Subscribe to The Podcast by KevinMD. Watch on YouTube. Catch up on old episodes!
Join us as we explore the challenges of health care non-compliance among older adults with gerontologist Michael Pessman. We discuss the underlying factors driving resistance to medical advice, the importance of rebuilding trust in health care, and strategies to promote proactive care in aging populations. Learn how education, cultural competence, and community engagement can empower older adults to embrace preventative health measures and live healthier, more fulfilling lives.
Michael Pessman is a gerontologist.
He discusses the KevinMD article, “Solving the health care dilemma: Why older adults are skipping vital care.”
Our presenting sponsor is DAX Copilot by Microsoft.
Do you spend more time on administrative tasks like clinical documentation than you do with patients? You’re not alone. Clinicians report spending up to two hours on administrative tasks for each hour of patient care. Microsoft is committed to helping clinicians restore the balance with DAX Copilot, an AI-powered, voice-enabled solution that automates clinical documentation and workflows.
70 percent of physicians who use DAX Copilot say it improves their work-life balance while reducing feelings of burnout and fatigue. Patients love it too! 93 percent of patients say their physician is more personable and conversational, and 75 percent of physicians say it improves patient experiences.
Help restore your work-life balance with DAX Copilot, your AI assistant for automated clinical documentation and workflows.
VISIT SPONSOR → https://aka.ms/kevinmd
SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast
RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended
GET CME FOR THIS EPISODE → https://www.kevinmd.com/cme
I’m partnering with Learner+ to offer clinicians access to an AI-powered reflective portfolio that rewards CME/CE credits from meaningful reflections. Find out more: https://www.kevinmd.com/learnerplus
Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Michael Pessman. He’s a gerontologist. Today’s KevinMD article is “Solving the Health Care Dilemma: Why Older Adults Are Skipping Vital Care.” Michael, welcome back to the show.
Michael Pessman: Thank you, Kevin. I’m happy to be back.
Kevin Pho: Perfect. Such an important topic. Tell us what this article is about for those who didn’t get a chance to read it.
Michael Pessman: Sure. It is about the amount of older adults in our country who are choosing to skip routine health care. And what I mean by routine is most older adults over the age of 65 at least see their doctor every six months to get treatment—a blood sugar draw, a cholesterol draw. They check their blood pressure. These are the three vital signs to grow old healthy and gracefully. Without maintaining those levels, people can run into problems both cognitively and physically. Statins, as you know, Kevin—you’re a doctor—have kept people alive much longer than before. So these are, in effect, miracle drugs if you need them, but just knowing that you might need them can extend a person’s life. So it is almost a crisis, in my opinion, after doing some of the research on this article, because lives could be saved.
Kevin Pho: So tell me, in terms of contextualizing the scope of this, tell us what you’re seeing in offices or maybe some numbers from your research. How big a problem is this?
Michael Pessman: Sure. Well, like I said, some of the numbers are one out of four older adults do not go at least once a year. That’s concerning. I do believe that older adults are healthier now more than ever—they exercise, they take care of themselves. I like to keep my finger on the pulse. I’m in a number of groups, I interact with older adults one-on-one, I have a garden club, I belong to church and other various outside interests. And these are educated older adults. They may have had a bad experience with their parents—it’s almost generational. So the distrust from doctors is not their own experience, but rather some interaction with their parents, before many of these treatments were even available. For example, treating diabetes in 1950 was much different than it is in 2024, as you can imagine. But some of that mindset goes back to that date and time. Educating these people can be challenging, and it’s a passion of mine. I think that we have to present research—there’s a lot of research that if you look at these three indicators, a longer life is possible. So it’s just something I’m very passionate about. When I meet an older person, the first question I ask is, “How often do you see your doctor?” because I know that is the single biggest factor in a long life.
Kevin Pho: You mentioned that about 25 percent—one out of four—older adults don’t regularly see their clinician. Through your reading and your observations, what are some of the reasons that you’re hearing that can lead to that number?
Michael Pessman: You know, there are some socioeconomic issues that people just don’t have the bandwidth to physically get to a doctor. I think that’s minimal. I also think that if people feel good, they don’t have a need to see a doctor and don’t understand the preventive approach—that oftentimes, it’s late, Kevin, if you get sick and you have to see a doctor. Just because you’re feeling well today doesn’t mean you don’t have high blood sugar or high blood pressure. So there’s this wait-and-look-and-feel approach that many of these folks are taking, and they have such negative opinions, they only will consider a doctor if it’s the last resort, some of them. Again, this goes back to interactions they had with their parents that were negative experiences, and at the time, they were probably best practices. It’s difficult to overcome that mindset, and it often goes back to that. But I do think that is the biggest factor—if they’re not sick, they just want to skip it.
Kevin Pho: Now, you mentioned a couple of things that physicians routinely check for: blood sugar, cholesterol. What other screening tests, whether cardiovascular screening or cancer screening, do older adults typically get when they see physicians on a preventive basis?
Michael Pessman: Oh, very good question. I think definitely PSA—your urine for older men. That can be an indicator and should be tested every six months. For older women, sometimes a urinary tract infection can happen and can go on unbeknownst to them for a long period of time. So just regular routine blood tests like those can really help a person. It happened to my own family member—I had someone who had a UTI for over a year and did not know they had it, ended up in a hospital with sepsis over the age of 70, which was a tough situation. We look for that now. But had she gone routinely every three months—in my family member’s particular case—that would have been caught. So I have people, Kevin, in my own family that do not follow my advice. I’m not a doctor, but I know the outcome. I’ve done the research, and I just cannot emphasize the importance of that enough.
Kevin Pho: And it’s not just ordering a test. Whenever I see older men in the exam room, we certainly have that discussion about PSAs and the pros and cons of ordering the PSA routinely. Just having that conversation about these preventive tests is tremendously helpful as well. Even if they don’t go through some of the tests at that visit, having it planted in the back of their minds so the next time they come in, they can certainly consider it. I think it’s valuable.
Michael Pessman: Absolutely. I agree one hundred percent with you, Kevin. I also want to follow up with preventive vaccines like the pneumonia vaccine, the shingles shot. Even having those conversations—if they’re not ready to do it right then, you’re planting that seed. These are life-changing vaccines for people over the age of 65. And I’ll also add that by 2030, the demographic of those over the age of 65 is going to supersede children in America. So it’s a big demographic we’re talking about, and it affects a lot of people. So you’re right on target with that last question.
Kevin Pho: Now, what kind of strategies are the offices that you work in, or the research that you’ve read about, implementing to bring more of these older adults in for preventive visits?
Michael Pessman: Well, there’s been some talk about what a mobile unit might look like, where a health care company brings in a few doctors on a mobile clinic outside an older adult residence, like a high-rise. I live in Chicago—there are several high-rises, I look out my window, where older adults live. Parking out front, doing some free screenings, trying to get people involved, and educating. Personally, what I would like to see is a policy shift where our government spends money on education, Kevin, to inform people that research supports these office visits to make sure that people can live a long life, and using examples of people who have overcome these challenges, who have lowered their blood sugar, for example, to control diabetes, and what that looks like if you don’t—you might lose a limb. These are things people need to know. I don’t see a lot of education in our public sphere about that, and I would love to see more of it, and perhaps even someone like Ted Danson, who older adults can resonate with, kind of spreading that message—someone who’s credible, that they like, that they trust, and diving in. I feel like older adults often overlook some of the research, but really hammering home, emphasizing that, because at the end of the day, I do think everyone wants to live a long life that is the highest quality. Sometimes people can overlook that, and it shocks me, because a lot of these older adults are highly educated and still don’t see the importance of these routine visits. So it is mind-boggling, but I try my best to spread this information on a personal level anytime I come in contact with an older adult.
Kevin Pho: So tell us a success story where an older adult may not have seen the value of a preventive visit, or didn’t come in for one, and an office brought that patient in and made a measurable improvement in their lives. Tell us a success story that you’ve seen in the various offices you’ve worked at.
Michael Pessman: I’ve worked at a major hospital for three years here in Chicago, and I had an older adult. I was giving an educational presentation in the community about dementia, and I had a lady who said she had dementia because she doesn’t have short-term memory. Well, I got her into a clinic, I got her to see a doctor. She had a urinary tract infection that was untreated, and that can mirror dementia symptoms. So she actually ended up in a hospital on an IV drip of antibiotics, and after two weeks, came out. Her memory went back to normal, and she vowed to never skip a doctor’s appointment again because she thought she was going down that dementia route; in fact, she was not. Her family was ecstatic. She’s actually a proponent now of spreading this message to her friends. And as you know, dementia is higher in African American women in particular—she was an African American woman, a lovely lady—and we don’t know why it affects that group more; we’re studying that. But it was rewarding to see that, by attending my educational program, she was able to get such help in time, in a timely manner. Because left untreated, you know, people can die from sepsis and a UTI. So, yes, it’s life-altering.
Kevin Pho: You mentioned earlier one of the reasons why older adults didn’t come in was how they observed doctors treat their parents in a past generation. Is there a role for older adults’ families to influence and help bring them into the office?
Michael Pessman: Absolutely. Great question, Kevin. I think that it’s really important. I have a set of older adults who go to their grandchildren’s doctor’s appointments and see how doctors are helping their grandchildren who are experiencing some health concerns. And so just physically going into an office, seeing the interaction with the doctor with either their children or grandchildren, can be a step in the right direction—just seeing what modern medicine looks like and how empathetic doctors are these days, how they’re able to treat. We have the best, smartest doctors here in America, I feel, and seeing that firsthand—absolutely, children do play a role. And even as a nephew, I played that role to my aunts and uncles, just always hammering that home anytime I can. I would love to see more community engagement of children of older adults, because they do trust their family members. That’s a very good question.
Kevin Pho: We’re talking to Michael Pessman. He’s a gerontologist. Today’s KevinMD article is “Solving the Health Care Dilemma: Why Older Adults Are Skipping Vital Care.” Michael, let’s end, as always, with some take-home messages for the KevinMD audience.
Michael Pessman: Sure. I think that the take-home message is, if you have an older adult in your life that you love and you want them to live a long life, please intercede now. Encourage them to go see a doctor once a year—start out with just an annual physical once a year. Sometimes people can tell a white lie that, to keep Medicare, you might have to go see a doctor once a year just to get that annual physical. And encourage them that you can go with them to that appointment—that they don’t have to go alone—and that you can research the correct doctor if they don’t have one. Really take the time, energy, and effort to make sure your loved one goes.
Kevin Pho: Michael, as always, thank you so much for sharing your perspective and insight. Thanks again for coming back on the show.
Michael Pessman: Thank you, Kevin.
