Join us for an inspiring conversation about the future of aging with Dr. Daniel Thomas, one of the youngest geriatricians in America and attending physician at Penn State Health! Hosted by CareYaya's own Chief Patient Officer, Nirvana Tari.
In this episode, Dr. Thomas challenges everything you think you know about getting older, debunking the myth that "everything is downhill after 65" and revealing why the secret to healthy aging isn't about avoiding decline—it's about never stopping growth. From his training at Johns Hopkins to his current practice, he shares why focusing on what's still good about patients instead of what's wrong revolutionizes care.
Discover the cutting-edge innovations he's most excited about, including AI-powered wearables that can predict frailty and falls before they happen, and why he believes we need "schools for seniors" in every neighborhood. Dr. Thomas also tackles the caregiving crisis head-on, offering practical mental health strategies for overwhelmed family caregivers and explaining why taking care of yourself isn't selfish—it's essential.
Key insights include his "never stop, never stopping" philosophy for longevity, why eating smaller portions and walking more beats any complex diet, and how he uses AI to fight insurance denials. Plus, hear the powerful patient story that transformed his approach to dementia care and taught him that healing doesn't always require curing.
Brought to you by CareYaya, America's #1-rated solution for in-home senior care, providing industry-leading quality care at the most affordable rates. CareYaya is known especially for delivering the most reliable and affordable overnight senior care and 24/7 care in many major metro areas including Atlanta, Boston, San Francisco, and Washington D.C.
This episode is perfect for anyone approaching midlife wondering what's next, caregivers feeling overwhelmed by the system, or healthcare professionals looking to transform their approach to aging patients.
Transcript
Hello and good morning, everybody. Thanks so much for being here with us today. Happy Friday. We are super, super excited to be kicking off today's episode with the one and only Dr. Daniel Thomas. How are you doing today, Dr. Thomas? I'm good. How are you doing? Wonderful. So excited to have you here. Yeah, I appreciate that. So before I get going into this, because I'm super excited to start, I just have to share a short disclaimer. So just to say the views I share in here are my own, and I don't represent Penn State Health or the Penn State College of Medicine, Johns Hopkins, where I trained, or any other of my affiliated organizations. This conversation is only for general education discussion, so it's not medical advice, and I have no financial disclosures or conflicts of interest. There we go. All right. Well, I'm going to go ahead and kick it off with a classic lightning round. So if you could answer these questions in ten seconds or less. And here we go. What is one thing that med school just did not prepare you for? I would say that care needs to start with the person's goals instead of the disease that we're focused on. I love that. That's good. I'm going to clip that out and use it somewhere else. Next one, jeans, lifestyle or luck? What matters most for living to one hundred? So jeans and lifestyle to get to seventy. OK. And then after that, it's really jeans. OK, that's that's a hot take. I'll take it. I love it. Scrubs or suit, which makes you feel more powerful? Oh, that's hard. Maybe honestly, probably still a suit. But I like both. I'm team scrubs all the way. And I'll do one more, and that is... No, I'll do two more. What is one thing that you do for your own longevity? Get outside every day. Wow, I love it. Did you hear that, everybody? Get outside every day. And last thing, what gives you hope about the future of aging in America? So we have more information and tools to live healthier than ever before in human history. We just have to eat. Ah, yes, I love it. You are just giving us amazing quotes left and right, Dr. Thomas. Thank you. But I am curious. So if someone were to only listen to the first couple of minutes of this podcast, what do you really want them to walk away from? This is good. I'm going to say a couple. Yeah, I'm going to say a couple things that might be jarring, but I'm hopeful will actually be helpful to think about. Please, we're all about jarring. Yeah. If we're all dying slowly, how do we learn to enjoy the journey instead of trying to avoid the destination? That's the first one. The other one I thought about, and I think there's actually two things I wanna say. The second thing is, and this really, this gets into a little bit of, it's almost a philosophical question of what is the point of healthcare? The goal of medicine and healthcare is not giving people more years or allowing them to be able-bodied in of itself. Those are just tools. They're valuable when they help us create lives that feel meaningful to the person who's living them. Wow. That's amazing. I guess, hey, you heard it here first. So listen to one of the youngest geriatric doctors that is out there right now. So actually speaking of, Dr. Daniel Thomas is a geriatrics attending at Penn State Health who spent years training at Johns Hopkins. But here's what's really cool about him and what I think is really cool. It's that he's figured out that his eighty-five-year-old, seventy-five-year-old, eighty-year-old patients are often some of the best teachers. So I feel like he's learned the most important stuff about aging and living well. It doesn't really come from the textbooks, but it comes from listening to the people who've mastered the art of getting older by actually getting older. What are the newest generations of geriatric physicians? What surprised you the most about just working with older adults? Yeah, that's a great question. I think the biggest takeaway for me has been that people just want to be seen, right? So I think people get intimidated by that whole older adult concept. Oh, these are people who are jaded. Maybe they're cynical. It's depressing to work with them because life is already in the rearview mirror. You know, maybe they have problems that can't be fixed. Some doctors are really allergic to the idea that they're going to work with people where they can't fix the problem, quote unquote. Right. And so for me, you go into it with a certain set of expectations and assumptions that you're bringing into it as a young physician. And you know that patient's going to bring in a lot of assumptions based on thirty plus years, forty, fifty, sixty, seventy, eighty years of interacting with the health care system. Right. So there's a lot of like baggage that comes into that encounter. But what I have found is when you cut through all that noise, people just want to be seen. They just want to be understood. They want their story to be heard. And they want to feel like the person sitting next to them really sees them as a person and not as a disease process and not as another office visit and not as just an old person, but just a person. And so when you strip away everything else, I think people actually respond really well. Oh, I love that answer. You know, I am really curious. So like, I guess you said earlier you started medical school around like twenty one. So twenty one year old Daniel Thomas, did you think that you would be a geriatrician ever? Like is that was that like your goal? No, it wasn't. And that's a great question. So I was very interested in how systems interact. So my background is actually like from a business background. And I think everyone in our generation understands that healthcare is broken, right? We understand that almost no one is happy with the status quo, and yet nobody seems to really know how to fix it. And so that was kind of my interest in saying, do I get involved in understanding the business side of this and how do I understand um how to align incentives like financial incentives with values and so that was sort of my passion I was thinking internal medicine I was thinking being a generalist um but I wasn't specifically thinking about geriatric medicine um it almost seemed too limiting like I wanted to see all sorts of patients of all ages I always have loved working with older adults in general And some of that probably is cultural, but I never thought this was going to be the one population I'd focus on. But as I went through my training, I think two things. One is I met people who were incredible physicians and realized many of the physicians that I most resonated with from a values perspective were geriatricians. And two, I had this understanding sort of evolve is that so already, sixty five, seventy percent of all the patients you see in the hospital are sixty five plus. Right. So most doctors are actually involved with geriatrics, even if they don't realize it. So then the question is, can you treat an eighty year old the same way you treat a forty year old? And I strongly believe the answer is no, but people. The entire medical system is not designed. We're designed as a one-size-fits-all approach, and people do not tailor their way of delivering care to older adults, right? So we don't have age-friendly healthcare systems, which is kind of like a buzzword in geriatric circles, but it doesn't exist, right? So we have that coupled with a rapidly aging population, especially with the boomer generation, really pressing into retirement and into older age. And so there's just a massive need in the country to think about how to deliver care differently to older adults. And we're just not set up for that yet. So I started getting extremely passionate about what I could contribute in this sphere. That is so incredible. And I feel like Hopkins is one of the greatest places to train for that. having met Dr. Estero, she's just seems so incredible and so inspiring. And so really, really glad to have one more geriatrician added to the small pool. And hopefully this inspires a few others to come out of the woodworks as well. But, you know, I feel like people, this is the question that people all want the answer to. What do you think is something that everyone just should start doing today if they want to age as healthily as possible other than going outside? Yeah. I think a huge aspect, I mean, going outside and exercising is a huge aspect. Nothing that I'm going to say here is groundbreaking, but I actually do believe it's part of the secret is if you eat tasty, healthy meals, stop before you're full, right? A lot of people talk about how, oh, the food is better in Europe or overseas. I don't think that's actually true. I've lived overseas for a bit for a few months. And I just think you eat smaller portions and you just walk a lot more. And people eat wine, they eat beer, you know, bread, cheese. I mean, it's not, you know, this keto optimized high protein diet that people are eating over there. It's the calories. I mean, it's that simple. It's like calories in, calories out. And longevity is very strongly associated with maintaining a healthy body composition weight. And I'm not at all saying that you have to be at a specific weight point. I think BMI is kind of overrated as a way of measuring actual health. But the idea that we all were evolutionarily designed to try to store food for the times where we won't get the food doesn't work with a Western, you know, three meals a day and each meal is bigger than the last and, you know, and plus snacks in between. And once you get used to that, then you're creating all sorts of downstream effects that add up over the years. That's such a good point about the each meal being bigger than the last. I feel like I'm guilty of that too. I start out with breakfast, like something really, really small, which probably shouldn't be the case. I feel like that should be your biggest meal of the day. And then it just keeps tornadoing as it goes along. But that's great advice. I'm actually going to take that myself. So thank you. So now tell me about a myth about aging that you just find yourself debunking constantly. You're like, that's just not true. Yeah, that's a great question because it's a myth that I actually debunk for my patients who are older as well, which is everything is downhill after sixty five. I mean, people really think that. Right. And some people will be like, oh, it's all downhill after thirty five. And that's just it's false for one. But it's also really lazy. Because I think it reflects this idea that we sort of assess people in terms of what's wrong or what has gone wrong instead of what strengths they have, right? So one time I was with this eight-year-old patient and we had a medical student with us who presented this eight-year-old's story. And so this is a medical presentation. So they're discussing the patient. They're like, you know, this is an eighty year old man who has blank, blank, blank conditions right now because they're eighty. There's about twelve of them. Right. So he's listing them all out and he gets the end of the sentence and the eighty year old interrupts him and he says, well, what's good about me? Oh, my God. So, you know, if you could write a patient presentation medically focused on their strengths, what would you write? But our system is not designed to think that way. And we don't actually think that way as human beings either. So we just focus on what can't they do instead of what can they do? What have they accumulated? What are the good aspects of this stage? And I think that's something that I'm always trying to challenge because I think the way you think of yourself and what you bring to the table really matters. And people just define that in terms of ability physically and ability to produce. We live in a world where it's like, what can you generate financially or from a productivity standpoint? And that's really not all there is to life. There's so much more to it. We are actually like, we're meant to be social creatures. We're meant to engage with other people in other ways. And so, yeah, I think it's a long-winded answer, but I think the myth is that everything has to be downhill after sixty-five and that, you know, it's just a matter of trying to like stave off that decline or manage that decline. And that's just not true. I love that answer, honestly, because, you know, I feel like as a society, we've kind of just become obsessed with youth. And like, there's like me myself, like I'm literally twenty five and I'm like, oh, my gosh, like I'm so old, like all this and like the next, like I need to figure out everything. And it's like, no, like you're in the first quarter of your life, like you're doing OK. Like this is this is just like one of the first few chapters. And like I feel like everything just feels so rushed, but sometimes just slowing down and taking a second and recognizing where you are in this in whatever space and time that you're in. And just like getting excited about getting old, because I think someone said this to me and it really stuck with me, but it's that, you know, aging is a privilege because if you don't get old, then you die young and no one wants to die young. So I think it's a really beautiful thing. And we just really need to start paying more attention to those like. Sixty five plus years so that we can make them as valuable and as beautiful as we possibly can. So. Yeah, I really like that answer. Have you ever heard of Teepa Snow's positive approach to care? Yes. Yeah, I do. I think she has a lot of really high value insights into thinking about caregiving and thinking about what it means to age, especially if people do have changes with their cognition. So absolutely. I mean, just to summarize for people who might not be familiar, I think it's very strengths based, just like how I was earlier alluding to. And it's very much based on like, how do we respect and honor somebody as they're aging, despite things that we might traditionally view as a deficit. Absolutely. A hundred percent. She's she's from we're based out of North Carolina and she's from the area. So she's like a local celebrity here. And I've gotten the chance to meet with her a couple of times. And I actually, I'm so giddy and excited about this, but I'm on a panel with her this coming Monday for Brett. We're doing like a screening of Bradley Cooper's caregiving documentary and her and our, and a few other wonderful social workers from the area are giving, um, like a discussion afterwards. And I think that her framing of just like aging and her approach to care, just like you said, like so perfectly, like it's just, let's focus on what we still have and let's really celebrate that instead of harping on what's, what we've lost. Like who cares if you can't do this, you can still do this, this and this. So I think that that's a really beautiful way of looking at it for sure. But let's see, I'm trying to think which question I should ask you next because there's, Two different directions that we can go into, but I guess I'll ask this one because it's a quick one and I'm interested personally myself. So you're on a TED Talk stage and you're giving a talk on the secrets of aging well. What do you think your title would be? So facetiously, I'm going to say never stop, never stopping. which is just, it's kind of a joke, but the, I think what I'm, what I'm trying to get at with that is that you have to continue to grow and you have to continue to have like, just want to learn and want to be willing to change. And I find that when patients stop growing, stop learning, stop looking for the next thing, That's when actually physical and cognitive decline accelerates. And this is borne out in the research. So if there's one thing that I try to get people to think about, even when they're thirty five, it's just continue to grow, like continue to challenge yourself, continue to pick up new hobbies, continue to learn new things, like continue to expand your skill set. Like there is a tendency that I think people have. They get to a certain age and they're like, no, this is what I like. This is what I don't like. This is what I know. This is what I don't know. And even whether it's career, whether it's like the way their personality, whether it's character traits, it's sort of like, no, this is who I am, right? And take it or leave it. And that's fine to an extent. But if you can sort of understand, okay, this is my base. This is maybe a lot of the stuff. This is my comfort zone. How do I expand and grow? And there is such a difference between, I mean, I would say every patient that I have who's healthy into their eighties and nineties, they all have this in common. And I think that's quite striking. Okay, that's really good to know. I mean, like, I also think that surrounding yourself with, I mean, if possible, of course, like, I feel like intergenerational relationships are just so valuable when it comes to, like, positive aging as well, not just for the older adult, but for everybody, every party that's involved. Like, I think that that's just such a beautiful aspect of life. My, we had a tragic accident in my family a few years ago that resulted in one of my like cousins who was at the time, like less than like a year old to move in with my grandparents. And, you know, it's been ten years since that's happened. But my grandparents, I'm going to knock on wood when I say this, feels like they're the exact same age as when this whole like ordeal started so like they didn't think that in their eighties they would be taking care of like a newborn or like an infant and here they were so they they kind of just like took the ball and ran with it so I feel like I love that having something to do and like giving that like new sense of purpose is just like so awesome and wonderful and that doesn't have to be a new child that could be a really cool new hobby, like whether it's, you know, doing Legos or like jigsaw puzzles or starting a neighborhood walk group. Like, I feel like all of those things are just that renewed sense of purpose is really, really something that's beautiful, especially in a country that is so focused on productivity. Like you were saying earlier, like productivity doesn't have to be yield and financial results or anything. It could yield in like a smile on your face. And that's honestly all that matters. So, yeah. Yeah, I love that. And you're absolutely right. The literature actually bears out what you're saying, which is that, you know, older folks who live in multi-international homes, I mean, you've got to control a little bit for income level, but when you control for that, they absolutely do better than those who are living by themselves. You know, in America, most Americans do not live even within a driving distance of their parents, like a thirty minute driving distance of their parents. That's like the norm here. That's not true in other countries. Most many other cultures, it's intergenerational homes, multigenerational homes is the norm. And I think it's something that we could really learn or try to reintroduce to just society at large. Absolutely. I think it's just so beautiful. I mean, I I've been telling my boyfriend, we're going to have an add you in our house for my mom because I do not want to live anywhere that's not in the same neighborhood as her. So yeah, and that's that's on being brown. But you have been training at some of the world's most wonderful institutions from Mount Sinai to Johns Hopkins. And now here you are at Penn State Health. So you've been kind of on the cutting edge. So talk to me a little bit about some some or just one tech or innovation like idea that you have found to be like super excited about within aging care? Yeah. I mean, I love that. I think a lot of times people in geriatrics tend to be like a little bit skeptical of tech just because a lot of tech is built for people who are younger and who are more tech savvy. And so a lot of older adults either are not going to access or it's just not It's just not useful. It's not going to add anything to their care. But the thing that I actually do feel very excited is the idea of doing wearables and using AI based or machine learning, really based analytics to start to predict frailty, fall risk and just changes in clinical status. Right. If you have wearables or you have surveillance in the home, that gives you data on how fast people move, right? How their gait is, how much they're actually eating, maybe a little bit of a sense of their metabolism slowing or changing their, you know, heart rate, the sort of the traditional vitals that we think about. Yeah, I don't know if I lost you. We might have lost our presenter. So sorry. I have no idea what happened. It would not be a live stream without at least one hiccup, now would it? No, it would not. That's fine. You were talking, please. Yeah, where was I? So I was saying... Wearables. Yeah, yeah. So I think if you collect all of that data, right, and you think about... what you could do with a predictive model, this is already being done. Like this kind of work is already started in all sorts of different ways. I think we're still a few years away from this truly being like prime time for all older adults, but we're getting there. This will happen, I think, in the next five to seven years. when you have all of that data you have the ability for physicians to start responding proactively instead of reactively everything we do in medicine is reactive right now and we're getting very close to starting to be more proactive and I'm very very excited about that and I'm really actively trying to think about what does uh healthcare like what does a clinic model look like that incorporates all of that proactive data um so yeah that I would say that's probably the one thing I'm the most excited about I totally and completely agree. And I think that like the most when it goes hand in hand with public health and public health truly is all about prevention and, you know, getting it to the root of the problem before it even really like arises. So I think that's, that's a wonderful answer. And something that's like, we've also noticed with Keriaya and our platform is that for those who may not know, we match undergraduate college students who are pursuing health careers with anyone who maybe need some in-home companionship care services. And like the, I guess, for lack of a better word, resistance to tech significantly decreases when someone is just takes the time to introduce it to them, you know? And, you know, these like, nineteen, twenty, twenty one year olds are all like, tech natives. So they understand the technology really, really well. And they love like sharing that knowledge. And so as long as there's like a listening ear and older adults love learning, like that's something that I've, that's one myth that I've seen in my work with older adults is, oh, like, you know, they're stuck in their ways, this, that, and the next. And I'm like, no, like if you just take a second and like show them something like cool, who wouldn't want to learn something new? So I think that really just taking the time and like showing them the tools that are at their disposal can go a really, really long way. Yeah, you've touched on a key point, which is the pedagogical approach matters, right? And when I say that, I mean the way that you teach someone, right? So just think about the fact that older adults were taught and learned learning in specific ways a few decades ago, and the way we teach has changed. And so tech is, there's specific ways that you and I, like if we pick up a new phone, right we go through that phone in a specific way that's actually quite generationally defined in terms of like trying to learn what it does does not apply that same learning methodology and gets easily frustrated when it doesn't result in learning how to use the phone so what they do is they shut down and focus on the two functions that they really need to know right so thinking about that in that way is part of what will help us connect with older girls. Because I completely agree with you. They're actually very receptive to learning. You just have to customize the pedagogy to them. Exactly. Wow. I love that. You were just a ball of insights today, Dr. Thomas. And I am all about it. Who would have thought that this... I'm just loving this conversation, every single moment of it. But I guess now that we have talked about the positives that tech can like bring into like the lives of older adults what do you think tech is like getting wrong about aging and elder care like is there something have you given that any thought Oh yeah. I mean, there, there's a reason why most of, or many, I'm not saying most, many of my mentors are very skeptical about tech and I totally get that because their concern is, and this is borne out by the people who run the big tech companies, right? Is that tech entrepreneurs often think that their tech is going to replace physical human connection. Right. I've seen that a lot too. Yeah. I mean, you know, recently the CEO of Facebook, got up and said at an investor meeting, right, that, oh, you know, most Americans are looking for more friends. Most Americans are lonely, which is so true in the older population, right? Social isolation affects about twenty five percent of elders and is a huge reason for depression, for worse health outcomes. I mean, it's such a major problem for most Western societies, actually. And I was like, oh, great. He's identified the problem. That's a great point. And then he said, we're going to create AI avatars that now can replace human beings so people can actually have the five to six close friends that they want to have. And I was like, we're missing the point, right? We're completely missing the point. Right. I feel like that's, like, I love when technology enables human connection. Like, that's why... that's why I think sometimes AI gets like villainized in this space is because they're like, Oh, it's trying to replace it. And I'm like, no, it's trying to allow for that human connection to occur because, and also like sometimes, sometimes it can be the case that there is absolutely zero, zero option for human connection. And like, you absolutely cannot bring that in. And then maybe it's more AI to kind of quote unquote, try and like step in and like, be the bare minimum, or at least be something that's there to like help out. But I don't think the goal is ever to have human connection be replaced. I think the goal is for AI to create more time in human's lives to be able to actually make those connections. So that's really, really cool. Are there any specific tools? I know you mentioned wearables, but are there any like more specific tools that you're excited to bring into your own geriatrics practice? Yeah. And honestly, some of these tools exist and some of them don't. But I feel like we have the capability to build them. Tell me about the ones that don't exist. Oh, my gosh. So I do think the idea of a mental health app that gives people access to like a CBT based or a therapy based curriculum. So this would not replace an actual therapist, but this would basically be an interactive way to go through the worksheets, right? Like the workbooks that therapist gives you. And sort of helps guide that, customize that. And honestly, would then forward those answers and forward that work back to a real therapist, I would see that as being an extremely useful piece, right? Because we have a huge issue in terms of like shortage of mental health providers. And so if we gave that as a way to kind of bridge those gaps in between visits even, I think that actually would expand who can access mental health services. I think that's a huge piece of it. You know, caregiver support tools. I think the idea that there's, I would say, so when I get questions posed to me as a physician, right, eighty percent of those questions are things that probably a really, really good Google search would have figured out. But they're coming to me for the fact they want someone to sign off on it. Right. And be like, yeah, you found the right information. They're worried about all the misinformation that accompanies all the junk. that they're going to find on that search as well and they want to make sure that it actually is relevant to their specific loved one um that they're asking me the question about right so that's the caregiver stress right and they don't have the time to do the google search so they send me the question well honestly if I had a tailored tool that could answer some of those questions then I can just like review the proposed answer and sign off on it that would actually save me a ton of time and it would be evidence-based It would be based on information that's already out there. It wouldn't be totally unsafe, right? There's still an opportunity for human review or even like having a clinical nurse who could review that for me. think that would actually triage like eighty percent of the questions that caregivers have in between visits and then that twenty percent would be like hey yeah this is actually more complex why don't we get you in for a visit or you know actually this does deserve a phone call or an extra video visit or something else right so there's ways I think that we can leverage um llm models to actually provide more caregiver support without replacing the doctor caregiver connection without replacing that relationship exercise apps, nutrition guidance. I think those things could be even more customized and personalized. And I mean, there's some of these tools out there, but I would love to see these tools specifically for the aging adult and for adults with cognitive impairment, et cetera. We're not quite there, but I think those tools will eventually become widespread. I love that answer. I think all of those are super, super necessary. And just like you said, really doable to get done. Absolutely as well. And just, I also love that you mentioned caregivers in this scenario, because I feel like a lot of the times we forget that there's a whole care team that's involved when it comes to a lot of older adults. And a lot of the times, the health of the caregiver is the last thing that's discussed and talked about. And I think that a lot of the times, geriatricians are kind of on the front line of seeing that decline in caregivers. So do you have any mental health tools and tips for family caregivers that are in the position of taking care of an older adult who's their loved one? The biggest thing I would say is you have to learn to take care of yourself, right? It's like the principle on the airplane, right? Like put your own oxygen mask on before you put it on someone else. A hundred percent. you and this is what I find resonates because I will tell people over and over again hey you need to take a break you need to make time for yourself you need to to you know take a respite break and let someone else care for your loved one people struggle with that right and maybe some of it is like oh I'm the only one who really knows like you know they feel guilt there's all of this complex emotions that go into caregiving right and it becomes their identity and they don't know how to not do that um What I always tell people is you are not going to be the best caregiver you can be for your loved one. Your loved one is not getting the care that you want them to have. And when I frame it that way, people are like, oh, okay. Yeah, well, it's like I have to frame it outside of them. I have to frame it as like you're not gonna be a good caregiver to get them to understand. But I will do that if it pushes them to take that three-day vacation. Sometimes I've had to do that. I've had to like literally convince someone to take a three-day weekend trip and let someone else watch their husband or their love or their parent um and then they come back and they're like oh my gosh that trip was the best thing I did in the last three years right so that's I think really important is to say if you want to be a good caregiver you actually need this yeah a hundred percent and I think hearing that from like someone with so much authority as yourself is really really helpful because again, a Google search would probably be able to tell someone that they need a break, but external validation and like knowing that like, Hey, like you, you got to put yourself first because honestly, something that was shocking, like that I wasn't even aware of before I got into the space is you like caregivers oftentimes have more health complications than like, they, they like, don't even like live as long as the person that they're taking care of sometimes because the health complications that result from the stressors of being a caregiver and that is so heartbreaking to me and like we all know this you know this I know this like anyone who's had to deal is a sandwich generation person or has aging parents knows that caregiving in america is in crisis right now So I guess from your view as a clinician, what do you think is breaking and is there anything that's giving you hope in this space that, you know, we're moving in the right direction when it comes to caregiving and caregiver support? Yeah. I mean, you nailed it is that, you know, and, and just for, I don't know who's watching or, and maybe everyone's already familiar with the term sandwich generation, but you know, you have more than a quarter of Americans who are actually, you know, sixty, seventy million people are about who are actually sandwich generation, which means they have to take care as well as their older parents. And so they're spending twenty plus hours on taking care of their parents. They're spending about thirty hours a week on their child care. So that's a huge amount of time in exchange, you know, in addition to working fifty, fifty five hours in a job. Right. So it's it's just it's not sustainable. And that center just cannot hold unless they get support. And we live in such individualized sort of ways of living that often people don't have any support outside of that unit and so that's a huge issue it's just not sustainable um and that's only going to increase right so we're having less and less kids and we're having we have more and more people who are aging and living longer but who might still be quite sick right so people live longer but they're living longer with more health conditions including cognitive impairment right so you're you're creating even more of a care burden The adult is not the burden, but what they need is sometimes a burden for the person who has to provide it. And we do not have people certified to help with that either. So that's a huge issue. And I know that sounds really depressing in some ways. I do feel hopeful that we do have more and more people who are starting to wake up to that reality. And our interest in thinking about healthcare in that way. So from a physician standpoint, I think people are starting to say, wait a minute, why do we focus all of our training and the way we think about healthcare in terms of organs and illnesses? How do we keep people out of the hospital and healthier longer, right? Instead of individual like patients journeys. And that is hard for a lot of reasons that I could get into. But that's a huge aspect of it. I think there's more and more interest in that. I think from a policy side and even the business side, we are just starting to realize that we're being short-sighted when we focus on more hospitals, more nursing homes, instead of how do we actually reimburse and take care of the people who are taking care of people outside of the healthcare system, right? Because what you don't understand, what most politicians don't understand is that it is more cost-effective to pay someone to take care of their older adult in the home than not pay them wait for them to show up in the ED after a fall, and then you're spending a couple hundred thousand, a lot of it coming out of the state budget, right? Now figure out what to do next, right? So it's just, we're being very short-sighted if we don't think that way. And I truly believe that's the future is when people start to realize that and then align the reimbursement because people are like, oh, well, we can't afford to pay for home health. That's not true. We can't afford the current system, right? And so- If we start redirecting money into home health, I guarantee we will see the benefit in the long term. But we have to be willing to think long term and we have to think about reimbursement models that are more long term. feel like we could literally have a podcast episode just on that because I have so much to say about that like honestly put a geriatrician put a physician in the white house because what are we doing right now like this is not this is just not the way that things should be going and like oh there's so many there's so many ways to improve this system like I feel like the entire caregiving atmosphere is stuck in the eighties and has been for so long. And it's been like, just, just craving innovation and like in need of that. And, you know, like I think that I do think that we are starting to move away from it and there are like non-traditional models coming out similar to Keriaya. And I think that that's kind of where we need to like shift our focus, but we are, we truly are in a crisis. Like there's, I think right now the ratio of older adults to middle-aged individuals is seven to one. By twenty thirty, that ratio is going to be three to one. So we're in a caregiving crisis right now. What do you think is going to happen in twenty thirty? You know? And also, I mean, there's like I don't want to get like political by any means, but like they're a large population of the care workforce tends to be undocumented. And there's a lot of the times that with the mass deportations and things like that happening right now, that's causing an even bigger gap in caregiving. And so we need to come up with solutions quick and figure out what we're going to do in order to be able to continue taking care of older adults. But I guess I'll leave you with this one question because I We were just talking about it, but if you had a little bit of a magic wand and you were like, I can change one policy to improve aging care tomorrow, what would that be? Yeah, that's a hard question. There's so many things. I'm going to pick one and not because I think it's the best one per se, but I think it's actually the most like imagine if we funded senior centers in every neighborhood, like schools. And those senior centers had nutrition support, had exercise classes that were engaged for older adults, had care coordination support, had social activities and other support all in one place. And they were walkable or within ten minutes or fifteen minutes. of every older adult. Imagine if that's how we funded senior centers and imagine the impact on healthcare for all older adults if we actually had a network like that. I've never heard of that idea before and I'm obsessed with it. That's, that's, that's incredible. Oh my gosh. I can't take credit. I can't take credit. It's definitely been talked in the, in the geriatric circles for a long time, way before I came on the scene, but, but absolutely. It's one of my favorites. I'm going to send you a very long email after this and we're going to make it happen because that's, such a good idea I mean we can we should start piloting that we could use we could use the college students to staff it honestly and we could we could just like get get a little something going I'm sure I'm sure we could um you know start we could write some grants and try and oh oh my gosh so many ideas cooking in my head right now we're I'm I'll be sending you a very, very long email after this. I love that idea. That's really, really wonderful. Honestly, universities should leverage it, right? Because universities have a lot of those supports already and universities easily build that even within their campus structure, right? Like it actually wouldn't be a lot and it would be a big PR win for them anyway. I actually think it's something universities could really leverage. I think that there's, I think it's ASU that's kind of a little bit doing that right now. I don't know if you've heard, but they have like a- Yes, yep, you got it. Yeah, they have like a Mirabella or something like that is what it's called. But they have for those at home, they have like a, is it a nursing home? It's a retirement home. I want to say retirement community kind of thing. I could be wrong on that. I've only read their press release. I haven't actually like delved into their model. I haven't looked into it too much either, but it just looked so cool. But it's on campus at ASU in Phoenix, which I think is just so, so cool. So that's something that all universities could start. could start concepting pretty soon. But we are coming towards the end of our call. So I do want to ask this one question that I've been really excited to ask you. And that is, what's a patient story that stayed with you and shaped the way that you practice today? Ooh, it's so hard. There are so many and I'm trying to think of what direction I want to take this in because there's patient stories that are really, that gave me like lit this fire underneath me to say like the system is broken. There are patient stories that are really about taught me about human connection. So I kind of, I'm almost like, which story should I give you? Yeah, I think the story, you know what, I'll tell you a more recent story, because there's a story that I could tell you from medical school, but I'll tell you something more recent. So I did the Stereotrics Fellowship at Hopkins, and part of that is doing memory care and dementia care. And this story kind of helped me understand why I cared so much about dementia, and I hadn't before, right? So when I was training, and this reflects back to the way that medical school education is set up, I wanted to fix problems that I could actually fix. right so if it wasn't a problem that I could fix I was less interested in it and that is a huge mistake to make as a young medical student and it was a mistake I definitely made right so I was like venture care not super interesting to me because I can't cure that so you know I'll let someone else be the specialist on that and like I'll tell someone I think you may have dementia you should go see the specialist because there's nothing I can really do for you that's just so not true right because we don't need to cure something to be involved in healing and taking care of that person and so So I had this patient who came to me who was still very, very active, listening to opera, going on amazing vacations with their partner, and just involved with their kids. I mean, just kind of what you would want to see an older adult doing. And they felt that their memory was changing and they could sense that they had gone to a couple of different physicians, including a neurologist over the last two years. And because they hadn't scored high enough on the screening test, they had just been told, oh, yeah, you've got a little bit of change, but it's probably just your age. You're fine. Right. And they were like, I know I'm not fine. I've been a smart person my whole life and I'm just not thinking the same way I was before. Right. their you know their partner could see that and so they came in and they were like you know we just want help thinking through this and just taking a really detailed history and understanding who they're where who they were I was like I don't think that this is just normal aging even though you're scoring super well I think it's because of the fact that you have such a high level of cognitive function to start with so as you decline you're not declining far enough to sort of pick up on some of these screeners and so I actually ended up fighting with their insurance company, but we actually got them a amyloid scan to look for Alzheimer's and it came back positive. Right. And that was a big moment for them. They were so appreciative that we'd gone through this workup and had an answer. Right. I thought they were going to be upset and they were, they were sad. They were grieving all of the possibilities that they had lost or might lose, but they were also so grateful for that opportunity to have that, that, inside that clarity and based on that they actually moved into a retirement committee where they had more support they told their kids they started checking off the last things on their quote-unquote bucket list right like it reframed the way they wanted to think about their life and six months later she actually declined a lot faster once she got to a certain point And so at that point, things were really different. She wasn't able to take the trips. She wasn't able to engage in the same way. She wasn't she I mean, her memory was very limited. It was very distressing to her partner. But he was so grateful for the six months that he felt like we gave him. Right. And that was honestly so humbling for me and just a reminder of what we can offer to patients, even if we can't, quote unquote, cure them. So people get scared about working with aging adults because we're like, well, they're all going to die. It reminds us of our own mortality. It makes us feel helpless. But there's so much that you can offer, that you can be a part of, that you can learn from. even as things may change and there's nothing that we can do to intrinsically cure that change, right? But we can be a part of that journey and we can change that quality of life. We can make that life meaningful. And that's why if I, that's why, you know, going back to what I said at the very beginning, if there's one thing, right, that I want people to take away, it's like, if we're all dying slowly, which we are, how do we learn to enjoy that journey instead of just trying to avoid the destination? Wow. I'm not going to lie. I was going to let you go with that one, but that was so beautiful that I do have to ask a quick follow up question. I wasn't going to ask this question, but I just because, you know, I've heard from so many doctors have been in the position of, you know, my my dad had a heart attack last year. It was pretty bad. And he had to get, you know, like a cabbage procedure, open heart surgery. And it was, you know, of course, like a lot. It was it was a lot of a lot. And I spent a lot of time. on the phone with insurance companies, with hospital people, and it was no fun. So from a clinician's perspective, when insurance or hospital policy kind of directly conflict with what you know is best for your patient, how do you navigate that? Or are you just kind of like, you can't do anything? I'm so curious. Yeah, it's really hard. And I just want to say, I'm sorry you had to go through that. That experience is not unique. Unfortunately, it's more common than I wish it was. I would say, you know, I'm going to try to keep this light because it's easy for us to feel like super frustrated about this. And I am super frustrated about it. But I try to focus on like, what can I change? Right. Like, what can I do? One aspect is actually really fun is that insurance companies, no matter how sort of short sighted their policies are, they usually do have some sort of like, you know, quote unquote guideline that they're basing it off of. And often I'll find that guideline and I actually feed it in nowadays to like chat GPT. And I'm like, if I wanted to construct a reason through explanation of why this patient doesn't fit this guideline, what would I do? And it generates that for me. And then I like basically use a script when I call the insurance company and I'm like, well, this is what your guideline says, and this is why it's wrong. And I've actually won. the two or three that I've done recently using that approach because I'm essentially just fighting them with the tools that they're using. And I think a lot of physicians in the past have like banged their head against the wall because we don't understand where in the world they're pulling this from. So I think it's sort of like, you gotta know how to play by their rules and try to beat the rules. You can't play a game if you don't know the rules, right? So I think that's a piece of it. But I think part of it is just also aligning the patient's expectations with that too, right? And being like, hey, I know it's a super frustrating process, here's our short term option. Here's our long term option. Here's like how I'm going to support you as we wait for this. And if this is too urgent or emergent, these are our contingencies. And if you help people understand that, I think it helps people have a lot less stress and fear as they go through that process. But most doctors don't know that. And this is why We honestly need social workers, we need care managers who can help us with this because the system is so arcane that honestly, this is not MDs, DOs, NPs are going to fix the whole thing. We need a team around us and that's why I'm such a big fan of team-based clinic or care models because it allows us to leverage all of those resources. I love that so much. This is what I was talking about earlier when I was saying AI to give back time to do the things that you actually should be doing because Why should you have to spend time writing up a script to call an insurance company when you can get that done for yourself in two seconds? And then just like you said, I feel like insurance companies are using all of these AI models to deny all of these claims. So it's like, let me fight you back with some AI because what the heck? Fight AI with AI. And I think that's the power of it that we just don't really talk about nearly enough. but there's the audience in the comments is really really grateful we have great idea such an important point for caregivers can't pour from an empty cup someone's loving the idea of schools for seniors and um oh this person said thank you so much for putting this on dr thomas thank you for your insight and caring nature so we've got some fans in the audience as well I really, really do appreciate you taking the time with me today. This was such an insightful conversation, I think, for me, first and foremost, but I think for everybody involved. And I honestly, I'm really excited to have another conversation with you if you'll have us because there's so much to talk about. And I can't wait to kind of continue picking your brain. I would love to. I would love to. Just tell me when. Awesome. You heard it here, folks. He promises he's going to do another podcast with us. So we can do that. But thank you so much for being here. And with that, I hope everyone has a lovely Friday and a wonderful start to the weekend. Go out and enjoy this lovely summer weather. It's a little less hot than it's been the rest of the week. So I hope that's the case for everywhere else, too. But thank you guys for being here. Bye, everyone.