Q&A With Dr. Michael Tehrani, Gerontologist

Art: Our guest for the entire show is Dr Michael Tehrani and he is a specialist in medicine for older Americans, gerontology as it’s called. So, welcome to our show.

Sixty-five seems to be a magic number, a dividing line between, if not youthfulness, younger or not older and 65, the older person. What happens, medically, at that age?

Michael: 65 is that age where it’s supposed to be golden years. Sometimes it becomes hospital years for our senior population and, as a gerontologist, who works in the hospital and the clinic, I begin to see patients instead not enjoying their golden years. Instead of enjoying vacations, they are going from hospital to hospital or, or medical office to medical office and they almost get robbed of their senior years, which is supposed to be years of enjoyment, years of enjoying the fruits of all their hard labor that they’ve done over the years of their life. Now they are dealing with falls. They are dealing with dementia and heart diseases; these things limit them.

Art: And stroke and cancer as well. And these things, perhaps, were not expected, but the good news is that they are preventable, actually, if you get proper care. There, you mentioned the five most common causes of, for elderly. Dementia, stroke, heart attack, falls and cancer. We’re going to focus on falls, right?

Michael: Right, now each one of these are very big threats to seniors and each of them are equally very important and we’ll talk about falls and all the consequences that can come from a fall. The nice thing about falls is, a lot of it can be prevented.

Art: Okay, here are some interesting statistics. Number one cause of injury in 65 or over are falls. Number one cause of death due to injury, falls. Number one cause of losing their independence in seniors, falls and a senior falls in America, every second.

Michael: Exactly and in America, you know these statistics are, they’re very surprising. The fact that the number one cause of injury in seniors is falls. And it’s not just falls, if it does not lead to injury of fall, it leads to a fear of falling and when a person begins to have a fear of falling, they participate less in activities because they’re afraid of falling. If you’re not participating in social activities and you’re staying home because you’re afraid of falling, you begin to get depressed. So, falls do lead to not just physical conditions, but also mental conditions as well.

Art: And I think all of us know folks that unfortunately have taken a bad fall and some have been able to brace themselves and protect their head and other vital areas. Others are more serious.

Michael: Right and, especially if you’re on certain medications also when you have a fall, it can lead to serious injury. A lot of seniors are on medications such as blood thinners and blood thinners can be sometime as simple as aspirin or Plavix or sometimes a little bit more aggressive, such as Coumadin or Eliquis. If you hit your head, you can have an internal head bleed and, so we have to understand that risk, we have to understand that a fall, is a major threat to seniors, but, again, how do we reduce the risk or, or reduce our risks as much as possible?

Art: And one way is to make our environment, as carefully as we can to protect against these kind of falls and what kinds of things can we do in our home, for example, to prevent falls that would otherwise occur?

Michael: Well, you first want to look at the individual as themselves. What can the individual do to reduce the risk of falls. So, medications is a common cause of falls. Dementia in itself puts a person at risk of falling. If you have weak bones, it can’t maintain your upper core weight. So, maintaining good vitamin D is another part, but then there is your environment as well and obstacles that can be in the way that can cause falls.

There are a number of things that, at home, that are common causes of falls.

Art: We were talking about environmental factors, but there are other reasons why seniors fall.

Michael: Right and when you look at one of the most common causes of falls, actually, in seniors and we’ll touch more a little bit on environment, but medications are a common cause of falls in seniors. One of the most common ones that most everyone is on; blood pressure medications. We’ll talk about how we can reduce the risk of blood pressure medications causing us to fall.

Art: I fell in the bathroom last night and I was luckily to hold on, but a bathroom is a particularly vulnerable place because there’s a lot of things that you can hit.

Michael: Absolutely, there is not just that, but there’s slippery floors, you’re barefoot and it’s a closed space. So, when someone usually has a fall in a bathroom, it’s not that they only fall and they hit their hip on the floor, but on their way down they hit their head.

So, usually bathroom falls leads to a broken hip and a head hit somewhere on a counter and that’s why, bathroom falls are one of the more dangerous ones and unfortunately one of the more common ones.

When you have certain medication conditions such as COPD or heart disease or heart failure, in these conditions, it’s hard to catch your breath, especially when they’re exerting themselves a little bit. So, either you feel dizzy and you can fall or when you’re about to fall, your reflexes are not quick enough to break that fall and prevent you from falling.

Art: And poorly controlled diabetes and poorly controlled dementia also contribute to a risky environment.

Michael: Absolutely. When someone has poorly controlled diabetes, they have what we call neuropathy, so their feet don’t have sensation and they don’t feel things and then when they don’t feel things, they trip over things.

Art: I think we all know or have seen ourselves how you can have trips and although trips outwardly don’t look like they’re dangerous, they could lead to great danger.

Michael: Absolutely, it can, it’s the number one cause of people losing their independence.

Art: Let me just mention a few environmental factors; pets tugging at your legs, wet floors, lack of grab bars in bathrooms and other areas, alcohol, bad shoes, walking down the stairs, all things that can lead to, can lead to problems, but are preventable if you consider your environment and take appropriate steps to protect yourself.

Michael: Yes, when we have patients in the hospital who has had a fall and, unfortunately, we have a lot of patients. Most hospitals have a whole floor dedicated to orthopedic falls and treatment for that. So, we see a lot of them and as I interview patients as to why they fell, so that we can prevent future falls and a lot of the stuff I hear are a lot of repeat stuff, I hear things like the bathroom was wet, they did not have enough grab bars, another common one is stairs.

By the time they get to the top or if sometimes they don’t, they have a fall and falls from staircases are one of the most dangerous ones. It usually leads to spine fractures.

Art: Michael, we’ve had some serious discussion of problems, but the good news is that there are preventions and there are ways to address this. We’re going to focus on preventative measures now.

Michael: Right, so, again, the good news is a lot of falls can be prevented.. Well, when I look at patients and when they’ve had a fall and they’re on blood pressure medications, most of them say I was dizzy, I’ve been feeling dizzy for weeks before or months before. So, when you look at patients on blood pressure medications, there’s three kinds of people. There’s people that their blood pressure is always elevated. Then you have people that are more on the emotional side. Then there’s the third kind of person who their blood pressure is usually always managed, but they go to the doctor’s office and their blood pressure spikes and then when they leave the doctor’s office, their blood pressure is low again. So, from the doctor’s standpoint, all three are high, but in real life, only one is high and the others are not.

Art: Exactly and the other two are not, but when you’re in a doctor’s office, the doctor’s office, a doctor cannot, does not know which one you fall into, so all three people get blood pressure medications.

So, you need to measure your own blood pressure at home before you go to the doctor’s office, so you have that information to give him.

Michael: Yes, you have to keep a log. Seven days or ten days before you see your physician, begin to keep a log and write down the, write down the blood pressure and write down the mood that you were in when you took that blood pressure and then, when you go to your doctor’s office, go in prepared and then when you have a number in the doctor’s office, the doctor has a baseline to compare it to. So if, he sees a discrepancy, he’ll say yes, your blood pressure is high here, but your normal at home. So, I feel comfortable not starting you on blood pressure medication.

Art: But if he doesn’t have that information, a doctor is going to feel very uncomfortable allowing a patient to walk out with a high blood pressure without prescribing that drug and that drug may not be right for that person, as you described.

Michael: Every Thursday I do a community talk on, on prevention education and this last month has been heavy on fall preventions and we, we do begin to see a reduction in falls from these talks. I post, a lot of my talks are posted Facebook.

Art: And I attended one last week and you really do a marvelous job and you have a chance to expand on some of the issues that we’ve talked about on the show.

I think our community is lucky to have a doctor of the quantity of Dr Tehrani here, treating seniors and non-seniors alike and doctor, we have a few minutes for you to say whatever you care.

Michael: Thank you and we want to make the community aware of prevention because it’s a lot. If you prevent illness, you don’t have to treat illness.

Art: And prevention is a lot less expensive, I might add, then the subsequent treatment.

Michael: Yes and when something happens, a lot of times it’s irreversible and all, as physicians, we can do is prevent it from getting worse. There are certain body parts that what we’re born with is all we have and it doesn’t, it’s not like hair, that it regrows. The brain, the heart, the, the cartilage in between the joints, these don’t regenerate and if we don’t take care of them through preventative care, they will not regenerate.

Art: Do you agree that medical care is really a joint effort between the doctor and the patients, they both need to contribute to the ultimate outcome?

Michael: I could not agree more because when a doctor sees you, he’s only seeing you for a small frame of time. The more information we get, the better decision we can make and patients need to come to their doctor’s office prepared with certain things and need to see their doctor when they feel well, so that we can maintain that wellness.

Art: Seeing a doctor when your well, that is a little revolutionary thought for so many. Doctor, thank you so much for joining us here on Straight Talk and everyone is invited to your community meetings. Thank you for joining us.

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