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T M C » P U L S E | S E P T E M B E R 2 0 1 8 T M C » P U L S E | S E P T E M B E R 2 0 1 8 14 Q | You are featured in UT Health videos discussing illness in older populations. What are some of the biggest challenges and misconceptions there? A | One of the cardinal signs of ill- ness in an older patient is an altered mental status, but it's hard to know how to interpret that. Are they just having a bad day? Are they getting Alzheimer's disease, or is it really that they're acutely ill? Whenever that happens, family members and caregivers need to get their older loved one to some sort of a health care provider, but I don't think people realize that. In addition, I don't think people realize that older adults can have infections without having a white blood cell count that's high or without having a fever. They don't, I think, understand that for some frail, elderly people, you can't drill down on their blood pres- sure or their blood sugar because you'll lower it too much for their body state, and that results in falls. In fact, studies now show that there could be brain and heart damage from ratcheting the blood pressure down and managing it too tightly in old age. Q | Of the studies you're conducting at the Consortium on Aging, is there one of which you are particularly proud? A | We were able to start a tele- communication program for Adult Protective Services clients—the first in the country. We've done almost 500 cases now, and we started it last June. We can do a tele-consultation with a geriatric elder mistreatment expert and geriatrician where the case worker goes into the home with an iPad and we FaceTime. It's all HIPAA [Health Insurance Portability and Accountability Act] protected. We help make determinations about how well the patients can make decisions about themselves, whether or not abuse or neglect is present and do they need any medical interventions. We are giving advice to the protective service worker so they can do a better job of taking care of these vic- tims. We just got a paper accepted on this subject in the Journal of the American Geriatrics Society. We were waiting until we got 500 patients, and now we're going to start analyzing. Jason Burnett, Ph.D., co-director of the Texas Elder Abuse and Mistreatment Institute, is lead- ing that. Q | You also talk about the concept of healthy aging. What does that mean to you? A | I think that the term has been applied really broadly, right? You start aging from the time you're born. Truly, where people start to be concerned about aging starts at age 65. That's when you need to prepare—if averages are correct—to live another 20-plus years. You have to make sure you're taking the steps so that when you are 85 and 90, you're the healthiest and the most functional you can be. It's never too late to start thinking about healthy aging. However, with the people and the patients that I've seen, there are probably two major things to do: First is exercise, exercise, exercise. I have a treadmill desk in my office so I can practice what I preach. The second thing is, research studies have shown that having a positive attitude helps preserve cognitive health. People who make lemonade out of lemons, people who look at the bright side and are resilient— they do better. We don't have to wait to be 65 to do that. We can start that anytime. Carmel Bitondo Dyer, M.D., was interviewed by Pulse Senior Innovation Writer Christine Hall. The conversation was edited for clarity and length. I like to say if I could teach every doctor in the United States one thing, it would be how to manage medications in the very elderly, because there are no algorithms you can follow for that. Spotlight