What does it mean to age well?

In this episode, we discover the meaning of whole-person wellness, and how to prioritize wellness at every age and stage of life. Plus, we discover some of the more unexpected habits for happiness and health.

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Episode Transcript 

Ellen

Stronger communities begin with good health—for everyone.

You’re listening to the “Good Health, Better World” podcast from UPMC Health Plan. This season, we’re exploring the joys, challenges, and opportunities associated with healthy aging. We’ll talk about what it means to age well; how to care for body, mind, and spirit as we get older; and the tools and programs available to ensure a good life, throughout life.

I’m your host, Dr. Ellen Beckjord. Let’s get started.

We're joined by Janine Jones and Dr. Richard Hoffmaster in this episode to talk about what we can and cannot control about aging. We’ll uncover what it means to pursue whole-person wellness and hear about some of the unexpected habits of healthy people. Janine, welcome to “Good Health, Better World.”

Janine

Thank you, Ellen. Glad to be here.

Ellen
Rick, thanks for joining us on “Good Health, Better World.”

Rick

Thanks so much for inviting me.

Ellen

Janine, if I could start with you. We talk about whole-person wellness a lot, but for you, can you tell us what that means in the work that you do, how you define it, and how it's related to healthy aging?

Janine

Sure. I think of whole-person wellness, I think of it in multiple ways. But a common one when I'm working with members as a health coach would be chatting with someone and really pulling through some of the dimensions of health. So, finding out how someone is doing socially and their occupation and how their occupation might tie in with their health. Intellectual health, too—often finding out the way they like to learn and their growth mindset. Finding out about spiritual health as well as their faith-based type of approaches in life. Physical health is important with sleep and exercise and diet. That's always going to come up. And then some other areas might be financial health and environmental health.

Ellen

Rick how about you in terms of whole-person health?

Rick

So as a geriatrician, I talk a lot about what it means to be a healthy older person. And one of the first things I ask my patients when I meet them and I have that question, or they have that question, is, what's important to them? What matters to them? How do they find joy in life? How do they find connection with other people? What are their priorities and their goals with their health?

And then we can kind of work backwards from there to find out ways that we can help with that, be it medical treatments or diet or exercise in trying to stay physically active, mentally, socially active, and do the things that actually matter to you and give you purpose. That tends to lead to better health outcomes and just happier lives overall. And that to me is what health is all about.

Ellen
Janine, in some of the dimensions of health that you mentioned like environmental, financial, occupational—those, I think, relate to social determinants of health, which are sometimes factors that are outside of our individual control. I wonder if you would care to speak to ways that social determinants of health in particular can affect wellness, health, and whether some of those social determinants loom larger than others particularly as we get older?

Rick

Yeah, I, I think there are a lot of different ways that health can be impacted by outside forces that are out of our control.

And some of the things that older patients in particular, I think, face that can be challenging. One of the things is, you know, sometimes you're dealing with increasing number of medical problems, which can lead to more medications, can drive up costs. And so financial challenges can be really problematic. I think people would be shocked to hear how often it is that an older person has trouble accessing food because of the cost of medications. And so those are kind of those behind-the-scenes things that can happen that you wouldn't really know about unless you asked.

Similarly, you know, if you're dealing with problems that are leading to trouble getting around, walking, taking care of yourself in the way that you used to, that can really limit your ability to get out to doctor's appointments to get the help that you need.

So transportation, finances, and just the support systems that we have tend to change as we get older. We may lose loved ones or friends to illness or to other problems. And those changes need to be recognized and need to be addressed, or all the things that we know improve health tend to get diluted and lost as a person gets older.

Ellen

So those social determinants of health, some of them I think we can also think of as structural determinants of health, are often things that are outside of individual control. But let's talk a little bit more about things that we can control and can't control about aging, or maybe it's better to say the things we can and can't control as we get older. I'm sitting here thinking of like, what can I really control about actually aging? I don't know if <laugh> there's not much that I can or that we can control, but as we think about aging and the changes that happen for us in our bodies, our cognitive function, even, you know, social function, what are some of the things that that we can control and what are some things that we can't? And what's your sense of how those show up for people and kind of the best ways of coping with them? And Janine, if I can start with you.

Janine

Sure. I feel like it's one of the most hopeful things with health. There are so many things that we do have control over when it seems out of control at times and somebody is in the midst of a health condition that's not going well, realizing that they are not the health condition and that there are small things they can change throughout the day.

Habits can be changed. They're not permanent. And as a health coach I often help members and clients look at what they can do that they do have control over. But tying into what Rick mentioned earlier, what brings them joy, what their strengths are, what their values are, and if through conversation with someone they're able to connect and have that insight, usually they're able to move forward and feel that sense of control over their health. And hopefully those small steps lead to improvement and that feeling of self-efficacy.

Ellen

Rick, how about for the patients that you treat, is this something that comes up a lot? And what's some of the guidance that you give to them or that you would just share with our listeners in general?

Rick

Yeah. I agree with Janine fully. There's so much that we know affects our health and well-being, especially as we get older when it comes to lifestyle and how we eat, how we exercise, what we do in our free time. And we know that that directly impacts health outcomes in terms of how long we live, how well we live, and other serious illnesses like cancer, heart disease, etc.

With that said, there are some changes that are kind of unavoidable and there's illnesses that we're more prone to when we get older that we can't really help. I call those “birthday-related problems.” I have patients who come in and say, you know, I'm starting to have problems with arthritis. I'm starting to have problems with my sleep or something else. And I say, yeah, those are birthday-related problems. You need to stop having so many birthdays and you won't have quite so many problems. <laughs>

But in all seriousness, there are some things that are out of our control. But I think one of the mistakes that I see people make is that they assume that being unwell is a natural part of aging, and that's not true. Actually, we know that if you are able to keep your medical problems in check and treat them appropriately or better yet, prevent them with a healthy lifestyle, we know that things like memory loss or weakness or falls are not a natural part of aging, and they can be prevented if you're proactive about it.

Janine was talking about making sure that you’re getting healthy and nutritious food and I would add that, you know, again, regular exercise we know has strong, strong ties to having good physical health, good mental health, and good cognitive health and avoiding things like dementia. And that's just one example. So I think focusing on that is a really important part of what I do with my patients much more, frankly, than medicines.

Ellen
Yeah. Oh, well, I really like the assertion that, you know, we shouldn't think of getting older as being determinant of our well-being, so thanks for pointing that out. And you both have done a great job of naming a lot of the real usual suspects when it comes to health and healthy aging. But are there any habits or practices that you've observed in your work to be particularly common or prevalent among people who have really good health span—not just lifespan, but who age healthy and who age and feel well? I think most people think about good nutrition, physical activity, things like that as being particularly important for health and well-being. But what are some maybe unexpected habits or practices that you've observed in your lines of work that are associated with healthy aging? And, Janine, if I could start with you.

Janine

Sure. One of the big ones is social connections. And I work with members who might have conditions that they're managing, that are difficult for them, but because of all of their connections—whether it's from their church, their neighbors, their family nearby, grandkids, their children, brothers and sisters, just a huge network of connection from others who are supporting them—it makes such a difference. And I think it lifts spirits, it gives somebody a reason to get up in the morning. It gives someone that sense of meaning, I think, too. So I will notice that.

And some people do it through volunteering as well. I've had members I work with who are either still working or looking for taking action to connect with others in their community as part of a weekly way of finding social networks. And I think they're a lot healthier and happier.

Rick

I fully agree. I mean, I was, she stole my answer because I was going to say the same thing that what we know is that those social connections and the ability to see a purpose outside of yourself is so important as you get older. It's really easy as you get older to lose friends, to lose family and to isolate, especially as it becomes harder to do day-to-day activities.

So it's really important that you stay outside of your own individual space by helping other people or by having strong communities within your family or outside of your family. It reduces depression, which in itself can make you sick. So I fully agree that it's really, really important that, as we get older, as we're not working anymore, that you have something that is meaningful to you and that matters to you, so you can have purpose. On the flip side of that, I think that isolation is the thing that you really need to avoid. And that lack of connection is what I see leading to a lot of problems for a lot of people with their health.

Ellen

Can I ask you a follow-up question about that, in particular about retirement? It seems like retirement age has changed a lot. I've been having conversations with people recently where it seems like the way we start our careers, at least in my field, which has been behavioral medicine, hasn't really changed that much since I got started 25 years ago.

But how people choose and when people choose to finish their careers is, like, pretty dynamic and way less predictable than I feel like it used to be. And so in the time that you've been a physician, are you seeing people navigate retirement more proactively or differently? Is it a risk factor? Do you think that it takes people by surprise, the profound ways that that might change, especially this opportunity to interact with others, sense of purpose and meaning? I think most people, when they retire, it seems like the assumption is they're looking forward to it. That might not always be correct, but are people proactive about thinking through the ways that that milestone might require them putting different things in place to retain some of those social connections?

Rick

Yeah, I think so. And I guess I'll start by acknowledging that, of course, it's going to be different from person to person. And I think it depends a lot on what your relationship with work is. Work can be a really unhealthy thing for some people. And getting away from it can be a positive. We work our entire adult lives, most of us, and it seems very tempting to say, yeah, I'll be so much happier when I don't have work. But work is about having structure and purpose to your day. It's about knowing when you're going to have your meals, who you're going to interact with. And those things are really important to having physical health, mental health. And when you lose that structure and those connections with something outside of yourself, it can lead to depression. It can lead to social isolation, which can cause all other sorts of problems with your health, not taking care of yourself.

I think that how folks approach it in my perspective, like I said, it's different from person to person. But I do think that in my experience, those that have a plan after retirement tend to do better because, again, they have that purpose and they have something that they are able to do to continue to build that structure around.

And with that said, I've seen lots of folks who are very happy in their retirement and they pick up a hobby, they pick up painting or they volunteer or they teach or they do something that they've been meaning to do for a long time. I think the challenge is always the case that as we age, some of the changes in our body make it harder to do those things. And so I always encourage folks to not wait until you're retired to do the things that are meaningful to you, because it is harder. And that's sort of the paradox of getting older, is that it's hard to do the things that we wanted to do when we were younger, but we have more resources sometimes when we're older, hopefully, to do that and more time. And that's not particularly fair. But it's the way it works. <laughs>

Ellen
Janine, is this something you observe in the folks that you work with too, or do you have thoughts about retirement in particular, that milestone, as it relates to some things that people might want to be proactive about when it comes to their social health in particular?

Janine

Yes, I think of the eight dimensions of health. One of them would be occupational or vocational. And I think sometimes we focus on work, but it could also be what someone decides to do during the week that's fulfilling, that connects them with others, that also ties into their skills and strengths. And the skills and strengths might change as they're getting older. So they might have to reassess that.

And you know, [maybe their] vision isn't as good, or they have arthritis and they used to do crafting. They might be able to still pass on some skills to others and still find some ways to volunteer or work in that field, but it may not be the same as what they used to be able to do, but finding some way to pass on something that someone feels they're strong with, that they love, that's fulfilling, that is a joy.

And it often could be volunteer, but I've worked with a lot of members who I think are doing the best, and they're also, you know, still working. They're still finding ways to work, but they're not doing the same jobs they did, possibly, for their careers when they were younger. They're finding opportunities to use their skills and strengths and joys in something that maybe didn't pay as much as or doesn't have the benefits that they needed when they were younger. And they can just enjoy it and it gets them out of the house and it gets them connecting with others.

Rick

I'd like to follow up on that if I could, because you mentioned something that I think is really important, particularly in folks who don't particularly have good baseline health. I work as a palliative care specialist, and I work with people with serious illness quite frequently. And I wanted to kind of point out that even when you're facing serious illness, you can still find ways to be healthy. And this isn't about trying to maintain, you know, this sense of youthful health where everything's perfect. Sometimes things aren't perfect and there’re still ways of finding meaning in that and to find ways of having a healthy outlook and a healthy life in really hard circumstances.

And I bring that up because you had mentioned this idea almost of like legacy. And that's something that we're finding more and more about passing on information to future generations, being able to pass on a recipe, being able to teach somebody a skill, even if you're not able to do it quite the way that you used to, is really important for a lot of people. And there's actually been a lot of research on that recently that shows that that has positive outcomes for older adults, especially when they're facing serious illness or reaching the natural end of their lives. And so those are all, I think, really important things that we can start early and that can be part of our lives, especially after retirement when we're not doing the work ourselves.

Ellen
Yeah. I'm glad that you mentioned that the idea of legacy is really important.

Both of you really zeroed in on social connection as maybe something that we don't think of right away when we think about the habits or practices of folks who do really well over their lifespan with staying healthy and well. Other habits or practices that might fall into that group of ones that might not jump to mind right away but through the work that you do, you've observed to be really important? Rick, if I could start with you.

Rick

Sure. Yeah. I think sleep is one of the big ones. Having good and regular amounts of sleep. I think one of the old wives’ tales is that older people don't need to sleep as much as younger people, or have to sleep a lot more—and neither are true. Older adults should have the same amount of sleep as younger adults, you know, typically seven to eight hours, maybe nine hours, would be healthy. Older people tend to go to sleep a little earlier and wake up a little bit earlier. But in general, the amount of sleep that they should be getting is about the same.

And, there are lots of ways that we can help with that, with sleep hygiene, looking at medications and trying to adjust those—not so much treating with medicines, but oftentimes the opposite. Usually medicines actually make things worse. Avoiding alcohol, that's a big one. And so avoiding alcohol, avoiding smoking, regular exercise, good sleep. Those are some of the biggest ones.

But also just learning to cope with change. There's going to be changes that come with aging that are unavoidable. And being ready and able to deal with those changes in a healthy way is really important. And having the support structures to do that and the skills to cope with stress are really, really important. We know that uncontrolled stress can lead to depression and other poor health outcomes. So it's really, really important that you have those tools. And if you don't, you know, to get taught it, which is what we do with counseling.

Ellen

Janine, how about you?

Janine

Yes, I think sleep is such a big part of the pillars of health, and so I’m glad you brought that up, and coping with stress. And those two tie in together often. The members I'm working with might be [wanting] to improve sleep, if that's what they've identified as what's something that's very important to them and having more energy. I get that a lot. They might end up working on reducing caffeine and improving some physical activity to help with their sleep, which can also help with stress management. And we might talk about gratitude and keeping a gratitude journal or mindfulness practices, or some members will tap into their faith-based practices like prayer and other rituals that help them throughout the day with coping and just finding that time during the day to wind down in the evenings.

And everything ties in together so well that one change helps, you know, the link with everything else. And hopefully if somebody sees the results, they notice I slept better and I have more energy within just a few days of cutting down on, caffeine, let's say, or alcohol. And from there, just moving on. They have more energy, then it's easier to walk. And then when they walk more, they notice they're sleeping deeper. And it just is a wonderful process to see those changes happening. And so it's not just one thing, yet at the same time, it could be just one thing.

Ellen

Well, I'm glad that you mentioned the way those things are often related, because what I've been thinking is it means there's no wrong place to start.

Rick

Right.

Janine

Exactly.

Ellen

Start anywhere with whatever feels most important. It sounds like that's a great way that you engage the members and patients that you work with. Start with what's easiest. Start anywhere. There's going to be cascading effects most of the time when it comes to these lifestyle changes. And that's part of what makes them, you know, self-reinforcing and hopefully helps people maintain them because it is hard to achieve change. But starting wherever is easiest [or] feels most important is always the right place to start.

Janine
Yes.

Rick

And expounding on the mindfulness piece that you brought up, we see that across the board when you look at the healthiest communities across the world, that's always a universal feature of those communities. They have some form of mindfulness that they engage in regularly as part of their culture that allows them to manage stress and get exercise at the same time often, or have healthy eating as part of that. And they usually tie it together. It's, sometimes it's a community meal. Sometimes it's an exercise program that the whole community engages in. Sometimes it's some other cultural aspect that brings people together, allows them to be active, allows them to make those connections, and allows them to decompress.

A lot of the research into things like alcohol use, you know, one of the reasons why there's such contradictory results in some of these studies where you think a lot about how we know that alcohol is not particularly good for your health in general. But then we hear, well, if you have a couple glasses of wine a day, that can be protective. And a lot of that, we suspect, is because it's not just the actual alcohol, or what you're doing, it's how you're doing it. Are you engaging in another activity while you're doing these things that's healthy?

And of course, with things like red wine, there's some evidence that that can be helpful from like an anti-inflammatory perspective, antioxidant perspective—everything in moderation, of course, but it's the other ways that we're doing that. Is it a glass of wine over a dinner with family? That dinner with family probably is doing a whole lot more than the glass of wine.

Ellen

Well, Rick if I can start with you, what are you most hopeful about when it comes to whole-person health and aging, and, you know, at this moment in time, what we're experiencing when it comes to navigating age with as much health and well-being as possible?

Rick
I think that I'm most hopeful that we can do a better job of thinking about, as individuals who are concerned about our health and as health care providers, about what I kind of said earlier, what matters most? What are the reasons why I get up every day? What are the things that are important to me that I can't live without? And what are the things that I'm really concerned about that I want to avoid?

I think so many difficult decisions that we have to make, as we get older and how we have to prioritize things as we get older and our bodies change is based on that really simple question, and it sounds simple, but it's actually kind of complex. And the reality is, a lot of health care providers, if you ask them what's most important to your patient, they wouldn't be able to answer that necessarily. And I think that that makes it really hard to give good advice on how to approach a person's health.

Ellen

May I ask you a quick question?

Rick

Yeah, please.

Ellen

So you mentioned that this is one of the questions that you ask your patients. And I'm curious about…are they a little surprised to be asked? And how does that conversation usually go?

Rick

I think I actually have been surprised by how poignant their answers often are. I mean, sometimes they'll give a generic answer like, “I just want to be healthy,” and then you have to follow it up by saying, well, what is health mean to you? Or, can you talk more about that?

But a lot of people will say things like, “My family, I want to have connections with my family.” Or, “I just want to be peaceful and I want to be comfortable.” Other people might say, “I want to pass on a skill to another person,” or “I want to be there for my grandkids.” Some people say, “I want to go golfing, and I want to keep golfing as long as I possibly can.” And it's different from person to person. That's kind of the point.

You know, a lot of what we've been talking about today is sort of, you know, boilerplate or generic sort of ways of approaching health. But I think what really matters and what makes the biggest difference is when you can narrow that down to what that individual actually cares about. Because a lot of the decisions we have to make are tradeoffs as we get older, and when you have to make those tradeoffs, you need to make sure that you're going in the direction that is going to be meaningful to that person. One, because they're not going to buy in if you don't. They're not going to change the way they eat or the way they exercise or any of those things if they're not bought in. And it's also going to lead to better outcomes because it's going to impact them in ways that they can see and that they can care about. And that will lead to improved mental health and physical health.

Ellen

Wonderful. And Janine, how about you? What are you the most hopeful about?

Janine

So what I'm hopeful for is that I feel like over the last 10 or 20 years, there has been more of a shift towards lifestyle. And I feel like at first I was kind of stuck with, what medically can we do nutrition wise with this patient or…and through health coaching that focus on lifestyle medicine and all of the research that's gone into it, it's just so hopeful.

And then also some of the research with the Blue Zones has been really exciting, I think. And bringing it to the United States and looking at how can we, again, change our environment (I mentioned that earlier) to promote healthy aging. And it's really promising, and it's giving me a lot of hope that over the years, we might cut down on some of the lifestyle factors that take away from our health and could speed up aging. And there's so much more research on that too, which is also something that gives me some hope. That not only are we going to see a little bit more of the science behind why it is, why the Blue Zones are—the people are living to 100 and thriving and don't have the chronic conditions—but also how we can make it happen through lifestyle changes right here in our communities and with individuals.

So I'm really excited to continue to work with people to help them on an individual level, look at their world and see what changes they can make. And I do see people, you know, some of the members that I work with, just within a few months of making changes, have such an improvement in their health and their well-being. And I have to bring up again that sense of joy and that sense of purpose is so important too. And I can hear it. I can hear people say, “I am now getting out of the house, and I'm able to walk down the street and get my mail. I couldn't go down the driveway and do that.” “I can actually visit my neighbor. I can walk across the street and do that. And I couldn't before.” And, “I'm sleeping through the night now, and I'm, started just eating breakfast and making a few changes with how I'm eating. And I'm noticing that I have less pain and inflammation” and just so many little changes.

And I hear it every day with the members I work with. And so every day I'm filled with, “Yes!” You know, I know it's working. I can see it globally. I can see it right with the members I'm working with. So it makes me feel really optimistic that we're on the right course with healthy aging. We’re figuring it out. <laughs>

Ellen

That's great.

Rick

I agree, and I love the stories of the, of how in these individual cases, we're making such big changes with small adjustments. That and I love that you didn't mention anything about medicines or anything about surgeries. And it's about, you know, these things that we can do day to day. And really, it's like a culture. It's a culture thing. Right? And I think I'm hopeful also that that culture is shifting. So I love those stories and I'm looking forward to hearing and seeing more of them in my own practice as well.

Ellen
Well, Janine, thanks so much for being with us on “Good Health, Better World.”

Janine

Thank you. It's been wonderful.

Ellen

Rick, thanks for joining us.

Rick

Thank you. Yeah, I had a great time.

Ellen

We hope you enjoyed this episode of “Good Health, Better World.” Be sure to tune in next time and visit upmchealthplan.com/goodhealth for resources and show notes.

This podcast is for informational and educational purposes. It is not medical care or advice. Individuals in need of medical care should consult their care provider. Views and opinions expressed by the host and guests are solely their own and do not necessarily reflect those of UPMC Health Plan and its employees.

 

Guest speakers:

 

Richard Hoffmaster, MD

Director of Palliative Care Services, UPMC St. Margaret Hospital

Director of Palliative Care Education, UPMC St. Margaret Family Medicine Residency

Clinical Associate Professor, University of Pittsburgh, Department of Family Medicine

Medical Director, Presbyterian Senior Care, Longwood at Oakmont Campus

Dr. Richard Hoffmaster is a board-certified family physician and geriatrician at UPMC St. Margaret. He earned his medical degree from the State University of New York – Upstate Medical University, subsequently completing a family medicine residency and geriatrics fellowship at UPMC St. Margaret. After concluding his training, Dr. Hoffmaster joined UPMC’s Palliative and Supportive Institute, and the medical education faculty at UPMC St. Margaret, with a clinical focus on palliative and elder care. In his current role, he provides inpatient and outpatient palliative care consultative services and maintains a geriatric primary care practice. He serves as Medical Director at Presbyterian Senior Care – Longwood at Oakmont Campus and Director of Palliative Care Services and Education at UPMC St. Margaret Hospital, and has collaborated to develop national family medicine residency curricula on advanced illness and end-of-life care.

 

 

Janine Jones, MEd, RDN, CDCES, NBC-HWC

Clinical Health Coach, UPMC Health Plan

Janine Jones has a master’s degree in nutrition education and is a Registered Dietitian-Nutritionist, a Certified Diabetes Care and Education Specialist, and a National Board-Certified Health and Wellness Coach. She has 30 years’ experience working as a dietitian in diverse health care and community settings. She has been a lifestyle health coach at UPMC Health Plan for over 15 years. As a health and wellness coach, Janine supports clients making healthy lifestyle changes for healthy eating, weight management, physical activity, stress management, tobacco cessation, sleep health, and diabetes care and prevention.