Knowledge For Caregivers

Dr. Bernstein Driving & Endgame

Episode Summary

Dr. Bernstein a Geriatrician explains seniors driving delimmas, how to think about how many tests and medical procedures to do, and diet for those with dementia.

Episode Notes

Episode Transcription

Katherine Cocks0:01 

Hi, my name is Kathy. I've been a geriatric nurse for over 10 years. Many times when I would meet with family members of aged loved ones, they didn't always know what to do. I started this podcast knowledge for caregivers, to assist them with practical suggestions as they assist their own loved ones age with dignity and grace.


Katherine Cocks0:34 

Last week I interviewed Melissa Bernstein. This week, I'm interviewing Dr. David Bernstein. They are a married couple who have used their joint knowledge to speak and write books. Dr. Bernstein is a board certified physician in both internal medicine and geriatrics. He has been practicing for 40 years. He likes to use his experience to help others. He has written four books about his experiences, and how to live a long life, but also how to help take care of our geriatric population. In this interview, I cover various topics with Dr. Bernstein that I think will be very beneficial to you. I've taken some of his ideas that came from one of his books about senior driving dilemmas. That seems to be something I get a lot of questions about. And I feel like Dr. Bernstein gives us a lot of wisdom on that. Another book of his is I've got some good news and some bad news. You're old. At the very end, Dr. Bernstein wants to give us some advice about the diet that we should use for our loved ones, especially those suffering from dementia. Thank you for listening, and let's join the conversation. Nowadays most seniors are going to outlive their ability to drive by almost 10 years. Can you expound on that?


Dr. David Bernstein1:56 

Thanks for having me on your program. Today, it's been a pleasure to be here, we've made great strides in the medical field in extending life, someone who is in their 90s or 80s. Today, were born in the 1920s and 1930s, when life expectancies were 50 and 60. And they've only gone up in the last 20 years and plateaued by the way. And so there never was an issue with taking away car keys for that generation. And so there's a generation now that are living much longer, when they get to that age have very little insight into what it takes that to be safe on the road. And they have no concept. So they continue to drive, they see it as the only way they can remain independent. And therefore it is a big struggle to deal with a generation that didn't have to go through that.


Katherine Cocks2:47 

Right, because you you can't turn to your parents say what y'all do. Because they didn't have that situation where they had to take away their parents, car keys you did talk about before I get into when to stop driving and what to do. You did have some specifics in your books that I wish you would expound on about if they can still drive. But maybe they need to take some safety precautions.


Dr. David Bernstein3:11 

I'm glad you asked me that question. I softened my stance on this, after I wrote my book, although it's in there and the general ideas of the same, I think as people age, they should reduce the radius in which they're driving. And if arrangements could be made for the longer distances to be done by other people in early in my career was a taxi driver would drive one of my patients around. But we now have Uber and some of my patients in their 80s and 90s have figured out how to use Uber or their families do that. And if they take shorter distances, and they're just going to go to the post office, bank, hairdresser church, and these are places that are very close by and there's an arrangement made that they're going to limit their driving that that's reasonable. I also believe it's reasonable to have an on road or in laboratory test for driving skills, because that might be the make or break point in decision making. I know that nobody wants to inflict injury on another person Least of all on themselves. They don't want to go out in a bang killing themselves in someone else and family members having the guilt associated with not taking action. It's a very serious and important subject to address with family members. And I might add that in my reading, I came across the fact that family members would rather talk about funeral plans than taking away car keys from their adult parents. So it's a difficult discussion, but one needs to be had.


Katherine Cocks4:45 

Right? You know, my dad's 90 And I went home. It's been the pandemic's was my first chance to get home and I heard a little rumors and he said something about driving out of town. I said maybe those days are over. He said, I think you're right. So I felt bad. He kind of thinking, okay, we can do a little closer around town and see where they're going and monitoring that. And then a lot of family members have stepped up and said, Hey, if we're going to go out of town, we'll take you so that we don't have the issue of him driving long distance on that. You talk about some strategies, when it is time to take away the keys where you feel like really, they should not be driving anymore. So what are your strategies on that?


Dr. David Bernstein5:28 

One of the expressions I learned when I was growing up, I don't know where it came from, but beg borrow and steal, to get something done correctly and properly. And, and I would advocate doing those types of actions to save the lives of other people, it might start with contacting a physician, it could be done anonymously, with great sensitivity and calling the nurse in a doctor's office and saying, Mom and Dad are coming in, can the doctor address the subject and just ask some questions. As a physician, I love to think of myself as Doctor inspector clue. So or Lieutenant Columbo and be a bit of a detective to get little details and information, asking questions and seeing if they really knew where they were driving to because there were patients who told me that we'd go to a restaurant every day, and they couldn't name the restaurant or how they got there, what the directions were, I was able to figure out when they said, Well, I made a right turn here, and then the left turn, and then I was there was a Cracker Barrel and Bob Evans, and, you know, the staff there knew those people, but it's important to for the safety of everybody. So the first thing would be have a doctor, evaluate the patient, I often made a deal with my patients that I wouldn't expose them to having their license removed, if they would go through a driver evaluation. And there was a, there was at the hospital near me, there was a program called drive able. And they did an online computer generated test that was validated to determine someone's safety on the roads. And I would say if you pass that you can drive by the time I was making those recommendations, nobody passed the 95% probable they'd have an accident based on that testing. So that they were they made an arrangement with me and their family, and they stopped driving. I think other things would be to have the car brought to a service station and not return mom, dad, you know, the service, it's really expensive to fix, I don't think we should be doing this. Or there are other ways of removing the car from the environment, so they can't drive and provide them with suitable alternative because that independence or being able to go get their hair done, go to the post office, bank, church, synagogue, what have you, those are things that are dignity issues for them as well. And there are times that the family has no opportunity to provide a dignified approach, they just need to tow away the car.


Katherine Cocks8:00 

Right? I think that when you look at there's different facets. So when you look at somebody with beginning maybe memory loss, dementia, you can do sort of that, let's take the car away, let's take the keys away, we lost the keys, whatever, someone's borrowing a car, I've heard a lot of those strategies. And that kind of works, because they sort of like oh, okay, and then they forget about it. I think when it's a physical limitation, but their mind is still sharp, then you do sometimes have to do a little more of that. Okay, we're going to have to be evaluated physically on that. And I think one thing you write in your book, do you still advocate that if that's just not gonna work of sending in an anonymous report to the public safety, or the DMV, or whatever your state has?


Dr. David Bernstein8:44 

I do advocate that and the family members could do it, the neighbors can do it. And Dr. Bernstein did it. You know, when the patients would leave my office and things didn't go according to the way I thought they would or hope I would address an envelope to DMV, and there was a form to fill out and I notified the DMV, however, I waited for five or six days before I sent it so that the driver wouldn't know that it was me who was reporting it.


Katherine Cocks9:12 

Right. Honestly, people have asked me that before and I really didn't even know how to do it. So I'm glad to read it in your book. I actually emailed my three brothers, they live a little closer to my dad, I said, if we get to this point, here's the process because my dad's mind is fine, but just he's 90 and there's


Dr. David Bernstein9:30 

we've talked a lot about the cognitive impairment but there's a physical impairment with this too. And certainly your ability to move your neck back and forth and check blind spots and and reflexes are diminished. So putting stepping on the brake is more difficult. And these are not self driving cars yet. And if you put your dad in a newer model car with all the whistles and bells, he'd have a difficult time too, so they don't have the safety features that newer cars have


Katherine Cocks10:00 

I'd read this book before, you know, I'd come home and I was reading, getting ready for this interview. But I definitely sent it to my brothers and said, This is not me need to get and be aware of


Dr. David Bernstein10:09 

a few years ago, my wife helped organize a TV interview spot. And I had three individuals in their 90s, who had different takes on driving. One was my mother in law for whom that car was taking away from her because of an accident, and she couldn't want to another one another was a woman who was thinking in her 90s That she's going to give up driving soon. I think she said on 95th birthday, by the way, I attended her 100th birthday later that half of that, and then the one in between was a really astute woman. And she did the math. And she said, You know what, with the cost of gas and insurance and other items and upkeep of the car, it was just cheaper to learn how to use Uber. And in her 90s, she used Uber. So there are different approaches. Hopefully they all lead to ones that result in safety and preservation of life. There is


Katherine Cocks11:03 

not an easy way to always have that conversation with your parents or your loved ones. I mean, sometimes it's just, you got to think about saving lives out there on the road.


Dr. David Bernstein11:16 

When I sat down to write my book, starting with I've got some good news and some bad news rolled. I always sat down thinking of my classmates, baby boomers, this was an opportunity for baby boomers at an earlier stage to talk to mom and dad well, before they had to give up driving and say, if it comes up, are you going to be acceptable and accepting of us talking to you about giving up your keys? Because when it's delayed until the cat's out of the bag, or the horses out of the barn, it became becomes a real struggle, and come someone financial? Well, you're in my will I can cut you out of my will, if you do this to me, because I can do that. And so that there's this financial given take also. And you know, when family members out of town, how do you know that I can't drive you're not here. And there's a lot of potential manipulation that goes into that as well.


Katherine Cocks12:09 

And you made an interesting comment in your book about most older people they want to be to live their lives without their kids interfering. But this is sort of the time that we have to kind of come in and but it's hard. Like I talked to my dad, seven or eight years ago about when mom passed away, when you don't need your tools. He was doing habitat in his 80s he was doing fine. I said, when you don't need them, what do you think about moving? He's like, I am going to move for sure. And then I'll suddenly he's like, Nope, I'm not moving. So I felt like I did everything to have the conversation and he changed his mind. It happens on that side of things. I also one of the things in your other book that I really liked, that I talked so much to people about is think about the end in mind. I had somebody say they they have blood in their stool, and I'm like, if they have cancer, what are you gonna do about it? So how much testing are you going to do so expand on that? Because I just think that that is sometimes gets overlooked in our medical field of there's so much testing, and we find so many different things?


Dr. David Bernstein13:16 

Well, we do have so much technology at our disposal now that we didn't have 20 3040 years ago, and sometimes it's too much. So we need to evaluate, you know, what's the end state here, this is a pretty old individual. But we're going to put him through this test this proceed only to not do anything about it or to find that at age 91, that they wouldn't survive that operation or they wouldn't survive that treatment, or it's going to have no impact on their long term survival, their likelihood of survival one way or the other is just six months or two years. Why put them through a difficult last two years of life. I had a friend who told me about golf. And golf is all about playing backwards, playing a golf hole backwards. You know, your last shot should be a three foot putt that you could make the shot before that is a chip to that spot, and then you play everything backwards where your ball needs to be. And that's how I would address what I did with my patients. I'd say well, the endpoint is this. Let's Let's track back should we start here? Because if the endpoint is we're not going to do anything about our findings, then we don't need to pursue this. I don't know if that answers your question. But it was so natural to me and innate and what I did every day that I just lived it.


Katherine Cocks14:39 

I think when you said that you worked with a lot of older people as a geriatrician versus sometimes a primary care doctor that sees all ages, you know, sometimes maybe they forget, you might do something to somebody in their 50s versus somebody in their 80s My mother in law was having all kinds of stomach issues. I think they just did a CAT scan. She goes why aren't they doing a colonoscopy and I'm like, well They didn't say anything on the CAT scan. And at your age, they probably don't feel that to put you through all of that type of testing. What questions if someone's going to a doctor and he is pushing test? What question, should they maybe ask their doctor to sort of get to that?


Dr. David Bernstein15:17 

Say something like, what's the endgame here? What what are we trying to achieve? My life expectancy is such a such I have a living well, I'm not likely to undergo any surgery or chemotherapy. At my age, I've had a really good life. So I'm not sure what the rationale is for what we're doing here. Can we take a step back and look at the bigger picture? Can we get some people involved? Who can we can put our heads together and then share information and see what makes the most sense. And one other point I wanted to make about something you said a few minutes ago, and that is, if you've never seen a bad outcome from a procedure, it may seem really innocuous, but those of us who've been around you have I have, you see some things that well, that shouldn't have happened, but it did. And it had a really negative outlook and outcome for that colonoscopies can go wrong, maybe one in 1000, or, or 10, in 1000. But if you're that person who has a bowel perforation, or something goes badly, or you read in the paper every day, that someone went in for a minor operation and didn't survive. This was in the news not too long ago, with high school or college football player, it was a minor procedure. And I don't know what happened. But something did. And those things happen being in medicine for 40 years, I've seen them. And it makes me put the brakes on a little bit when I'm making recommendations to people and saying, Well, let's be careful about what we're doing in this test, because we may find something that's going to address something else, and put us in a position to make a very uncomfortable decision. Let's be patient about things, let's watch things. Because we don't want to get on that slippery slope. It's the same slippery slope when a senior adult is in the hospital in in the intensive care unit. And someone's thinking about intubation or some other more heroic measures that the patient never wanted in the first place.


Katherine Cocks17:23 

I had a client with Parkinson's dementia. And then I do not understand, I don't know if there was pressure, why they did a hip replacement, not just some steroid shots, because he was already walking so bad, and then never could walk after that and just went continually downhill from that surgery. And I was just so frustrated, because I was like, who did this, because I think his quality of life would have been better, maybe with some other type of pain management, rather than just going into doing a hip replacement on somebody who didn't have the potential to rehab because he couldn't understand directions, and that kind of stuff. And I guess that's kind of what you're talking about.


Dr. David Bernstein18:02 

Begin with the end in mind. Because if the end is you put a hip in someone and they're not capable, either physically walking because of their Parkinson's, or cognitively learning this over again, you've not done anything to improve his quality of life. And so you're correct pain management, finding ways of using that discomfort, adjusting medications in some way would certainly be better.


Katherine Cocks18:27 

Right. And unfortunately, you know, his quality of life wasn't great. And I think it hastened his demise. And I when I read that, it's something that I've always said, but I liked how you put it in that phrase, think of the end in mind. I knew it. But you said it so well, in your book that I just really liked that and how you said that?


Dr. David Bernstein18:46 

It medicine changed a lot in 40 years. And I used to think I had more time, but you don't have as much time with a patient. And there's a lot more pressure that way. And younger physicians don't spend as much time with their patients because they don't have it and making decisions on on a geriatric patient when they have 567 chronic medical conditions. And then there's something that's really complicated, we have to begin with the end in mind, sometimes very little thought goes into it. And the patient gets sent off to some consultant who doesn't know all the background, and it's difficult to make decisions. And as advice to your listeners. This is one of those occasions when a family member can intercede a little bit and say that's coming in for an appointment today. It's okay with him if I come in if it's okay with you. And I would like to make sure we really focus on his hip pain. We're really focused on his Parkinson's meds or what he's eating at home. Because if we're dealing with his high blood pressure, diabetes, cholesterol and so forth, that really important thing for us is going to be swept under the under the rug. And so even the people with whom you work who are advocates caring for patients, they make that extra call and advocate that the focus be directly on the main problem at hand. And all too often that doesn't happen. I want to say one more thing about about eating, because we didn't talk about it. But I want to say something about it. I know my wife has written her book, The Power Five Test Kitchen caregiver edition. And one of the things that's worth noting that I think is really important for our population, is that there's this urge to eat sweets, and sugar. And sugar is really bad for an aging sweets might be one of the few sent taste sensations that people have left. Giving them sugar is not a great idea. Same way with salt, although, you know, if you add a little bit of salt, it provides some additional flavor. But there are and I know I've spoken to Melissa Bernstein about it, that there's other ways to sweeten things that might satisfy the palate. Agave might be one and and monkfruit sugar, sweetener is another that can give the sensation of the sweetness without that glucose, sucrose rush or the high fructose corn syrup and those sorts of things that really derail the brain function.


Katherine Cocks21:16 

I did read that in your article you were you were talking about sweets. And I've just definitely something I've seen a lot of people are like, Why did they only want chocolate or cookies or whatever. And they've really struggled, they they have so many new products nowadays, I do like my chocolate. So there's a Lilly chocolate, they sweeten it with stevia which doesn't affect my bladder as much as some of the other artificial sweeteners and so it gives me that little chocolate without going overboard. So there's a lot of products nowadays that we can use to help sweeten their food. And I know sometimes even people have looked at some of the protein drinks and I'm like, and they have a lot of sugar in them. So


Dr. David Bernstein22:00 

they do and they're pretty high carbohydrates. And if you can find the right balance that might be helpful. For my morning meal or my midday meal, I mix some chia seeds with almond milk to give it some texture and that I add my protein powder and we'll have hemp seeds in there and, and not to forget the high fiber powder benefit fiber which helps with bowel regularity. So that there are some things that people can do all around geriatric wise to meet some of those requirements to


Katherine Cocks22:32 

try to do more fruits and some of them stevia or


Dr. David Bernstein22:37 

the natural stuff, natural things, even adding yogurt, excuse me, applesauce, just as a sweetener is another thing. That's why applesauce without sugar added isn't another way to sweeten things up a little bit. It really is important because otherwise they won't eat very well.


Katherine Cocks22:51 

Correct. And I guess I hadn't realized. I mean, it seems intuitive that sugar is not good for your brain. But I know so many people get desperate to get their loved one to eat. I know


Dr. David Bernstein23:02 

it's a shame the older brain or the dementia brain would rather have ketone bodies. I'm not suggesting people go on a keto diet. But a higher protein, lower carbohydrate enables the brain to use some ketones, and the brain would rather than age brain would rather use ketones


Katherine Cocks23:21 

to have you found that does kind of I mean, I know we can't reverse, you know, Alzheimer's, but it seems to help to have less sugar in their diet.


Dr. David Bernstein23:30 

Yes, it does. Especially if they're diabetic patients to where blood sugars are likely to become really high. We need to really modulate that. And, you know, a pill or insulin injections are not the only answer to the problem. We can do a lot better diet wise. And when someone's 89 years old, and they've had their habits of what they eat, it's hard to change that.


Katherine Cocks23:52 

It is hard. Sometimes you just have to do the best you can.


Dr. David Bernstein23:56 

Correct you know, and it fits in with taking a deep breath in this process. And I'm doing the best I can. I've attempted many of these things. Here's my priority list of things that are important. Taking away the keys might be the most important. And you know there might be a problem. If there's a lot of bad things I listened to with senior drivers. We started talking about that. But getting a call at three in the morning that your loved one is 500 miles away from home looking for Denny's. And he knows it's around here somewhere that's a bad phone call.


Katherine Cocks24:33 

Right I had a client that he was pretty scraped up the police out of my thing at 6am he had gone in a ditch and then he was walking through stuff and banged up and everything and to somehow he got him to his house when they picked him up but I think maybe he knew his address. But yeah, it's definitely especially once you start dealing with dementia, that's when you really gotta gotta check those things and totally agree with you and it's it's not an easy process. But anyway do tell us again how we can get in touch with you where we can get your books. Like I said, I found them very helpful. I would love for people to know where to get that and I also will be putting that in the show notes.


Dr. David Bernstein25:12 

Oh, is my website where I where I have posting of my wife's read Melissa recipes, but I have my blogs that that address some of the subjects that you talk about with your guests, one in particular was choosing a retirement community or a nursing home and things like that things that you've reviewed with some of your listeners, is my email address. And my books are available on our website and and all our books are available on Amazon as well. I encourage people to read them and thanks so much, Kathy for for talking about my chapter begin with the end in mind. I think that chapter nine in my book, it was a joy to write and it was interesting for me to recall the interactions I had with my patients and making those difficult decisions but clearly you found it instructive and helpful, and I hope others could get the same benefit.


Katherine Cocks26:08 

I hope you have enjoyed this podcast. If you have found it helpful, then share it. If you wish to contact me for consulting services you can reach me at and Kathy's Kathy s. Remember, our content is meant for informational purposes only, and not to replace the advice of health care professionals.


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