Join us for a revelatory conversation with Dr. Peter Abadir, Associate Professor of Medicine and Geriatrics at Johns Hopkins University, who is quietly engineering a revolution in how America ages. Hosted by Nirvana Tari, Chief Patient Officer at CareYaya.
In this episode, Dr. Abadir pulls back the curtain on the Johns Hopkins Artificial Intelligence and Technology Collaboratory for Aging Research, one of only three national centers funded by the NIH with $60 million to reimagine elder care. The statistics are staggering: over 900 applications reviewed, technologies funded in 45 states, and 45% led by women engineers in a field historically dominated by men. But what's most striking is Dr. Abadir's unflinching mission: to put every nursing home in America out of business by keeping older adults safely at home.
From engineering students who discovered that memory clinic patients universally complained about sleep fragmentation (and built a headband that extends deep sleep using specific sound wavelengths), to voice-cloning technology that raises profound ethical questions about AI caregiving, Dr. Abadir navigates the promises and perils of aging innovation with unusual candor. He reveals why there's only one geriatrician for every 10,000 older adults in America, why the phrase "anti-aging" itself perpetuates dangerous ageism, and how polypharmacy (the cascading prescription of medications to treat side effects of other medications) lands countless seniors in nursing homes unnecessarily.
The conversation tackles uncomfortable truths: male caregivers struggling with role reversal, the epidemic of tech-based scams targeting vulnerable elders, the guilt that haunts families at end-of-life, and why we're not having essential conversations about who decides when crisis strikes. Dr. Abadir introduces the "four M's" framework transforming geriatric care: mobility, mentation, medications, and most crucially, what matters most to each individual patient.
Key insights include: why blood pressure is the silent killer everyone should monitor at home, the myth that cognitive decline and falls are "normal aging," how a simple Alexa device reduced frailty by encouraging homebound seniors to walk to the kitchen, and why decluttering your parents' home might be the most important fall prevention strategy you're overlooking.
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. It 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 essential listening for sandwich generation caregivers watching their parents slow down, innovators developing age-tech solutions, and anyone who refuses to accept that aging must mean decline, isolation, and institutional care.
Episode Transcript:
Hello and good evening, everybody. My name is Nirvana Tari. I'm the host of The Care Plan, and I'm here today with the one and only Dr. Peter Abdir. Hi, Dr. Abdir. How are you doing today? Hi, Nirvana. I'm good evening, everybody. Really happy to be with you. Thanks so much for being here. I'm so, so excited to record this episode, and I've been looking forward to it all month. And I just know that our audience is going to have so many amazing takeaways. So Just a little bit of an intro before we get into it. Dr. Abdir is an associate professor of medicine and geriatrics and electrical and computer engineering at Johns Hopkins University, where he also serves as co-principal of the Johns Hopkins Artificial Intelligence and Technology Collaboratory for Aging Research and runs the Gerotech incubator where students build real world solutions for older adults. He is also the deputy editor for the Journal of American Geriatric Society. That is a mouthful for sure. I love it. So as our audience already knows, we're going to go ahead and just kick things off with our lightning round. going to ask this one because it's the holiday season and i feel like people are always like scrambling for last minute gifts but what do you think is the best gift to give a family caregiver i i think nirvana the best gift to give to a family caregiver is a reliable block of time just relieve give them time that is their uh, own, uh, arrange for meal delivery, house cleaning and respite care. Uh, basically just that would be the best gift. I love it. I hope everyone's taking notes because that was a really good answer. And you know, what better gift is there to give anyone than the gift of time? Cause it's, it's the most fleeting thing. Um, so next one is what's a biomarker everyone over forty should start tracking. So this, I mean, I know I need to stick to thirty seconds, but I do think that there is a lock in the market that promises absence wearables, that promises measurements of different things. But if there is Such a thing that allows you to measure blood pressure. I think home blood pressure is going to be one of the most important biomarkers that everybody should be measuring. It's the silent killer, nirvana. It's silent, truly silent. You don't feel anything and all of a sudden you end up with a stroke or with heart attack. So home blood pressure measurements is one of the most recommended by the American Heart Association, by different task forces. And that would be, the one of the if you don't do anything else that would be the biomarker to follow i love that because it's super accessible as well you can just log on to amazon and order one for like probably less than twenty bucks and also another good gift idea potentially for someone in your life as well um i have personal experience with this uh my dad actually had a heart attack uh thankfully he survived um but he had a heart attack about wow it's almost been two years now um and blood pressure was was the explanation for it so it's uh it's definitely something that really creeps up on you and it's something that we should all be watching out for so thank you for shouting that out thank you um if you could give your thirty year old self one piece of health advice what would it be um sleep protecting sleep and making sure you get your own uh sleep and uh not push yourself to the uh to the uh extremes basically that uh you know with time everything will be done so protect sleep like like it's a training time this is my time uh of sleep and of course uh exercising you know i really needed to hear that because If I tell you how much sleep I've gotten this week, I think you would just stop recording this podcast with me altogether. So thank you. Now, this one's a good one, too. What's a myth about aging that you'd like to bust? So I think that the word that I hate hearing, it's aging. OK. And equating with it is normal. to have cognitive deficits. It's normal to fall. It's normal to have confusion when you go to the hospital. This is a myth. Aging is not aging as an opportunity. Aging is growing. Aging is maintaining independence. So I think that myth, that saying It is aging and expecting that just explains everything is a myth that I like for us to start ignoring. Well, there you go. I love it. I guess technically, aren't we all aging every single day? I'm aging, you're aging, a two-year-old is aging. Why is there such a negative connotation to that word? You and I were going to figure out ageism in our lifetimes. I'd love to get on a project with you on that. This next one is, what's the best piece of advice you've given to a patient's family? So again, I will stay with the thirty seconds, but I want to explain the four pillars of geriatrics, the four M's. of geriatrics. So in geriatrics, you try geriatrics is the specialty of taking care of older adults. It's built on the four pillars, which are the four M's. M for mobility, M for mentation, M for medications. And then the last M is the one that I want to leave with everybody is what matters most. So start with what matters most, because what matters most to one older person is not exactly the same like the next older person. So talking with your loved one and figuring out what matters most to them, I think is really important. Clarifying goals, clarifying, you know, what would they want to be done before arguing about, shall we do this test or shall we do this or not? I love it. That's really, that's really, really great. And I really also love that you mentioned that, you know, there isn't a solution that's a one, one size fits all, you know, every single patient is going to have their own unique needs. And that just like goes to show how that this is why you've gotten as far as you have in your life, because that's like, I feel like that's like realized, like for all healthcare providers and like anyone who's looking to go into the healthcare space as well as, If you try to find a solution that's going to fit every single person, then you're going to be searching for your whole life, probably. And then I'll give you one last one, and then we'll wrap up our lightning round. So this one is, what technology do you think will change elder care in the next five years? It could be like a magic wand thing where it doesn't necessarily exist yet, or it's something that's in the works right now that's developing that you think would be ready to go. technologies that will change elder care are technologies that will remove the burden of work from families. So technologies that can increase the independence of older adults, even as simple as technologies that can open the jar for an older person. So it doesn't have to be the most complicated nirvana. It's just how can that older person stay at home longer, safer, independently, and whether this technology is based on Wi-Fi technologies that will allow early detection of adverse events like falls and stopping breathing and heart stopping and all of that, or robotics that will offer support to the older person in terms of bringing stuff to them, including technologies that are conversational. I think we Uh, we have to acknowledge that, uh, at this point, we don't have enough people to support our older population. So relying on technologies might not, uh, be, uh, such a bad option, including, uh, for example, uh, the, the, the generation, uh, generative AI technologies that allow conversations allow, uh, this discussions. And I want to share one of our. technologies that I thought was really interesting. It was based on a study that was not done in our center, but in Texas, looking at Alexa kind of technologies that were placed in older homebound, older adults' homes. And the finding of this study was that older adults that had that technology in their homes were noted to have less frailty symptoms. The interpretation of the study was that they were so excited to talk to this generative AI tool, that it would walk from their room to the kitchen. And that was all what they needed, just the early two, three minutes of walking. You don't have to run a marathon. This is an example of using technology that you can argue that, well, this is not real conversation. It is what it is, but it actually did help improve outcomes for older adults. That's really, really cool. You'll have to send me the name of that article so I can share it with our audience as well. I'll attach it to the LinkedIn post because I think that's really, really awesome. While you were talking about that, I was thinking about how A lot of the times the worry is that technology is replacing humans. But the way that I think about it is, of course, we should be supporting technology that enhances human connection, absolutely. But also if the alternative is nothing or technology, like no human connection or technological connection, then of course a technological connection makes a lot more sense not necessarily to replace but to supplement and make sure that people are getting that engagement that movement that socialization things that you know matter so so much especially with age um but you know you're leading the johns hopkins ai and technology collaboratory for aging research um which I'm going to give a little shout out. Keri Yaya's AI-powered caregiver training app, Yaya Guide, was graciously actually selected for, I think, a little over two years ago now. So for our audience who's juggling work and maybe caring for aging parents, what does this actually mean for their lives? And maybe just share a little bit more about the program as a whole. OK, so I will share a little bit about the program first, just to bring everybody on the same page. The Johns Hopkins Artificial Intelligence and Technology Collaboratory for Aging Research is one of three national centers that were funded by National Institute on Aging to support the development of technologies. Hopkins is one. UPenn is the second center. and a consortium between humans and Harvard is the third center. And each center has their own flavors, but in general, they are meant to support development of technologies that improve independence and allow older adults and their caregivers to stay home longer. Over the past five years, combined three programs, we have received over nine hundred applications. And Nirvana, that's a big number, especially when you think about those are companies, those are academia, those are centers all around the US that are wanting to serve older adults, want to develop technologies for older adults. So this is a big number. We funded, we funded with twenty million dollars, so combined total of sixty million dollars to develop technologies for older adults. I want to share a couple of statistics because numbers, you know, speak volumes. For the past five years, We have funded technologies in over forty five states. And this is really important. A little bit less than half were startup companies in those states. Look at that. And a bit over forty five percent were led by women engineers, which is an amazing number because I mean, electrical and computer engineering. is mostly male predominant. I think we know that there is this next generation of women engineers that are not only developing technologies, but also leading startup companies and leading the field of developing technologies for older adults is something that we're all celebrating. So wanted just to give this overview of the AITC or the Hopkins AITC, which is basically, we were very excited to support the work of Kiriaya and the the project because it's basically, you know, you equate funding karyaya with a technology that will lead to fewer uh crises right here guidance uh less of a guest work and more of guidance into what needs to be done in real life uh not something just for a demo purposes but life kind of impact so that's why um we were excited and uh and proud to support your important work Well, thank you. I appreciate that. And I got to say, the women in STEM supporters in me is very, very happy right now to hear those statistics that you just mentioned, because that truly, really is awesome. Because both from a leadership standpoint and from just general, the fields that you mentioned, that's really, really great. It kind of goes to show that, you know, age tech really is the next big thing, huh? Yeah, with, you know, guardrails with limitations, with concerns, with a lot of, you know, with a lot of warnings that, you know, we're entering a new territory and that we all have to be mindful that the promise comes with concerns, comes with risk, comes with uh you know one of the listeners uh posted about phishing scams and definitely ai is uh one of those tools that uh expose older adults to even more vulnerability uh so Currently, and I think another listener raised the question is, when will FDA require certification of biomarkers? I do think that this is very important. Stephen, thank you for this question, because I don't know the answer. But I will tell you that I'm with you, that there should be some regulation and guidelines for the claims that are currently being made of just this thing can measure that, this thing can do that. So I do think that this is going to be important. And it's on us not only to require certification, but because of the nature of those new tools like generative AI, like the large language models. Not only certification, but regular validation, regular evaluation, coming up with very specific uh you know approval process evaluation process is going to be extremely important yeah that's it's it's something that's not talked about nearly enough you're right i did i hadn't even like thought of that until you just kind of brought it up but that's so important i feel like government needs to play a bit of catch-up um to kind of get to how fast the technology is advancing because these guardrails really really do need to be in place in order for um everyone to you know have the most benefits from the technology that's um being created as well Also, Nirvana, when you think about it, the pace of how things are moving is extremely fast. I mean, ChatGPT a year and a half ago was what? What is ChatGPT? We are in version five of ChatGPT, right? So it just tells you that this is something that we have. Yes, it is the new reality. No way back. This is happening. It's being used in ambient technologies, in hospitals, in providing support for education, etc. But guardrails is going to be still very important and validation of the sensitivity, specificity, reliability of the models are all biomarkers of success and validation for the models. You should consider writing a book about this because yeah, that's, that's, it's so, so interesting to just like, even like ponder these things and like, think about just how like how much information is being collected, how much data is like being stored. I mean, I feel like ChatGPT is becoming the new Google, you know, I feel like people are going and asking more questions to chat than they are like, just like doing like a regular Google search. And even if you do do a regular Google search, your first answer is an AI response and people are just generally reading the AI response and moving along with their day. Um, So, you know, the internet is changing as we kind of know it in front of our eyes. And let me give you a different example of concerns here and seeing this and Jake, this will support your questions that this should be a lot more regulated than it's currently. So one of the technologies that is becoming very popular promising for caring for older adults is based on voice cloning. Voice cloning of caregivers is a promising technology because there is a body of literature that suggests that older adults with cognitive impairment are more likely to respond to familiar voices. And if you combine that ability to clone the voice of a caregiver And by cloning that is much more than just the pitch of the sound or the tone, or it's much more, it's how, because I mean, this is AI, it's actually cloning The way you say things, the accent, everything. The intonation. Right? Which is very promising because you want that. You want ability to relieve the caregiver by something that will have a conversation and will be a reminder that using the caregiver's voice. But at the same time, this carries a huge ethical risk because you have a clone of a voice of a caregiver. And just bringing to everybody's attention the recent incidents with... generative AI pushing a person to commit suicide and all of that. So I think this is an area that would require a lot of thoughts and a lot of regulation. Yeah. And guardrails. Because everything can be used for bad too. Like, I mean, I'm thinking of ten different ways that that could be used in a negative way and like ten different ways that it could be used in a positive way. And, you know, we need we need pick up the speed and figure that out as soon as possible, because it's not just older adults lives, but like everybody's lives are kind of big. with, with something, with something like this. So, you know, as, as we heard from the intro, you are doing a million and one things between running a research lab, editing JAGs, working with AITC, being a practicing geriatrician and so much more. I have to ask, how do you do it all? I'm being on this podcast. So there about a correction. I don't do it. All teams do. I think that's really what is exciting and fun about what I do is that I work, I'm blessed to work with teams that have been instrumental in making sure that we get to our goal and complete our mission. The AITC is a team of people that work together, and Wicker and all the PIs that I work with from the engineering, clinical medicine, and from geriatrics, basically. um and school of business so i do i do think it's it's about uh making sure that you have the right teams and picking uh your team members and working with them and identifying their strength and building on their strength that's so beautiful i think that's yeah i mean power and numbers and at the end of the day humans are creatures that are meant to collaborate with other humans. And I think it's so, so important to kind of remind people that it's the people along the way that kind of like make your experience what it truly is. So I'm sure that your colleagues absolutely adore working with you. I can just tell from this one conversation. But, you know, the Gerotech Incubator, I just love this program. You know, it's you help lead it and it sends engineering students right into hospitals to shadow patients and clinicians, find real problems and then build the technology solutions from medical and business students. What are the coolest solutions that would you say they've come up with? So coolest is, I think the coolest solution is the most practically boring solution, meaning that solution that is just, it's practical, very practical. and user-friendly and useful for older adults. I will share with you a little bit about this Gerotech incubators program. Gerotech incubators program was born out of the Center for Innovative Medicine as an alliance between the School of Medicine at Hopkins and the School of Engineering. And at that time, there was a violent agreement that good things happen to older adults when we work together. We decided that we will bring the Hopkins engineering students to shadow, rotate through the clinical enterprise that we have. But the mandate that we got from the School of Engineering is that send these students in unpolluted and unrestrained hunt for problems and solutions. Unpolluted means don't tell them what's wrong. Don't say anything. Let them go. in passively and let them find the problems. Unrestrained hunt for solutions mean don't tell them how to fix it. Let them be innovators, let them come up with their own solution for the problem. And I will share with you one of our Geratech incubators teams that after shadowing in a bit of a hundred and twenty opportunities, meaning that a few times in this clinic, a few times in the emergency department, in there, in here. What got their attention was that sleep fragmentation is one of the most frequently observed complaints in the memory clinic, the best memory clinics that is led by geriatrics, psychiatry and neurology. Absolutely. And the engineering students, like silent bugs, were sitting in the room. And they noted that every patient that came in was complaining about sleep quality, not sleeping well. Interesting. And being engineers, they did not want a pharmaceutical approach. They looked at solutions for that. They found that there are drugs in the market, but that the risk profile that comes with them is high for fog, for confusion, et cetera. So what they did is they looked for devices, technologies that can support healthy sleep. And what they found is a patent from University of Wisconsin, and which says that science is accumulative. You don't have to come up with something completely new. It's just the way you package it sometimes is what matters. They found this from University of Wisconsin, I remember. I think that shows that there is a certain sound wavelength. The person is in deep sleep. They stay in deep sleep longer. interesting what they did is they developed a prototype of a headband that allows you to figure out if the person is in deep sleep it's an eeg an electroencephalogram uh brain uh wave reader okay where it's like one of those sports headbands And that headband is synced with a device that starts to emitting that sound wave. Once the person enters deep sleep, it starts emitting that sound wave. They definitely were one of the most interesting applications among others that I thought simple. I thought interesting. Yes, technologically, it might have been difficult for them to figure out how to do the brain waves reading and then to sync it. But once they got it together, it was very practical. You put it in and you go to sleep. That's all what you need to do. Don't need to do anything more than that. So that was one of the technologies that I think were key. I mean, it's kind of like you were mentioning earlier. Like, it's the little things, like opening a jar, like something that can open the jar for you without having to exert yourself. But this is even more important because, again, going back, your number one advice to your thirty-year-old self was to get sleep. So clearly, it definitely just improves quality of life as well significantly when you can get good sleep. You know, there's a lot of research about sleep, but I don't think there's enough sleep. There's enough... Well, there's no enough sleep, but... enough research about the nature of sleep. Sleep is a very interesting phenomenon that happens. And there is a lot of theories about autophagy and cleaning your bloodstream from neuro and cytotoxic metabolites when you sleep. So I think sleep fragmentation is a big deal in aging, in physical and cognitive decline. I had the opportunity to interview Dr. Nisha Chellam over the summer, I think is when it was for this podcast. And it was really interesting. She's a functional medicine doctor. And her number one piece of advice was cut out the caffeine and take naps instead. Because when you are sleepy, your body's telling you something. You're putting Band-Aids on bullet wounds when you're taking, when you're drinking your fourth cup of coffee at four p.m. And she honestly like that, like, you know, that really changed my line of thinking as well when it comes to sleep, because like, why is it that a twenty minute nap? It's that effective, like it will wake you up and make you feel that much better than a cup of coffee ever will. I mean, obviously, I know why it is because like your body needs it. But it's just so interesting to like actually like kind of conduct these experiments on your own self and like see how truly they are like impactful and beneficial. But, you know, so I guess kind of like to close a loop on this, maybe some of our listeners who are listening at home see problems in their parents or their spouses or loved ones care or in their own aging journey. Is it possible for people to submit ideas to the Gerotech incubator as well? Absolutely. So I want to just, I want to just, you know, broaden this, not only from the Gerotech is definitely one way and to... tackle the problems and suggest problems. And I would say bring problems, not product ideas, because I mean, that's what drives the engineers to get that suggestion of an area to work. But the AITC, the Artificial Intelligence and Technology Collaboratory for Aging Research, we have what we call the Key Stakeholders Engagement Core because designing and developing a technology starts with key stakeholders. If you have ideas, please go to the Hopkins AITC and submit. the ideas, but also if you want to help, if you want to be a voice of older adults, if you want to be a voice of caregivers, I would encourage you to contact us, to be on our key stakeholders engagement. You get to say your opinion, to be the person that will think through all those ethical and usability issues of different technologies. And those stakeholders have been so valuable to us as well, just in our journey of developing the AYA Guide, because user experience is the thing that matters the most. If you're developing something and the end user is not going to have any use for it, then what's the point of developing it to begin with? That's why I'm such a fan of technology for the aging population, but only if it's actually built for the aging population and you're not just trying to pawn something off of them that worked for like, you know, the thirty year old. Now it's going to do the same thing for the eighty year old as well. So, yeah, I'd love the brought up stakeholders because they truly do make the program like they're like the bow on top of the program that makes it that makes it perfect. So, you know, in our in our conversations in the past, you've um talked a lot about you know um just like sandwich generation caregivers as a whole um and specifically maybe some sandwich generation men so you know A lot of men approach caregiving like a problem to solve, just generally speaking. They want to fix it. They want to optimize it, make it efficient. But, you know, like we're kind of talking about aging isn't a problem with like a solution, you know. So how do you counsel male caregivers who are struggling with the fact that they can't fix their parents decline? Yeah, I guess. So you need to switch mentalities from fixing to stabilizing because you really can't control the disease. Some of those diseases come with traits, phenotypes, progression trajectories that you cannot control. But you can reduce the chaos. You can reduce that amount of just uncontrolled actions there. So I would pick two to three areas that can fall under your control and One of them, we said one of the four Ms, the medications, simplifying medications. There is a whole initiative called deprescribing. You know, it hurts me when I get an older person in the hospital and they are on fifteen, sixteen medications. Oh, my goodness. We have one exercise back in the days to ask our medical students to sit and have a chart of show me how frequently this patient is taking medication to the point that they are having to wake up every thirty, forty five minutes to take a pill here and there and just to realize that this is not practical. So I would say that's one of the things that you can control. Talk to your physician about prescription. What are the important medications that can be eliminated? A medicine that is without the reason only carries side effects. So I always teach my medical students, be suspicious of medications. When somebody is admitted to the hospital, look at their blood pressure medications, look at their blood sugar medications, all those medications that we just keep accumulating from one visit to the next. That's such a good point. Go ahead. sorry there's this concept polypharmacy is that correct yep maybe you could speak on that a little bit too because i know that like you know when you start prescribing things that are fixing the side effects of another prescription i think that's there are horror stories i don't want to scare people but there are horror stories about one medicine that was started for one reason and then you know, a pain medicine or something like that. And then patients started having nausea and then took another medicine for nausea and soon enough started having movement disorder and was diagnosed with something else that they added another medicine. And soon enough, they are so debilitated that they end up in assisted living or a nursing home. And after some thoughtful thinking, uh about the medications you start to eliminate it and patients start to regain function and able to actually work with you um so are not without uh side effects and i think we have been always uh you know trained to watch for the side effects of medications for a reason so So that's the first thing that I would say. Simplifying medications is going to be something that I would say for that generation to control. You can talk about medications with a primary care physician. False. Big deal in older adults. Making the home more accessible, maybe. Right. Safe. Declutter. getting a simple assessment of fall risks at home. One fun technology that we are seeing, robotics is becoming an interesting set of technologies that are coming to the market. One of the technologies that we were looking at a dog robot that would be able to bring stuff to the older person but while not bringing stuff will go around and declutter the room. So remove obstacles from the room. I mean, still, you know, experimental and whether it would work or not. It's just those kinds of ideas. Yeah, I I appreciate that. Can I get one of those dog robots? That's awesome. Is that through AITC or that's like a different thing? One of the engineering technologies that we are working with the engineers. So recently Hopkins, we have had the ribbon cutting ceremony for the new geriatrics engineering center, which is a new, center at Hopkins that brings engineers and geriatricians to work together in Bayview campus of Hopkins and square foot facility that, you know, people technologies like that. oh my gosh, we'll have to come stop by and see it. That sounds really, really awesome and amazing. So, you know, kind of like circling back to family caregivers and some Things that they should start thinking about and watching out for. It's kind of like a twofold question. So I guess, you know, folks are seeing their parents kind of slowing down. What are some signs that they should be watching out for as the first part? And also, what's like, what are the conversations that you feel like a lot of people are missing from having just in terms of, you know, getting older? so back to what we discussed the four m's of geriatrics right four m's means watch for function or diagnoses so look for troubles in getting up and down from stairs trouble from standing from a chair, walking speed, falls or near falls. Those are warning signs that you should be looking, but all of those would fall into that functions. So for their daily functions. With aging diagnoses, you accumulate diagnosis from high blood pressure to diabetes, to heart failure, et cetera. More importantly, shift your attention to how they are doing on a daily basis. Medication mix-up is a really big deal in older adults. Did you take your medications and finding that they mixed this with that medicine or took somebody else's medicine? I didn't even think about that. Weight loss, signs of isolation, mood change. All of those are, you know. Yeah. Things that we should be watching for. Learning science that you should be looking at. So if you notice something like that, it's definitely worth a proactive discussion with your primary care physician. You don't have to wait until you go to the emergency department with a full-blown form to say something about this. Or to attribute it to just normal teaching. I feel like all of this is like a lot of it is just trying to avoid the crisis before it happens. Prevention, prevention, prevention at the end of the day is, you know, and then sometimes it can, I can definitely be someone like this where I'm like, oh, like if I don't know that the problem is there, like if it hasn't been identified as a problem, then it's not a problem. Again, I don't even think about it, but that problem is still there and it's only getting worse. And the sooner that it's addressed, the more peace and calm can come. And Nirvana, you asked a very important question. What conversations that they are not having, right? And I do think that this is an important question because a lot of people are not asking who decides and what matters most. We see that frequently at the end of life when there are multiple people making decisions. And in some families, it is a shared decision. All members will make decisions. But honestly, it makes a lot of sense to decide on a person that is going to make the decision for me for that. and to have that conversation on what matters most. So talking about durable power of attorney, realistic expectations, what would you want us to do? That leaves a lot of guilt. One of the major issues that we see at the end of life for the caregivers is that feeling of guilt. uh so it really helps to have that conversation to have the conversation on who's going to decide absolutely what matters most to that loved one yeah yeah that's so oh my goodness yeah absolutely goals of care important and these conversations need to be had before it's too late or before it's you know and i i've seen it myself like things like this if not dealt with in like a timely manner can break families apart. You know, siblings, like children and their like parents, it's just, it's definitely something that is not talked about nearly enough and something that is such an avoidable problem if it was just, you know, a little less taboo or felt a little less, I don't know what word I'm looking for, but yeah, agree with every single thing that you said. That's so, so important. Um, so yeah, I guess maybe just going back a little bit to the, to the, also, I just want everybody to know that I'm not even halfway through the questions that I have for Dr. Apatir and we are basically at time for this podcast. Um, so I will obviously not hold you for a long time over, but I think we should definitely take into consideration recording a follow-up episode in the new year, if you have the time. I would love that Nirvana, maybe in the new geriatrics engineering center. We'll invite you when we have a live. I'll drive up there and we can, I love that an in-person podcast recording is my dream. Cause I feel like that's, that's really, really awesome. Um, yes, I will be emailing you immediately about that. Um, and we can definitely sort something out, but, um, I'm going to pick a pick and choose a couple more here so that we can sort of wrap up what we're talking about and we can dive into other topics later. Um, but going back to that male versus female sandwich generation, um, thing. Caregiving kind of requires skills that are traditionally coded as feminine and, you know, emotional labor, nurturing, patience with that decline. So how do you help male caregivers see that strength isn't just portrayed through like, you know, like strength. It's portrayed in different ways and guide them through what may be seen as sort of like a role reversal, if that's something that you faced in the past. I think one of the problems with caregiving for males is that steadiness, right? So strength is not, when it comes to caregiving and supporting, it's not about control. It's about being steady and about being, you know, having the... the ability to be present, patient, consistent in your approach. Those are extremely important skill sets that you will need to develop as a caregiver. And it's not about being a male or female, it's about being steady, consistent in providing that support. And it's okay to acknowledge that nobody is born with those skill sets. That it's okay. You have a permission to learn. You have a permission to ask for guidance. You have a permission to understand the practicalities of caregiving. There is a beautiful book that is written about caregiving for patients when they have the thirty six hour day, which is written by Professor at Hopkins, that has practical tips. And that's a good way of rethinking about those skillsets that you need to persist in consistent care. That's so interesting. You'll have to, you know, if, you know, send me the name of the order and things like that as well. And I'll be sure to add that to the description too, because this is all great nuggets of knowledge that I think we all can do. And also potentially maybe another great gift for someone stocking for this holiday season. So, okay. What I'm going to do is I'm going to turn a little bit to our comments from the audience and see if we haven't addressed anything yet. And then I'll ask you one last question. And then we'll wrap up for the night. And then, like I said, promise we'll be back again for a second episode. So I know that Jake earlier was asking about his grandparents and, you know, phishing and things like that. Is there, you know, and I know we talked about how that's like a huge problem, but do you have any practical tips or advice that he or other people could impart on their grandparents to help them avoid tech-based scams in the future? So unfortunately, Jake, there is nothing like that out there. And scammers are becoming more and more professional and effective on preying on the vulnerable older adults. I think it is on all of us to make sure that we're keeping the eyes on uh on that and just uh following closely with uh with your loved ones so there's there's nothing uh other than just you know that being diligent being watchful yeah and always thinking twice right like just tell them don't believe anything it's better to be over careful and not careful enough you know with karyaya for example we have um we have quite of our students to make sure that they're good to be caregivers, but also we background check the families as well to make sure that their students are going into safe environments. Of course, that's all done with no cost to the families, but the background check does require a social security number, and I always love it. when someone reaches out to us to double check, to make sure that this is a real thing that they need to actually submit their social security number, because I'm like, yes, you should double think about that because like, you know, it's, it's not like a normal question that you get asked on a day-to-day basis. Like, Hey, what's your social security number. So it's better to always ask and be more careful because you know, It's not that that thing will still be there if you take five, ten minutes to think about it before kind of committing to something that could cause irreversible damage. I mean, I think the numbers I've read of how many like thousands, if not millions of dollars have been lost to these scammers is just like. breaks my heart um so oh this one's i like this one actually um so for innovators who are looking to apply to the aitc program what advice would you share when you look at these applications what makes a project sort of stand out to you it seems like dr abadir is looking for applications to help with scam prevention if i'm not um a very um a very interesting project Yeah, absolutely. I do think that for innovators that want to apply, and innovators can come from the clinical clinician science caregiver side or from the engineering. side i think one advice that i would uh like to share is just make sure that you talk with us before you submit the application the application has to be uh fluent both in the clinical world and uh engineering world so it has to be reliable technology validated that is uh feasible to be And also it has to address all the clinical questions. Is this an important area? Is this something that will change the field? Is it ethically thought through? How about HIPAA? How about privacy? All of those elements. We are definitely wanting to get applications and we want to help filter the application by providing support early on so that the folks that will apply will put their best possible application out there. Yeah, there you go. I love it. And I think that at the end of the day, we all have a common goal in mind, at least for the folks that will be applying. So it's just a matter of, you know, making sure that the things that are really, really important that can be looked over, I guess, like you were mentioning the guardrails and making sure that things are being developed in like a safe manner are truly in place. We have another person that just made a comment saying lots to think about. I was at a conference recently and someone reminded us how effective using a short phrase or password only known by the caregiver and the aging individual can be. That's definitely an interesting point, yeah. Oh, and then we have Dr. Phillips back again. Measuring and augmenting pre-cortical wavelengths to enhance sleep quality. As a geriatrician, it is my opinion providers are not well-educated in the field of sleep medicine or the presence of sleep apnea. Oh my gosh, sleep apnea is another really big one because the lack of oxygen to your brain can really cause damage, right? True, true. And Dr. Phillips, I didn't realize that you're a geriatrician, but One just fun fact, there is one geriatrician for every ten thousand older adults in the U.S. We need more geriatricians. We need more physicians that are trained to take care of older adults. We really need to motivate our current pre-med students to pursue careers in geriatrics. These are such important fields. Like these are just, you know, I, as a former pre-med student myself, it wasn't even something that I thought about. You know, it was all like the flashy stuff of like, oh, dermatology, oh, pediatrics, oh, like this, that, and the next. There's a place for everything, but geriatrics definitely. Absolutely. And I feel like all those are very, very important, but it's just like the media I feel like that we consume doesn't really highlight these things as much. And the statistic, I think there's, correct me if I'm wrong, but there's, somewhere between five thousand and ten thousand geriatricians in the United States. Right. I think I think they are less than that, but less than seven thousand. I remember the numbers correctly. I'm not one hundred percent sure, but I think I think you're right. And I think, Nirvana, we should have another and maybe invite Dr. Phillips to join us. Yes. That it isn't. and the role of media in promoting that. So the words like anti-aging cream itself convey the message that aging is a bad thing. You don't want aging. Portraying older adults in movies as looking ugly or hard of hearing or confused, yeah? Oh my gosh. I had never even thought about that. The anti-aging thing. Wow. There's so many better ways that we could phrase that. And, you know, in this, like, I feel like, you know, we're moving towards like a more, um, like politically correct world in general, where we're like careful with how we phrase things and like try, but that those advancements haven't been made in the aging, in the aging field. And I just, you're so right about that. Yes. Our next podcast is literally going to be ageism in all caps. Dr. Phillips also suggests that Kariya posts the four M's worksheet developed by the Age-Friendly Health System, as it's a great tool for caregivers and visiting providers with their loved ones. And I will absolutely take that consideration and make it happen as soon as humanly possible. That's really, really helpful, actually. And he also mentioned that he finished his two year fellowship in nineteen eighty eight. And he's a professor at UNR School of Medicine. So that's really, really great. Dr. Phillips, love to have you on on an episode as well. I just it's my passion to if I could interview every single one of those seven thousand something geriatricians that I would spend the rest of my life doing that. But for now, I'm going to just sort of. wrap up this episode with one last question for you, Dr. Abadeer. And I just again want to thank you for your time and for staying, staying until this hour. But if you could wave a magic wand and solve one problem in aging and elder care right this second, what would it be? This will sound not politically correct. But I would love to find a way to put nursing homes all out of business by providing tools and technologies to keep older adults at home. And I know that may sound like preying on that desire of people to stay home longer, but in reality, I would love for us to find ways to support that with that magic wand and find ways to support that that dream. Yeah. Support our older adults in a completely different way that's not, oh, I'm not even going to say anything either because I'm going to be even less politically correct than you were. But that is a beautiful magic wand answer. And that's going to go in my books as one of the best magic wand answers I've ever gotten because, wow, I could not agree with you more. And earlier today, I was actually onboarding a patient that's going to start booking care with Kariaya in the new year. She's moving her mom out of a nursing home because she's had a wait for it, four UTIs in the span of five or six weeks. And, you know, I don't have to tell you this, but for our audience, UTIs are extremely detrimental for our older adult population. It can present in symptoms that like, like cognitive symptoms, right? And it can make them, it's something that is really easily avoidable. It's something that should not be happening. But that's just one of like, and that's literally just from today. And Nirvana, I want to just... Yeah, follow up with just a statement that I have tons of respect for all the the work that's done in nursing homes by all the colleagues that work in nursing homes it's just my dream is that we reach that level of development of technology that people want need to leave their homes and stay at home there you go healthier and close that gap between lifespan and health span people's being uh healthier at home absolutely and i want to say i also have so much respect for all of our care workers as well it's just heartbreaking because It's not the fault of the caregivers that are at the facilities. It's because there's not enough staffing. There's just not nearly enough humans for how fast our population is getting older. And again, yeah, so much respect to anyone who has ever been, is ever going to be, and was a caregiver because being a caregiver is one of one of the most honorable jobs in this world i would say um and sometimes you choose to be a caregiver and sometimes you have to be but care touches us in one aspect or another no matter what you're either gonna be cared for at some point in your life or you're gonna take care of someone at some point in your life and i think that that's a beautiful thing and um it's not something that we should put behind closed doors and hide because it's impacting one in five americans right now and that's a really really significant number But Dr. Abadir, I could not say this enough. I've thoroughly enjoyed this conversation with you so, so much. And I know that our audience is just really thrilled right now as well. We'll be in touch about recording a new episode soon. And thank you again for being here with me today. Thank you. Happy holidays, everybody. And I hope you have a great, you know, new year. And, you know, thanks for thanks for being here with us as always. Bye, everyone.