Recently, I was honored to be part of a four-person panel at the Wayland Public Library speaking on the topic "What's New in Aging?" We discussed navigating the new terrain of aging in the 21st century, followed by a question and answer session from the audience. Juergen H. Bludau, MD (photo at right), Harvard University and Brigham and Women's Hospital geriatrician, and Carol Sneider Glick, Esq, elder law specialist with Squillace & Associates of Boston, were wonderful fellow panelists. (Part 2 of this talk is scheduled for April 6, 7pm at the same location - register here)

I want to note here high points of the evening, including the excellent questions the audience brought. I felt very much at home in the company of these speakers, all on the front lines of bringing best-quality care in a quickly changing landscape. My fellow panelists as well as the audience of about 45 from Wayland, Weston and beyond were enthusiastic and engaged with every presenter's points.

Dr. Juergen H. Bludau, MD (photo, above right), a Harvard University and Brigham and Women’s Hospital geriatrician, built a powerful case for why geriatricians are so vital for elders. Despite the enormous demographic change of aged and aging people in our society, the need for geriatricians is not universally accepted. "Older people are biologically different from people of other ages," said Bludau, "this must be understood to treat them correctly." During their standard training, physicians receive very little information about treating elders. Because symptoms of serious conditions like pneumonia or a heart attack often present very differently in elders, it takes a specially trained eye to not brush off what may otherwise appear to be insignificant conditions. Though children now are widely understood to benefit from specially trained pediatric practitioners, there is still a long way to go for such general acceptance to extend to physicians specially trained to treat elders.

Bludau pointed out that even among aged individuals who are enjoying good health and vitality, they may be living very close to the edge of their their ability to rebound from an illness or injury. "Homeostenosis, the point at which a person has used up all their inner reserves and resilience, may be close to the daily functional level of many elders," he said. This is why once an elderly person who was healthy becomes ill or has an injury, one problem after another may develop, and they may not be able to regain their health. Seemingly small health events may appear to have disproportionately negative effects on elders if they are viewed through a non-geriatrician's lens.

Aging is Complicated

Attorney and Wayland resident Carol SneiderGlick (photo, right), elder law specialist with Squillace & Associates, P.C., in Boston, made it clear that being an elder lawyer isn't just about preparing documents like a will and power of attorney. While these are important to have, the attorney has to get to know much more about the elder's life and goals, as well as their financial situation, and should be a specialist in elder law, including Medicaid and tax planning, in order to be able to prepare the correct documents so that the client can be adequately protected and that the documents serve them as intended. "Many aspects of elder law are complex, such as tax planning," said SneiderGlick, who holds an advanced law degree in this area. "It's heartbreaking to see a client who thought they were all set with their asset protection and tax planning, to find that they haven't even come close to meeting their goals."

I spoke about how dramatically aging has changed in the last 40 years, with people living substantially longer with many more complicated medical conditions, with family often no longer nearby, or nearby but so busy with work and raising children that they can't consistently help. But also in the past 40 years, many of the ingredients for successful aging have become available, but that they are not being put together and used nearly as frequently as they should be. The audience and my fellow speakers warmly received the messages I offered about bringing home care into the 21st century: the importance of choosing caregivers who perform up to modern care standards, reducing at-home care costs by bringing in monitoring technology, how teamwork is vital, and the way we are keeping the family and care partners informed about care in the home through our one-of-a-kind online system.

Audience Questions

The audience was very attentive, and had a wide range of questions the panelists answered.  In the final analysis we can see that regardless if they were asking about lawyers, medicine, physical therapy or other disciplines, many questions were touching the same point: "How can family and professionals know that others on the care team know what they are doing, are making the right decisions, and carrying out the right care?"

In general, the panel said it was important to make sure there is proper credentialing of professionals, that when possible you choose care team members from institutions or private practices that specialize in your area of need, and that if necessary you get a second opinion from some other institution or practitioner.

After continuing to think about this question, I would add that this underscores the need for a fully integrated team approach with great communication: it's likely that team members have worked with similar circumstances to your or  your loved one's, and have also worked with other professionals in many different disciplines. Periodically check in with those seasoned practitioners to get their take on how the team is performing.  If they are all from the same practice or institution, my experience is that it's likely you may not get straight answers as politics may overwhelm an urge to speak frankly.  However, if you watch their body language, listen to their voices, to what they say and especially to what they won't respond to, you will get clues to what they really think. More direct questioning may or may not bring out their true opinions.  Do your best to be uncritical, non-blaming and calm, and try to elicit their best recommendations for improvements without pointing fingers at any particular team member.

SneiderGlick concurred. "A good, caring professional is going to notice if something isn't going right, even if it's in an area that isn't their specific expertise," she said. "I was just referred a client by a financial planner who had an instinct that her client's trusts weren't set up correctly, although she didn't know enough about it to know exactly what was wrong." Upon review, Sneider-Glick found several deficiencies in that client’s estate planning client’s estate planning documents that if left uncorrected, would have defeated that client’s goals. Fortunately in this instance she was able to correct them before it was too late.  "Talking fully with the client and talking among professionals is vital -- there is no substitute for working together as a team," she concluded.

The second part of this series is scheduled for April 6 at 7pm at the Wayland Public Library, and focuses further on 21st century care essentials, helpful to both elders and adult children looking for help with aging parents.  Both presentations are a free service to the community, and are sponsored Caring Companion Connections of Concord.  To reserve a seat, sign up at http://info.caringcompanion.net/21st-century-caregiving/.