
Memory screenings; a fresh round of poetry; hearing loss referrals: Upstate Medical University's HealthLink on Air for Sunday, Dec. 15, 2024
Geriatrics chief Sharon Brangman, MD, explains the value of a memory screening for people over 60. Editor Deirdre Neilen, PhD, shares the 24th edition of The Healing Muse, Upstate's literary and visual arts journal. Amer Mansour, in his final year of medical school, talks about his research on which patients with hearing loss tend to get referred to an ear, nose and throat specialist.
Transcript
Host Amber Smith: Coming up next on Upstate's "HealthLink on Air," a geriatrician explains the value of memory screening for people older than 60.
Sharon Brangman, MD: ... What we want people to know is that not every memory problem is dementia or Alzheimer's disease. It could be related to a number of things that it would be good to get it evaluated so that we can address them. ...
Host Amber Smith: The editor of The Healing Muse shares the latest edition of the literary and visual arts journal.
Deirdre Neilen, PhD: ... As our parents age, and we are in a new version of ourselves with them, the poignancy of life comes to the fore. ...
Host Amber Smith: And a medical student talks about his research on referrals for hearing loss.
Amer Mansour: ... Once we reach about 75 years of age, more than half of the people in the United States do have some level of hearing loss, so it's a fairly prevalent issue. ...
Host Amber Smith: All that, right 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 talk about universal themes in The Healing Muse. Then, a medical student shares his research on referrals for hearing loss. But first, a geriatrics expert tells why memory screenings can be helpful for people age 60 and older.
From Upstate Medical University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
Upstate Medical University and Syracuse University have teamed up to assess the benefit of memory screenings, and here to tell us more about this partnership is Dr. Sharon Brangman. She's a SUNY Distinguished Service Professor, the chair of geriatrics and the director of the Center of Excellence for Alzheimer's Disease at Upstate.
Welcome back to "HealthLink on Air," Dr. Brangman.
Sharon Brangman, MD: Oh, thanks for having me.
Host Amber Smith: Do I understand correctly that some residents can participate in this collaborative project and get a free memory screening?
Sharon Brangman, MD: So yes. What we've done is we've collaborated with the New York State Office for Aging, and we're focusing on seven counties. And as part of their normal client intake, we trained some of these workers to perform a quick mini cognitive screen.
So it's not like you can call and sign up. This is going to be for people who are part of the client base of Office for Aging. And what we've learned with our collaboration is that the Office for Aging sends caseworkers out who do normal screenings of all sorts. They do screenings for isolation, for depression, for substance abuse, and as part of their normal workday so that they can help point their clients to appropriate resources. They ask them a lot of questions. In doing so, they've noticed that some of them may have some memory issues, but they weren't sure what to do with them.
So this was kind of what spurred our program along. But here in Syracuse, we also noted that we were getting a lot of people who were, had more advanced memory problems or were in a crisis. Their families suddenly realized that there was a problem, and something was going on, and they didn't know what to do. And so we wanted to figure out how we could reach people earlier on so that we could help them, when we can maximize our care plan and help keep them independent for as long as possible, and help reduce the stress on the caregivers. So there are many factors that kind of came into play when we decided to work on this project.
Host Amber Smith: So what is the youngest age person that might get services from the Office for Aging?
Sharon Brangman, MD: The Office for Aging starts providing services at the age of 60.
Host Amber Smith: OK, 60. And then what counties are included in this?
Sharon Brangman, MD: So we are focusing on seven counties, and those counties are Cayuga, Herkimer, Lewis County, Madison County, Oneida County, Oswego and Tompkins County. And everybody asked me, "Well, what about Onondaga County?" Well, several years ago before the pandemic, we tested this program out in Onondaga County working with our local Office for the Aging, and we trained one of their neighborhood advisers, and this is someone who would go out to homes that, people in their homes, and tell them about low cost heating options or home repairs and other things. And again, they noticed that some people were a little confused, and they didn't really know how to handle it.
So we trained their neighborhood advisers on doing this "mini cog," and we found it worked really well. We got a lot of referrals from people very early on. Now some people didn't want to come, and some people didn't need our services, but then they were aware of them so that maybe down the line they could always take advantage of it. So we found that this was a very workable way to reach people before they were in a crisis.
So from the work we did in Onondaga County, we then expanded it to these seven counties. And then the other thing people asked me is, "Why isn't another county added?" You know, they want more. Well, we're testing it in seven counties. And there are expenses associated with this, but we're hopeful that once we show that these seven counties are successful, we can get this worked into the budget for the New York State Office for Aging, for the whole state. So we have to start somewhere.
Host Amber Smith: Sure. Now, why is it important to find out early if someone has memory problems?
Sharon Brangman, MD: Well, memory problems, we have learned, are one of the biggest concerns that people have as they get older. And they automatically think if they have a memory problem, that they have dementia or Alzheimer's disease. And so that often makes people so afraid it paralyzes them and they don't do anything about it, or they make up excuses.
But what we want people to know is that not every memory problem is dementia or Alzheimer's disease. It could be related to a number of things that it would be good to get it evaluated so that we can address them. And then if it turns out to be something like a dementia, it's better to catch it as early as possible because the current treatments are most effective in the early stages. And then we also find that families and caregivers benefit from education and support services, and the patient can actually participate in making decisions for themselves and other things because then down the line, we don't want people to be in a crisis when their options are limited.
Host Amber Smith: Well, I'd like to ask you a little bit more about the memory screening. I know you called it a mini cognitive test, so it's really short, right? Can you kind of walk us through how it's done?
Sharon Brangman, MD: Yes. It's called a mini cog. And it was developed to be given in less than five minutes. It's not a diagnostic test. And so there's no pass or fail, or if you get a certain score, then that means you have dementia. It's really a screening test, which means we just need to look a little closer at that person.
And we ask them three words. Then we ask them to draw the face of a clock and put a certain time on the clock. And then we ask them those words again, and there are certain points you get. So it is something that is easy enough to teach to someone who doesn't have a medical or a nursing background. And it can be done out on the road in a home setting. It doesn't have to be done in a hospital or a doctor's office. And again, it's not making a diagnosis. It's just giving us some information about someone we may want to look a little closer at.
Host Amber Smith: So if you do come across someone that you should look a little closer at, what does that involve? Like, what are the next steps after that?
Sharon Brangman, MD: So part of the training that we did for these workers is to teach them how to administer the test and then to review with them the process for making a referral. And so our team on this side here at Upstate is ready to get these referrals. And we gave the Office for Aging workers the process for making that referral.
And it's not a forced thing. If someone doesn't want to do it, no one is going to nag them or refuse to provide them services. It's just offering them an option to look a little deeper if they are interested.
Host Amber Smith: So information like this, that something might not be working as it used to, can be unsettling. Are there people at the Center for Excellence for Alzheimer's Disease who can help families digest this?
Sharon Brangman, MD: So absolutely. This is what we do every day. We've been doing it for years. We are the only center in the region that provides this type of comprehensive care. So we have a whole team. You can get a medical evaluation, you can get deeper testing with neuropsychologists that are embedded in our team. We also have nurses who can help families gather information, and we have a team of social workers that can let patients and families know about resources in this area. The Center of Excellence for Alzheimer's Disease serves 14 counties. That includes these seven counties, plus seven additional counties, so we're aware of the resources and the support services in the whole Central New York region.
Host Amber Smith: This is Upstate's "HealthLink on Air" with your host, Amber Smith. I'm talking with Alzheimer's and geriatrics expert Dr. Sharon Brangman.
Now, what is the role of your partner at Syracuse University, Dr. Maria Brown?
Sharon Brangman, MD: So, Dr. Maria Brown and I have worked together on a number of projects over the years, and she and I worked together on the initial pilot program that we did here in Onondaga County.
And actually, if you look back, she did some of her training with us, back when she was a graduate student. So we've known about her for years, and she's always had an interest in aging and in helping people with dementia and memory problems. And her role is really helpful because she can help us analyze the data to see if what we're doing is effective and to help us understand if we are hitting all the targets that we hope to get -- and then help us determine if this is something that we can then expand to other counties in New York state. So her expertise is evaluation of a program and the data that's being collected and organizing that data for us.
Host Amber Smith: So previously you looked at residents of Onondaga County. Can you tell us what you found looking at just that county?
Sharon Brangman, MD: So just looking in Onondaga County, which you think with us being so close to those residents, we found that a lot of them did not know where to go. They didn't have information about memory loss. Their families didn't know what to do.
A lot of primary care physicians in our region are overscheduled. They have so many patients and really only about 15 minutes to evaluate somebody, which nobody thinks is enough time, but it's the way our health system is set up.
And so it was very hard for them to get information. And then we have the fear factor. You know, people are afraid as they get older, if they're forgetting something, that it means that they have a dreaded disease. And so they would put things off unnecessarily sometimes. So it was a combination of things that we found when we did it here in Onondaga County that made us realize that this was an important program to try to expand to other older adults.
Host Amber Smith: Well, 20 years ago, 10 years ago, you didn't have that many options to help someone who was having memory loss or early dementia, but that's changed now, right?
Sharon Brangman, MD: Well, yes. We've always said that we can't cure this disease, but we can always care. And we can always help people handle the stresses associated with dementia. We now have some medications that, although they don't cure, in the early stages they may help to stabilize for a period of time. So that's something that people can be offered if they're eligible and if they're appropriate.
But most of all, it's understanding what's going on so that people can do what we call anticipatory planning. We try to help people anticipate what might come next so that they can plan ahead.
Host Amber Smith: Now, are there any reasons someone over 60 in the participating counties might not want to get a memory test? I'm wondering if there's anything that would disqualify someone from participating.
Sharon Brangman, MD: No, there's no disqualifications on our end at all. Some people may not want to have one. They may not care to go through the testing or something like that, but that's their decision. But there's nothing on our end that would exclude anyone.
Even though we're geriatrics, and we generally see people who are 65 and older, when it comes to memory loss, we see people of any age. So we have seen people in their 50s, in their early 60s, every now and then, somebody a little bit younger. But when we look at Alzheimer's disease and other dementias, they're primarily a disease of aging. So these are diseases that are more prevalent as we get older.
Host Amber Smith: Are there any health conditions, medical conditions that predispose someone to have memory problems?
Sharon Brangman, MD: So that's why it's so important to get checked. Because if you have high blood pressure and that's not under good control, or if you have diabetes and that's not under good control, or if you have high cholesterol and that's not under good control, if you're overweight and not exercising, there's also lots of medications that someone might be taking even without a prescription, and those can affect your memory.
So there are a lot of things that can happen as we get older that can have a negative impact on our memory, but it doesn't mean that you have dementia. So what we try to do is optimize someone's health and tell them what they can do to reduce their risk, if we find that they don't actually have a real memory problem.
Now, there are certain memory changes that happen as we get older that are completely normal, and that's when people get nervous. So, for example, it takes us maybe a little bit longer to remember someone's name. You meet someone at a party, or if you're out in the grocery store and you see someone coming and you suddenly can't remember their name, you can remember other things about them and where you knew them from, but you just can't remember their name. And then, about a half an hour later or something, maybe you're driving home and you remember their name. That's called slow retrieval. That's actually normal as we get older.
So I like to tell my patients, it's like your brain is a big computer full of information. And as you get older, it has more and more pieces of information. It can take a little bit longer to dig through those files in your brain and pull out that name. So that doesn't necessarily mean you have dementia. That's called slow retrieval. That's OK. Or you might forget where you put your glasses, your cell phone, your keys, and you're looking all over for them. Generally, as we get older, we are thinking of too many things at the same time. So when you put your cell phone down, you don't remember where you put it. But if you sit and think for a minute, you can retrace your steps and find it.
So what we're doing generally, most of us, is that we're on overload. We get so much information. We have breaking news, we have big newspapers to read on the weekend. I probably have too much information about the Kardashians in my brain. So we get all these idle, useless pieces of information, and they take up room. So that is not necessarily dementia. That means we're not focusing on the task at hand. We're thinking of too many things at once. So that's some of the things that we talk about with patients and families and reassure them what's normal and what may not be normal.
Host Amber Smith: So if a person has slow retrieval or can't figure out where they've left their keys from time to time, would they probably still be able to pass the mini cog test?
Sharon Brangman, MD: It depends. So that's why, just because you may get a referral, it doesn't mean that you have dementia. It just means we need to look a little closer and then we can help that person figure out ways to reduce their overload or to optimize their health so that they can have their brains working at the best way possible.
Host Amber Smith: Well, that sounds like a really good idea and very good information. I want to thank you for making time to tell us about it, Dr. Brangman.
Sharon Brangman, MD: So yeah, this is the, these are the things we all worry about. These are the everyday concerns, and it's not necessarily dementia.
Host Amber Smith: My guest has been Dr. Sharon Brangman, the director of Upstate's Center of Excellence for Alzheimer's Disease. I'm Amber Smith for Upstate's "HealthLink on Air."
The new edition of The Healing Muse -- next, on Upstate's "HealthLink on Air."
From Upstate Medical University in Syracuse, New York. I'm Amber Smith. This is "HealthLink on Air."
The new issue of Upstate's literary and visual arts journal, The Healing Muse is available, and its editor. Deirdre Neilen is here to tell us about some of the work in this 24th edition.
Welcome back to "HealthLink on Air," Dr. Neilen.
Deirdre Neilen, PhD: Thank you so much for having me, Amber. It's always a highlight of the year when I get to talk to you.
Host Amber Smith: Well, I know you get submissions on a variety of subjects, but let's look at how different writers respond to some universal experiences. There are several examples, but let's start with "Follow Up Visit With My Mother." What can you tell us about this?
Deirdre Neilen, PhD: This is one of my favorite poems in the issue, Amber. It's not as though... I can't really define the universal themes, but it seems to me that this poem encapsulates how strong the bond between parents and children is. And we think about that in a delightful way when the children are young, and their growing up and everything is so much fun the first time, et cetera. But as our parents age, and we are in a new, in a new version of ourselves with them, the poignancy of life comes to the fore.
And David Ram sent us this poem, and he has it as an epigram. He says, "for Mary Ram, 1923 to 2001." So he lets us know right from the get go, this is about his mom. And I'd just like to read it if that would be all right.
Host Amber Smith: Sure.
Deirdre Neilen, PhD: "Follow Up Visit With My Mother."
When I see in the phone my silhouette
reflected in the photo of a store
display, I remember your instruction
about a common childish frustration:
we cannot be in two places at once;
lacking the power of bilocation,
your words, we must choose between here and there.
Ages later we're sitting side by side
in your neurologist's waiting room,
when out of the blue, you say, "People who
don't know me don't know I am not myself."
I know you. I know you are both here and
someplace far beyond my understanding,
a place from where you will never return.
Sitting across from the doctor, he asks
where you are. You tell him confidently
you are here. When he asks following up
where here is, you sigh, then slowly, as if
for a little child, enunciate,
"I am here, and you are there," gesturing
both hands at this innocent getting schooled
in logic by his Alzheimer's patient.
He goes on asking who I am. You shrug
silently. He repeats his question.
Looking at me, you say "He's a good guy."
You may not know where we are or our
relationship, but you know here and now.
I'm a good guy. What more, Ma, could one ask?
Host Amber Smith: Very nice.
Deirdre Neilen, PhD: Oh my goodness. That poem, the absolute emotion of being with your mother and accepting that what is happening is far beyond both of your control, but you love her. You have that relationship, and she's still teaching as she schools, the wise neurologist asking what appears to her to be a very silly question. I am here and you are there. So I loved it because at the end, his acceptance, his mother says he's a good guy. And, really, for those people who have gone through the experience of having a loved one in the various stages of Alzheimer's, you know, some days are a really good day when the person you're taking care of says you've done well, or they're happy with something because so many of the days are not like that.
So I loved this poem because it does what the Muse is supposed to do: Let us meet people at a moment of sometimes crisis, sometimes faith, sometimes acceptance, grief, and we get to know them, and we get to think about our own lives with it. And I think we're all enriched by doing that.
Host Amber Smith: It's very, very nice.
Well, let's look at "Escape from Cincinnati." What is that about?
Deirdre Neilen, PhD: Yeah. OK. So here's a very different poem by a poet named Lane Falcon. And she's talking about several things here, the very serious illness of a child, but it's taking place in the backdrop of Cincinnati, Ohio, which has a drug crisis as many of our big cities do, and we know that the marketplace is being flooded with knockoffs of fentanyl and what that's wreaking, how that's wreaking havoc with people.
But we also know, those of us in the medical field, that fentanyl can be a very beneficial drug to reduce very severe pain. So we meet this speaker, this mother, who tells us about her escape, metaphorical, from Cincinnati.
I still haven't gone back to that place -- the vacuosness
I felt while they dripped fentanyl into my son's bloodstream
after his second reconstruction surgery. How I'd go
on a panicked run every day in a city where opioids reigned
where a man fell to his knees, a woman froze under the overpass.
In the waiting room, a grandmother cried, her daughter
just dead from overdose, her grandson, just waking
from general anesthesia. How (f****d up) it felt
that night when I begged the nurse to hurry
and give my son more drugs, enough to sustain him, dull his pain
and mine, his pupils blooming with fear when he started to wake.
How small a measure they lent. How small the graces we get
when we're rowing in grief.
Host Amber Smith: Wow.
Deirdre Neilen, PhD: You know, so there's another example of language and the setting of this poem, at the son's bedside, when the person in pain begins to awake, whether it's from you're awakening from anesthesia, your awakening from sleep, and that look in the patient's eyes that, oh, I'm coming back into what I know is going to be severe pain. And her begging at the beginning of the poem, she wants the nurse to hurry, hurry, give that fentanyl. It just drips, drips, drips.
And then she goes off on those frenzied runs, and she's aware of her surroundings. And she gives us very stark images of what this drug is doing to people. And it's, I think, a clarion call. I don't know what we are being asked to do. I guess, maybe, just to be aware to, to open our eyes.
And the drug problem is not merely good guys and bad guys. The drug problem is so many layers of people getting caught in the addiction cycle. And yet, this drug provides a lifesaving function, and we have to somehow steer our way between those two absolutes, I guess. I just liked it because I thought there's no one who loves you like your mother. And this mother is running for her life and running for her son's life, and and she's got us with her, you know, we're just, we're just right there with her.
Host Amber Smith: Very true. This is Upstate's "HealthLink on Air" with your host Amber Smith. I'm talking with editor Deirdre Neilen of The Healing Muse, Upstate's literary and visual arts journal, and we're talking about the 24th edition of the journal.
You can learn more about it at TheHealingMuse.Org. You can actually buy copies of it at that address as well.
So can you talk about "Out of Reach," by Patricia Behrens?
Deirdre Neilen, PhD: Yes, yes. This is a lovely poem as well. This one reminds us of what partners, spouses, caregivers, what they go through while watching the person they love have to go through the disease cycle.
And she gets us at a moment when the person is frustrated. Something happens, the person has hoped for something, and it doesn't happen.
So, "Out of reach:"
It's dropped. What you'd planned
to eat -- a ripe peach with cream --
lies splotched like a Pollock
on our stone floor, one more thing
slipped out of your grasp
and now beyond your reach.
It's my job to clean up the mess,
replace the loss, find something else
to substitute for what you'd wanted.
It's my job, too, to tell you, hands on mop,
that everything will be all right.
And yes, it falls to me to try to call
back out in you the laughing man
who'll share the rue of this
before he slips beyond our reach.
So this poem is, the speaker sees what's coming, and perhaps the person who's ill also sees what's coming, the deterioration that there will be no going back. But at this moment, yes, the hoped for peach has dropped to the floor. This person cannot pick it up, for whatever reason. The spouse or caregiver will clean up the mess, but she's talking here about so much more than that initial satisfaction of wouldn't that peach and cream taste good?
You know, she's talking about the satisfaction of, you're a person, you make me laugh, I you, there are things we do together. Don't let's lose that. I am going to make you come back. And even though she knows, she says before he slips beyond our reach.
So, again, what I think poetry does is to crystallize for us the evolutionary process that we're all engaged in. And we all do our best. I think most of us, anyway, are doing our best all the time to make it be as good as it possibly can be. But at these moments of illness, wow, it calls for every bit of strength you have to keep smiling and tell that person you love, it's going to be all right, when you know nothing's going to be all right. You know, nothing's going to be, really, all right.
So, again, I just really liked how matter of fact it was, and yet really beautifully profound.
Host Amber Smith: "The Refugees" is by Sylvia O'Connor. What can you tell us about the author and her poem?
Deirdre Neilen, PhD: Well, this one, this one is really good because, what did you think when you first saw that title?
Host Amber Smith: Well, of course I'm thinking about the crisis, at the border.
Deirdre Neilen, PhD: Right, right.
Host Amber Smith: But that's not it at all.
Deirdre Neilen, PhD: No.
Host Amber Smith: So it was a little surprising.
Deirdre Neilen, PhD: Yeah. She's a local poet, Sylvia, and I liked that she did that because I think it's done deliberately. Refugees are in our minds on a daily basis. They are being vilified, many times, by different forces out in the world that want to use them for their own purposes. The image of a refugee is someone who doesn't have a home and is on the move and is attempting to reestablish ties, bonds, you know, everything.
So what Sylvia does is to remind us that there are many kinds of refugees, and the one that she's choosing in this poem is to talk about our senior citizens. And I found this poem very hard to read because I like to think that we want to honor our parents and our grandparents, that as their life comes to the end of the road there, that we will continue to take care of them. But as we know from reading the newspapers, certain places that make a promise to us that they are going to care for the people that are residents do not. And there's lots of excuses. We don't have enough staff. We don't train them very well. We don't pay them very well. We don't.... But listen to this poem, "The Refugees." We're going to meet one of them named Anne, and this is how it begins:
Anne extends an empty palm, offering
the life she left just one month ago
before coming to the Home.
I was very sick, she said.
Only one month gone and all
my things distributed.
My daughter says, I don't need
those things anymore,
my favorite things.
She packed my life into a power boat.
I sit as on the beach of an island
in my wheelchair.
I am a refugee.
We are all refugees here.
I could bring only a few
of my things with me.
Just one month ago
they took me to the hospital.
Late at night they came.
Now I will live out my life here,
but I want you to know that
just one month ago I had
beautiful things --
I had a beautiful life.
Host Amber Smith: Very nice.
Deirdre Neilen, PhD: Yeah. Yeah. I mean, I would like to put this up in every health care facility that we have to remind us that yes, people have lives. And just because there's a transition, I mean, and sometimes it's for a person's own safety, they cannot stay on their own, perhaps. But that does not mean we should treat them, as she says, her daughter, I mean, if I were the daughter in this poem, I would feel so guilty, right, to tell your mother you don't need those things.
I mean, we're very quick to say you don't need that, mom. But it's like, that's your mom. She gets to tell you things like you don't need that. And yet we, we know all the time that our roles shift. And I just can't imagine what it must feel like the first time you hear your child say, "that's ridiculous. You don't need that. And I'm taking it, and it's gone. And here you are." And you know, the poem opens with that empty palm that she's offering it. This was my, this was my life. And it closes with, I had a beautiful life. I am a person here. So I thought it was very simple, structured, but so powerful. Really, really a very fine poem.
Host Amber Smith: Well, author Nancy Christopherson also takes us to a nursing home. What can you tell us about "Dearfoams?"
Deirdre Neilen, PhD: Yeah, so Dearfoams, you know, do you remember Dearfoams? I'm surprised, I guess, that they're still selling Dearfoams, but that's an old fashioned kind of slipper company.
And, Nancy Christopherson makes sure that she has the trademark in her poem that she writes it down there. So, I don't know if some of our readers would never have heard of Dearfoams, but they were a very comfortable slipper. So in this poem, I think the hardest part, the most difficult part of the poem is the opening stanza, because she wants to talk about suffering. And that's not something we're very comfortable talking about. We all want to avoid it. We don't want to give it to other people. And if somebody we love says, I am suffering, we want to do anything we can to stop it. But just listen to how she says, "Dearfoams (TM)"
We are meant to suffer
so that by the time the suffering
eases we can no longer
feel it as such
and it seems like nothing less
than the highest form
of praise.
That's how I'd put it.
The two of us walking the grounds outside
the nursing home along the smooth
paved sidewalk well beyond the high rise,
apartments built for retirees.
A few ash trees, some maples,
some lovely dense azaleas, boxwood along
the edges and flowers in pots
on balconies, their doors slid open, screens
exposed on the windows.
Happy, relaxing days near the end.
Mom with her softly slippered feet
padding alongside my sneakered ones
holding my hand and
gazing around at all the marvelous
wonders, saying not one word
but two, mahvalous dahling, in her tiny
size 6 ivory Dearfoams (TM).
Her hair by then
pure-as-a-seagull's-wing white.
We have a very different view of "the home." The person is visited by her daughter. The two of them are taking a very companionable walk. But we know from that opening stanza that there has been great suffering, and she's asking us to think about those times that it lifts, like if you've ever been in great pain, and I don't know if it's that somebody then gives you a shot to relieve it or the pain passes, the cramp is over. You get to take that first deep breath. And she says, how there's nothing like that. Then the pain is totally gone. And she says, it seems like you're happy. You have the highest form of praise.
And then she swings into this walk with her mom and the two of them looking around at what they see, and it's nothing terrific except that in this home, windows are open, plants are growing and blooming. Things seem to be alive. And she says her mother -- I think, anyway, the idea we get is that her mother -- is indeed happy. It's a marvelous day to be walking with your daughter outside, enjoying all these lovely flowers. So I like this one because it's not our, oftentimes, very sad note that we have when we feel our parents are not being treated the way they should be.
Well, looking ahead to the 25th anniversary next year, writers and artists out there, they can find information about making submissions at TheHealingMuse.Org website. Is that correct?
Yes, Amber. If they go there, they can find out information and will be taken to our website and we are actually open now. We have just recently opened for submissions for next year's issue, so you don't have to do it right now because, I mean, we'll tell you within two months if you are accepted or not, but you won't see it in print until next October.
Host Amber Smith: Well, thank you so much for making time to tell us about this issue.
Deirdre Neilen, PhD: Thank you for giving me the time. I love to talk about our Muse. I really appreciate your taking the time on the show to do it.
Host Amber Smith: My guest has been Dr. Deirdre Neilen, the editor of Upstate's literary and visual arts journal, The Healing Muse. I'm Amber Smith for Upstate's "HealthLink on Air."
Next on Upstate's "HealthLink on Air," if you had hearing loss, would your doctor send you to an ear, nose and throat specialist?
From Upstate Medical. University in Syracuse, New York, I'm Amber Smith. This is "HealthLink on Air."
A medical student from Upstate's Norton College of Medicine recently presented research at the American Academy of Otolaryngology-Head and Neck Surgery annual meeting.
I'm talking about his findings with Amer Mansour. He's a fourth-year medical student.
Welcome to "HealthLink on Air," Mr. Mansour.
Amer Mansour: Thank you, Amber. It's good to be here. I'm excited to talk about my research today.
Host Amber Smith: Well, I'm curious how you chose the topic of hearing loss.
Amer Mansour: As you mentioned, I am a medical student, and I'm applying into what's known as otolaryngology, or ear, nose and throat (ENT), as my specialty. And I have a pretty long history of working in hearing and hearing loss, going back to some of my days in undergrad.
And I discussed with one of our physicians, one of our doctors here, Dr. (Alexandra) Quimby, about potential projects to learn about or to better characterize the population-level trends of hearing in Central New York. I thought that would be an interesting topic to explore, seeing as it hasn't really been looked at in the past.
Host Amber Smith: Well, how prevalent is hearing loss?
Amer Mansour: Generally in the U.S. population, it's fairly prevalent. About 25% of people actually suffer from some level of hearing loss. That's about one in four people.
And as I'm sure you probably could have guessed, as we age, that number increases. So once we reach about 75 years of age, about, or more than, half of the people in the United States do have some level of hearing loss, so it's a fairly prevalent issue.
Host Amber Smith: What differences jumped out at you in the research that you did?
Amer Mansour: Our data and our research really demonstrated some interesting insights. The main kind of factors that we were looking at that impacted hearing loss, we looked at a lot of social factors and socioeconomic factors.
So we looked at how patients were referred based on their race or their socioeconomic class, based on household income or insurance status. And we found, I guess one of the key findings was, that the patients that were referred to us had a pretty significantly higher income when compared to the overall population of Syracuse.
So the patients that were referred to us at Upstate ENT had an average income of about $72,000. That's an average household income. Whereas, if you compare it to the overall median income of Syracuse and the surrounding area, that income is about 55 ($55,000) or in the mid-50s, so that tells us maybe that patients from a more advantaged socioeconomic class are more likely to be referred than some patients from disadvantaged classes.
Host Amber Smith: So these are patients who went to their primary care provider either complaining about some problem with their hearing, or their provider came across that when they did their exam, and they either referred them to an ENT specialist, or they didn't, it sounds like.
Amer Mansour: Yeah, that's correct. ENT is kind of a specialty field, so it's not really a primary care field, so we don't really see patients unless they're referred to us, as you mentioned, by a primary care or some other physician. So in order to be seen by us, as ENTs, they would first have to be screened or identified to have some sort of ear, nose or throat problem by a primary care physician.
Host Amber Smith: So the data set that you worked with was patients who were referred to the ENT practice at Upstate. Do you know what year it was for?
Amer Mansour: I conducted the study at the beginning of this year, in 2024. And the data that we looked at were from patients from the full calendar year, the previous year, so from Jan. 1st of 2023 until Dec. 31st of 2023.
Host Amber Smith: Did you break it down by age or gender or race? I know you mentioned income. Did you look at other factors?
Amer Mansour: Yeah. This study is what's known as a retrospective chart review, which means we went through all the patients through the Upstate electronic medical record database that were referred to ENTs, and we collected data from those charts.
And as you mentioned, age and gender were both collected, insurance status. We collected the patient's ZIP code and then used that data to estimate their household income because that income data was not readily available on their chart. And then beyond those social factors and data, we looked at some clinical or medical data, like how severe their hearing loss was and the types of treatments that they've tried in the past before seeing us, to try to address that hearing loss.
Host Amber Smith: Did your paper address any of the possible reasons for the disparity that you found in income?
Amer Mansour: Identifying any specific cause was a little bit outside the scope of our project, so we weren't able to identify specific causative factors, but we did, certainly, propose some theories based on our available data.
And so, we believe that patients with greater income, as I mentioned, are more likely to find the time to attend visits with medical professionals. We think they're more likely to be able to afford a day off work or afford child care and make time to see medical professionals, like the primary care physicians and, then, us as well.
Host Amber Smith: This is Upstate's "HealthLink on Air," with your host, Amber Smith.
I'm talking with fourth-year medical student Amer Mansour about the research he presented at the annual meeting of the American Academy of Otolaryngology.
Now, I realize you're still a student, but do you know what is typically done for someone who comes to their primary care provider with trouble hearing?
Amer Mansour: From a primary care perspective, there really are two main things that a primary care physician can do when a patient comes to them complaining of hearing loss. The first is to just refer them out to an ENT, an otolaryngologist, so that they can get their hearing done and see the specialist that really focuses on hearing.
And that's, I think, what most primary care physicians do. In other cases, there are certainly some primary care providers that are able to just prescribe and offer hearing aids directly from that primary care office.
Host Amber Smith: Do you think there are patients who have some degree of hearing loss but don't tell their doctor about it?
Amer Mansour: I certainly do.
Host Amber Smith: Why do you think that would be?
Amer Mansour: I think there are a couple of reasons.
I think the main problem is that it's a little bit difficult to recognize when you have a hearing loss, especially if it's not too significant or too impactful. I think some patients kind of have, or show, some compensatory behaviors, like they might speak louder so that they don't notice it, or they might turn the TV up a little bit louder or turn their phones up louder, so even though their hearing is declining, their environment's getting a little bit louder to match that. So they're not really impacted by it, and they don't really see it as a big problem.
Host Amber Smith: So if they're recommended to try hearing aids, and they get some over the counter, are those generally helpful for people, do you think?
Amer Mansour: Hearing aids are certainly very helpful, and I'm not totally sure about how much more helpful specifically tailored hearing aids are compared to ones that you can get over the counter. But there have been a lot of studies looking into how effective and how helpful hearing aids and implants are for patients with hearing loss.
They've made pretty remarkable strides in the treatment of hearing loss.
Host Amber Smith: Do you know if insurance usually covers hearing aids or even hearing testing or implants? If someone was recommended for that, is that generally something that's covered by insurance?
Amer Mansour: Of those three, health insurance generally, especially when it's medically necessary, as deemed by an ENT or a primary care physician, insurance does generally cover the hearing testing, and that's known as an audiogram.
But usually hearing aids are not covered. It does, of course, depend on the insurance plan and the insurance company that you're working with, but I think, from what I remember, Medicare, I don't think covers hearing aids.
So we think that this expensive medical technology is one of the main barriers to care that patients face when they are suffering from hearing loss.
Host Amber Smith: Well, you mentioned how there's more hearing loss as we age. Are we all destined to lose our hearing, or are some of us protected from losing our hearing?
Amer Mansour: So as I mentioned earlier, it's estimated that more than half of us will lose at least part of our hearing by the time we're 75.
And there are certainly some genetic factors and some environmental factors that we can't really control. But the main thing that patients can do is to decrease exposure to loud noises. Some common environments or areas where that is really prevalent is people that work in construction or in factories, and even military personnel. A lot of those communities suffer from hearing loss because of the consistent, elevated exposure to noise. And so in these contexts, adequate hearing protection is pretty important to prevent these issues.
And then in our paper, we touched on some improved screening strategies that will allow us, as health care providers, to identify hearing loss in patients earlier so that they can be addressed in a timely manner.
Host Amber Smith: I know you've been studying otolaryngology for quite a while. How did you choose this specialty? What interested you from the very beginning?
Amer Mansour: I'm a musician. I played the saxophone growing up. And in high school and middle school, I was always interested in science, and so in high school, actually, I wanted to combine these two interests in science and in music.
So that's when I started doing some research. Over the summer I did a couple of research internships, in hearing and the biology of hearing, and that's kind of how that all kicked off my interest in otolaryngology.
Host Amber Smith: So that hooked you, and what's going to keep you in the specialty? Is this something you can do for the rest of your life?
Amer Mansour: Well, yeah, I hope so. As I mentioned, I'm a fourth-year medical student, so that means I'll be graduating in May. And I'm currently applying for a residency (training) position in otolaryngology, which as I kind of broke down earlier, involves hearing, nose and throat, so ear, nose and throat.
Host Amber Smith: Good luck to you. Thank you so much for making time to tell us about your work.
Amer Mansour: Absolutely. Thank you. I appreciate the time.
Host Amber Smith: , My guest has been Amer Mansour, a fourth-year medical student at the Upstate Norton College of Medicine. I'm Amber Smith for Upstate's "HealthLink on Air."
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: David Radavich is a poet and playwright whose most recent book is "Under the Sun." His short poem "Close Call" delicately sketches a hoped-for return to health.
"Close Call"
Your voice is frail
as the whisper
of a monarch's wing --
I try to hear carefully,
imagine how a stroke
might feel, its capillaries
feeding all those memories
with a blitz of loss.
how you must be
sitting up in bed now,
phone in hand, speaking
unfamiliar words
that come from elsewhere --
maybe Mexico, that last
lepidopteran migration --
so far away, yet in the blood
as a luminous treasure,
yes, you will be coming
home soon, someone will help
you for the first month,
you'd like me to bring you
a rose from your garden
on my first visit --
I will see you then
with new wings scarcely
perceptible, words flying
from face to face,
this bouquet
a charm
for hovering.
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," research on loneliness, the concept of elder orphans and some precautions about marijuana edibles.
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 and graphic design by Dan Cameron.
This is your host, Amber Smith, thanking you for listening.