{ "version": "1.0.0", "segments": [ { "speaker": "Anna", "startTime": "2.0", "endTime": "34.25", "body": "When mum ended up in emergency recently, a friend suggested we ask for a geriatrician consult and I'm just so glad that we did. She'd been in and out of hospital with different health issues, but once the immediate problem was assessed, she was sent home. But the geriatrician had time to listen and she asked mum about her well-being, her mobility, the medications she was on, her memory, nutrition and really importantly, safety and confidence at home. We feel so relieved now as we have a plan for Mum moving forward." }, { "speaker": "Tracy Parish", "startTime": "38.97", "endTime": "97.4", "body": "It's no secret we are all getting older. So how can we age well? If you're older and living with multiple or complex health conditions that may be impacting your quality of life, should you see a geriatrician? Well, let's find out if they can help. Welcome to Help! I'm Ageing. It's a podcast from the National Centre for Healthy Ageing. We're Australia's leading healthy ageing research centre and tackling the big questions we all face as we get older. I'm Tracy Parish, and together with my co-host, Dr Taya Collyer, we'll be talking with visionary researchers and people with lived experience, sharing their real stories, real evidence, real insights with you, and we'll discover new ways of thinking and find out how data and science can help you have a healthier future. With Australia's population rapidly ageing, the time has never been more pressing to shine the light on what's possible when research, health care, and lived experience collide." }, { "speaker": "Tracy Parish", "startTime": "97.945", "endTime": "103.545", "body": "How can we age well? Let's find out. But firstly, who are we, Taya?" }, { "speaker": "Taya Collyer", "startTime": "103.784996", "endTime": "111.01", "body": "Tracy, I'm the lead biostatistician at the National Centre for Healthy Ageing. That means I do the stats and love the stats." }, { "speaker": "Tracy Parish", "startTime": "111.01", "endTime": "121.01", "body": "You do indeed. It sounds very impressive. Well, I'm a journalist, Olympic broadcaster turned medical research communicator, and now a podcaster. Who are we speaking to today, Taya?" }, { "speaker": "Taya Collyer", "startTime": "121.01", "endTime": "141.73999", "body": "I'm excited today, Tracy. We've got one of my favourite people on the pod. Our special guest is Dr Chris Moran, a geriatrician with Bayside Health here in Melbourne and an Associate Professor of Health Services Research at Monash University School of Public Health and Preventative Medicine. Chris is a research on a Living Lab project at the National Centre for Healthy Ageing. Welcome, Chris." }, { "speaker": "Chris Moran", "startTime": "141.73999", "endTime": "142.7", "body": "Thanks for inviting me." }, { "speaker": "Tracy Parish", "startTime": "142.7", "endTime": "150.14", "body": "It's great to have you on, Chris, because we're going to delve into the world of a geriatrician. Firstly, let's unpack that. What is a geriatrician?" }, { "speaker": "Chris Moran", "startTime": "150.195", "endTime": "171.62001", "body": "A geriatrician is a medical specialist who is really passionate about looking after older people. Really, what their interests and what their skills are is the person as a whole person. So that means that they had training as a physician. So they're used to dealing with lots of complex medical problems. But what they do is really focus on how those complex medical problems interact with each other." }, { "speaker": "Chris Moran", "startTime": "171.7", "endTime": "204.06999", "body": "So it's not just focusing on a single organ. It's not just focusing on how those organs connect to each other. It also focuses on how those organs connect with each other with that person and how that person connects with their environment, connects with the people around them. So it might be something as simple as how do we manage someone's medications that make them pee a lot when it's difficult for them to get to the bathroom on time and their spouse is trying to help them manage it. We love that complexity. That's something we think we do well. We do that in hospital settings. We do that in outpatient settings. And we do that in community settings, as well as sometimes in nursing homes as well." }, { "speaker": "Tracy Parish", "startTime": "204.06999", "endTime": "209.45502", "body": "You started your career in acute care, so more working at the hospital interface, is that right?" }, { "speaker": "Chris Moran", "startTime": "209.535", "endTime": "235.35501", "body": "Yes, absolutely. So like most junior doctors, we start our training in hospital settings. Over time, people gravitate towards different specialties. I like the complexity, I like intellectual challenge of working with older people, so continue to work within the hospital setting. As you train up further within your geriatric medicine training, you move out of the hospital. You continue to do some hospital stuff, but you start to work in nursing homes. You start to do outreach programs into the community. You start to do more clinic based work as well." }, { "speaker": "Taya Collyer", "startTime": "235.35501", "endTime": "251.93999", "body": "And, Chris, is there a age limit or floor or I'm guessing there's not an age ceiling on geriatric work, but I'm thinking of pediatricians that I know. That that field is kind of bounded by age in some ways. What age of a person is is your training relevant to?" }, { "speaker": "Chris Moran", "startTime": "251.93999", "endTime": "277.445", "body": "Very difficult to say and a very common question that is asked. We often talk more about it's not the years, it's the mileage. So some people will jump up and down about particular ages that are relevant. Once upon a time we used to call 65 was a cut point that was commonly used, but anyone who looks around themselves these days will see plenty of 65-year-olds that do not qualify as needing any medical assistance whatsoever. So very much it depends on the space of where you're in." }, { "speaker": "Chris Moran", "startTime": "277.97998", "endTime": "307.675", "body": "Oftentimes hospitals will draw the lines depending on the kinds of patients that they see. More commonly these days 80 or 85 is a cut point that is commonly used, but really if you have lots of complex medical problems and in a lot of settings, if you're over about 50, there's a lot of people if you can find a geriatrician that can help, it's likely they will have some skills that will be able to assist. Whether they're the only people that can help, that's unclear, but we tend not to jump up and down too much about the age itself. It's a bad predictor of what someone needs." }, { "speaker": "Taya Collyer", "startTime": "308.24002", "endTime": "325.245", "body": "Fascinating and complex, as you've already highlighted. So staying with that complexity, talking about people out there who might have, quote, several complex health conditions, are people generally aware of the complexity of their own health needs? Like, what kind of profile are we talking about there?" }, { "speaker": "Chris Moran", "startTime": "325.72498", "endTime": "355.475", "body": "Tricky to say because it depends on the complexity. Yeah. So some people may have complex mental health needs that interact with their complex medical needs. They may be in complex social situations. So having an injury, breaking a bone, breaking a foot may not be that complex of an issue, but if you live somewhere that has stairs and your bathroom's upstairs, all of a sudden that become complex very, very quickly. So it's hard to be specific with regards to exactly what makes something complex, but often that's the space that geriatricians like to work in." }, { "speaker": "Taya Collyer", "startTime": "355.475", "endTime": "363.875", "body": "Yeah. That's the picture I'm getting. So it might be like the number of medical conditions that a person has. That could be a source of complexity, or it might not be." }, { "speaker": "Chris Moran", "startTime": "364.12997", "endTime": "401.05002", "body": "Exactly. It can be number of medications. There are lots of people who are able to manage lots of medical conditions very, very well. It might be one medical condition, but has been very difficult to control, needing lots of changes to medications and other things. It might be conditions that their management is relatively straightforward, but their day-to-day is very complex. That person may have a relatively straightforward disease, but they act as a carer for one or two other people. So how that interacts with all of those things starts to become much more complex as well. So if you're an older person, for example, who's trying to manage a spouse or a family member who's really unwell, perhaps you've got carrying duties for a child as well. All those things can dial up the complexity." }, { "speaker": "Tracy Parish", "startTime": "401.05002", "endTime": "408.57498", "body": "And are these conditions always medically-based as opposed to bringing in, like, a social worker or someone else who can sort out your other issues?" }, { "speaker": "Chris Moran", "startTime": "408.57498", "endTime": "432.13998", "body": "Not necessarily. And we love working within multidisciplinary teams. So usually the stuff that we would call challenging wouldn't be, if you want to call it traditionally medical, it's across all of those things. So medical diseases interacting with mental health diseases if we want to think of those things as being distinct, but how that interacts with the kinds of skills that social workers have, that occupational therapists and physiotherapists have, that's our bread and butter." }, { "speaker": "Taya Collyer", "startTime": "432.13998", "endTime": "445.285", "body": "Mhmm. This is a specialty for the real world listeners. You heard it here first. So, Chris, what are the various paths by which a person might end up in front of a geriatrician? Thinking about Australia's health system." }, { "speaker": "Chris Moran", "startTime": "445.445", "endTime": "482.77", "body": "Yeah. For a lot of people, I think their first interaction with a geriatrician might be with an acute hospital admission. So for example, if they've become acutely unwell or in a lot of settings if they've needed surgery, whether that's elective surgery and they have complex medical issues, they may be asked to see a geriatrician to help optimise those issues to try to make sure that they're fit for surgery or decide whether they want to have surgery. In a lot of our hospitals in Australia, we have an ortho geriatric service, so these are geriatricians who work with the orthopedic team for older people who have frequently had a fall or some kind of injury that's resulted in a broken bone. They will meet a geriatrician frequently in that kind of context." }, { "speaker": "Chris Moran", "startTime": "483.33", "endTime": "517.76996", "body": "In the outpatient setting, there's lots of ways that people can meet a geriatrician. One of the more common places that you'll find us will be in cognitive clinics. If people are worried about their cognition and they're asked to see a specialist, it's not uncommon that it'll be a geriatrician will be the training of the person that they see. Sometimes they may see us as a general outpatient clinic. If their general practitioner thinks that they've got a lot of complex medical problems, often if they've got lots of specialists, they're looking after each individual organ. Sometimes a geriatrician can be a little bit like a GP with regards to trying to bring all those threads together, tidy them up and make a plan." }, { "speaker": "Taya Collyer", "startTime": "517.76996", "endTime": "528.915", "body": "Right. So if someone's got a cardiologist, a neurologist, a dermatologist, you might or a geriatrician might come in and and and zoom out a little bit and take a view of the whole the whole picture?" }, { "speaker": "Chris Moran", "startTime": "528.915", "endTime": "529.635", "body": "Absolutely." }, { "speaker": "Tracy Parish", "startTime": "530.675", "endTime": "556.705", "body": "I wanna drill down a little bit here, though, particularly ... if we can take an example of someone who might have all those specialists in their world, but in fact fall down the stairs or something happens to them and they end up in a public hospital in an emergency setting. How much information do you need in that setting to be able to realise there's all these other army of, you know, specialists behind them which obviously don't operate necessarily in that space, in the public space." }, { "speaker": "Chris Moran", "startTime": "556.785", "endTime": "577.36", "body": "As much information as possible. The more things we know, the more that we can make informed decisions and have proper conversations about what matters and what doesn't. So the less information we have, then the more conversations we need to have with the patient or those supporting them, trying to find out as much as important to figure out what is important and make decisions to make sure we keep our eyes on what's important." }, { "speaker": "Tracy Parish", "startTime": "577.36", "endTime": "579.28", "body": "What do you wanna know? What is important?" }, { "speaker": "Chris Moran", "startTime": "579.66504", "endTime": "607.06", "body": "I don't get to make that call. So nine times out of 10, it's the person I'm speaking to. They tell me what's important. So the patient might tell me it's really important that I get home. It's really important that I'm kept pain free. That actually I'm pretty miserable with my disease right now. I just want to be kept comfortable. Life prolonging is not necessarily something that I want. Someone might say, I want to be kept alive as long as possible. I want to make it to a granddaughter's wedding, birthday, all those things. The patient tells me what's important." }, { "speaker": "Tracy Parish", "startTime": "607.335", "endTime": "614.85504", "body": "What happens when there's conflict between what the patient wants or the person wants and what family think they should need?" }, { "speaker": "Chris Moran", "startTime": "615.335", "endTime": "628.92004", "body": "Yeah. That's not an uncommon scenario. Fairly familiar with dealing with that. Patient's the boss. So our job can sometimes be helping everyone realise that, but I would argue ethically, morally, and legally, patient is the boss." }, { "speaker": "Chris Moran", "startTime": "628.92004", "endTime": "644.52496", "body": "So my job is to make sure that we try to set goals as a team that are realistic. But even if I can't necessarily deliver what the patient would like me to deliver, it's still really important that all my decisions are framed, acknowledging that that is what they want. If I can, that's what I call a win." }, { "speaker": "Tracy Parish", "startTime": "644.52496", "endTime": "652.07", "body": "Are you trained in that? Yes. That part? And how are you trained? Like, from a counsellor point of view? How are you trained to deal with it?" }, { "speaker": "Taya Collyer", "startTime": "652.07", "endTime": "653.91003", "body": "It sounds pretty, it sounds pretty tricky." }, { "speaker": "Tracy Parish", "startTime": "653.91003", "endTime": "656.95", "body": "Yeah. It sounds much, it's much harder I'm sure." }, { "speaker": "Chris Moran", "startTime": "657.35", "endTime": "697.565", "body": "It is tricky, but we do get trained. We get trained in the way that doctors have always been trained to some degree, which is an apprenticeship model. We watch people who do it well. We learn from them. We mimic them. We have formal training as well. We have lots of sessions with simulated patients to try different scenarios. But we learn every day. Every time we have yet one more of these conversations, you reflect on that and go, that worked. That didn't work. I could have done that a little bit better. We're not flying solo. We have a multidisciplinary team. We have the nurses. We have our social workers in particular who are really great at pulling those threads together. We don't do it solo, and we don't do it once. It's an ongoing conversation." }, { "speaker": "Tracy Parish", "startTime": "697.805", "endTime": "701.16504", "body": "And at what point do families just take your advice?" }, { "speaker": "Chris Moran", "startTime": "701.405", "endTime": "711.83997", "body": "I like the assumption that they always do. They don't. So sometimes they're with me and the patient from the beginning, sometimes they never get there, and sometimes it's somewhere along the way." }, { "speaker": "Tracy Parish", "startTime": "711.83997", "endTime": "752.605", "body": "Recently I was talking with a friend and they've got an elderly parent and there was some concern about whether they needed to go into residential aged care. And their brother who was interstate thought, oh, well, that'd be terrific if you could just mum could just stay with you, you know, like at home. When you've got family that aren't even in the room and the reason I'm talking a lot about families today is I I feel like this generation, my generation, the generation behind me, feel they're empowered to actually say a lot of things to medical doctors that perhaps our parents would never do. So you're tackling that Mhmm. face on all the time." }, { "speaker": "Tracy Parish", "startTime": "752.925", "endTime": "755.565", "body": "When do you find it too much of a challenge?" }, { "speaker": "Chris Moran", "startTime": "755.725", "endTime": "757.245", "body": "Too much of a challenge?" }, { "speaker": "Tracy Parish", "startTime": "757.64496", "endTime": "758.365", "body": "You must have days." }, { "speaker": "Chris Moran", "startTime": "759.56494", "endTime": "767.94", "body": "Oh, there are hard days, but too much of a challenge is an interesting concept. I wouldn't argue it's ever too much of a challenge. There's always a way." }, { "speaker": "Chris Moran", "startTime": "767.94", "endTime": "814.875", "body": "That doesn't necessarily mean we have to solve a problem directly. So for example, conversations around nursing homes which is not an area anyone likes talking about, they hardly ever need to be decided in that minute. So there is time. This is not an intensive care conversation, which sometimes I have to be part of as well. These conversations take time, and you have to live with those decisions. So there's no hurry to do those. If something's particularly difficult, we are we work within a team. We use our team members to support us and to support the people that we're dealing with as well. So if the patient's struggling, if those supporting the patient is struggling, we have a team. It's not just on one person. And for those kinds of scenarios you're describing, it's not as one time conversation. That would put far too much emotional pressure on the decision to be meaningful." }, { "speaker": "Tracy Parish", "startTime": "815.33997", "endTime": "820.45996", "body": "And is the team different inside public health system to private health system?" }, { "speaker": "Chris Moran", "startTime": "820.45996", "endTime": "847.95", "body": "It absolutely can be, depending on where people work. For example, in the public health setting, if you were in a clinic setting, you might not have the same number of team members around that you might have if you were acutely unwell with a full multidisciplinary team. In the private setting, it's more common for geriatricians to work solo. They may have access to a full team, but the full team may not be there with them at that point in time. So call those team members in if and when they are needed. So it does vary, but it varies depending on the problem that needs to be addressed." }, { "speaker": "Taya Collyer", "startTime": "847.95", "endTime": "866.445", "body": "Okay. So, Chris, it's the reality that couples often age together. And so you might be perhaps working with two patients who are in fact living together or married. And what happens if they're both in hospital at the same time? Is that a the kind of complexity that you might be working with?" }, { "speaker": "Chris Moran", "startTime": "867.085", "endTime": "885.94", "body": "It absolutely happens. It's happened to me a bunch of times. It can be quite interesting that simply because depends on the reasons why they're in. I've had stories where both are in the same car when they've collided. We've had ones where someone's been acting as a carer managing their own medical issues, they've come in on separate wards with completely different things." }, { "speaker": "Chris Moran", "startTime": "886.205", "endTime": "906.1", "body": "It absolutely happens. We've had stories where someone is physically less well than the other who is cognitively, less well, and one provides the physical support for the other while the other provides the cognitive supports for them. Wow. So they work together really well, but separated, it really does struggle. Those kinds of scenarios will often put people together in hospital." }, { "speaker": "Chris Moran", "startTime": "906.25995", "endTime": "938.96", "body": "Sometimes spouses are quite happy to be separated, but if they're happy to, beside and working with them together can be a really nice way to provide some really nice quality care where they get to provide those additional supports. Our focus almost always is to get people back to the home that they came from. So if a scenario where one is physically stronger and the other is mentally stronger, then we need to be planning for both of to return home at the same time so we can work with both of those people to coordinate a return to home with those supports and everyone on the same page. You know, the best laid plans of mice and men, it's a reasonable plan." }, { "speaker": "Taya Collyer", "startTime": "938.96", "endTime": "947.04", "body": "Yeah, wow. That surely is unique in medicine, that you're actually working across individuals here in order to optimise someone's discharge planning?" }, { "speaker": "Chris Moran", "startTime": "947.745", "endTime": "952.22504", "body": "I wouldn't say so it's not uncommon in geriatric medicine. Yeah. The other thing I would think ..." }, { "speaker": "Taya Collyer", "startTime": "952.705", "endTime": "953.825", "body": "In other specialties?" }, { "speaker": "Chris Moran", "startTime": "953.825", "endTime": "957.34503", "body": "This is where I'll go back to the very beginning of our conversation, pediatrics do this all the time." }, { "speaker": "Taya Collyer", "startTime": "957.34503", "endTime": "958.065", "body": "Ah, okay." }, { "speaker": "Chris Moran", "startTime": "958.065", "endTime": "969.45", "body": "So I think we have a lot in common with our pediatrics colleagues with regards to thinking about that person in the context of their social structure and support that is often dependent." }, { "speaker": "Taya Collyer", "startTime": "969.45", "endTime": "973.05", "body": "So like discharging a child if the if a parent is also hospitalised?" }, { "speaker": "Chris Moran", "startTime": "973.495", "endTime": "976.695", "body": "Absolutely. You think mother and baby units, for example, things like that." }, { "speaker": "Taya Collyer", "startTime": "976.695", "endTime": "977.09503", "body": "Yeah. Right." }, { "speaker": "Chris Moran", "startTime": "977.255", "endTime": "978.53503", "body": "Mental health concerns." }, { "speaker": "Taya Collyer", "startTime": "978.53503", "endTime": "985.73505", "body": "But you could just say yes. You could just say yes. Geriatricians are amazing, and we're doing all of this really creative and really complex stuff in the hospital city." }, { "speaker": "Chris Moran", "startTime": "985.73505", "endTime": "987.255", "body": "I agree, but it's much better if you say it." }, { "speaker": "Taya Collyer", "startTime": "989.13995", "endTime": "991.3", "body": "What's your favourite part of the job, Chris?" }, { "speaker": "Chris Moran", "startTime": "991.38", "endTime": "1024.97", "body": "Not knowing what part of the job's coming next. I really like the unpredictability and thinking on my feet. I've always enjoyed that component of it. I like the mix of science with humans. That's a fun place to play in. A textbook can tell you what should be done in this an ideal scenario, but the person in front of you has very different expectations, needs, and preferences. Trying to get a win/win knowing the perfect doesn't exist is fun. It's a creative process, and you basically invent a plan every time. You try to combine the best knowledge that exists with your best judgement." }, { "speaker": "Taya Collyer", "startTime": "1024.97", "endTime": "1026.97", "body": "Yeah. So a bit of puzzle, a bit of puzzle solving?" }, { "speaker": "Chris Moran", "startTime": "1027.45", "endTime": "1027.85", "body": "Pretty much so." }, { "speaker": "Taya Collyer", "startTime": "1027.85", "endTime": "1029.21", "body": "Optimising under uncertainty." }, { "speaker": "Tracy Parish", "startTime": "1029.555", "endTime": "1043.395", "body": "Chris, you were involved with the National Centre for Healthy Ageing, with what we call a Living Lab project, and it was called the Digital Health Passport. I think it was to try and improve communication, within the hospital setting. Is that right? Can you explain it?" }, { "speaker": "Chris Moran", "startTime": "1043.395", "endTime": "1065.795", "body": "Yeah. So one of the areas I'm passionate about is how can we reduce the risk of harms for older people when they're in hospital. And oftentimes when older people in hospital, they're not able to advocate for themselves. Maybe their cognition isn't what it used to be. Maybe they're simply in pain, But it's not uncommon for family members to know a lot about really important stuff that we would benefit from in the hospital setting if we knew that." }, { "speaker": "Chris Moran", "startTime": "1065.795", "endTime": "1092.2451", "body": "So for example, that mum gets up seven or eight times to go to the bathroom overnight can be really important information for us to know. Let's put mum somewhere where she can see where the bathroom is and it's not too far for her to walk and support her to do those things. These things may sound silly, but they can be really important. It can stop the risk of a fall in the middle of night, which can be life changing. So what we wanted to do was to work with those supporting someone with cognitive problems." }, { "speaker": "Chris Moran", "startTime": "1092.2451", "endTime": "1119.105", "body": "We worked with people with dementia and the staff members on the ward to try to design what kinds of information do staff members want, what kinds of information can staff members use to make sure that those daily routines, needs, and preferences can be incorporated into care as much as possible. In the early days of someone's hospital admission, they can be quite sick. Oftentimes the medical team and the hospital team can get distracted by all the medical complexity and forget these routines. They are important." }, { "speaker": "Tracy Parish", "startTime": "1119.105", "endTime": "1122.545", "body": "And it was tested in one of the hospitals down at Mornington Peninsula?" }, { "speaker": "Chris Moran", "startTime": "1122.545", "endTime": "1133.75", "body": "We developed it in Frankston Hospital, and we've tested it with regard to what people think of it. They really, really like it, and we're in the process of trying to get some funding to actually design it and implement it." }, { "speaker": "Tracy Parish", "startTime": "1133.75", "endTime": "1140.87", "body": "Oh, Chris, it's such a great initiative, but I know you need more funding. So if anyone's listening today and want to support this, get in touch with us now." }, { "speaker": "Tracy Parish", "startTime": "1141.355", "endTime": "1152.155", "body": "What's the most exciting new tools or technology or approach to some of these complex medical conditions that excites you? What's coming over the horizon?" }, { "speaker": "Chris Moran", "startTime": "1152.555", "endTime": "1184.5199", "body": "I'm really interested in how older people I think are getting better and better at advocating for themselves. I think there's a generational move in that regard. I think that's quite exciting. We've probably never had patients being as comfortable advocating for themselves as individuals or advocating as a group. I think that's making for some really interesting conversations, not just for me on a one on one contact with a patient in a hospital, for example, but also what that means for our society and how we treat our older people. I think that's really interesting." }, { "speaker": "Taya Collyer", "startTime": "1184.6799", "endTime": "1190.12", "body": "Can you say more about that? In what ways are older people becoming more confident or more able to advocate?" }, { "speaker": "Chris Moran", "startTime": "1190.12", "endTime": "1205.345", "body": "I think they simply are becoming more confident, and they are more they're less willing to shut up and put up and more willing to say this is what I wanted. I think family are the same. I think that is ultimately a good thing. I think medicine's had a long history of paternalism. That's been gradually shifting." }, { "speaker": "Chris Moran", "startTime": "1205.345", "endTime": "1227.875", "body": "And I think the cohort of older people that are coming through are pushing us to be better people in that regard and work more as team members. So this idea of joint goal setting with patients bringing in the family if the patient wants us to, I think is a really interesting way of working. I think it's challenging a lot of the assumptions that we've had in the past and lots of ways of working the way we've worked in the past." }, { "speaker": "Taya Collyer", "startTime": "1227.875", "endTime": "1239.13", "body": "Right. So the assumption that an older person needs to have the support of family a 100 percent of the time, you know, that that assumption's being questioned and maybe turned on its head?" }, { "speaker": "Chris Moran", "startTime": "1239.2101", "endTime": "1255.195", "body": "I think any assumption that's generalising what older people do in general is going to fall down. I think we're seeing more and more ways of people getting older. We have older people who are getting knee replacements because they can't ski moguls the way they used to. We're seeing it all. This is good." }, { "speaker": "Tracy Parish", "startTime": "1255.195", "endTime": "1258.6349", "body": "Yeah. Okay. Not because they are skiing moguls. Both." }, { "speaker": "Taya Collyer", "startTime": "1258.955", "endTime": "1278.34", "body": "Skiing is a statistically unacceptable activity. I just wanna make that very clear. I have a no skiing policy. We have a no skiing policy on the podcast. Can we change gears slightly and talk about an acronym that I have heard so many times working at the National Centre for Healthy Ageing, which is the CGA, the Comprehensive Geriatric Assessment." }, { "speaker": "Taya Collyer", "startTime": "1278.74", "endTime": "1292.375", "body": "And in my experience with my own family, this is something that's talked about. Do we need a CGA? Has anyone done a CGA? I feel like this is something that listeners out there would possibly never heard of. Could you describe this thing and its and its value?" }, { "speaker": "Chris Moran", "startTime": "1293.7799", "endTime": "1336.715", "body": "Yes, so CGA or Comprehensive Geriatric Assessment is simply a way of thinking. It's a framework to help support people, make sure that we think about, assess, and manage a patient in a comprehensive way that treats those things that are important in a way that they can interact with each other. In other words, it's a way of thinking comprehensively about the person both medically, psychologically, and socially, and how all those things interact. By taking a comprehensive approach, that hopefully means that we can identify all the relevant things. If we know those relevant pieces of information, then we can formulate a plan that actually makes sense. And when I say making sense, that aligns with what the patient wants." }, { "speaker": "Taya Collyer", "startTime": "1336.715", "endTime": "1339.275", "body": "Right. And but what actually is it? How do you do it?" }, { "speaker": "Chris Moran", "startTime": "1339.275", "endTime": "1343.915", "body": "You be a human. And what I mean by that is you start with a conversation. You take a history." }, { "speaker": "Tracy Parish", "startTime": "1343.915", "endTime": "1345.035", "body": "So I walked in the door with my ..." }, { "speaker": "Taya Collyer", "startTime": "1345.275", "endTime": "1346.875", "body": "Welcome to Tracy's CGA." }, { "speaker": "Tracy Parish", "startTime": "1347.9701", "endTime": "1349.65", "body": "Okay. Hello, Dr Moran." }, { "speaker": "Chris Moran", "startTime": "1349.65", "endTime": "1350.29", "body": "You get comfy?" }, { "speaker": "Tracy Parish", "startTime": "1350.29", "endTime": "1354.53", "body": "Yep. Yeah. No. I am getting comfy. Am I going to need to be comfy for a couple of hours, or is this like a 10 minute thing?" }, { "speaker": "Chris Moran", "startTime": "1355.65", "endTime": "1356.93", "body": "It's probably over an hour." }, { "speaker": "Taya Collyer", "startTime": "1357.01", "endTime": "1358.3701", "body": "Okay. Yeah. That's a lot of time." }, { "speaker": "Chris Moran", "startTime": "1358.3701", "endTime": "1359.41", "body": "It is a lot of time." }, { "speaker": "Tracy Parish", "startTime": "1359.41", "endTime": "1360.77", "body": "Do you offer coffee? Or?" }, { "speaker": "Chris Moran", "startTime": "1361.145", "endTime": "1364.745", "body": "Coffee's fine. If you want coffee, that's hospital coffee, it might be." }, { "speaker": "Taya Collyer", "startTime": "1365.0651", "endTime": "1366.505", "body": "Careful careful what you wish for." }, { "speaker": "Chris Moran", "startTime": "1366.505", "endTime": "1369.385", "body": "There's plenty, plenty bring their own coffee in. Alright." }, { "speaker": "Tracy Parish", "startTime": "1369.545", "endTime": "1371.145", "body": "Alright,so I walked in the door. What happens now?" }, { "speaker": "Chris Moran", "startTime": "1371.385", "endTime": "1408.3599", "body": "We find out why you're here, and that will be a conversation, as broad as we can take it. Might be that you've got one issue. It might be that you've one issue that you know about and a few others that you don't know about. It might be that you've got a lot of issues. It might be my GP sent me here because he thinks I'm on too many medications. My surgeon said that I have come see you because she wants me to lose weight before I have surgery for something. So all those things I think can be part of that conversation. We go over your medical history, we go over how that's working for you, We go over what medications you're on. We talk about how that's working for you. We talk about your function, your functional independence." }, { "speaker": "Chris Moran", "startTime": "1408.36", "endTime": "1431.98", "body": "We talk about what things from day-to-day you may struggle with. We would talk about what kinds of things you would like to do but can't do. We talk about how you're being supported to do those things. Do you have social supports? Do you have formal supports in place? We talk about your cognition. We will likely do some assessments as well. So we'll do a physical examination, which is a pretty robust head to toe examination, I'll be honest. We will be wiggling arms and checking ..." }, { "speaker": "Tracy Parish", "startTime": "1431.98", "endTime": "1432.46", "body": "Does that require a gown?" }, { "speaker": "Chris Moran", "startTime": "1440.22", "endTime": "1468.9801", "body": "Probably not. Not that throrough. We tend not to get that enthusiastic unless we absolutely have to, but it can happen. So sometimes, because these are long consultations, we can get to know people quite intimately sometimes and people are willing to volunteer things they wouldn't otherwise have volunteered. It would be pretty common for me to be taking shoes and socks off, for example. So looking at feet, looking under dressings and wounds, that's a big part of what we do. Sometimes people have not had the time to do those things and we can sometimes find stuff that's really important there." }, { "speaker": "Tracy Parish", "startTime": "1469.5751", "endTime": "1494.33", "body": "And particularly if there's diabetes or other underlying health issues, I'm just thinking with wound care and ... Absolutely. And whether or not they've had that support. Exactly. So we get into all those things. We will often look at your walking. We will ask you to walk or stand up from a chair and walk a distance and walk back again and time you're doing it. We will likely do some cognitive tests as well. We might, assess your grip strength and see how strong you are and a few other things." }, { "speaker": "Tracy Parish", "startTime": "1494.33", "endTime": "1525.025", "body": "Mhmm. I remember talking to a dementia doctor who is a very good fan of NCHA actually and what they said was one of the things that they check is when they first ask a patient to come into the room they talk and walk with them at the same time and they find from a cognitive point of view, if they can't walk and talk at the same time, that can be a flag because they have to concentrate on both. And I always thought walking was just such a natural thing to do, but in fact, it does take brain matter to do it, obviously." }, { "speaker": "Chris Moran", "startTime": "1525.025", "endTime": "1543.85", "body": "It does, and we've all experienced this. Who's not been walking down the street and almost walked into the person in front of us because they've suddenly slowed down to use their phone? Motor cognitive risk, which is the fancy medical term for that, being able to walk and use your phone or think at the same time, is not that straightforward. So very few of us can genuinely do both of those things at peak performance." }, { "speaker": "Taya Collyer", "startTime": "1543.85", "endTime": "1548.17", "body": "Mhmm. So back to the CGA, like this is not six minute medicine." }, { "speaker": "Chris Moran", "startTime": "1548.17", "endTime": "1549.45", "body": "No, it's really not." }, { "speaker": "Taya Collyer", "startTime": "1549.45", "endTime": "1564.365", "body": "Yeah. I think that's perhaps what makes it quite special, you know, for an adult to be having such a long, such a holistic conversation about their well-being, about their challenges, about what the their goals. Like, in medicine, this seems like it strikes me as pretty unique." }, { "speaker": "Chris Moran", "startTime": "1565.11", "endTime": "1594.91", "body": "It's pretty uncommon. I think one of the ways in which it's uncommon is we tend to do this less commonly than other specialties. So you might see your GP over a period of ten years, you ultimately get that level of complexity built in, but it's not done in a single hit. If you've got diabetes, you might be attending a diabetes clinic and they may focus one day on your sugars, another day on your wounds, another day on your continence, and they will cover those things, but it will be incremental rather than a pretty intensive, an hour and a half session sitting in front of someone like me." }, { "speaker": "Tracy Parish", "startTime": "1594.91", "endTime": "1596.59", "body": "Yeah. Okay. Is this expensive?" }, { "speaker": "Chris Moran", "startTime": "1596.8301", "endTime": "1612.1649", "body": "I work in a public setting, so it has no cost to the person, when they attend the public clinics. I work in the cognitive clinics as well, and they are at no cost to providers. There are private providers out there as well, and that can vary quite a lot in cost." }, { "speaker": "Tracy Parish", "startTime": "1612.245", "endTime": "1617.125", "body": "And the waiting list. So I walked in the room, but when would I have booked this with you?" }, { "speaker": "Chris Moran", "startTime": "1617.125", "endTime": "1623.125", "body": "Depends where you work. For some people, particularly those who live regionally, it may be really difficult for them to see a geriatrician at all." }, { "speaker": "Taya Collyer", "startTime": "1623.125", "endTime": "1630.01", "body": "Yeah. There are some Australian states that got a real serious shortage. I've got it in the back in my head, the Tassie has got a shortage. Is that right?" }, { "speaker": "Chris Moran", "startTime": "1630.01", "endTime": "1633.37", "body": "I'm biased. I'm gonna say that we need more geriatricians everywhere." }, { "speaker": "Taya Collyer", "startTime": "1633.37", "endTime": "1634.25", "body": "Everywhere all the time." }, { "speaker": "Chris Moran", "startTime": "1634.25", "endTime": "1650.105", "body": "That's just my bias. It is a problem regionally and rurally. It is tricky for some people to get access. Oftentimes, there are some people who are out there private, but if there's a small number of private people, it can be very difficult with long wait lists." }, { "speaker": "Tracy Parish", "startTime": "1650.28", "endTime": "1659.0", "body": "So if we've got listeners at the moment in regional Australia that are listening, can they access someone who comes into the regional area? There are many of those fly in, fly out type specialists?" }, { "speaker": "Chris Moran", "startTime": "1659.0", "endTime": "1671.415", "body": "There absolutely are. And some of them are in the country as well, so they are absolutely out there. My best advice is to speak to your GP. They will have a good understanding of who's out there and how to access them. " }, { "speaker": "Taya Collyer", "startTime": "1671.415", "endTime": "1680.9501", "body": "And what are some common patterns, perhaps, or constellations of events that might suggest it's a good idea for an older person to have a CGA?" }, { "speaker": "Chris Moran", "startTime": "1680.9501", "endTime": "1689.8301", "body": "Yeah. I might get in trouble for this. I don't think everybody needs a CGA. If you're doing really well and everything's fine, then you probably don't need to. And you could think of it a little bit like a roadworthy for a car." }, { "speaker": "Chris Moran", "startTime": "1689.8301", "endTime": "1740.4299", "body": "Mhmm. If you think that it's been a while since you have a good, look over all of the systems and make sure all the lights are working okay, then we can absolutely do that role. And if your motivation is to give yourself the reassurance that you're doing everything you can to optimise your ageing, then that's completely appropriate. If you have problems such as, and we have these things we talk about geriatric syndromes, So concerns about cognition, concerns about falling, concerns about managing medications, those kinds of things are our bread and butter. They're hardly ever due to one single thing. And if they are, you probably are getting the right treatment for those. But if there's lots of things that might be contributing to your fall, you're awake in the muscles, maybe you're worried you're not eating enough, maybe you're worried that you've had a stroke in the past and you're not sure if that's still affecting you, maybe your heart's not as good as it used to be and you just want a general look over everything, that's the kind of stuff we're really good with." }, { "speaker": "Taya Collyer", "startTime": "1740.4299", "endTime": "1744.2699", "body": "We've used the phrase managing medications a few times, what does that mean?" }, { "speaker": "Chris Moran", "startTime": "1744.35", "endTime": "1776.7101", "body": "Yeah, so sometimes what can happen is different specialists can focus only on their things and they focus on their organs. So a classic example, which is a little unfair, but it's a good example, is we talk about a cardiologist might be really passionate about making sure somebody's blood pressure is as close to perfect in a textbook manner as we possibly can. It's relatively common for older people as they get more frail, and I'm aware I've just introduced another concept here, is that that really strict blood pressure control can cause someone to get quite dizzy and lightheaded if they stand up quickly." }, { "speaker": "Taya Collyer", "startTime": "1776.7101", "endTime": "1777.11", "body": "Okay." }, { "speaker": "Chris Moran", "startTime": "1777.5851", "endTime": "1799.8", "body": "That can cause people to fall, that can cause you to have a really miserable life. And while it's happened to all of us, at least sometime in our lives when we get dizzy and lightheaded, if this keeps happening, you can be feeling really miserable. Sometimes it can be difficult to get another medic to hear you when you're making those concerns and complaints. A geriatrician can sometimes give you coverage to use a little bit of common sense here as well and back off a touch." }, { "speaker": "Taya Collyer", "startTime": "1799.8", "endTime": "1805.415", "body": "So you might actually be recommending that people reduce the number of medications that they're on. Is that right?" }, { "speaker": "Chris Moran", "startTime": "1805.415", "endTime": "1826.75", "body": "I love stopping medications if I can. It's one of my favourite things. When I was doing my training, I used to work with a geriatrician who after I would see someone, his first question would be, and what medications would you like to stop? We love rationalising medications. Older people are often on medications that were started twenty years ago, and no one's really looked at whether or not they still need that." }, { "speaker": "Chris Moran", "startTime": "1827.39", "endTime": "1829.0701", "body": "I love getting rid of medications." }, { "speaker": "Taya Collyer", "startTime": "1829.0701", "endTime": "1833.965", "body": "And I guess that that would have the effect of reducing any potential interactions between medications, right?" }, { "speaker": "Chris Moran", "startTime": "1833.965", "endTime": "1846.6799", "body": "That's the theory. One, if you don't need it you shouldn't be on it anyway, but these medications are often not completely benign, they can cause other problems, they can interact with other medications, Let's make complexity simpler wherever we can." }, { "speaker": "Taya Collyer", "startTime": "1846.6799", "endTime": "1865.2549", "body": "Uh-huh. Uh-huh. So that's a strategy for managing complexity. And I I think we're getting near another concept, and at the risk of going full jargon, polypharmacy is a word that gets thrown around quite a lot when discussing the care of older people. So I know there's not going be a straightforward answer, but, like, how many medications is too many medications?" }, { "speaker": "Chris Moran", "startTime": "1865.735", "endTime": "1876.04", "body": "I would argue too many medications is more than you need to be on. Polypharmacy is often used to describe someone who's taking more than five medications." }, { "speaker": "Taya Collyer", "startTime": "1876.04", "endTime": "1877.08", "body": "More than five every day?" }, { "speaker": "Tracy Parish", "startTime": "1877.08", "endTime": "1877.32", "body": "Yeah." }, { "speaker": "Taya Collyer", "startTime": "1877.32", "endTime": "1879.7999", "body": "Yeah. Okay. So the pillbox is full. She's rattling." }, { "speaker": "Chris Moran", "startTime": "1879.88", "endTime": "1887.095", "body": "Oh, it can be. I certainly see people who five would be almost an impossible dream to be on so few." }, { "speaker": "Taya Collyer", "startTime": "1887.095", "endTime": "1888.9349", "body": "Right. So how many are those folks on?" }, { "speaker": "Chris Moran", "startTime": "1889.255", "endTime": "1890.375", "body": "20 plus easily." }, { "speaker": "Taya Collyer", "startTime": "1890.375", "endTime": "1891.495", "body": "Oh, every day." }, { "speaker": "Chris Moran", "startTime": "1891.8151", "endTime": "1915.415", "body": "It it yeah. It can be pretty intense. And you don't need necessarily have lots of medical conditions to be on those kinds of number of medications. The five medication thing is really a flag because we know that people on more than five are at an increased risk of lots of other things happening like medication interactions or complications because of their medications. But I would never be telling people that more than five is straight up bad and you should simply take less." }, { "speaker": "Chris Moran", "startTime": "1915.735", "endTime": "1921.0951", "body": "So it's look at all your medications, make crystal clear that we understand what that medication is doing." }, { "speaker": "Taya Collyer", "startTime": "1921.0951", "endTime": "1922.375", "body": "And that it's still of value?" }, { "speaker": "Chris Moran", "startTime": "1922.375", "endTime": "1935.4", "body": "If it's still having benefit and it's the best version we can be on, then we keep it, it's fine. But you can be on four medications and three of them could be irrelevant, in which case I'm going to stop those three if I possibly can. It's less about the number and more about whether it's relevant." }, { "speaker": "Taya Collyer", "startTime": "1935.4", "endTime": "1937.0", "body": "Yeah, more complexity. Wowie." }, { "speaker": "Tracy Parish", "startTime": "1937.205", "endTime": "1954.7999", "body": "Can we talk about when mom or dad or somebody that we love is going into hospital multiple times? They're turning up because they had an original fall and then there's some other complication. At what stage should they go and get a more complex assessment, really?" }, { "speaker": "Chris Moran", "startTime": "1956.0", "endTime": "1978.235", "body": "Sometimes in that scenario they will be getting that assessment in hospital. So these days with people who are coming into hospital multiple times, the fact that they've come in multiple times will be a trigger for people like me to look at things and go, is this the same thing that keeps happening or is it something new? And that will trigger different responses. If it's the same thing, for example, somebody keeps falling, then we look at why that's happening and what we can do to make that safer." }, { "speaker": "Chris Moran", "startTime": "1978.5701", "endTime": "1983.9299", "body": "If it's a lot of different things and we have to ask, is there something else going on in the background that's causing all these new things to happen?" }, { "speaker": "Tracy Parish", "startTime": "1984.17", "endTime": "2008.3398", "body": "I need to touch on dementia. And when an elderly person turns up at hospital, we've had robust discussions about this, in the office, that some families get really stressed about it, about leaving mom or dad there because they're busy. You know, the hospitals are busy. And how can they, make sure that mom or dad stay safe when they can't watch them the whole time?" }, { "speaker": "Chris Moran", "startTime": "2008.58", "endTime": "2051.925", "body": "Yeah. We do this a lot in hospitals, so we're pretty good at it. We're not as good as we could be, but we are okay. Speak to the staff. Let the staff know your concerns. The staff will only give you the specifics. Sometimes the staff will reassure you and let you know it's absolutely fine for you to go. Please go look after yourself. Sometimes your presence can be really helpful, and that could be a conversation around the time of let's talk about busy times in the hospital where it'd be great if you were able to be around. Maybe we don't need all five family members all to come in between seven and 9pm in an evening, but what would be lovely if you could split that up throughout the day and then can someone come in for a couple hours in the morning, someone come in whenever in the evening, maybe someone stays later, maybe and I've got a bit of a bee in my bonnet about hospital visiting hours." }, { "speaker": "Chris Moran", "startTime": "2051.925", "endTime": "2062.805", "body": "Maybe we should waive some visiting hours and let you stay earlier or later because that's actually what the person needs to help them feel comfortable. Those things are, I think, really good. So if you're worried, speak up and let the staff know." }, { "speaker": "Tracy Parish", "startTime": "2062.805", "endTime": "2080.3853", "body": "Because often people who are living with dementia who might be in like an aged care home for example or in a specific area where they're well looked up by people that are quite trained. Are you confident that the hospital setting are trained well enough to be able to deal with people with dementia?" }, { "speaker": "Chris Moran", "startTime": "2081.8252", "endTime": "2093.65", "body": "Provocative, sorry. It is provocative. And I suppose I'd maybe push back a little bit. The kinds of people you're talking about are quite uncommon. The vast majority of people with dementia are not living in dementia specialty care units." }, { "speaker": "Chris Moran", "startTime": "2093.65", "endTime": "2137.375", "body": "That's just not their life. So we're talking a really small number of people. However, if they are at that point where they are in a dementia care unit, there's lots of places in the hospital that don't have those skills. Emergency departments do their best, but a really busy emergency department that is lit the same at 2AM as it is at 2PM, lots of noisy emergencies happening, nobody thinks that's a relaxing place to be regardless of whether you have dementia or not. So there's certainly parts of the hospital that have that kind of speed and noise. Those kinds of places, often the staff are used to working really fast and not being able to have the luxury that I have of spending time to get to know people and working with them. Those high turnover places are tricky for people with cognitive problems." }, { "speaker": "Taya Collyer", "startTime": "2137.535", "endTime": "2158.55", "body": "Perhaps we can talk about what might be exemplary care for an older person. I think too often we are looking for red flags or maybe that's just my personality. I'm a fan like, I'm a bit of a drama llama. But in your experience, when you're meeting someone, like, are the green flags for care of an older person? What are the signs that, like, someone's really getting great care?" }, { "speaker": "Chris Moran", "startTime": "2158.79", "endTime": "2172.545", "body": "I think that the person's happy with the care that they're getting. They think they're doing fine and the people around them think they're doing fine. Those two things aren't always the same thing. Sometimes people don't have insight. I think that's probably the best standard." }, { "speaker": "Chris Moran", "startTime": "2172.785", "endTime": "2200.935", "body": "If I were to give a general answer, there may be care where I can see lots of people are doing lots of really clever things and it's really insightful, but the person themselves may not appreciate it. That's pretty good. That's the best that we can do, but that wouldn't be what I call exemplary care, which is the patient thinks they're well looked after, they're feeling supported, they can do the things that they want to do, or can understand why they can't, because we can't fix everything if the patient tells me they think they're receiving exemplary care. And I happen to agree that would be what I would call exemplary care." }, { "speaker": "Taya Collyer", "startTime": "2201.2898", "endTime": "2218.5251", "body": "Yeah. I feel like that might sound like a really obvious answer, but I think within medical culture, I feel like we're always grasping for like some quick fix or some tool that'll tell us what's working and not working. But what you're saying is that actually all that matters is the individual and their perspective." }, { "speaker": "Chris Moran", "startTime": "2219.3252", "endTime": "2227.405", "body": "I think that's the most important thing. I wouldn't say it's all that matters in that sometimes people don't know what care they're missing out on, the preventative side of things." }, { "speaker": "Taya Collyer", "startTime": "2227.405", "endTime": "2229.3", "body": "Oh, of course, yeah, yeah, of course." }, { "speaker": "Chris Moran", "startTime": "2229.3", "endTime": "2239.22", "body": "So that's definitely part of it. But I see if someone's receiving textbook care, but they just don't think that they are, and there's lots of other gaps, think that's worth exploring." }, { "speaker": "Taya Collyer", "startTime": "2239.22", "endTime": "2241.875", "body": "What is preventative care for older adults?" }, { "speaker": "Chris Moran", "startTime": "2242.035", "endTime": "2276.575", "body": "That's a long list. So we can start from something as simple as making sure that people are up to date with their vaccinations and they're staying on top of all of those depending on their age and what their risk factors are. It can be staying physically active, making sure that you're staying strong, that you're staying as fit as you can. Those things are really good for your brain. They're really good for your heart. They reduce your folds risk. So staying physically active really helps in keeping you functionally independent. Socially engaged is really good exercise for your brain as well. It's really good for keeping your brain sharp. Trying to make sure if you can, your medical conditions are as optimised as possible." }, { "speaker": "Chris Moran", "startTime": "2276.735", "endTime": "2294.5", "body": "So we do have targets for where we want things like blood pressure and blood sugar control and stuff like that. Ideally trying to sit in the middle of those targets as possible, achieving those things with the fewest number of medications as possible where they're not causing too much problems is pretty close to what you'd be aiming for if you could. Easier said than done." }, { "speaker": "Tracy Parish", "startTime": "2294.5", "endTime": "2313.135", "body": "I can see the smile on your face. Is it something about working with older people and helping their quality of life that really gets you excited every day? Because, yeah, I can just see how up you are about it, and I can imagine other people would go, that's a real challenge. That's not an area I want to be involved in. What is it that you love about it?" }, { "speaker": "Chris Moran", "startTime": "2313.59", "endTime": "2326.15", "body": "I would go back to the five-year-old Chris. We like helping people. I think many of us who go into health care like making a difference and like to help people feel good about themselves. I get to do that. That's pretty cool." }, { "speaker": "Tracy Parish", "startTime": "2326.715", "endTime": "2332.715", "body": "And did you see yourself in that world when you were that little person?" }, { "speaker": "Chris Moran", "startTime": "2332.955", "endTime": "2334.155", "body": "Not in geriatrics." }, { "speaker": "Taya Collyer", "startTime": "2334.155", "endTime": "2336.155", "body": "You were doing CGAs at five year's old?" }, { "speaker": "Chris Moran", "startTime": "2336.155", "endTime": "2357.5952", "body": "I was not doing CGAs at five years old. Otherwise, wow. I once asked when I was doing my medical training off a geriatrics trainee why she was doing geriatric medicine, it didn't make any sense to me. And the answer she gave me, and I still think is the best answer, is it'll make sense when you get older. I was a 20-year-old medical student at the time and was quite insulted, but she was right." }, { "speaker": "Chris Moran", "startTime": "2357.8352", "endTime": "2374.58", "body": "I think it often lacks sex appeal. Looking after older people can sometimes, to outsiders, seem not rewarding. They're wrong. They're completely missing the point. Helping anyone makes people feel good about themselves." }, { "speaker": "Chris Moran", "startTime": "2374.58", "endTime": "2390.865", "body": "And if you're in any situation to do that, I think that makes you feel really good. For me, because I like complexity, I get the intellectual dopamine hit as well of feeling good about myself solving a complex problem with the ultimate aim the same as the rest of us, trying to make someone else's life a little bit simpler, a little bit easier." }, { "speaker": "Tracy Parish", "startTime": "2391.185", "endTime": "2401.29", "body": "Chris, that's a great way to finish, but I know that we're all getting older. We've talked about how we can age well, live well, but how do you want to age well?" }, { "speaker": "Chris Moran", "startTime": "2401.3699", "endTime": "2422.415", "body": "I think the same way as everybody else, which is ideally with as much dignity as we can muster and with as much autonomy and as control as we possibly can. Things will happen. We know that happens. And we can do all the right things as often as we can, but probably not as often as we should because we live in the real world. But ideally doing the things that I enjoy." }, { "speaker": "Chris Moran", "startTime": "2422.4949", "endTime": "2430.4502", "body": "And while I'd be willing to accept some compromise in some of those things, I'd still ideally do that as smoothly as possible." }, { "speaker": "Tracy Parish", "startTime": "2430.4502", "endTime": "2432.05", "body": "Any snow moguls in that?" }, { "speaker": "Taya Collyer", "startTime": "2432.05", "endTime": "2437.9702", "body": "Not from me. Correct answer. Thanks so much for joining us today, Chris. It's been a fabulous conversation." }, { "speaker": "Chris Moran", "startTime": "2437.9702", "endTime": "2438.9302", "body": "Thank you for inviting me." }, { "speaker": "Tracy Parish", "startTime": "2439.155", "endTime": "2453.795", "body": "It's been great to have you on board, Chris. Today, we took a look inside the world of a geriatrician to find out how they could help you to age well and live well. We hope it helped. Thanks for listening. This podcast is from the National Centre for Healthy Ageing." }, { "speaker": "Tracy Parish", "startTime": "2454.2002", "endTime": "2474.035", "body": "We're proudly driving innovation and transforming health and care through research so we can all lead healthier lives as we age, especially those most vulnerable. If you want to know more, check out our website at ncha.org.au. If you like this episode, please tell your friends, your family, your colleagues, share it more widely." }, { "speaker": "Taya Collyer", "startTime": "2474.035", "endTime": "2475.2349", "body": "Your golfing buddies." }, { "speaker": "Tracy Parish", "startTime": "2475.2349", "endTime": "2493.03", "body": "Anyone. Speak to anyone down the street. The more we can share, the merrier. The more people we can reach, the greater impact the research will have in helping people age well. There's still so much more to talk about, so join us next time for more real stories, real evidence, real insights about healthy ageing." }, { "speaker": "Tracy Parish", "startTime": "2493.03", "endTime": "2513.475", "body": "Tune in wherever you listen to your podcasts. This podcast was recorded on the land of the Boon Wurrung Bunurrung people of the Kulin nations. We pay our respects to elders past and present and extend that respect to any Aboriginal and Torres Strait Islander people listening today." } ] }