Science as a career; heart disease and cystic fibrosis; 'age-friendly' hospital care: Upstate Medical University's HealthLink on Air for Sunday, Feb. 12, 2023

Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a world-renowned scientist explains what drew him to the profession.

Stephen Faraone, PhD: ... You can ask an interesting question and actually get an answer to that question. And if you're working in a field like mental health, you can get an answer that actually helps people. And that's very rewarding. ...

Host Amber Smith: An internal medicine doctor discusses why heart failure is showing up in some people with cystic fibrosis.

Andres Cordova Sanchez, MD: ... This is going to become a much more prevalent issue in the future. And we should start thinking about how to attack it, how to help these patients. ...

Host Amber Smith: And we'll learn what it means for a hospital to be age friendly.

Quonitra Bullock: ... We have purchased a blanket warmer for our patient population. Many of our clientele complain of being cold, and we want to keep them warm and comfy during their stay. ...

Host Amber Smith: All that, and a visit from The Healing Muse, coming up after the news.

This is Upstate Medical University's "HealthLink on Air," your chance to explore health, science and medicine with the experts from Central New York's only academic medical center. I'm your host, Amber Smith.

On this week's show, we'll learn about heart failure in people with cystic fibrosis. Then, we'll hear about an age-friendly hospital designation. But first, what does scientist Stephen Faraone find most fascinating about research?

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

A world-renowned ADHD researcher from Upstate is ranked as one of the top 80 scientists in the world, largely because of the volume of his research into attention-deficit/hyperactivity disorder. Dr. Stephen Faraone is a distinguished professor and vice chair of research in psychiatry and behavioral sciences at Upstate, and he serves as the president of the World Federation of ADHD and the editor of the journal Neuropsychiatric Genetics.

Dr. Faraone, welcome back to "HealthLink on Air."

Stephen Faraone, PhD: Thank you, Amber. Nice to be here.

Host Amber Smith: Your bachelor's degree in psychology came from SUNY Stony Brook. Did you go into college thinking that you wanted to become a research scientist?

Stephen Faraone, PhD: I did not. Not at all. No, when I went into college, my first major was in comparative literature, and as I was taking some other courses to round out my liberal arts degree, I became interested in psychology, and I, more and more that as that interest developed and also became interested in the, I would say, scientific side of psychology, I was drawn to that and then decided to seek a graduate degree in clinical psychology after my undergraduate years.

Host Amber Smith: So the classes you took just interested you, and you followed where your interests were.

Stephen Faraone, PhD: That's really what happened, yeah.

Host Amber Smith: So then how did you choose the University of Iowa for your master's and your doctorate in clinical psychology?

Stephen Faraone, PhD: The truth behind that is, I was a poor student at the time, and they offered me the best financial package, (laughs) including one year where essentially they would pay me, but I didn't have to work at all for the pay.

Frankly, that's really what it was.

My first choice was actually to go to Purdue because there was a psychologist there I wanted to work with, and I did get accepted to Purdue, but they didn't make me as good a financial offer. So I went to University of Iowa. But after I finished my graduate work there four years later, that person I had wanted to work with had moved to Brown University, and I ended up doing my internship at Brown. So we ended up working together after all ...

Host Amber Smith: Oh, very good.

Stephen Faraone, PhD: ... and actually became lifelong friends as well. So it's a nice kind of story.

Host Amber Smith: At what point did you start getting involved in research? Was that in Iowa or at Brown?

Stephen Faraone, PhD: No, that was in Iowa. What I liked about the University of Iowa was a psychology program that was essentially oriented to producing what they would back then would call the Boulder Model psychologist, which was a classic kind of clinician that was also a good researcher but also had good clinical training. So that's where it started. And it only intensified at Brown because Brown had an internship, which, unlike most internships, allowed for us to do some research as well and continue that work.

Host Amber Smith: So what is it about science in general, and research in particular, that you like?

Stephen Faraone, PhD: The first thing is that you have a method whereby you can ask an interesting question and actually get an answer to that question. And if you're working in a field like mental health, you can get an answer that actually helps people.

And that's very rewarding. It's also rewarding to actually help people. And I used to practice as a clinical psychologist, and I don't mean to, by any means, put that down. That's a great profession to go into. Any kind of mental health profession where you're working one-to-one with people is a wonderful thing to do.

But literally, by doing research, instead of helping maybe under a thousand people in your lifetime, you can help millions -- millions -- of people by the dissemination of the work that you do. That's really one of the reasons why I ended up becoming a full-time researcher as opposed to a part-time researcher, part-time clinician.

Host Amber Smith: You've published more than 1,500 journal articles, and you're one of the scientists who are most frequently cited by other scientists. Did you ever dream that you would have so much influence as a researcher when you got started?

Stephen Faraone, PhD: (laughs) No. When I got out of graduate school, the big worry was, would I have enough data to publish papers on?

I never thought we'd have so much productivity. Now, of course, people have to understand that productivity is not just me, it's me and teams of people, teams of researchers. In some cases, some of my articles have 10, 15, 20 or more co-authors. So I would say that my influence in the field has been being able to surround myself with people that are also good and that we can produce work that is good enough that other colleagues will cite it and use it in their own work.

And that also was rewarding, and it's a very nice kind of benefit -- not benefit, but accolade -- if you hear from your colleagues that they cite your work and say, I think, it's important enough to actually influence their own work. That's a great thing.

Host Amber Smith: Which do you enjoy more: doing the actual research or sitting back and writing about it for a journal?

Stephen Faraone, PhD: I like the planning part and the disseminating part. The actual doing part, I don't like as much. It's OK, but the actual implementation part is ... in fact, in my career I've, when possible, (laughs) I've found other people that could do that, who like to do that more. I like the planning and the dissemination part mostly.

Host Amber Smith: Like you said, it's a team effort.

Stephen Faraone, PhD: It's a very big team effort, especially these days. Any kind of big science. Our Genome Wide Association Studies of ADHD, which now comprise upwards of 50,000 research participants, there's probably at least a hundred authors on that paper.

And that was an international consortium from around the world that put that together. I had the privilege to lead that consortium for about two decades. But it would never have gotten anywhere if we didn't have all these people participating. And with all sorts of expertises, like statistical genetics or clinical assessment and many more.

Host Amber Smith: You've become known all over the world for your expertise in ADHD. What sparked your interest to begin ADHD research?

Stephen Faraone, PhD: It's hard to believe that, and this is a lesson for some of the young people out there, that a lot of the directions you take in your life sometimes occur by happenstance, not by out-and-out planning.

We tend to think, oh, we can guide our lives, and we can plan everything out, and you can. But sometimes happenstance pushes you in different directions. And I was a young faculty member at Harvard Medical School back in the early '80s, and I was working mostly in a group that was doing work in schizophrenia and bipolar disorder and largely in family studies and genetics.

And during that time a another young faculty member at Harvard, who was at the Mass General (Massachusetts General Hospital), came to our group and actually went to my mentor at the time, Ming Tsuang, and said, "Hey, I need your technical advice about this grant proposal I'm putting in." And he was studying kids, he was studying ADHD.

His name was a superstar.

I would vet people for him, say, is this person worth talking to or not? And if I thought they were worth talking to, he'd interview them. And this was my colleague Joe Biederman, and I said, yeah, this guy is definitely worth interviewing. You should do that.

And he came down and we met with him, and he just was very influential in getting me to turn my sights away from adult psychiatry into child psychiatry, for a few reasons. One of which was that child psychiatry back then was relatively undeveloped as far as research, compared to adult psychiatry.

They were, I would say they were way behind in terms of solid, empirical knowledge about the disorders they were studying. So I saw a real need there. And then in my friend Joe, I just saw a colleague that I know I could work with and probably do some really good things together. And that turned out to be true because we ended up working together for almost 40 years before his, actually, his death, just a few weeks ago, ended that.

But it was a good example of how happenstance can change your career for the better.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Upstate's distinguished professor Stephen Faraone. He turned up in a ranking of top scientists by the website research.com. He's No. 80 worldwide and No. 57 nationally, and that's based largely on the number of publications and citations and some other factors.

Now, what, if anything, has surprised you the most about ADHD?

Stephen Faraone, PhD: Probably what surprises me the most is that even after four or five decades of accelerating research, there's still a lot of misunderstanding and stigma about the disorder out in the community, out on the internet, out on TikTok, where you'll get people just saying things that are just untrue about ADHD.

It's been a lightning rod for some of the anti-psychiatry forces, and that sounds Darth Vader-ish, I say anti- psychiatry forces, but I guarantee, you just Google "anti-psychiatry": You'll find many websites that are devoted to saying why psychiatry is bad, and they frequently choose childhood disorders because kids are vulnerable, and so they see that as a better way for them to recruit more people to their cause.

It's really amazing. The child psychiatric disorders, like ADHD, are as well validated as any psychiatric disorder, are as well validated as most medical disorders. And yet they continue to be stigmatized. And any listener out there who has any thought that ADHD, or any childhood disorder, somehow not real or some kind of crazy invention of psychiatry, it's just not true.

I'll send them to my website, adhdevidence.org, where I curate evidence-based information about ADHD, including an international consensus statement by leaders around the world.

That's continually the biggest surprise in my career about ADHD.

Host Amber Smith: You've contributed to the understanding of genetics in ADHD. What were your most important findings?

Stephen Faraone, PhD: I would say the most important finding was this very big group finding that required so many scientists from around the world that we could finally document with information from collecting DNA samples from people with and without ADHD that there were clear genes, that it was very clear to us, without any uncertainty. In the past there's been lot of uncertainty about which genes might be involved, but now we have certainty that at least we know 27 of the genes that are involved in ADHD.

And when I say certain, meaning the likelihood that would be overturned by future research is almost zero. In addition, this probably is maybe in terms of the most interesting scientific fact that ADHD that I've learned, is that ADHD is highly polygenic.

And what we mean by that is, back in the '80s, we thought maybe there'd be one, two, three, four genes that can account for ADHD. And if so, that would help us find treatments. Maybe even prevent the disorder by knowing who's at high risk and not at high risk. Turns out from this last paper, which just came out in Nature Genetics, that we now estimate there are probably 7,000 genomic loci that regulate ADHD.

Now I say genomic loci, not genes, because some parts of our genome aren't actually genes. They're parts of DNA that regulate other genes. I'll say genes as a shorthand, but the main point is that it's not one, two or three or 10 or a hundred. It's maybe it's as many as 7,000 is our current estimate. And that creates difficulties because it means that it's not going to be simple to track out a pathophysiological pathway or to take it into drug development, but it does have some implications for how we think about the nature of ADHD as a disorder.

Host Amber Smith: You received a Book of the Year Award in 2003 from the American Journal of Nursing for your book "Straight Talk About Your Child's Mental Health: What to Do When Something Seems Wrong." Are there lessons on those pages that would still apply to parents today, 20 years later?

Stephen Faraone, PhD: Oh, absolutely. I think the main thing I would say to parents is that if they suspect that their child has a mental health problem, they need to, as soon as possible, bring it up to their pediatrician. If their pediatrician won't deal with it, or it seems to not be able to deal with it effectively, then you need to find specialist care, which would mean a child psychiatrist. That can be difficult or impossible in some areas of the country, I realize.

But it is really essential that the treatment be sought and that it'd be sought soon, that if you wait -- a lot of parents will say, "We can wait and see how this goes." And again, that's part of the stigma about mental illness. You'd never say that about cancer, right? If your child was diagnosed with cancer, you wouldn't tell a doctor, "Let's wait and see how it goes before we give them medication."

But yet we say that a lot. Not me, but many people, say that about psychiatric disorders. So seek treatment and seek it soon, because otherwise, every year your child's not treated, there's one more year that they're living with disability, that they're not achieving in school, that they're not making friends, that they're perhaps associating with the wrong kinds of friends and so forth, exposing themselves to substance use risk, to many potential problems.

Host Amber Smith: When you're asked what causes ADHD, how do you respond to that?

Stephen Faraone, PhD: I say that there are many causes. I say that it's unusual that only one thing causes ADHD in a given person. That can happen, but it's very rare. There are some very rare genetic variants that do that. There's some rare environmental circumstances, like extremely adverse environments, but for the most part, most of what we call common ADHD, like 99% of the cases, are caused by the accumulation of many risk genes, but also many environmental risk factors as well.

Host Amber Smith: You mentioned your website, adhdevidence.org, where you post responses to some popular questions about ADHD, so I'd like to ask you a few of those questions now and get your response.

The first is, what are the most effective changes people with ADHD can make to improve their lives and management of ADHD?

Stephen Faraone, PhD: First one is to adhere to whatever treatment is prescribed by your prescriber, be that a psychologist, a psychiatrist, a primary care doctor. One of the biggest problems in ADHD is people forget to take their medication, or they don't adhere to their therapist's guidelines for how to approach their cognitive behavior therapy.

If you don't take your medicine, or if you don't follow your therapist's guidelines, you're not going to be able to improve. I would say that's really the most important thing that a person could do that has ADHD.

The second most important thing would be to keep in mind that ADHD does not define your life, does not define you as a person. You are not an ADHD person. You're a person that has been diagnosed with ADHD. But that means there's many other things about you that, including some strengths that you have as a person, that you need to discover if you haven't discovered them.

And therapy can help you with that if you don't know them already, and find those strengths and use them to make your life a better life because although your ADHD would make that more difficult than (for) the average person, it by no means makes it impossible. And there are many people with ADHD who live productive and happy lives, especially when they have effective treatment.

Host Amber Smith: What suggestions do you have to help an adult heal from the stigma from being judged and bullied since childhood for the ADHD symptoms?

Stephen Faraone, PhD: This is where the medications don't help.

The medications are good for the symptoms of ADHD, but for these other kinds of problems, that's where a good therapist can help a person. I always suggest cognitive behavior therapy because there are cognitive behavior therapies that have been devised and tested specifically for adult ADHD.

And with a good, competent therapist, they can help you work through not just your ADHD problem, but other problems of the sort, Amber, that you're talking about.

Host Amber Smith: What advice would you give to a young person who's interested in science today?

Stephen Faraone, PhD: I would say that to be effective in science, you have to be somebody who likes the idea that they can ask a question, and they can get an answer to it.

They're curious about the world. I would advise young people, let's start with kids, right? Young kids are very curious by their nature. We know that from just observing how they interact with the world. Unfortunately, as we get older, boy, that native curiosity sometimes gets beaten back by society, which kind of wants to funnel us in this direction or that direction. Instead of making us curious about the world, it really just makes us want to focus on, "I want to get this goal." And not that that's wrong, some people are very goal driven, and that's OK, and they don't see the rest of the world.

But if you want to be a scientist, you really have to be curious about the world around you and to kind of be willing to live with the uncertainty that goes with that.

Now, the other thing I will say is that, this is really plus anything you'd want to do, that you have to do something. You have to work in an area that you feel some passion for, that something about it just lights a fire, and it could be a fire that's lit for all sorts of reasons.

It could be that you just find it fascinating, almost from a puzzle point of view. It could be that you feel a real need, that you want to help a certain kind of patient, maybe because you have a brother who has autism and you really want to work on autism, or a parent with Alzheimer's disease.

There's lots of ways that one becomes passionate about a field in science, and I would say all the people I know that are successful have some kind of passion that has driven them to do what they do. And it's not a 9-to-5 job. It's the kind of thing where it's work that you do it because you really love it and enjoy it. Not that you can't have a life outside of science. Of course you should and can, but it's not a 9-to-5 job.

Host Amber Smith: Dr. Faraone, thank you for making time to talk with us.

Stephen Faraone, PhD: Always happy to do it. Look forward to it next time. Thank you.

Host Amber Smith: My guest has been Dr. Stephen Faraone. He's a distinguished professor and vice chair of research in psychiatry and behavioral sciences at Upstate, and he serves as the president of the World Federation of ADHD and the editor of the journal Neuropsychiatric Genetics.

I'm Amber Smith for Upstate's "HealthLink on Air."

Why are some people with cystic fibrosis developing heart failure? Next, on Upstate's "HealthLink on Air."

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Just three decades ago, the average person with cystic fibrosis would live only to the age of 30, but now 50 years is typical, and some patients with CF live into their 80s. This means they live long enough for other health concerns to surface. Here to tell us about that is Dr. Andres Cordova Sanchez. He's a resident physician in internal medicine at Upstate, and he presented research on this subject this fall at the annual meeting of the American College of Chest Physicians.

Welcome to "HealthLink on Air," Dr. Cordova.

Andres Cordova Sanchez, MD: Hello Amber. How are you doing?

Host Amber Smith: I'm well, thanks. I'd like to have you explain how it is that the life expectancy has improved so much for patients with cystic fibrosis.

Andres Cordova Sanchez, MD: There are several factors that that play a role here. I think that it took us several decades to really understand how the disease works and get some working drugs for it. So there are some milestones that have happened across the decades. One of them was the discoverage of the CFTR gene and therapies that can actually work in this specific protein. What happens with patients with cystic fibrosis is that a protein that is involved in the production of mucus in the body gets altered.

And as a result you have a lot of very thick and sticky mucus, especially in the lungs and in other organs like the pancreas. By using specific enzymes and specific medications that target this protein, we can really dramatically improve the life of these patients.

And to that, we have other therapies that have been discovered, like the use of antibiotics, early recognition of the disease with neonatal screening in the U.S. and respiratory therapy.

Host Amber Smith: So basically new treatments have evolved and have made a significant impact, it sounds like?

Andres Cordova Sanchez, MD: Yes, exactly.

Host Amber Smith: Now, how is it that some patients live even into their 80s? That seems amazing to me.

Andres Cordova Sanchez, MD: It is certainly amazing, and I do have to say that's not the most common thing, at least in the pool of patients that I used for my research, for example. We only had about 10 patients that lived in their 80s. And I think it really depends on how the disease presents in these patients and how they respond to the medication. It's really more of an individual response rather than the norm.

Host Amber Smith: Now, you did a study looking at patient medical records that you presented at the American College of Chest Physicians Conference, is that right?

Andres Cordova Sanchez, MD: Yes. We took a large database of patients across the world and looked into the electronic medical records to pull out data. This type of research, it allows us to have a big picture of what's going on and have a good approximation of what is happening in real life, but it also has the caveat that we can't really, for example, go into each patient's chart and identify specific problems.

Host Amber Smith: Why is it significant that one in 10 adults with cystic fibrosis were found to have a diagnosis of heart failure?

Andres Cordova Sanchez, MD: Well, one in 10 adults means that it's a very common disease in these patients. And what's even more interesting is that once you divide the patients by age, the patients start to have older ages. They have much more rates of heart failure. So, as we see that we have every decade patients with cystic fibrosis live longer, this is going to become a much more prevalent issue in the future. And we should start thinking about how to attack it, how to help these patients.

Host Amber Smith: How prevalent were heart attacks, or myocardial infarction, in adults with cystic fibrosis?

Andres Cordova Sanchez, MD: We found approximately 4% of patients having myocardial infarctions. This is about what the general population has.

I know atrial fibrillation is an issue. Did you see that in people with cystic fibrosis as well?

Andres Cordova Sanchez, MD: Yes. Atrial fibrillation was actually a very interesting finding. Overall, we found a rate of 4%, but once you take all those patients that live more than 50 years, that were more than 50 years old, the incidence, the rate of atrial fibrillation, went up significantly.

Those patients had 15% or more, and every decade as the patients grew older, let's say patients that were 60 years old, they had 20%. And patients that were 70 years old, they had 25% of atrial fibrillation. So it is very common in these patients.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith. I'm talking with Dr. Andres Cordova Sanchez. He's a resident physician in internal medicine at Upstate, and he's done research on cystic fibrosis and heart disease.

Now, we think of cystic fibrosis as a lung disease, mostly, but how does cystic fibrosis affect the cardiovascular system just in general?

Andres Cordova Sanchez, MD: So there are two ways in which we think cystic fibrosis can affect the heart. One of them is indirectly, which is the most obvious way. So, by affecting the lungs you have pulmonary hypertension, which is basically high blood pressure in the vessels of the lungs, and that makes it harder for the heart to pump blood into the lungs, which can cause right heart failure.

You also have low oxygen levels, and that will cause, also, issues with the heart. And because these patients have a lot of inflammation going on, this chronic inflammation can cause a lot of issues as well. So that's indirectly. And directly, we are not completely sure so far, but there are some studies that have identified this protein that's altered, in cystic fibrosis, in their heart.

So some studies suggest that this might be related with arrhythmias, but we are not completely sure what its function is.

Host Amber Smith: Is heart disease in cystic fibrosis patients more of a risk for men or women, or did you notice a difference?

Andres Cordova Sanchez, MD: I did not notice much of a difference. In reality, the differences were very small when we compared both. It seemed that males had more arrhythmias and heart failure, but I cannot really make a conclusion based on the data that I have.

Host Amber Smith: Is heart disease treated the same way in someone with CF as it is in someone who doesn't have CF?

Andres Cordova Sanchez, MD: So far, yes. And that's where it can get tricky as well, because the treatment of heart failure depends on the type of heart failure. And although we don't know exactly what type of heart failure is more common in these patients, I imagine it's going to be right-sided heart failure just because of what we were talking about -- pulmonary hypertension. This type of heart failure is difficult to treat. We don't really have great medications for it. So it's definitely an area in which we have to look more into.

Host Amber Smith: Now, I think patients with heart failure in general are recommended a low-salt diet. Is that right?

Andres Cordova Sanchez, MD: Yes.

Host Amber Smith: So, well, I wonder, will that work for someone with cystic fibrosis?

Andres Cordova Sanchez, MD: That's actually a very interesting topic. I don't think it will work. Patients with cystic fibrosis are usually recommended a high calorie diet with high salt, which is kind of the contrary of what we recommend for heart failure. So it will really need to be an individually recommended diet for each patient based on what their weight is and so on and so forth.

Host Amber Smith: Thinking of heart failure, but also some of the other heart diseases, do you think that they have an impact on the life expectancy for someone who has cystic fibrosis?

Andres Cordova Sanchez, MD: I don't know for certain if they impact, but I would imagine it does. Certainly heart failure is a disease that in the general population carries a high burden. It's very symptomatic and it can be very difficult to leap with and also has a, can have a high rate of mortality. So I expect that in these patients, the life expectancy will be also affected.

Host Amber Smith: Work like yours, it seems to me, would let people with cystic fibrosis know that this is something to be aware of. Are they able to do more than that with the information? Are there preventive steps they can take or screenings that they can sign up for?

Andres Cordova Sanchez, MD: I don't think they should worry too much about this at this stage because we are really starting to characterize heart disease in these patients. But having regular follow-ups with their physicians is vital. I am sure any physician will be able to recognize heart failure in these patients and set them up with cardiology and whatever other resources that they need.

Host Amber Smith: Well, Dr. Cordova, I really appreciate you making time to share your research with us. Thank you.

Andres Cordova Sanchez, MD: Thank you very much.

Host Amber Smith: My guest has been Dr. Andres Cordova Sanchez. He's a resident physician in internal medicine at Upstate. I'm Amber Smith for Upstate's "HealthLink on Air."

Next on Upstate's "HealthLink on Air": What it means for a hospital to be age-friendly.

From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."

Upstate is becoming known as an age-friendly health system, dedicated to caring for older adults. Upstate University Hospital received a Level 1 designation over the summer, and recently, upstate Community Hospital's Transitional Care Unit, and the Ambulatory University Geriatricians' Office earned a Level 2 designation.

Here to talk about what that means is Quonitra Bullock, nurse manager of the Transitional Care Unit, and Carrie Dickinson, the operational excellence leader for ambulatory services administration at Upstate. Together they led the team that worked to earn the age-friendly system designation for Upstate.

Welcome to "HealthLink on Air," both of you.

Quonitra Bullock: Thank you for having us.

Carrie Dickinson, PhD: Yes, thank you for having us, Amber.

Host Amber Smith: This age-friendly health systems designation is an initiative of the John A. Hartford Foundation and the Institute for Healthcare Improvement, in partnership with the American Hospital Association and the Catholic Health Association of the United States.

So it's a national effort meant to acknowledge hospitals and health systems that are taking good care of seniors. Is that right?

Quonitra Bullock: That is correct, Amber.

Host Amber Smith: Well, Mrs. Bullock, for people who aren't familiar with the hospital terms, can you explain what the TCU, or Transitional Care Unit, is?

Quonitra Bullock: Absolutely. The transitional care unit, at the Community Hospital location, is actually a short-term rehabilitation unit. It is definitely considered skilled nursing, where you are provided physical therapy, recreational therapy, occupational therapy, as well as nursing care, to get you into a place where you are able to transition back to your home environment.

Host Amber Smith: So how long are patients typically there?

Quonitra Bullock: Patients who frequent the TCU have a general length of stay, that is a hospital term, of approximately 12 days.

Host Amber Smith: And are all of the TCU patients above the age of 65?

Quonitra Bullock: Not exactly. All of the TCU patients are Medicare patients. Most of our patients are 65 and older, but these are the Medicare population for the most part.

Host Amber Smith: Can you give us some examples of things that the TCU has done that are considered age-friendly?

Quonitra Bullock: So there are so many things that any unit could do that are age-friendly, but specifically speaking for the TCU, one of the major things that we recently have done was we have purchased a blanket warmer for our patient population. Many of our clientele complain of being cold, and we want to keep them warm and comfy during their stay.

Other things that the TCU have done to be more age-friendly is we have created documentation in large print as well as in other languages to be able to support the understanding and transferring of that patient education to our patient population.

Host Amber Smith: And Dr. Dickinson, I know you have a doctorate in control system engineering, but I'm not really sure what that is. Can you explain it?

Carrie Dickinson, PhD: Sure. Amber, I'd be happy to. I have a background in engineering. Control systems engineering is a subset of electrical engineering, and prior to my coming to Upstate, I had various experiences working in different manufacturing facilities.

And part of my engineering background is really a process improvement methodology, and that's really what led me to Upstate a few years ago, is applying that lean methodology to our patients here at Upstate, always looking at how we can improve and make things better for our patients.

Host Amber Smith: Can you explain what lean methodology is?

Carrie Dickinson, PhD: Lean methodology, it's really looking at it from a customer perspective, a business process. And that business process can really be anything. So as I mentioned earlier, my background was in engineering, but really here at Upstate, we have many business processes, but really our customer, in this case, is our patient, so really the most important thing.

And in terms of lean, we look at what adds value from a patient perspective. So anything that doesn't add business value to a process we consider to be waste. And we want to make our processes as efficient as possible and certainly also as effective as possible, so we look at things from a big picture. And we really try to focus in on what matters the most and streamline those processes.

Host Amber Smith: Well, for the patients specifically that are part of University Geriatricians, I know they have robotic therapy pets, but how is that going, and how did that come about?

Carrie Dickinson, PhD: Within our ambulatory geriatricians' office, and I believe also in our TCU, we have, the availability of robotic therapy pets, and what those really are is if you imagine a cat or a dog at home, a normal pet that a person may have, you interact with that pet, you pet the cat, for example. The cat responds, meows, purrs, things like that.

But with the robotic pets, you don't have the worry of having to take care of the pet, to feed the pet, to change a litter box, to take the pet to the doctor's, to the veterinarian.

And it really helps the patients, that may have anxiety or really just to have some comfort and some interaction.

Host Amber Smith: So are these robotic pets that they bring home with them?

Carrie Dickinson, PhD: Yes, they do. It's a pet that they take home, and they keep the pet.

Host Amber Smith: Can you also describe how nursing has been collaborating with the pharmacy on behalf of patients who need help, maybe paying for their medications?

Carrie Dickinson, PhD: Sure, Amber. So, some of our patients may have some challenges paying for their medications. We do have a very helpful pharmacy department here at Upstate, and they have ways of looking for financing to help our patients pay for those medications that they need.

Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.

I'm talking with Upstate's Quonitra Bullock, she's the nurse manager of the Transitional Care Unit, and Carrie Dickinson, the operational excellence leader for ambulatory services administration. They led a team that earned the age-friendly system designation for Upstate.

Mrs. Bullock, can you walk us through what was done to obtain this age-friendly designation?

Quonitra Bullock: Absolutely, Amber. Well, to start, we joined the HANYS webinars. HANYS offered webinars about age-friendly health care, speaking about some of the things other facilities in the surrounding areas were doing to be more age-friendly. And in attending some of those webinar series, we found that a lot of these things we are already doing, we're just not as organized and they were not defined as being age-friendly. And so what we did was we came back to our own smaller work groups, work team, and we started to discuss some of the things that we heard during those webinar series.

And we started to discuss some of the things that we were doing and some ideals of things that we could do to create a more age-friendly environment for our patients.

One of the major things that we did as a committee was, we included a resident from the community who is 97 years old. She just recently celebrated 97 years of life. She is sharp as a whip, and she has provided us with a wealth of knowledge regarding what she, as an individual, felt was important for residents like herself.

And that is where we were able to look at the blanket warmer. That is where we started looking at making sure that in every room we had chairs with arms, because the elderly patient population could oftentimes get into a chair but would have trouble getting up from that chair.

She asked questions about devices on the unit, if we had things that would help amplify conversations for those that were a little more hard of hearing, but who were too embarrassed to say that they were hard of hearing, who sometimes would seem as if they may have been confused because of the way in which they answered a question.

So just really recognizing those little things that we could do to make this a better stay. When we spoke about pharmacy earlier, one of the major things that pharmacy did on the inpatient side was we began to offer a one-stop shop when it came to vaccinations. And so instead of just offering the flu and the pneumonia vaccine, which were very typical, very routine in the hospital, we began to make sure that we offered Tdap (tetanus, diphtheria and pertussis vaccine), shingles, COVID vaccinations, as well as the COVID booster. So we wanted to make sure that we gave them that, made it convenient, for the patients that we served, and we went from giving maybe 50 vaccinations prior to initiating this process to over 150 vaccinations right on the unit prior to discharge, which is a patient satisfier.

The robotic animals that we use on the unit, we currently have dogs and cats, and we do tend to use them more with those patients who fall under dementia or a delirium protocol. And it is really about providing them with a safe space for themselves and some level of comfort, so they pretty much function as emotional support animals, and we've been very successful in trying to help reorient and calm any anxieties that come to patients who may be experiencing dementia or delirium during their hospital stay.

I spoke about our average length of stay being approximately 12 days. Most of the time, actually 80% of the time, the patients that come into the TCU are discharged back to home, and we are very proud of that, and we want that number to continue to climb. That other 20% at times have to go to more of a longer-term, skilled nursing facility and/or some type of assisted living, but for the most part, our goal is to get people home, and we are really working hard to do that.

Our physical therapists are right on site. Our pharmacists are right on site. They're there for any questions nurses may have. We have recently updated our computer system to allow nursing to document all of the things that we are doing that are considered age-friendly for the patients that we serve.

So we're able to run reports to see how we're doing and looking at surveys and things as such to see how we are doing. And right now our patients are pretty happy with us, so I want to keep that momentum going.

Host Amber Smith: You mentioned HANYS -- I know that's the Hospital Association of New York. It sounds like being age-friendly means that you took the time to kind of look at things through the eyes of someone who's a senior at the surroundings and everything in the hospital environment.

Quonitra Bullock: Absolutely.

Host Amber Smith: Dr. Dickinson, what are the four M's for older adults? I saw that in one of the write-ups about age-friendly designation.

Carrie Dickinson, PhD: The age-friendly health systems, the key that they talk about are the four M's, and those four M's are what matters, mentation, mobility and medication, and I'll give a brief description of what each of those are.

For what matters, we're really asking the patients, "What's important to you?" For example, maybe in the TCU the patient is there for rehabilitation; just understanding what matters to them every day. Or, you know what, I have a cat at home, and I want to make sure that my cat gets fed. So it could be some simple things like that for the "what matters?"

In terms of mentation, it's really looking at the patient's mood or memory, so in terms of looking at any screening for depression, dementia, delirium.

And then, mobility is making sure that the patient is, to the best of their ability, moving every day in a safe manner, right? Really being able to stay up and about.

And then, medication: If the patient is on medications, are those medications friendly from an age perspective? Oftentimes our senior patients may be on many medications, so looking at them as a whole to make sure that there's not a lot of interactions, do they need to be on those medications, things like that.

So, really looking at each of these four M's and really the four M's together, so that what matters to the patient, the other three M's are supporting that.

Host Amber Smith: I'd like to talk to both of you for advice that you would give to someone who needs to bring an older relative to the hospital.

Is there anything that they should bring along with them when they come?

Quonitra Bullock: I can answer from the TCU's perspective. One of the things that I think is really important for a family member of an older relative is to ensure that nursing is aware of things that support healthy living for that older adult. If you know that this person has an issue with, let's say for an example, they do not really like oatmeal. Like if that is something that's such a big deal, and nutrition is something that we are working on with that resident, we will want to know that about that resident.

I would also encourage family members to bring something that is very familiar, and that helps sometimes ease the anxiety, that absolutely helps with delirium, just having those familiar items, in their room. Because for a short period of time, we treat it almost as if it's a short-term home, and they are getting dressed every day to go to their therapies in street clothes. They're not wearing hospital gowns. So if you look up, and you see pictures of the family, that's natural to them, and that helps motivate them to get better and get home.

Host Amber Smith: Now what about things like hearing aids or CPAP machines that someone might use when they're sleeping, or even eyeglasses? People use these on a daily or regular basis, but can they bring them to the hospital?

Quonitra Bullock: Absolutely. We highly encourage those items are present with the patient. One thing: We really worry about those items, and so it's something that if you are a family member, bringing your relative who is in need of a CPAP machine, eyeglasses and/or hearing aid, that you make it known that that item is on site with that family member, so we are able to document for it and keep track of its whereabouts.

There are times where patients leave the unit for testing. They may leave the unit to go to another unit at times. And these are what we call life-safety type of items. We want to make sure that they have them, so that their stay is a pleasant stay.

Host Amber Smith: Are there ways in which senior patients are treated differently than other adult patients in a hospital stay?

Quonitra Bullock: For myself, and Carrie may want to jump in at some point, and I will speak from not only experience as the transitional care manager. In relation to personal experience, I think that is just recognizing that their senses are maybe a little more sensitive than someone who may be a little younger.

So maybe they are moving a little slower, maybe they cannot hear as well. Their vision is a little altered. Really taking the time to consider those factors when you are addressing any senior. They may not even share with you that they cannot see as well, due to embarrassment, or they don't want to feel like they are a burden.

Host Amber Smith: So, I'm imagining maybe their room would be put at the end of the hall, where maybe it's quieter, or there's less commotion around. Or even thinking about foods, if they need something that's soft to chew, perhaps the menu is adaptable for that?

Quonitra Bullock: The menu is adaptable. As far as room placement, we really look at the overall safety of a patient as an individual.

So we do not look at that as "everyone in this age group needs to be in this certain room type." A lot of times when you're dealing with a patient who is suffering from delirium or dementia, it's best to keep them closer to points of highlight visual contact -- you know, nurses are easily able to peek in and just make sure that they're OK. Unless we feel that that additional stimulation is causing a problem for that particular patient or resident.

Host Amber Smith: Now, Dr. Dickinson, it seems to me that the age-friendly health system designation is important, and it's only going to become even more important in anticipation of the aging population.

Do you have projections for the numbers of seniors in America that are projected to come in the years ahead?

Carrie Dickinson, PhD: Yes, Amber, that's a great question. So according to the U.S. Census Bureau, our last census in 2020, there are about 50 million individuals 65 years and older. And they estimate in the year 2050, so about 30 years, 83 million people, aged 65 and older, so a significant increase in the next 30 years.

Host Amber Smith: Well, I want to thank both of you for taking time for this interview.

Quonitra Bullock: Thank you, Amber, for having us.

Carrie Dickinson, PhD: Yes, thank you very much, Amber. It's been a pleasure.

Host Amber Smith: My guests have been Quonitra Bullock, nurse manager of the Transitional Care Unit, and Carrie Dickinson, the operational excellence leader for ambulatory services administration at Upstate.

They were co-leaders of the team that earned the age-friendly system designation for Upstate. I'm Amber Smith for Upstate's HealthLink on Air."

Here's some expert advice from Dr. Palma Shaw from Upstate Medical University. How can someone with diabetes protect their feet?

Palma Shaw, MD: Well, it's very important that patients with diabetes are informed about the potential changes that can occur in their feet. They may develop numbness in the foot and not understand that they actually can't feel if they step on something sharp.

So we usually advise diabetic patients to use shoes in the house. They really should never walk around with bare feet in the home. We've had patients come in with a nail in their foot that they couldn't even feel that can cause an infection. They also get dry skin, so they need to cream their feet, and they really should get evaluated by a podiatrist to look for deformities of their foot to see if they need special inserts for their shoes.

Host Amber Smith: You've been listening to vascular surgeon Dr. Palma Shaw from Upstate Medical University.

And now, Deirdre Neilen, editor of Upstate Medical University's literary and visual arts journal, The Healing Muse, with this week's selection.

Deirdre Neilen, PhD: Leah Johnson is the author of "Bindweed," published by Cherry Grove Collections in 2021. The poem she sent us is called "Trauma," and it captures the steady horror of living in pandemic times, when we cannot relax our vigilance.

"Trauma"

A squatter in the landscape

of the body, this beast. This echo

from childhood. The well-loved child

unsafe at home, unsafe at play.

And the habit of vigilance learned

so early is exhausting. I drag

the days and nights of pandemic

and deaths and riots, politics

and murders and insurrection,

the noise of the news. The incessant

noise. We wonder why we feel dread

gnawing at the edges of our beings.

Wonder what is this bitter flavor?

And I remember. It's the scent

of the beast in our mouths.

Jacqueline Jules is the author of "Manna in the Morning," from Kelsay Books 2021. Her poem "Every Death" asks us to consider what part we all play when spreading misinformation and demonizing anyone who disagrees with us.

"Every Death"

Should I be sad?

Watching a father of five, filming himself

from a hospital bed, pleading with others

not to make the same choice he did.

Does he deserve my grief

when he had the chance

to trust the truth as I see it?

My Facebook feed isn't filled

with posts tempting me to take

a drug meant for horses and cows.

But I'm guilty, too,

clicking on headlines

to confirm my opinions,

seeking spaces

where my own thoughts

are echoed.

When chemo failed,

we tried everything

from onions to turmeric.

Every death,

preventable or not, leaves

loved ones gasping for air.

Host Amber Smith: This has been Upstate's "HealthLink on Air," brought to you each week by Upstate Medical University in Syracuse, New York. Next week on "HealthLink on Air," on update on diverticulitis.

If you missed any of today's show, or for more information on a variety of health, science and medical topics, visit our website at healthlinkonair.org.

Upstate's "HealthLink on Air" is produced by Jim Howe, with sound engineering by Bill Broeckel. This is your host, Amber Smith, thanking you for listening.