We have been very excited to have the quality of guests on our programs. Recently we had Dr. Ankur Bharija,(fondly called Dr. B), a specialist in the geriatrics field on our program. He was kind enough to send us over a written transcript of our interview. Please read it and enjoy!
Q: Thanks for coming on my program today. Tell us a little about the type of patients you care for and your specialty in working with geriatric patients.
A: As a Geriatrician and Palliative Care physician, I see older adults at various venues – from relatively healthy older adults for comprehensive geriatric assessments to frail elders residing in nursing home to those admitted in the hospital with serious illnesses. My personal interests include providing and advocating for care of older adults, especially the frail and seriously ill; care which keeps them and their families at the center of all medical decision making addressing not only their physical but psychosocial and spiritual needs as well.
Q: You work primarily with Sr. Citizens, could you tell us what you do with them?
A: Well, it depends on where I am seeing them but the most pertinent for today’s conversation would be the comprehensive geriatric assessments at the Geriatric Evaluation Center. The assessment involves a comprehensive review of their medical and social history, medications, detailed cognitive testing, mental health screening and physical evaluation. Cognitive testing implies “Pen and Paper” tests to assess for memory and higher functions of the brain, which are typically affected in dementia. Mental health screening questionnaire help us to assess for depression and anxiety. Physical evaluation assesses for risk of falls and frailty etc. The ideology is to promote healthy ageing, and diagnose physical, mental or cognitive decline early so as to ensure our elders are as safe, healthy and happy for as long as possible.
Q: I have researched a lot and learned that for many senior citizens, staying connected with their family and friends is crucial to their mental health, helping them to avoid depression. What is your experience with this issue?
A: Social engagement is very important at any age and even more so for the older adults. It provides a sense of belongingness, purpose and pride in them. It has positive effects on all parameters of health- physical, mental, cognitive, overall quality of life an even longevity. Social isolation on the other hand is the harbinger for development of fatigue, depression, loss of appetite, memory problems and so forth.
Q: Do you have a certain “prescription” for patients who come to you—a checklist of sorts, to encourage them to stay in touch with their family and friends?
A: There is no one “right” way of being socially connected with friends and family. Generally whatever works best for them consistently on the long run is favorable – whether it’s meeting with friends, family or engaging in church activities. I do believe that interactions that involve physical activity are always preferable like walking, outdoor hobbies etc. For those elders that are physically impaired and/or family is out of town – staying connected via the web - video-chat, social networking would be good options.
Q: Why do you think it is important for seniors to be computerized?
A: As we all know with the Internet there are innumerable opportunities. I see three major areas of benefit for older adults: First as I mentioned “Social Engagement” with friends and family. Secondly it may be useful as a source of “Mental Stimulation” as they could try new projects/ games online or formal cognitive retraining programs. Thirdly, it can be a major resource for “health information” whether it is getting access to their charts or being more informed about general health issues.
Q: How important would you say it is for seniors to be able to do research on their health—as far as medical treatments, medications, etc.?
A: Absolutely! This is very important in current state of medicine – where healthcare delivery is more complex than ever before. The average 75-year-old in United States suffers from 3 chronic conditions and takes 5 prescription medications. Medicare beneficiaries with 5 or more chronic conditions see an average of 14 different physicians a year- this makes care delivery extremely complex and can be a huge burden on the patient and family. It is best for the patients and families to be well informed about health issues affecting them so they can ask appropriate questions and participate actively in their medical decision making process. There is a lot of misinformation on the web so one should look at websites that are reliable – websites ending with “GOV” or affiliated with academic health centers. WWW.NIHSENIORHEALTH.GOV is one such website, I would recommend highly as being most senior friendly and addressing key issues pertaining to seniors. As more and more providers are getting EMRs (Electronic Medical Records), seniors may be able to access their health records as well. These are all the ways to increase patient engagement in their own health care delivery.
Q: The statistics for seniors with Dementia are staggering. Can you talk a little about the preventative things you like to suggest to your patients to help keep their memory sharp?
A: Longevity is increasing and so is the population above 65 years of age. Alzheimer’s Disease (AD), which is the most common type of Dementia is prevalent in 5% of those above 65 and in 30% of those 85 years of age. The two main risk factors of AD are age and family history - neither of which we can do much about and there is no definite preventative method either. The key interventions which may possibly delay cognitive decline (memory loss) are: 1). Nutritious heart-healthy diet, 2). Regular physical activity and mental stimulation, 3). Social and spiritual engagement and 4). Control of the risk factors for heart disease most important being blood pressure.
Q: Tell us about your thoughts on mental stimulation? Do you think that diseases like Alzheimer’s Dementia can be curtailed with more mental stimulation and interaction? Do you ever use computer games, like luminosity as a tool for your patients?
A: The research regarding mental stimulation or cognitive retraining is inconclusive at best! The general consensus is that cognitive (mental) stimulation may be more useful before the onset of any cognitive impairment (memory loss) where it may possibly delay the onset of Dementia. Older Adults are encouraged to keep challenging the brains - trying new tasks, activities, while continuing those they have been doing in the past. Those in the early stages of memory loss or dementia may not be able to adapt to new and complex tasks so they are recommended to continue what they have always been doing on a consistent basis. The goal is to maintain their cognitive function or slow down the further decline rather than regaining what has already been lost. Some examples of activities that are mentally engaging are reading, writing, crossword puzzles, soduko, uno games, bingo etc.
There are a few websites which offer cognitive retraining via formal games: WWW.LUMOSITY.COM, WWW.HAPPY-NEURON.COM, WWW.COGNIFIT.COM. These programs have some data behind them stating improvement in “attention span” in those who did these for a consistent period of time. I do not generally recommend any of these unless I am specifically asked about them. I would say if someone has much interest in joining these programs online and doing these consistently 2-3 times a week then it may be worthwhile.
Q: Do you feel that our social society contributes to the longevity of patients today?
A: A study of those living past 100 years of age - published about a year ago from Georgia Institute of Gerontology - showed that Centenarians’ feeling or sense of their own health, well being, and social support systems was a stronger predictor of survival than their blood pressure, blood sugar values. It is apparent that their attitude towards life – towards themselves as ageing well and as having a purpose in the society reflects on their longevity. So our social society does play an important role towards longevity but it can do more. Our society needs to move away from the concept of ageism and start seeing ageing as a natural and beautiful phase of life. I believe, this may also reflect on how our elders’ see themselves in the ageing process. well and still being an essential part of the society – who can still contribute in so many different ways – be it their time, knowledge, wisdom, blessings and much more.
Q: What one thing do you tell your new patients and their families when you have the initial visit with them that they can do to improve their general health?
A: If you don’t use it – you lose it! So get involved socially and stay busy physically and mentally to keep your body working!
Disclaimer: Dr. Bharija has no financial or personal interests to disclose. This information is only for the purposes to spread awareness about Ageing Well. It is not meant to diagnose or treat any health conditions and should not be used in lieu of your doctor’s visit. If you have any specific questions for Dr. Bharija – you may contact him via Email:
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and if interested in similar stories or conversations, you may “Follow” him on Twitter: @AnkurB_MD
Make Your Life Healthy! Isn’t that something that everyone wants? Well, maybe…but who really wants to WORK at it? Not many people! And that is the problem.
