for older adults. And the more we know about your goals as physicians, the more personalized care we're able to recommend.

Melanie Cole (Host): Well, I agree with you on all of those things. I love the four M's. As someone who's been really in the field for 35 years, working with the older population, I can see that all of those four things that you just mentioned are absolute necessities to be keeping track of and looking at. And Dr. Coskun, when we're young, we hear a lot about the importance of diet and exercise. How should women, especially women in my age group and above, be thinking about exercise and healthy eating as we age? What are some of the most important concepts and things we should be thinking about?

Dr Emily Coskun: So absolutely physical activity is so important across your entire lifespan, especially as you age. In addition to benefiting metabolic health and improving conditions like high blood pressure, diabetes, high cholesterol, exercise can also help to preserve your bone density and improve pain from osteoarthritis. It can help with your mood and anxiety. It can help preserve cognitive function. And it can increase your longevity. We typically recommend about 150 minutes of aerobic exercise a week or 30 minutes a day. And aerobic means anything that elevates your heart rate, so walking, swimming, cycling, all of those things count.

Women with certain medical conditions like osteoporosis or arthritis in the hips and knees often need to be creative in identifying exercise that's safe, effective, and enjoyable. And if you're having trouble like this, if you have serious issues with your bone density, it'd be a good idea to talk to a physical therapist or a doctor about what exercises are safest for you.

In terms of nutrition, nutrition is also very important. We always say that exercise is medicine and food is medicine, and both of these medicines have fewer side effects than the ones that come in a pill bottle. A few simple tips on how to improve your nutrition is, first of all, prepare your own food if you can. When you order takeaway or go to a restaurant, you have less control over what's in your food and you have less control over how much you eat. People tend to eat more when they're at a restaurant or when they order take away. A second tip would be to eat vegetables with every meal. Vegetables are rich in micronutrients. They have lots of fiber and they keep you full longer without adding too many calories to your meal. And my third tip would be to set healthy limits to the foods that you love that aren't so healthy. So if you love ice cream or cheeseburgers, tell yourself that you're going to have those once or twice a month, and just avoid eating them every day or a few times a week. You should still be able to eat the foods you love. You just need to eat them in moderation.

It's also important to note that healthy eating means different things for different people. Some women in their 80s and 90s can start losing a dangerous amount of weight. And in those women, we don't set limits on how many high fat or high sugar foods they can eat. We just want to make sure that they get enough calories to stop losing weight.

Dr Emily Fessler: One thing I'll add is that it is normal just for your sense of taste and smell to change with aging. So for some older adults who are really struggling to keep up with nutrition, we'll often recommend varying temperature and texture and level of spice in addition, just to make food more interesting. And then, also just to make sure that mealtime is a social experience. I think we know that people have better appetite when they're eating with others that they care about.

Melanie Cole (Host): What a great point that you just made. Those were such great bits of advice as well, Dr. Coskun. So Dr. Fessler, as we think about exercise and nutrition, we also think about being a good advocate for ourselves and seeing our primary care, our obstetrician gynecologist. Tell us about important screenings to consider as we age. I mean, I just had my DEXA scan, so I had my bone density and my mammogram and my colonoscopy. As we get older, we make these jokes that we spend a lot of time at the doctor's trying to stay healthy, but it's important that we do these. Can you speak about some of the more important screenings? Whether it's vitamin D or hearing or balance, or all of these things, put them together for us, about screenings and visits for our well visits.

Dr Emily Fessler: Absolutely. So you're right, there is a lot to keep track of. I think I'll start with sort of the cancer screening bucket. So the screening tests we think about most often for women in terms of cancer are for cervical, breast and colon cancer. And then, we think about lung cancer as well for women with an extensive smoking history.

Pap smears, which are a screening test for cervical cancer, start at age 21. And then, they go through age 65 as long as they've been normal in the past. Mammogram screening for breast cancer, the guidelines actually vary a little bit by professional society, but it's generally recommended for women ages 50 to 75. And then, there is room for shared decision-making between the physician and the patient in the years before and after that interval. And then colon cancer screening, somewhat similarly is recommended for folks between the ages of 45 and 75. And then, from ages 75 to 85, it's a shared decision-making, based on the person's other medical conditions and their care preferences.

And then, I'll say, you know, beyond just cancer, there are a lot of other issues that are really important to screen for and older adults, many of which you touched on. So we'll think about depression, anxiety, cognitive changes, cognitive health, vision or hearing loss, fall risk. And I'll say many of these screening questions are part of the Medicare Annual Wellness Visit, which is this yearly preventative health visit that's covered under Medicare without a copay, and is a really great opportunity to focus on some of these preventative health questions with your doctor.

Melanie Cole (Host): What about vitamin D, Dr. Fessler? As long as you're talking about screenings here, do we get screened for vitamin D? Are there any kinds of other things that you think are important that we get screened for?

Dr Emily Fessler: I think the last big category is bone health, including vitamin D. So screening for osteoporosis is done via a DEXA scan, which is a noninvasive test. It's sort of like an x-ray that measures bone density in the spine, the hips, the forearm. And this test typically starts at age 65, but can be recommended younger if you have certain risk factors such as a smoking history, low body weights, long-term steroid use or personal history of fractures.

And then, the vitamin D question is a really good one. It's sort of a hot topic in the news lately. There was a recent study in the New England Journal of Medicine that showed some surprising results actually that vitamin D supplementation didn't impact fracture risk, even in people who had low baseline vitamin D levels or low bone density, which really sort of shook up how we're thinking about vitamin D screening and supplementation, because we want to make sure that any test we order really has a purpose. So I'd say not all women need to be screened for vitamin D deficiency. It's a very common nutrient. It's absorbed from food. It's produced in the skin when you're exposed to sunlight.

For the average woman, I would say your physician really only needs to check your vitamin D level if you have a risk factor for very low levels. So one example would be people with conditions that impair absorption, like celiac disease, inflammatory bowel disease, prior bariatric surgery. And then, in women with osteoporosis, I do think that the majority of primary care doctors and endocrinologists are still checking levels and are still supplementing vitamin D. And it's particularly important to do this for patients who may be treated for osteoporosis, because some of the medications we use really do require adequate vitamin D stores to work effectively and safely.

Melanie Cole (Host): What an excellent answer that was, and thank you so much. Now, Dr. Coskun, we women, as we care for everybody else in our lives, and we've learned that we have to put our own masks on before we can take care of our loved ones, well, one of the things that we seem to lack as we're trying to be superwomen and we're trying to do everything all the time all at once, is sleep. We have to answer our emails. We have to look at our phones. We have to get up and do the dishes are finished the laundry, but really a good night's sleep is so important. And we're learning more about that link to diabetes and heart disease and sleep. Can you speak about that just a little bit for us and why sleep is so important and how do we know if we're not getting that quality sleep we need?

Dr Emily Coskun: Sleep is so important for both your physical and your mental health. Getting better sleep is also associated with lower risks of cognitive issues later in life. We usually recommend that people get seven to eight hours of sleep a night. There's routines that we suggest for people who are having trouble sleeping to have a better sleep schedule. We call the tips we give about sleep sleep hygiene.

So good sleep hygiene involves having a bedtime routine. You have to go to bed at the same time every night and try and get up at the same time every morning. Have a routine to try and get yourself relaxed before bedtime, drinking a cup of herbal tea, reading a book, doing something calming like meditating for 30 minutes to an hour before bed and avoiding stimulating activities like screens, exciting movies, rigorous exercise. You should keep your bedroom dark and reserve it for sex and sleep only. No TV or computer screens in the bedroom. Put your devices on do not disturb mode. Getting interruptions in your sleep can be very disruptive to a healthy sleep cycle.

If you're unable to fall asleep after 20 minutes or so, it's best to get up and do something calming again, until you feel sleepy. You don't want to associate your bed with anxiety related to insomnia. So that's why it's good to get up and then try again. Getting enough exercise during the day can also help improve your sleep at night. But like I said, don't exercise right before bed. Avoid caffeine in the afternoon or evening. And it's also important to note that many sleep aids or sedatives are not safe in older women and can be associated with falls, confusion, dependence, and tolerance. Examples of those types of sleep aids include Ambien, clonazepam, and Benadryl. A lot of over-the-counter sleep aids will just be labeled sleep aid, but the active ingredient is Benadryl, which can cause a lot of dizziness and other side effects in older people. If you aren't sure of something safe or the right fit for you in terms of a sleep aid, it's a good idea to run it by your doctor.

Melanie Cole (Host): Wow. This is so comprehensive doctors. This is such an informative podcast. Dr. Fessler, as we look at ourselves and the things going on in the world right now and in the country, we're all kind of suffering from anxiety right now. We're all feeling this sense of something and whether or not it is our own mental health, or we're looking at our kids, because there's really an epidemic in our kids with mental health issues. What about depression screening? Because when we're young, in our 40s, we're still juggling; in our 30s, we're having babies and stuff like that. But now, that we're starting the empty nesting, that's where I think for the first time in my life that I've felt depressed. Looking around, there's no kids in the house. So what do you want us to know about depression screening and self-care? Because this is supposed to be the time in our lives when we're supposed to be able to be happy, jump up and down, do anything we want. Speak about that just a little bit.

Dr Emily Fessler: I'm really glad you brought that up, because I would say depression, anxiety are just so prevalent in the older population, I think, especially in the context of the last few years and just everything that's going on globally these days. I'll note that sometimes older patients do experience symptoms of depression a little bit differently than younger adults. So we'll sometimes have more physical symptoms like extreme fatigue or cognitive symptoms, even feeling a little bit foggy compared to younger adults. So we do have specific screening tools for depression that are targeted for older adults. But those tests can take time.

So I would say my biggest advice is that if you're worried about depression or anxiety, to bring this up with your doctor at the beginning of the visit. I think mental health is a really serious concern and it deserves to be prioritized as much as physical health. There are a lot of resources from psychotherapy to medication options that can really make a big difference in quality of life for our patients.

And then, the other common mental health concern we see quite often in our patients is caregiver stress. Just because as we get older, the people we love and care for like a spouse, close friends, our own parents are also getting older and caregiving can really be just incredibly difficult. It could be exhausting. So I'd say if you feel like you're getting overwhelmed by caregiving. This is also something that's important to bring up with your doctor. And often we can help connect our patients with caregiver support groups and other resources for additional support.

Melanie Cole (Host): Ladies, I'd like to give you each a chance for a final thought, because this is while there's so much to cover and so much to talk about. Dr. Coskun, as we think of our cognitive health, all of us want to be sharp as a tack. That's the word that we hear. We want to be smart and sharp when we're older, because that really helps in quality of life. So for your final thoughts, I'd like you to speak about cognitive health and any recommendations that you have from a geriatrician to help us keep our minds sharp. I mean, I'm lucky I get to do a show like this, which keeps my mind sharp, you know, talking to you brilliant doctors. But for other people, what can they do to keep that sharp mind as we age?

Dr Emily Coskun: You know, we do see patients with cognitive issues or people who are worried about developing cognitive issues. And some advice that we give is first and foremost, do the best to take care of your physical body. There's strong evidence that physical activity can benefit cognitive health, including executive function, attention, processing speed and memory. It's also important to get enough sleep and make sure you're staying on top of your medical problems and going to your doctor's visits. Making sure that all of your health conditions are under control is something that can prevent cognitive issues later on.

The second thing is to try and take care of your mental health. So like we just talked about depression, anxiety, and other mental health disorders can be very debilitating and, if gone untreated, can lead to cognitive issues later on. So definitely bring these things up with your doctor and get treatment.

The third thing, like you said, is staying cognitively and socially engaged. You don't have to do crossword puzzles or brain games, but it's important to have a hobby that stimulates your brain that you enjoy. And it's also important to cultivate strong social support network. For people who don't have families close by, there are a number of organizations in the city that help make connections and build community for older adults.

The fourth thing would be to avoid substances that can be bad for the brain. So that includes things like recreational drugs or excessive alcohol use. In addition, some medications can have negative cognitive effects later on. And so that's another important reason to talk to your doctor. Or if you're getting older, try and find a geriatrician to review your medications at every visit.

Melanie Cole (Host): Wow. That was great advice. And Dr. Fessler, last word to you because sometimes as women, we're hesitant to voice our concerns to our physicians, but we need to listen to our bodies. And as we said at the beginning, we have to take care of ourselves or we cannot care for our loved ones. And we women, we are the caregivers to the world. I'd like your last words here to be about how we should be looking for a care team that can best give us those things that we need. What should we be looking for so that we can be our own best health advocate as we age?

Dr Emily Fessler: I would say not every older adult, older woman needs to be cared for by a geriatrician. But you certainly want a healthcare provider who really cares about and honors what matters most to you with your health, because that can vary pretty widely from person to person. Also, as women age, they often start seeing more specialist providers as well in addition to primary care. So it's really important to have a primary care doctor who is ready to jump in there and communicate and collaborate with colleagues in other fields to make sure that your entire care plan is the best it can be. And this includes not only other physicians, but colleagues in physical therapy, nutrition, social work, other fields, really depending on your personal care needs.

And then, I would say in terms of self-advocacy, it's really important for you to identify which are the most important health problems you want to discuss upfront at every visit. So stay organized, make a list, bring it with you and show this to your doctor. That way, you can make a plan for each visit that really addresses the concerns that are important to you. Your doctor may not be able to get to the fullest every time, but always make a followup visit before you leave, so you can continue the conversation and just make sure you're being heard.

Melanie Cole (Host): Great advice. This was such an informative podcast. Every woman should listen to you both tell us this great bits of information so that we can stay healthy as we age. And thank you both for joining us so very much today.

And Weill Cornell Medicine continues to see our patients in person, as well as through video visits. And you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back To Health. We'd like to invite our audience to download, subscribe, rate, and review Back To Health on Apple Podcast, Spotify and Google Podcast. For more health tips, go to weillcornell.org and search podcasts. And parents, don't forget to check out our Kids Health Cast. I'm Melanie Cole.

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