Neha Pathak, MD, FACP, DipABLM: Welcome to the WebMD Health Discovered Podcast. I'm Dr Neha Pathak, WebMD's Chief Physician Editor for Health and Lifestyle Medicine. At some point in our lives, almost every single one of us will either need a caregiver or become one, and yet so few of us are ever truly prepared for what that looks like: the late nights, the hospital visits, the impossible decisions, the guilt, the isolation, and the quiet fear of not knowing if you're doing enough.

Caregiving for an aging loved one is one of the most profound and complex experiences a person can go through, and our healthcare system, for all its advances, has not made it easier. This is the final episode in our six-part series in collaboration with The John A. Hartford Foundation on Aging in America. We're talking about how to have the conversations you've been putting off with your aging loved ones, the frameworks that can help you navigate care decisions when everything feels overwhelming, how to protect the people you love from scams that are becoming more sophisticated by the day, and why palliative care is one of the most misunderstood and most powerful tools available to families facing serious illness.

Whether you're currently in the thick of caregiving, preparing for what's ahead, or simply someone who loves an older adult in your life, this conversation is for you. First, let me introduce my guest, Rani E. Snyder.

Rani is the president of The John A. Hartford Foundation, a private nonpartisan philanthropy with a mission to improve care for older adults by creating health systems that are age-friendly, supporting family caregivers, and improving serious illness and end-of-life care.

With more than 25 years of experience in health philanthropy, Rani has advanced national movements that have reshaped care delivery, strengthened federal and state policy, enhanced medical education, and improved health outcomes and support for millions of older adults and their caregivers. Welcome to the WebMD Health Discovered Podcast, Rani.

Rani E. Snyder, MPA: Thank you. I'm so glad to be here. I appreciate your having me. I've been looking forward to this conversation.

Pathak: Well, I am very, very thankful to have you here, and just reading your bio, there are so many things that just popped out to me because I know that a lot of things that we learn in medical school don't necessarily become real until we start experiencing them ourselves. And so I can say for certain that as I have become a caregiver for elderly parents, seen what end-of-life care can look like, the barriers, the pitfalls, a lot of the pain that can happen within health systems when they don't work as we imagined that they did—I'm just really thankful for your time today.

So that brings me to your own health discovery. Could you help share your own experience when it comes to working with aging adults? What questions or issues arose that inspired you in the work that you are doing today?

Snyder: When you ask most people in the field of aging, whether they're in clinical work or working on aging in community settings, what brought them to aging, they will say, “I had a grandparent who helped raise me,” or “I had a wonderful relationship with either a grandparent or an aunt or an uncle.” An older person in my life is where most people start.

Interestingly, that's not where I started. My interest in aging and health began professionally—and I think maybe intellectually is the right way to say that. The first job that I had out of college was at The John A. Hartford Foundation. At that time, we had two different program areas. We had an area on healthcare cost and quality, and we had an area in aging and health. And although I didn't work on the aging side of those two programs, I saw the demographic shifts coming, the lack of preparation in our healthcare system that was coming down the pike—that huge cohort of baby boomers who, at that time, were in their mid-forties.

So if you fast forward to where we are now, with more than 11,000 people a day turning 65, that rate is increasing every single year. So for me, I found it really appealing to tackle a big, complex societal issue. It was very clear that this was not an issue that was going away. In fact, this age wave is still building, and it led me to graduate work and a 25-plus-year career specific to healthcare philanthropy with a focus on improving care for older people.

So I love going to work every day and knowing that there is meaning in what we do and that we're genuinely making the world a better place for older people—and really for all of us who either are older ourselves or care about someone who is an older adult. And that's basically every single one of us.

I'll add one thing, which is that I've also really developed an interest and a passion for supporting family caregivers. So very much like aging, caregiving is a complex issue. There's a lot of overlap between the two, and the complexity comes at both the level of family dynamics, as you've described. It's different learning about it or hearing about it than when you're actually in it, and also at a societal level, which is where we focus at The John A. Hartford Foundation.

Pathak: So this is a conversation that we're having as the final episode in a six-part series that's explored Aging in America. And so we've had topics ranging from improving care for older adults to age-friendly health systems, new technologies, protecting older adults from scams, and advance care planning. With everything that you just said about all of the needs that aging adults and caregivers have, in this conversation, can we bring everything together?

What is standing out to you most when you think about the challenges and the opportunities that are facing older adults and their families today?

Snyder: If there's one message I want people to take from this conversation, it's that aging and family caregiving are very personal issues to every one of us, and at the same time, they're not unique. There are so many other people out there who are struggling with the same kinds of issues and challenges, and that can lead to certainly a level of stress, but also certain kinds of isolation.

And it's really why we work on that at The John A. Hartford Foundation—to have an opportunity to fulfill our founder's mandate to do the greatest good for the greatest number. I don't want people to feel like they're going it alone. So people assume their situation is unique. They often feel overwhelmed, and rightly so, and sometimes there's even a level of not just discomfort, but possibly feeling ashamed or that they're a failure when it comes to caring for either themselves or an aging relative or friend who has really complex health needs.

We have a very long way to go in our society in the right way to care for older people and for caregivers themselves. But still, people ought to know that help is available. There are resources that exist. There are steps you can take at any stage of life, really, to better prepare for yourself in aging and as a caregiver. And this podcast series is a really good example of that.

Pathak: That is really just so helpful. And I'll say that as you were talking, so many things stood out for me. One is what you mentioned around isolation. So I will say, as a family caregiver, I think in the beginning of this journey, because no one tells you how long or short it's going to be, what exactly you need to be able to optimally help your loved one, you do often feel like you're failing.

Just every time your loved one is hospitalized—particularly, you know, coming from a healthcare background—I certainly feel that. The isolation comes where, after a period of time, I used to call my friends and say, “Oh, my dad's in the hospital,” and everyone would come together, help me, take care of my kids, take them different places. And I've just found more and more I don't necessarily even want to bring that up. I don't want to talk about it. My dad's in the hospital right now. I have not told anyone because I just feel like, “Oh gosh, I'm just telling everyone the same story.” They talk to me, and that's what they're going to hear about.

So I really loved what you said about recognizing that you're not alone. Help us understand some of the resources that are available so people can find some of these pieces of information that make them feel less alone in this journey.

Snyder: Well, first of all, I'm sorry your dad's in the hospital. That is stressful for anyone in any situation, and so I'm glad we can talk about it today—for you and for other people, too.

I'm going to bring up a well-known, in caregiving circles, quote from former First Lady Rosalynn Carter. She died a few years ago, and she was a huge champion for family caregivers. And she has this quote that, to paraphrase, says every one of us either was, is, or will be a caregiver—or will need one ourselves. And that is the truth.

So there are 63 million caregivers in the U.S., so count yourself in good company. That's about one in four people. And the vast majority of those people care for an older adult. Caregiving is both rewarding for many of those people, and at the same time, it can take a toll.

So our most recent data show that caregivers spend an average of about 27 hours per week providing care. That's a lot of time. Nearly half of those caregivers report at least one negative financial impact from their caregiving responsibilities. And then caregiving also can take a toll on the physical and emotional health of caregivers. About one in five caregivers rates their health as fair or poor.

But, you know, you've just described some of the sort of—over time—you don't want to keep talking about it. It feels like the same old thing. Those statistics aren't meant to scare people, but really just to show the reality and the need for advance preparation wherever possible. Some things you can't prepare for, but that is why having conversations with your family, with your aging parents, with your children about your own aging, is really important.

Talking about what arrangements one should make in a health crisis—things like how are you going to provide care? Should it be in the home? When could or should it be in a nursing home? Most people would rather be at home. What is the plan financially? Those are all really critical things.

And the questions around what matters to your parents—in your case, let's say, take that as an example—when it comes to their healthcare and their lives: who do they want to be involved in medical decision-making, and at what level? Those decisions are always better made when you're not in a stressful situation. It's always going to be harder—and sometimes less accurate and less apt—if you're doing it in a crisis.

So those are the kinds of conversations that, whenever possible, should happen—with people my age and with my adult or young adult children, too.

So I'll go back to where I started a minute ago and say that there are resources to help. One of those is called the Elder Care Locator. It's run by a federal agency called the Administration for Community Living. If you Google “Elder Care Locator,” you can put in your zip code and look for your Area Agency on Aging. We call them AAAs. These Area Agencies on Aging will be able to connect you with family caregiver supports in your community.

If you have a family member diagnosed with dementia—which is very common and, again, can be very isolating—you can use a site called Best Programs for Caregiving, and it can connect you with evidence-based (so we know they work) dementia caregiving support, either in your community or online. And that's in a variety of different languages as well.

So the last thing I'll say on that front is that more and more employers are recognizing this caregiving issue and are offering support to family caregivers as well. So I would just say: don’t be shy about asking for the support that you need to be productive in all kinds of ways in your life.

Pathak: Such a powerful reminder to not silence yourself when you are struggling. You also mentioned a key phrase that has stuck with me since we began this series: really thinking about what matters, and that sits within the larger Four M’s framework. And I have to say that I definitely think about that framework. As I've been to probably every area hospital with my loved one over the past year, some places just do it better than others. So help us understand the Four M’s framework and how family caregivers can use those principles to ensure that they can improve the care, or really be looking out for some of these components as they're caring for their loved ones in a hospital setting.

Snyder: I love that question because it's something we spend so much time thinking about for older people and their caregivers. So as you referenced in a prior episode, doctors Terry Fulmer and Ellen Flaherty explained the power of the Four Ms of age-friendly care, and I think it's helpful to just very top-line review them again.

So, what matters is always sort of the top of the list: understanding and honoring an older person's goals and preferences. So, what matters most to me and my caregivers? And these are designed to be used as a set. The other three M’s are medications—so ensuring that medications are age-appropriate and don't cause harm to older people, especially because as we age, most of us are likely to be on more and more medications to sometimes manage multiple and/or chronic conditions.

Another M is mind—anything cognitive. So addressing cognitive health, preventing and managing conditions like dementia and delirium and depression. And then mobility—so mobility is about helping older people, and really all of us, stay active, stay independent, avoid falls. So this is very much about physical function.

So I referenced that they are a set—they're all interrelated. I mean, if you think about it, if you're on the wrong medications, it can affect your mind. It can affect your mobility, your balance, let's say, potentially putting you at risk for a fall. And it can very much, therefore, get in the way of what matters to you.

So if you talk about those four Ms with your family members—what matters in their lives and in their health, how is their memory, do they worry about forgetting more? Most of us do, by the way. How are their medications affecting them? How active are they and how mobile are they? And then if they want, joining them and talking to their healthcare providers about those four Ms can really help them achieve better health.

My dad has recently invited me into some of his—and he's not in terrible health—but he's recently invited me into some of his medical appointments just to hear and validate and ask questions with him along those four Ms.

Pathak: Yeah, it's really helpful. And I think what strikes me as we've sort of gone through this process is that often, when it comes to medications, mobility, even mind, there's sometimes a trade-off where you're having to choose. So if someone's on a medication that may prevent blood clots but then also increase their risk for bleeding, now they are a fall risk.

So it really helps you come back to the “what matters” to this person. So for each medicine, you can say or think about: do we want to keep this on? Do we want to take this off? What are the pros and the cons? And I found it really helpful as we're making all of those decisions—in the medication lane, in the mobility lane, in what we do to support the mind—coming back to that question, which has helped a lot in making some of these decisions around the pros and cons.

Because sometimes we get it wrong, and at least I can feel like, okay, I don't feel guilty because we really thought about it and we really thought about what would be most meaningful to him. So even if something were to go wrong, I at least feel like we processed it in the right way.

Snyder: You know, there's a great resource called My Health Checklist that you can find on our website, and that speaks to exactly what you're saying—a workbook that you, as a family caregiver, can give to your older relative to complete before a health visit. It was created by one of our partners, the Institute for Healthcare Improvement, and you can also find it on their website, which is ihi.org, and then the slash “My Health Checklist.”

And I would say that all of this is about aging with intention rather than reaction, wherever possible.

Pathak: That's really helpful. So shifting us to another piece of hospital care, which has been the integration of newer technologies and AI. So I will say, on another hospitalization, when he was discharged, there was a virtual discharge manager who—it was on the television screen, and you clicked some buttons, and then you got all of your paperwork for discharge.

And as we were doing it, I just kind of had this feeling like this is just not helpful. My dad certainly could not have done this on his own. I would much prefer to speak to someone in real life for this piece because there are so many questions that we have. So can you talk to us about—and this is kind of hearkening back to another episode we had in the series around technology and AI—where do you see technology actually helping caregivers and older adults that we should kind of lean into? Because I've just given an example of something that I did not feel was super helpful.

Snyder: That's a great point. And there's so much innovation that's happening right now in the tech space for caregivers and for older adults. And in the previous episode you referenced, where Dr Mate noted in the AI episode of this podcast series, there are remote care and healthcare tools that began expanding during COVID that are helping older people and their caregivers to get care in the home.

That's one place that I would say it's not appropriate for everyone who's in a real acute hospitalization, but for home-based primary care and for certain conditions where even hospital-level care could be done at home—hospital at home is a fantastic program. And they rely on tech that's not necessarily AI, but a lot of the virtual telehealth kinds of options.

There are also wearable devices that can provide monitoring for falls and for other health risks. And there's a whole fairly new set of smart home technologies that many of us use for convenience that can be life-changing, especially for a long-distance caregiver. We're also starting to see a lot of care coordination and caregiver support apps and online programs for things that range from medication management—that might have been helpful to you at the time you're referencing—to emotional support or support groups, say for caregivers, to even things like exercise, which speaks to that mobility item.

I actually just started attending—there's a service called Vivo—and I just started going to those with my mother. It's largely for older people to focus on—it's an online program to focus on physical exercise, and it's a small group format as many times a week as you want to or are able to join. I do it specifically to get my mom on there for her own balance, and she'll join because she wants to see me. And the instructor does a phenomenal job of speaking to each individual older person about what their issues are and giving them exercises that are specific to their needs and keep them safe.

For example, an older gentleman last week had just had surgery on his eye, and she said, “I am going to give you options that do not ask you to bend over in any way.” Only after checking to make sure that he was cleared to even be there, which she did, and he said he'd been cleared.

So I'll just note that AI and other tech are absolutely going to change everything for all of us, including older people and caregivers. And we're really excited because we just awarded a grant to UT Health in Houston that is using AI to facilitate asking and acting on what matters, that “what matters” piece referenced in the Four Ms.

Older adults, before they get to their healthcare visits—so right now, if a healthcare provider is age-friendly and asking about what matters, that information might be recorded in a note, but it doesn't really lend itself very well to actual documentation in an EHR and changes in treatment plans or care plans. So using an AI tool over the phone, an older person can have a conversation about their goals and preferences with this AI chatbot—it sounds just like a person—and then seamlessly integrates that into the electronic health record, the EHR, and translates it into a recommended care plan for the clinicians.

So that's just one example of how tech is going to simplify, streamline, and help to spread age-friendly care for older people that ultimately helps caregivers as well.

Pathak: Yeah, that's a really great example. And I think just reflecting on what you're saying, where tech and AI have the potential to really help personalize care—so take recommendations that are helpful at a population level, take that best-practice information, and then help create strategies or help ensure that the care plan is really individualized to that person. That's where these technologies really can shine, it sounds like.

So then let's move to, in our scenario, post-hospitalization—but this can really happen anytime—I always notice a spike in random text messages or worrying letters that are sent to me from undisclosed senders, where they're somehow aware that my loved one has recently been in the hospital, and they're asking me for money or they're telling me that some very important piece of clinical history is needed. And then I might get some sort of durable medical equipment or something else. So let's talk a little bit about protecting older adults from scams, which we did cover in one of the episodes of this series as well.

Snyder: Yeah, I think everybody needs to realize that. It can happen to me, it can happen to us. This is a problem for all of us. I actually recently had one of those issues as well, and my own family has. Well, all of us ultimately are gonna encounter these kinds of things. Scams and frauds are so prolific right now, and so sophisticated in part because of the AI that we just discussed, that all of us have to expect it.

We need to have those conversations with the older people in our lives and make that kind of conversation normal and routine. And we need to not just cover the basics, but do so repeatedly because these things are evolving so fast. It includes understanding the red flags associated with the sense of urgency we see so effectively used in phone calls and emails and letters that prey on our sense of fear. Any of that sort of, you must do this now or else you're in trouble, you must do this now, or your family member is in trouble. And as Bob Blancato, who is the guest on your scams and fraud episode, shared, all of us have got to encourage the reporting of those scams to the authorities.

There can be a lot of discomfort, even shame, in admitting when you've fallen for a scam. But honestly, if we don't report it, we're not gonna be able to do what we can to stop those bad actors. Bob also pointed out in that episode how social isolation comes into play with fraud and with scams. And for older people, if they live alone or if you are caregiving and you are isolated with the person you're caring for, they're gonna be at much higher risk, 'cause you have fewer people to reach out to to discover what these scams are. And you're also going to be seeking a certain level, or more likely to seek a certain level, of interaction.

So there's a whole new wave of programs happening to address the social isolation piece, including some that we're funding, which we think are going to make a difference in preventing all kinds of fraud and abuse. And we're really eager to see where those lead us in the programs out in our communities that support older people and promote connectivity in a variety of different ways.

Pathak: As we've had this conversation, so much of what we've talked about is, you know, whether you are sort of at risk for falling for a scam or just struggling with the acute care when things are urgent, sudden, it's really hard to know exactly what to do. And it all speaks to the power of preparation. So really kind of having thought through some of the scenarios that you might encounter as we age.

So can you help us think about preparing for aging? So for families who want to be proactive, what are some of the most important steps that people can take now as caregivers with their loved ones about aging and future care needs that one might have?

Snyder: It's a great question, and the first line of answer I will give is something every one of us who's ever flown in an airplane has heard before, which is put your own mask on first and then help whoever you are with. It sounds really basic, but it's so true, and it can be especially hard to do when you're in a really complex caregiving situation with an older person who's struggling or suffering.

I think that it's a natural instinct for many of us to put the other person's care first. And I just wanna point out that if you are not well, then the person you are caring for is at even greater risk. You yourself are a twofer if you are a caregiver. And so from there, I'm gonna go back to this concept that we've already referenced, that if you're a caregiver, you're not alone.

You can join caregiver support groups as a way—a really powerful way, honestly—to support yourself and learn about not just the fact that you are not the only person out there, but learn from other people what has worked for them, often from other people who have gone before. Finding community that knows your struggles can really help to alleviate the burden, reduce the stress, help with certain elements of depression, and this is backed by evidence. A lesser-known way to get support is called respite care. So respite programs provide essentially a break for caregivers, and more programs are being offered as a way to let caregivers get recharged.

So again, I referenced earlier the Elder Care Locator. You can use the Elder Care Locator to find your area Agency on Aging, which will know about the local respite services available to where you are. And then there's another organization I haven't referenced yet called the ARCH National Respite Network, and they can also help with respite. They have an online respite locator service, and they can connect you to state respite coalitions as well.

Pathak: That's really, really helpful. And as you were talking, I was sort of reflecting on my brother and I, who both share caregiving responsibilities for both of our elderly parents. And I would say probably the person who does the least to put their own mask on—and this is really a testament to him—is my brother, who will just be there at the drop of a hat, middle of the night.

He has this intense feeling of guilt, I think, when we talk about it, that he's got to be there. And some of this is sort of cultural components as well. So I think really thinking through preparing for aging care also means you think through some of these cultural pieces and work through that as well. I think he's always kind of seen himself as, I'm the son of the family. They should be with me. This was the plan for the long term for their retirement. And I think that that piece also needs to be thought about before you're sort of in the urgent throes of caregiving. So I just would love your kind of reflections on cultural components to these pieces as well.

Snyder: Yeah, I think that's a great point. In some cultures, people are very familiar with the concept of talking about these kinds of things, and in others, not at all. So culture is another place where I'd say that this is both unique, because there are different kinds of cultural foci, and also universal, because you're not gonna be alone. There will be other people from the same culture who are dealing with similar issues.

I think an awareness of what the culture is and how it will impact your own and your family's expectations is key here. And in your case—or in your brother's case, maybe I should say—being able, knowing that in advance, and being able then to sort of talk through it with him, tell him to cut himself some slack, show him he's not alone—all of these things will be enormously helpful for each of you as together the caregiving unit.

Pathak: I love that point, and I love what you're saying about having these conversations early as a unit with everyone that you anticipate—or everyone that's anticipated—to be part of these care decisions as life moves forward, and recognizing that these conversations can be uncomfortable or emotional when your elderly loved one is perfectly healthy and you can't even envision some of these changes happening. So how should someone start having this conversation—talking about aging, talking about long-term planning—with a loved one?

Snyder: Well, I think it always starts with what matters most to you. That's sort of the top-line note. So I would say first, start small. A conversation about aging doesn't have to begin with these huge, major life decisions. It can and really should be as simple as asking certain kinds of exploratory questions.

Have you thought about what you'd want if something unexpected happened? What do you hope your life looks like in 10 years? How can we help ensure that you stay independent and active? Because that is what most people ultimately will want.

And then I would say, as you have those conversations, focus on values, not on the exact solutions. And that's harder for some of us than others because we wanna solve a problem. But really this is about values. So instead of leading with, we've gotta talk about whatever it is—assisted living—try what's most important to you as you age.

And then I would also say bring in some outside perspectives where appropriate. So sometimes older adults are more receptive to advice from doctors or from faith leaders or from their own peers than from their children. And that can be cultural as well.

So the other thing I wanna note is for caregivers to remember that this is a marathon, not a sprint. So the best approach really for all of us is to start early, to revisit the dialogue. It's not a one-time conversation and done, because people's responses aren't gonna be static. As health and finances and personal preferences evolve, families should be prepared to the best of their ability to check in and say, are your goals still the same? Do you feel supported in staying active and independent? And is your healthcare meeting your needs? Because there are ways that we can reframe some of that or approach it differently.

So again, that four M's framework can be a guide, ensuring that care plans and life choices align with what matters, safe medications, cognitive health, and mobility. And at our foundation, we emphasize that the best plans are flexible and put older adults at the center of decision-making with their caregivers, where and when they exist, always.

As a part of that, I'd love to talk a little bit about some do's and don'ts as part of these—

Pathak: Please, yes.

Snyder: A couple of dos. First of all, do start early, as I referenced. Don't wait for a crisis. The sooner the conversations begin, the more choices will remain open. Secondly, ask, don't assume. So it really does help in these instances to begin with open-ended questions, like what's most important to you as you age, and then really listening.

To the extent that we can, family dynamics can sometimes get in the way, but try to acknowledge feelings, validate concerns rather than rushing to solutions. And I'll just say that sounds like it should be easy, and it's not for many, many people.

A couple of the don'ts are sort of the opposite of the dos. One of those is don't be directive or controlling. Try to avoid phrases like you need to or you should, and instead center the conversation on their choices and their preferences. Don't wait for the emergency to happen. Those high-stress situations make decision-making harder, and for a lot of us, much more emotional.

Don't overwhelm them with details. Conversations ideally should unfold over time, and that's why not expecting to have one big, “the talk” kind of conversation makes a big difference. So focus on, as I said, values first, logistics later. And then don't ignore emotional cues. So if someone is shutting down, if someone starts getting defensive, step back. You can revisit it again when folks are ready.

So when you frame that conversation collaboratively and with care instead of as a we're gonna make a decision now and then you're gonna do it, the whole family has a better chance to ensure that older people feel heard and respected and empowered, and that caregivers therefore have a smoother journey also.

Pathak: Yeah, that is so helpful and so practical and so real. Because when you think about having “the talk,” as you said, and making some decisions, it completely eliminates the ability to recognize that this is going to be something that you're gonna come back to very often. You can't really think about every potential scenario, and that there are so many factors that are gonna change.

So I love how you said really center values. It's sort of like a birth plan—like we all might have one very clear idea of how we'd like everything to go, but you constantly need to reflect and recognize that these things will shift in real time, and there'll be so many new inputs that will shift and change how you're looking at the situation in front of you.

And then I'd like to take it to something else, 'cause I think a lot of us think of healthcare, medical care, as okay, I have this condition, this is how I need to treat it. And really, as we get farther into complex care—aging really—when it becomes very complicated and there are so many different pieces, health pieces, that might be interacting with each other, thinking less about the condition or conditions and thinking more globally about how can you manage symptoms, what's gonna be most helpful for your quality of life.

And that's where I have found palliative care teams to be so helpful. And we've had an episode about palliative care and palliative care messaging as well in this series. And I think it's still so misunderstood with regard to what it means. And does this mean you're giving up? So can you talk to us a little bit around palliative care and why you think there's still so much confusion or stigma around this type of service?

Snyder: It's a great question, and I'm glad you had an episode specifically on palliative care. Tony Back is a fantastic clinician in this area. Palliative care, the term in and of itself, is one of the issues, right? Surveys have consistently shown that palliative care, those two words, remain a pretty unfamiliar term to the majority of people in this country, but that when it's explained, the benefits of what palliative care can be, people overwhelmingly want this kind of care should they face a serious condition.

So I just want to describe it for a second. Palliative care is specialized medical care for people who are living with a serious illness. It's focused on providing relief from the symptoms and the stress of the illness. The goal of palliative care is to improve quality of life for both the patient and the family—so back to the caregiver piece as well.

And as they say, palliative care can be delivered at any age and any stage of illness. It does not mean that you are stopping other care. It can and often is delivered alongside other and/or curative treatments.

So the stigma around palliative care has to do with an incorrect association with end-of-life care. It's not untrue that palliative care is good at the end of life—it is an excellent course of care for many people at the end of life—it just isn't the whole story.

So in our culture, we don't like to think about or talk about death. And we haven't mentioned it here, but should note that the same is true about aging. We have some very deeply ingrained negative views about getting older, and ageism itself is a barrier to much of what we are discussing today. But palliative care itself is actually a plus for people who can get it, and most of us would want exactly that if and when it's needed.

Pathak: Right, and I've certainly found it as it's an add-on to the care that your loved one is already receiving to manage their conditions. And this is really just a way to center: are we thinking about the whole person and not just a particular condition or disease state? Are we thinking about the other symptoms that actually I've seen impact life so much more, like constipation or urinary retention because of certain medications, or the ability to get up and not feel dizzy?

And I think sometimes we think of that when we're younger as just sort of, okay, these are side effects, I'll have to figure out how to manage them, or these are side issues as long as I'm kind of managing the main condition. Really, this is the core of how well you're able to get through your day-to-day, at any age really, but something that we really need to be keeping track of and thinking about. And I think palliative care helps you refocus on some of those pieces as well.

Snyder: Absolutely.

Pathak: Well, I just wanna thank you so, so much for your time and for really helping us think back on all of the episodes, all of the conversations that we've had in this series. And so as we come to the close of our time together, for listeners who wanna keep learning after this series, how does The John A. Hartford Foundation serve as a trusted resource for older adults, caregivers, families? You've given us so much information about the work that they do. Where should people go for more information?

Snyder: Well, I wanna thank you, Dr Pathak. It's been such a pleasure speaking with you. And people can go to learn more about age-friendly care and find resources here at WebMD.com/age-friendly or on our own website, johnahartford.org/age-friendly.

And I would really—since this podcast is for the public—I would encourage everyone to start by learning more about the four Ms of Age-Friendly Care. You can check out that resource I've referenced called My Health Checklist. I, on more than one occasion now, have brought it home when I have visited my parents, 'cause we don't live near each other, and sort of just surreptitiously dropped one on the counter so that they can have that and really bring in those four Ms principles to any of their appointments or any of their interests.

I would say that every single one of us deserves age-friendly care. Age-friendly care is not just best care for older people, it's best care for all of us. It's just more important for older people who, by virtue of age, may need it more.

And then last but not least, I just wanna make the point that I already said and which I think speaks to all of the comments and great things that you've already shared, which is that it's really very much about aging with intention rather than reaction. That's what all of us want for our parents, ourselves, and honestly our children when they get there.

Pathak: Yeah. Thank you so much for such a powerful conversation. And I just wanna bring it back to what you said earlier around purpose and how you found purpose in this work. And I find so many of your resources give me purpose when I am in the hospital, sort of sharing what has worked with the hospital staff.

And so I'll send a message to the administration too when they've done an amazing job and just said, “Hey, this really kind of connects with what The John A. Hartford Foundation says about age-friendly care.” And then it's helped me when I'm upset about some of the care that we've received really be very concrete about things that can be done to improve care for the next patient, for other aging patients. So I wanna thank you so much for all the work that you do, the Foundation does, because it really does make an impact for people.

Snyder: Thank you. I appreciate your having me.

Pathak: I'd like to share my three key takeaways from this episode. First, you are not alone, and help is out there. If there's one thing I want every caregiver listening to hold onto today, it's this: what you are going through is not unique, even when it feels that way. There are 63 million caregivers in this country—that's one in four people—and there are real, concrete resources available to help you right now.

You don't need to feel isolated and alone. Start with the Elder Care Locator at eldercare.acl.gov and find your local Area Agency on Aging. If you have a loved one that has dementia, check out BEST programs for caregiving for evidence-based support. It might be your first time navigating the caregiver experience, but you don't have to figure this out alone. There are resources available.

Second, the four Ms of age-friendly care are your roadmap to better care and quality of life: what matters, medications, mind, and mobility. These are important to discuss with your loved one and with their healthcare team. At their next appointment, ask the care team: are we honoring what matters most to this person? Are these medications appropriate and safe? How is their cognitive health? What can we do to better protect their mind? Are we supporting their ability to stay active and independent and optimizing their mobility?

You can find a free tool called My Health Checklist at ihi.org to help you prepare. These four questions can fundamentally change the quality of care your loved one receives.

Finally, by starting the conversation now, you can help your loved one age with intention versus reaction. The single most powerful thing you can do for yourself and your family is to start having conversations about aging before a crisis forces your hand. This shouldn't be limited to one big talk. It should continue as small, ongoing conversations centered on values, not logistics.

Ask them what matters most to them as they age. Ask what they'd want if something unexpected happened, and don't overlook palliative care, which is not about giving up. It's about ensuring that your loved one's quality of life is at the center of every care decision at every stage.

Please make sure to listen to all six episodes of this podcast series created in partnership with The John A. Hartford Foundation. We've touched on so many important topics, from the role of AI in helping older adults get age-friendly care, to scams and fraud in healthcare, to advance care planning strategies.

To find out more information about The John A. Hartford Foundation, their resources, and to access all of the episodes we've made together, make sure to check out our show notes.

Thank you so much for listening. Please take a moment to follow, rate, and review this podcast on your favorite listening platform. If you'd like to send me an email about topics you are interested in or questions for future guests, please send me a note at [email protected].

This is Dr Neha Pathak for the WebMD Health Discovered Podcast.