Episode Transcript
[00:00:06] Speaker A: Hi, welcome to Aging in America. I am your host, Beana Coleman with parent projects. I am so thrilled to have a friend on today, Doctor Richie. She is not only a wonderful woman, but an awesome ankle and foot surgeon, and we are just so lucky to have her here. So let's kind of dive right in. Our first topic, we really want to hear about how increasing foot function helps to reduce falls.
[00:00:29] Speaker B: Yeah. So I'm so excited to be here. Thank you so much, Bina. When we first met, it was through our children and it's been amazing to find how our paths intermingle. And we both have similar passions about taking care of the elderly. So it's kind of an unappreciated part of the body. How the foot functions really contributes to stability and certainly as we consider maturity and the natural progression of what starts to happen to muscle function, joints, alignment issues, how your foot functions really dictates how balanced and stable you're going to be as you try to do normal daily activity.
[00:01:05] Speaker A: And it makes sense. I mean, truly, like, you lay it out like that and I'm like, well, yeah, that makes sense. You are. You're walking on these feet and ankles and everything. And when you say daily activities, are you talking about true ADL's activities of daily living?
[00:01:18] Speaker B: Absolutely. And again, it's something so simple for people that have normal function, we don't really appreciate how difficult it can be with even simple deformities that our parents are dealing with and how that can impact things like pain. And our body has a way of dealing with pain that sometimes can be a spinal cord reflex where you could fall. And so preventing falls, I think, is really important and certainly something that we talk about in our clinic on a.
[00:01:44] Speaker A: Pretty regular basis, I assume that is talked about a lot. Yes. Especially with this aging population.
So you mentioned all of that wonderful stuff. Also, let me know before the show that there's something called the steady approach.
[00:01:58] Speaker B: Yeah.
[00:01:58] Speaker A: Can you kind of dive in? Because I do think it's important for people in our generation who are caring for their elderly loved ones how to even look for something like this.
[00:02:07] Speaker B: Absolutely. And, you know, it's fun. As my career has progressed, the more I interact with kids that are now trying to figure out how to manage things for their parents, half the battle is just knowing what to ask. How do we start these conversations? How do we figure out who's at risk? And then if they are at risk, what could we do about it? And so when I found the steady approach, what I thought was really useful, and we'll put some resources that you can put online to help families find more information. If this is stuff that resonates with you, is really a simple approach, which is screen, assess and intervene. And so for screening, three questions that you can ask your parent, even over the phone if you don't necessarily live nearby, is have you fallen? You guys had a really great episode. I think it was number 44 with Noelle Graham, who is an occupational therapist. And she had some great information, tips, resources about things people can do in the home to prevent falls. But I also really loved how she talked about communication.
We forget, again, being very able bodied, how scary it can be as an elderly person.
[00:03:14] Speaker A: I think embarrassing if I don't want to cut you off, but I appreciate you starting with this because I do think that that's a big part. If you don't have eyes on your elderly loved one, they could be lying to you on the phone as well. So I love this approach of that. Communication has to come with all of it. So keep going. Sorry.
[00:03:33] Speaker B: Just like having that empathetic approach, watching my own patient or parents age, they are not here anymore, but watching them go through that process is humbling as a child. And it's hard because you get a question in your head like have you fallen at home? And it feels very pointed and directed. And if your parent isn't really sure, maybe what your intentions are with that question, they may not be very honest about it. And we know that one in four adults over the age of 65 fall every year. That's a big number, right? Half of them won't tell their kids or their healthcare provider. That's a problem.
[00:04:12] Speaker A: It's a big problem. I agree with you wholeheartedly and it's why there are so many wonderful resources.
Keep going. Sorry. I agree so much with you, Doctor Ritchie, on this that I want to just talk about it. It's amazing.
[00:04:25] Speaker B: And it's the kind of thing too, that unless there is some awareness like you don't even know how to maybe start it. So those three questions. So have you fallen? Do you worry about falling? Because maybe your parent hasn't fallen yet and we don't want them to. We'll talk about some of the things that are really devastating for patients when they do fall, but we don't want your parents to fall, so can we prevent them? And the answer is absolutely false, are preventable.
And then do you feel unsteady? Because again, maybe they don't worry about falling. Maybe they haven't fallen, but they do feel unsteady. But they don't necessarily think that that's a problem. I've had some of the most amazing patients, and they're like, oh, honey, this is just part of getting old. And that's not absolutely true.
[00:05:12] Speaker A: Correct.
[00:05:12] Speaker B: The body does weaken. There are some things that change. There's a natural progression of maturation. Right. That the body does go through. But I have had 80 year olds that are healthier than some 40 year olds that I know. And so the key, again, is this prevention idea. So if you've asked your parent one of, you know, three of those questions, have you fallen? Do you worry about falling? Do you feel unsteady? If there's one, yes, they are at risk for a fall. And so, again, then it gets scary. Like, well, what do I do with this now? Like, my parents at risk? Like, what do I do? So another resource that, again, I'll give to you, Bina, so you guys can have on your website, is the stay independent questionnaire. So, as I've talked to elderly patients about why they haven't maybe talked to their family members about their concerns, a lot of patients are very honest about, yeah, I worry about falling all the time. Have you talked to your kids about this? And they're like, no, because I don't want them to worry, or I don't want to be put in a home. Like, they are afraid of losing independence, and they're afraid of being a burden. And so having the opportunity to engage in a compassionate conversation, which is, again, what I really loved about Noelle's conversation, was this idea that there's a lot behind that communication, that my goal is to keep you at home. Like, we can help you age in place, but I need to know what you need. We need to know how we can support you. And so the stay independent questionnaire is a more in depth questionnaire. And again, if you, as a child, don't feel comfortable, like, okay, wow, this is a little out of my wheelhouse now. This is a great opportunity to make an appointment with primary care provider.
[00:06:44] Speaker A: I was going to touch on that as well. That or home health. Home health, which is your pt or, sorry, your physical therapy, your occupational therapy. So you can bring, like Doctor Richie just said, these other resources in for this conversation.
[00:06:58] Speaker B: Absolutely. And in our specialty in podiatry, we sometimes will see patients more frequently than their primary care for a variety of other things that are going on, so they can also come to their podiatrist.
It's a simple thing, and not every foot and ankle surgeon is going to address it. Maybe the same way, but at least helping connect you with the resources that you need. And I also really like that. Noelle had talked about, if you don't feel like you're getting the help that you need, sometimes, our current healthcare system, you really have to be your own advocate. Advocate. And if this particular provider is not answering the questions, doesn't have the expertise or know how, which is a possibility, then keep asking until you find someone that will help you or can help you.
[00:07:38] Speaker A: Yes, I cannot stress this enough.
You have to be your own advocate and find who you feel the most comfortable with and what answers you're going to receive and how you think you're going to move forward with all this. That was really spot on. So, Doctor Ritchie, how did you get into this? You are so passionate. I could listen to you talk about feet and ankles all day, but how did you fall into feet and ankles?
[00:08:03] Speaker B: Yeah, so I had kind of an untraditional background. I actually started as an art major in college and through a completely random series of events, ended up in healthcare. And when I was shadowing a bunch of different doctors, trying to figure out, okay, in healthcare, what do I want to do? It was probably the podiatrist personality more than anything, but he loved what he did. He did surgery, he saw older people, he saw little kids, like the whole spectrum of it. And there's dermatology, musculoskeletal, there's surgery, there's diabetic wound care, limb salvage. Again, a whole separate topic, but it was so much variety, and I clearly am a little not add, but maybe add where it was so much variety that it just. I could do this. This is right up my alley.
[00:08:45] Speaker A: I think that's incredible.
It's so different. Like you said, you go from art to this. Both you have to be passionate about. So I get it. That's incredible.
All right, so we talked about this assessment, or what is the name of it again?
[00:08:59] Speaker B: The steady s t e a D I.
[00:09:02] Speaker A: Sorry.
[00:09:03] Speaker B: To the center for Disease Control CDC website.
[00:09:07] Speaker A: CDC.
[00:09:07] Speaker B: Okay. It's where you can find.
[00:09:09] Speaker A: Where is that independent questionnaire I want? That sounded incredible.
[00:09:13] Speaker B: I believe it's on their website, but I definitely have it as an attachment and I will send it to you.
[00:09:17] Speaker A: I think that's a really wonderful tool for what you are touching on as well as so much other in the elderly world, because like you said, everyone's gonna mature, everyone's gonna do it, people.
[00:09:30] Speaker B: Wanna stay at home.
[00:09:31] Speaker A: So let's keep you home as long as possible using these tools. So I know you referenced we had another, we had a physical therapist on. But is there anything like a walker, any dme that you can touch on just shortly about what you recommend mostly in your practice?
[00:09:48] Speaker B: Yeah. So part of. So if your family member answers four or more of that stay independent questionnaire, then they start to get put into different risk groups. So if your family member is at high risk or even moderate risk, we can do some assessments to evaluate kind of what their needs might be. And so one of the, and there are videos, again, I'll give you links to YouTube videos. I send these to patients. You could do this with your family member at home, but again, if that's not in your comfort zone, you do not have to do. These are things that healthcare providers. So some of these resources are tips and tricks that we are trying to spread awareness amongst healthcare providers. Because again, so another part of why I became really passionate about this topic is working in a trauma center. A lot of what my day today was was fracture care and fracture management. And, you know, we have, I think this was 2001 or 2021 data, so it's not totally most accurate, but I think that was the last time that some of these statistics were available. But it's somewhere around 36 million people will fall.
[00:10:52] Speaker A: Wow.
[00:10:53] Speaker B: Of that 36 million, there are 8 million ER visits. ER visits are expensive, very expensive. Of that 8 million, 3 million will end up in the. Sorry. 8 million injuries, 3 million ervs.
[00:11:07] Speaker A: Okay. Okay.
[00:11:08] Speaker B: And then of that 3 million emergency room visits, about 100,000 patients get hospitalized for their falls.
[00:11:15] Speaker A: I mean, you do hear that, right? You hear like, oh, grandma fell, hurt her hip. So I can totally see that.
[00:11:23] Speaker B: And we see, unfortunately, the morbidity associated with falls. You know, if 100,000 people come into the hospital, 30,000 don't make it out. And what I don't want to do is scare the audience and I don't want to give any kind of reason for hesitation, but much rather empowerment. Falls are preventable. They've shown with the steady approach, there's a 20% reduction in falls. So if we take those statistics and we start kind of applying, that's almost 7000 people that we can save, and again, possibly more if we can prevent the fall in the first place. So you do have some opportunity to help change the course of what maybe could happen for a family member. And it literally, your part could be as simple as three questions.
[00:12:06] Speaker A: That that's mind blowing, to be honest, because as someone who, I'm a gerontologist, so I'm dealing with families as well.
They are such simple questions, and I feel like, as long as you're getting those straight answers, truly, why wouldn't you want to move forward with all these other resources?
[00:12:23] Speaker B: Yeah.
[00:12:23] Speaker A: So that, that's incredible.
[00:12:25] Speaker B: So then to assess things like gait, strength, and balance, they have a couple different tests, and they're very simple. Again, the other thing that I really liked about these tests is I'll have, I'll have kids come talk to me, and they'll say, look, I think my.
[00:12:36] Speaker A: Parent needs a walker or a cane.
[00:12:38] Speaker B: But they don't want to use it. They don't think they need it. And so what's nice about these assessments is it does actually help the patient understand maybe what, their limitations or their weakness. So you may ask, do you feel unsteady? And they're like, no, I'm doing great. And then you have them do the time up and go test, where they go from seated to standing to walk about 3 meters, turn around and come back. Very simple test. But there's a timeframe. They have to be able to do it. And if they can't do it in that timeframe or if they're visibly unsteady, they're at risk. So it helps them maybe become a little more aware. And again, as a child, it's easier to say, look, we just did this test.
I'm worried because it looks like you're unsteady, and I want to support you. I don't want you to fall. I don't want you to have to feel embarrassed about falling. What can I do to help? Can I set up an appointment for us to talk with someone? Can we get some physical therapy? Physical therapy is amazing. Therapist, but they're amazing. And I often will write for physical therapy, just evaluate or PTOT. So it's physical therapy and occupational.
[00:13:42] Speaker A: Okay. I was gonna say you do like, a consultation first. You'll have them come in and say, really? Like you said, they'll do that sit to up test, and then are they falling in the shower? Are they at risk of falling in the shower and all the different rooms in the home?
[00:13:56] Speaker B: And then they can come. And a lot of patients do qualify, especially elderly patients qualify for in home evaluation if they're homebound, for sure. But again, healthcare plans now are very different, that there may be some cost sharing. So the organizations are usually very good about helping answer those questions. If you have a plan or you know that your parent has a plan, maybe there's some cost sharing that's there. But Medicare, you know, a lot of these things can be covered if there are some criteria. So again, certainly not something that should be a barrier to having an evaluation done and in the home, especially, because evaluating all of those things is great. But even if you can't get it in home, bringing the patient in, having the assessment done, and then writing a referral for physical therapy.
[00:14:42] Speaker A: It's funny you touched on insurance, because I know it changes all the time. Plans change all the time. It's just something we know.
But you really are right, because I've worked in home health companies, agencies in the past, and we want them. So if you, as the adult child, have a question about your parents insurance, call your local home health agency and, you know, kind of ask with, with this plan, can we get service and stuff? So that is a great tip, just really to get the ball rolling on this fall. Prevention.
[00:15:13] Speaker B: And it's funny because until I had children asking me, so I was practicing in a rural health environment. And so kids weren't always local, but we had a lot of retirees, and so kids weren't necessarily there, but they would call our office and we can just set up a phone appointment. Especially now with healthcare, there's so much options for telemedicine that we can have. But even just say, I really need to, you know, speak with the doctor about my concerns about mom, and certainly the doctor can talk with you without having any HIPAA violations or any kind of concerns. But hear what your, what your concerns are as a child and as a provider. That actually taught me a lot about, like, well, let me connect you to this organization that we will often send referrals for home health. Maybe they can answer these questions, because I won't necessarily always have the answers, but let me see what I can do to connect you to the people that might. And then you just start to develop these networks of relationship building that, again, if you're not in the same physical location as your parent, you can still provide a network of people that you have touch points with, that you have communication with, that can see what's going on, and then even start to evaluate for other, like, you know, we need to consider cleaning services, food service, like.
[00:16:20] Speaker A: The whole gamut of things that can help. I mean, we really, I was gonna ask you about this because when I was, like I said, I was with the home health agency, one of my favorite things was that they had mobile podiatry. And I mean, yes, you see some mobile pcps, but mobile podiatry was pretty prevalent. And I think that it's probably one of the best tools and resources assets out there, to be honest, especially your aging loved ones. Yes, they may still be able to drive, but let's keep those drives to very limited reasons and have someone come and see you for whatever your foot and ankle needs are. There's just so many resources, and you said it like, you might not have all the answers, the resources, but people in your office will, or people like us at parent projects do. So there's so many different ways to get that information that's so vital and so important.
[00:17:15] Speaker B: Yeah. And actually, that was when I first found out about what you do, bina, as soon as I was. If I could have had your resources ten years ago, because again, as a provider, most doctors are not going to sit down and. And take the time to, like, build all those roots. They just don't have time. It's not really their expertise. It's not their wheelhouse. So this is also, though, where there's so much disconnect, I think, in our system is that doctors don't know where to go. It takes too much time to figure it out. Patients don't know where to go. They're lost. They're lost. And there's so many resources and opportunities out there, but you don't know how to connect the dots. So I think even just if you're not getting the answers that you're looking from the team of healthcare providers that you work with, you guys have a lot of great resources in terms of ways that they can engage and get more information and figure out how to support their family members or themselves. I have patients that want to support themselves and don't know where to start.
[00:18:08] Speaker A: So it's funny you say that. I always say that, too. Like, of course we want the aging loved ones to be good, but this is the time to start thinking about your own health. 40, 50, whatever your age is, you know what's coming. As you said, everyone matures in ages, so it completely makes sense.
You know, I could talk to you all day. We are going to continue this. We're going to do a second show with you all about pain and tools and tricks on combating pain, unless I'm missing something. But in the meantime, did we forget anything you want to talk about with the steady approach or anything on this?
[00:18:41] Speaker B: Mostly just, and we'll talk more about this in future shows. But just the idea that falls are preventable. There are simple tools that can be done to evaluate where the risks are, and we have interventions that have been proven to help. So it's not something I want people to feel powerless against, but really feel like there are very simple things that can be done to support the family at home. In home. Keep them at home and physical therapy referrals. We'll talk more about inserts, bracing, treating deformity, helping with gait balance strengthening. In another discussion, yeah, there's a lot around all of that.
[00:19:16] Speaker A: So yeah, you touched on something I was gonna oh, keeping people at home, you said that. And I know that is a such a big thing right now. I don't know if you, for those watching and listening, feel that with your own aging loved ones, they want to be home. But like doctor Rishi said, let's keep them safe and secure wherever they happen to call home. And we'll get into those aspects of keeping them home and safe and secure in our next show.
How can people find you?
[00:19:45] Speaker B: So my clinic is with the midwestern university here in Glendale, Arizona. I'm more than happy we see patients there. All of my colleagues are also fantastic. So certainly if for whatever reason, there's difficulty getting in with my schedule specifically, any of our staff are absolutely wonderful and all board certified surgeons. So more than happy to be helpful in whatever ways that we can love it.
[00:20:08] Speaker A: Well, again, thank you my friend, for being here. Stick around. We will get another episode with Doctor Richie.
[00:20:16] Speaker C: Well, that's it for the team this week, and thanks for joining us. If you've enjoyed the content, remember to subscribe and share this episode on the app that you're using right now. Your reviews and your comments, they really help us expand our reach as well as our perspectives. So if you have time, also drop us a note. Let us know how we're doing for tips and tools to clarify your parent project, simplify communication with your stakeholders, and verify the professionals that you choose. You can find us on YouTube. Follow us on Instagram and Facebook. Thanks again for trusting us until our next episode. Behold and beheld.
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