The Aging Consumer Market | Tom Hartwig, PhD, Mature Living Environments

Speech to text:

Mike Koelzer, Host: [00:00:25] Tom for those who haven't come across you online, introduce yourself and tell our listeners what we're talking about today. 

Tom Hartwig, PhD: I'm Tom Hartwig. I bring you a good deal of graduate training, but also maybe more importantly, uh, 30 years in, uh, longevity and gerontology, uh, including working with pharmacists almost all those years.

The average length of life is increasing dramatically. Uh, and there's a lot of implications for, for healthcare in general, behavioral healthcare and, uh, pharmaceutical care. So that's sort of the conversation today. It's a topic I love to talk about 

Mike Koelzer, Host: when I was younger, my grandma, my grandma bore B O H R.

Whenever I looked at grandma, she looked like a grandma. I think she lived till she was like 93 and she'd look like a grandma probably from the time she was like 50, you know, mm-hmm she had these big clunky black shoes on and the nylon stockings around her ankles and a sundress on, and her hair was, you know, white, but not really curled or anything.

And she looked old forever. And I look at my aunts for an example of people who are older and I'm always like when. Are they gonna start looking like grandma boar and they don't though. I mean, people look young. To the grave almost. They never turn into this grandma look for me. And I can just tell that the generations are getting, you know, closer together.

Well, 

Tom Hartwig, PhD: Mike, there's so much of that and I swear your grandmother. Uh, we may have a grandmother in common because that's the, that's the prototype of my own grandmother. My Irish grandmother. There's a lot of things that are affecting that one there's as, you know, dramatic improvements in medical technology and healthcare, uh, overall, uh, and the pace of innovation is increasing.

Uh, research says right now about every 18 months, there are major breakthroughs in terms of everything from, uh, pharmaceuticals to, um, genetic research and treatment. And, um, the other thing that's happening is, uh, if we look at the generations past, uh, most of their activity and it's really fascinating, and that was global tended to be outside, tended to be manual for both men and women, uh, different, maybe different work, but it tended to be manual outside, uh, depending on where you lived, Michigan winters, Florida summers, uh, go to the far east, uh, And, uh, climates vary tremendously.

The other thing we didn't have is the kind of, uh, dermatological care, the kind of sunscreens, the kind of vision services, um, that basically allow us to, um, Age, uh, relatively well, and then overlay on that, the fact that, uh, seniors, as let's just define it, arbitrarily, cuz the term terms have been evolving along with, uh, your grandmother's look and mine.

Um, the available number of resources for seniors, we, by and large, is 55. Years of age, plus has far more discretionary resources. Historically, the resources, their time and their money went towards survival, went towards making it all work, whether it was the farm or an auto business or whatever they, a pharmacy, whatever they had.

And now we have. Uh, more time, more resources, some of us in relative terms, some of us not, uh, I don't wanna over generalize, but we basically have more opportunities if we choose to take care, uh, of ourselves, our skin, our hair, our pharmaceutical care, um, our lifestyles. And so we are, we are looking different.

The other thing that research tells us, and we know this is. You know, I got off of a bike trail this morning after about 20 miles and I couldn't believe the amount of gray hair I saw on that trail. It's becoming a new day, but I always caution people. We shouldn't take too much credit for that because my grandmother and my grandfather looked much like yours and others that may be listening, they needed to work manually.

They needed to work out in that climate. Uh, they made a go of it, uh, during wars and depressions and. In their later life, sometimes physically, like you mentioned, the hair, your skin quality, even, even the dress in terms of what what's, what was available or affordable things have changed. 

Mike Koelzer, Host: I think about my grandma, as you're mentioning here, I think about her.

I know in their basement before she died, I know they had one of the old wringer washing machines. They didn't have air conditioning. And so their dress was almost more industrial. You know, the shoes had to be clunky to get up and down the steps 10 times a day and their hair, you know, when you're sweating, the ladies are kind of [00:05:25] pushing their hair back outta their eyes.

And so on. They're not worrying about having it curled and you got the sun dressed on and things like that, just because of the heat. And so they just worked a lot. 

Tom Hartwig, PhD: Very strenuous work, women and 

men, 

Mike Koelzer, Host: The part I don't like hearing about 55 year old people like me are now old people. Now that can't be right.

Tom Hartwig, PhD: Um, no. And maybe, uh, no, just the opposite. Um, programs for seniors 20 years ago, uh, started at 60, 62 plus. Then we saw them go down with the term senior 55 plus. And now the terms, you know, if we look in one generation, the term senile. Elderly seniors, they're all fading away. people don't want to be termed in those ways.

And we know that's true ethnically and racially. I mean, there are some, the terminology we're using in our entire society is changing. 

Mike Koelzer, Host: As you said that I was thinking, and I said, okay, I understand senile and that, but then when you got to senior and elderly, I'm thinking now, what else do we call them at this point?

If it's not elderly and seniors, 

Tom Hartwig, PhD: Maybe we don't need a term. 

Mike Koelzer, Host: Oh, there you go. Just as we don't, when we see someone who's, uh, 30 or 40, we don't say, oh, there's one of those, uh, midlifers mother age people, you know, whatever you, maybe you don't need a term. That's really 

Tom Hartwig, PhD: interesting. I think both marketing, but also research supports that I remember at one point saying to someone, I think they may have been three or four, you know, how's it feel to be a little kid these days?

And they said, what do you mean little I'm four. And it was the term they were reacting to. And so, you know, what we do at mature living environments is, um, both with our maturity market initiative and our homes for independent living is we tend to avoid terminology and if somebody needs to use it because generationally it's familiar, if there's a program that needs a title like geriatric long term care, uh, we get that.

I think we're evolving fairly rapidly now in the marketplace. And I think within a few short years, and by that, I mean five or less, I think we'll see terminology, not. Uh, classify people by what we used to call a cohort. That's a cohort is a group that has something in common, moving through time. And as we know with people that walk into any door, including pharmacies, a 65 year old isn't a 65 year old.

Isn't a 65 years old. I mean, I work in Florida, uh, off and on, and there's a fellow. I don't swim. But he's probably 82 and he can out swim me in a heartbeat and he probably looks better than I do. 

Mike Koelzer, Host: People maybe now are grouped by interest and maybe physical capabilities and maybe, you know, things like that, but not necessarily focused on the age itself.

Tom Hartwig, PhD: Yes. Um, unless there's an external reason for doing that, an example we could call, uh, I love to bike and many others do too. And it's gotten to be, as we know, for people that have arthritis or some, uh, challenges, and some of them may be age related. It's a sort of almost a non-weight bear. Exercise.

That's really good for us. Well, occasionally you'll, you'll hear, uh, as you know, there'll be a, uh, senior bike ride because the sponsors needed some cutoff at, you know, age 60 for competition purposes or something, or the senior Olympics. So, but those are more and more arbitrary, uh, and, and they tend to be more and more, uh, for causes third party, not specific to, to the age.

Mike Koelzer, Host: Marketers are probably ones that do want to group us because then they can show these rate cards, you know, to the different companies that are going after certain demographics. 

Tom Hartwig, PhD: Yeah. Uh, a quick example, uh, to support what we're talking about. Um, I know a colleague who was hospitalized with COVID for five days, temp, 104, and all the classic symptoms in a major hospital, which will go unnamed.

Admitted for those four or five days, one night, uh, happened to be a nurse came in and, uh, he had heard, uh, you know, some upheaval on the unit and she said, well, you know, this is the geriatric unit. And there's three people tonight that are here with Alzheimer's disease and dementia, and they're terribly confused.

And they're agitated. This guy was like 61, maybe 62. And the term psychiatric. You know, he thought, what, how did I get here now? In reality, we know beds were probably limited and maybe his placement non COVID days would be different, but. [00:10:25] All to say. I, I think the terms in the marketplace, as well as some of the stigma that historically went along with those terms, I, I really think they're going away.

And I think a younger generation is, is helping drive that I've heard 

Mike Koelzer, Host: that the generations because of society are a lot closer. So like in the old days, when you had a 20 year old and a 60 year old. That was 40 years apart. And now, because of social media, that 40 feels more like 15 years. It's like all the generations are smooshed because of society.

And for example, you know, people pick up slang easier and things like that because everybody's kind of like in this bigger conversation, more Squitch than you did years past. 

Tom Hartwig, PhD: You know, that's really interesting that you bring that up, Mike, because, uh, we do a lot of care planning, uh, for people as part of our service.

And, um, there's a real mix of opinions about social media right now, and neither voice we're hearing in the marketplace. Is it correct or incorrect? I should preface it that way. It's a real dynamic now that is working on getting resolved and is probably gonna take a couple of years if not a little longer, but here's what it is.

And it's very interesting. Some people feel social media allows given all the changes and the impact of COVID, uh, for families to be either generationally or closer in terms of, uh, membership and communications. I have heard from other people that I would take six tweets, set them aside for one, one hour, visit with my son, help me do this or that, or my daughter do this or that.

And one of the things that we've heard around communication, especially with older people, and this has implications for pharmacists clearly is, uh, since by research, uh, human communication is, uh, 70 to 80%. Behavioral or visual. When we talk about social media that goes away, we don't see the gestures. We don't see each other's eyes.

We may hear sadness. We may interpret sadness, but sometimes that's our reading because we don't see anyone. Now. Now zoom has helped with that, where you get a visual. Certainly zoom has helped and technology has helped a lot of people, uh, families and especially people with advanced age. Maybe isolated people have some contact in many ways they wouldn't.

So it's not a categorical negative to social media. It's probably more just a limitation 

Mike Koelzer, Host: as I watch movies sometimes. I'll see online, they call 'em movie cliches, you know, and certain movies. They always have the bad guy, you know, the bullets run out, you know, that's a cliche in a movie and there's a ton of other ones.

It's like, yeah, you see those in all the old westerns or you see 'em in all the chase movies and different things like this. What are some cliches? You'll see, maybe in the movies for the older generation that Hollywood doesn't wanna let go of, but you say that's outdated or it's almost derogatory. Do any of those come to mind?

Marketers and Hollywood that they want to grab onto that are just not that way in reality anymore. 

Tom Hartwig, PhD: Some of the stereotypes of aging, um, in Hollywood, in general and in the media in general, that really need to go away are one, uh, that a diminished capacity of people as they age is like a straight line down.

There's a lot of research. This says now it's, it's more like the waves on lake Michigan. Um, and, um, that it's not a straight line down at all. The cliche would be, well, don't go talk with grandma. She's having a bad day. The other is, uh, references to a memory. Well, they wouldn't remember anyway. Both with short and long term memory minus the impact of cognitive processes or diseases like, uh, dementia, uh, can sustain themself because today people in advanced stages and let's just say, Over the age of 55, as we were talking about earlier are more active.

They're healthier. They're better educated on the whole, whether it's formal or informal. So it could be a school education. It could be a military education. It could be, uh, 30 years on the farm, making sure everything works and grows. Um, they also tend to, um, they're more informed, so they seek information and, um, they're more mobile, geographically and personally, uh, physically in terms of ambulation and mobility.

Um, Our our overall emphasis with, uh, [00:15:25] especially with their homes for independent living program, is we all wanna, we all wanna be at home for as long as humanly possible and we're right on the edge of being able to do that short of intensive medical care near the end of life. 

Mike Koelzer, Host: I've heard before that prostate cancer, it's like, everybody's gonna get prostate cancer.

It's just that people don't live long enough to see it always like everybody who's a hundred would probably have prostate cancer talking about. Memory does to advanced aged people. Is it a given that memory starts declining as you age? I mean, I saw it in my mom and my grandma, and I think part of that was just their genetics.

Is that a given that memory goes bad the longer you live? 

Tom Hartwig, PhD: Well, a little caveat, Mike, cuz that's a, that's a fascinating question. Um, what we know. Um, people over the age of 70, 75, somebody will say, well, boy, I, I don't remember Millie or Max, uh, being that ornery. Uh, cuz I knew him in school. Well, what we know by research is if people had personality quick quirks, when they're, if they had 'em you're old, they had 'em when they're.

Mike Koelzer, Host: The lines that you thought were parallel to the rest of the world were not paralleled; they're at an angle, but as they get older, the angle gets bigger. 

Tom Hartwig, PhD: Oh, sure. Right down to perpendicular . Yeah. Yet in reality, we know with healthcare and, and medicine that, that with vascular, uh, loss and limitations with, uh, The just the, the time, like with the yellowing of the eyes, uh, with age there's some, there's certainly, as we know some realities that also apply to memory, it also is interesting as it relates to, uh, younger people and my, uh, quirk about if they had a.

Odd personality when they're old. They probably had one when they're young. If they do, they may have had bad memories, a good deal of their life, but it wouldn't be so apparent and people wouldn't be so likely to dismiss it because now they're older. And the, one of the things I loved about my training at the Institute of gerontology, uh, and one of the things that, uh, one of the granddaughters of the founders of Steelcase in grand rapids, Teach about this was K P Walters used to talk about, let's talk about ability, not just disability or limitations.

And she did a lovely job, uh, through time. Of, uh, talking about if you didn't exercise, for instance, your memory throughout time, you're gonna be more likely to lose it the same way as if you didn't exercise your legs or your arms, you're gonna have more limitations as time sets in and with some arthritis and some vascular limitations possibly.

So part of it also depends on how we exercise our memories. That's why, you know, I had an experience the other day and I thought it was interesting. It was from K pharmacy down on Plainfield. I've been with them for about 30 years. I've heard the owner of that as an asshole. Well, I see his picture at the post office, but other than that, uh, and Purdue, university's still looking for him.

Oh, here you go. He evidently has some kind of degree that they question, but yes. Yes. This is all in fun. That's not true, but she took time to deliver. A prescription, uh, to talk about where I was living in a little bit about, uh, my history and I talked to her about hers and it was a five minute conversation.

So it was efficient from a business standpoint, but at the same time we were talking about our memories at all. So one of the things that I really encourage young people to do. And this flies against some of the wins of social media when you see dad or mom, grandma, or grandpa, aunt, or uncle friends across the street to take time and say, what was life like when you were six?

I mean, those kinds of exchanges are getting lost, and they exercise memory. 

Mike Koelzer, Host: I've seen this online a little bit. They talk about, you know, regrets of the elderly or the advanced aged. Whenever I think of some of my regrets, sometimes I have to say, yeah, but that might be a regret now, but in the midst of it, you did as well as you could, you know, you were in a dilemma and you didn't have a million options.

You had two and they were both kind of crappy options as you're talking to the elderly, what are some of them? Uh, regrets that you hear from them ever. And are they legitimate regrets or are they regrets that the marketers seem to have shoved in their face? You know? So they feel like it's a regret. What kind of things are you hearing from our [00:20:25] advanced age family?

And so on, on regrets in 

Tom Hartwig, PhD: life, you know, this is a whole nother broadcast or series of broadcasts because that is such a magnific. Question. And it has so much impact on people's wellness that it gets overlooked. I'm writing a book on, um, relevance as we age. Oh, oh. And how people feel, or don't feel relevant to the environment and those around them anymore.

Um, it's, it's interesting. We hear a lot about regrets and one of the things, when we do, I encourage the team that works with me to take a little time. Because someone may be depressed. They may, uh, be having a day in which they sort of feel melancholy or just gray. It may be a bad weather day. They may have had something they're not talking about.

It could be as you know, biomedical, it could be, uh, Endogenous as we call it all sorts of options. But what I hear about regrets are things that are tangible, uh, two quick examples, a business decision, looking back, knowing what I know now, uh, I would've made a or B. Or gee, during my divorce, if I wouldn't have had to work to support the family and get through the transition, my son or daughter may not have turned out a or B.

Um, and so a lot of the regrets tend to be tangible and the value of hindsight and there's, there's a marvelous, uh, Ted talk on. Uh, compassion. And it talked about people who are known to be compassionate, uh, doctors, pharmacists, um, ministers, rabbis, uh, and many others that, and, and many people regardless of their profession are compassionate.

Compassion turned outward is a wonderful thing towards all of those around us, but then sometimes what I had to remind myself about. And then that's where this Ted talk hit was. Self-compassion is very rare where we say, damn Mike or Tom, you did the best you could in that business decision, in that divorce, in that experience in the group, whatever it was, uh, with a customer, a patient.

The judgment, the regret you have is the value of hindsight. You have much more information now, your world is much wider now. So let it go. And the hard, the hard thing for all of us to do. And it, I think it's harder when you're older, because you have more volume, you have more experiences you think about, and I wanna overlay them.

And I want to do this with caution, but, uh, religion, both, uh, formal and informal in terms of what people believe, or I have faith in can either help that out or make it very complicated in terms of how they approach guilt. And, uh, my own clinical experience over the years has been one of the biggest detriments, in my opinion, to people's behavioral and physical health.

Feeling guilty or responsible for things they never had control over to begin with, or at least didn't have as much control as they needed to make a difference. That's a fascinating question. We 

Mike Koelzer, Host: all are. We're always harder to run ourselves. Like I think back when I was like 25 and I think what I expect the same from my son or daughter, would I expect them to know what to do in the similar situation is like, no, I'd be compassionate to 'em I'd say, Hey, this sucks.

What are you feeling about? But we don't do that to ourselves. All right. We've gone down the, uh, the social psychological aspects of things go into some of the nuts and bolts of living. As we age, I got some friends that are building a house we're in our mid fifties and a blink of an eye. We're gonna be, you know, 70 and need some of the things in the house.

So. I'm thinking real easily, you know, like not a lot of steps, a pretty big bathroom, that kind of stuff. What do people have to know that we should be doing physically in our 

Tom Hartwig, PhD: homes? One can do a lot with their home. However, they define that. From public housing to an elite condominium. So let's use home in the generic.

That's my second book I'm writing about, how people define the importance of home regardless of, uh, the type of setting or the characteristics. Okay. To answer the question. One thing is if we think. At a younger age, however one defines that, that we're gonna be staying like, uh, I do in my current home in Michigan as I age, uh, and my wife and, um, my kids are all over the country.

Now our kids, then we approach it as that, that [00:25:25] investment is valuable. So when we, uh, renovated the house, we made sure that those things you mentioned got done and okay. Times are tough economically for people, but at least get the plan. One of the things we do is we'll develop a plan for people. , they don't have to do it all at one time.

They don't have to bite the bullet and pay a contractor. The other thing we do is we make the plan adaptable to future changes. Uh, example, uh, in my family there's dementia in my family, there is, uh, mobility issues. So as we go in with people that are clinically. And sit down and say, what's ahead. I just interviewed somebody. He's 45, he's got four kids.

He was just diagnosed with Ms. He just bought a condo and he says, what can I do? And I said, well, let's develop a plan. So that's the other thing you can do is, uh, imagine adapting where however you define home, adapting that to future changes. You can't imagine now. You can narrow those down as to what's genetically more likely, which is what we do, uh, with family histories.

But you can also sort of plan saying, well, if we're gonna renovate, we're gonna widen the doors now. So our wheelchair makes it through. Uh, when we put in our shower, it wasn't just going out and buying a walk in the tub. We put in, uh, very attractive. We try to make what we do very aesthetically appealing, and the customer decides what that is, but we put it.

And the tile that's, is over a styrofoam block. And so at this point we have to have a rollin shower. We take that tile out, we cut out the styrofoam block. We put the tile back in, and we got a rollin shower. So there's some things like that you can do that aren't terribly expensive, but that, uh, are helpful.

The other thing I really wanna stress though, is right now, technology is a big boom, uh, a technology enabled home, whether that's $129 of. A smart speaker, connected to a computer system. Or a smart thermostat, which our son has that senses his movement. I think he paid $119 for it. It's paid for himself five times over in three years. We, we do, uh, also encourage people to infuse technology into their plan.

So the big thing is the plan. The other thing is it's gonna increase the value, whether people, uh, whether Tom Hartwig stays in this house, the remainder of his life short or long or not, it's gonna increase the value of the house tremendously. It's not 

Mike Koelzer, Host: like you're building the house for something that may never happen.

Let's say blindness or something like that, whether you're there or not, everybody is going to 

Tom Hartwig, PhD: aid that's right. And that, that's another thing, uh, before we leave the topic, I should mention when we, when we talk about a home being accessible, we think about. Uh, Mike or Tom owning the home or their family living there.

The other part of accessibility, we do a lot of work with the Michigan disability network, uh, young and old, uh, is it should be accessible to people that would visit. My wife has retired. Teachers that are, let's say 75 to 85. They're starting to have mobility issues and they like to visit.

They like to get together for retirement gatherings and stuff. And the good part of that is when we designed our house, we designed it. So it's not only accessible for us. It's accessible for family and visitors. We have a 

Mike Koelzer, Host: cottage about 30 miles north of grand rapids and, and it's, uh, relatively.

There's no steps and things like that. And something I tell my wife, I'm like, I don't want to get rid of the steps too soon because in our house we're three levels and you're up and down the steps 10 times a day. I think that's really good for me. I mean, it's not the ultimate exercise, but when you are up and down the steps, it's pretty good exercise.

And I think some of that can be let go too early and that might be symbolic. Other stuff that we let go too soon. And I think I've heard it said, they said anything that a person can do on their own, let them keep doing. And for this example, it's steps. 

Tom Hartwig, PhD: That's a great example and steps, as you know, are excellent exercise.

What we do is, uh, at a minimum maybe with, uh, your steps, we'd say, consider putting in an attractive handrail now, uh, nothing that looks institutional. Uh, our house happens to be Oak. And so our handrails up and down are Oak and they look fine. Uh, but I'll tell you, even at my age biking, like I do in fairly mobile, I've caught myself a few times with boxes going downstairs where I would've fallen.

So. That's one thing. The other thing we do is when we talk about adapting homes to future changes, I also have a friend and a [00:30:25] colleague who talked to me about getting a portable lift chair to go up and down his stairs. He's 60 something. And, you know, I said exactly what you're saying right now. That's great exercise.

Uh, as long as you don't think you're gonna fall, and if you do there's, you know, let's, let's get some, the right kind of handrails in cuz you can get the wrong kind of handrails. And I've seen people put 'em through, uh, drywall with plugs, you know, I. Ever wanna rely on anything like that. But all we did at his house is we put backers in.

So when he gets ready someday, if he stays in that house and wants that motor chair up and down, that 's not gonna be a great expense. We had to do some work on the walls anyway. So we just put the backers that such a system could eventually be installed with. 

Mike Koelzer, Host: What's something that people do? Hold onto too long in their home when they maybe should not have been in their home.

Let's say someone that falls down a hundred times a day and bloods their nose. Every time they fall down, I'm thinking, okay, they maybe shouldn't have been there anymore. What's something that people maybe wanna hold onto, but it's like, no, that should have been outside the home at a certain let's say disability.

Tom Hartwig, PhD: Boy, just wonderful questions. Um, and this one is tough for people cuz it, it, as you know, it just backs right up against that wall saying I'm gonna have to leave the place that I thought I could stay in forever. What we encourage people to do is exhaust every possibility to stay at home. And then there's a line and that line is dotted because sometimes people's health improves and quite often, and this is true.

This is true of people in my profession, yours and others, others docs, nurses, clinicians in general, small C is that quite often when we do a judgment or a diagnosis, we're doing it at that person's low. They just fell. So mom's got mom really? West we need to, I can't tell you how many times Mike, I've heard families say, we, we need your help.

Tom. Looking for assisted living. Cuz dad fell. Okay. Dad fell. Is he okay? Do he break his hip? No, he pretty badly bruised cut his head. Oh, okay. Yep. Band aids. Yep. Uh, cuz if. And, and there's a difference. I don't wanna be naive, but if a 21 year old fell, those are the kind of questions you have. Okay. So bones are, bones are more brittle, balance is disturbed.

Sure. So what can we do about that fall prevention before we talk about anybody coming out, same with a diagnosis of dementia. Well, we need to start looking for quote, dementia units. First of all, I hate the term, uh, but not dementia, but dementia units. So one of the things we need to change is our own evaluation of how serious the situation is at the time that something adverse or concerning happens and people react because we, we know, tend to overreact.

We do too. Uh, and some people underreact, uh, Um, that's the point in which we can be very helpful if somebody walks in the pharmacy or somebody calls us, uh, and say, well, let's, let's sort of take a look at the whole picture. 

Mike Koelzer, Host: Well, you're right. They're always going at the worst time and that's not a bad thing to do, but most of the time things get a little bit better after that first fall or something.

Of course, unless it's a, you know, huge diagnosis, but it's a good time to look. Not necessarily pull the trigger at that point. 

Tom Hartwig, PhD: Exactly. It's a good time to look and I would add it's a good time to plan this. This young colleague of mine was diagnosed recently with multiple sclerosis. It's a critical time to plan, not a time.

In addition to the, uh, effects, the impacts of multiple sclerosis as you know, to get thinking. Uh, while my, the quality of my life is over, uh, there's some remarkable as you know, better than I do, uh, interventions now for neurological disease. Uh, but one, one big thing about changing the house is, or changing that moment is just slowing down that evaluation process with people.

It, you know, if it's an emergency, you know, even if somebody breaks their hip. They will heal the, the statistics about how many people over the age of probably 65 get admitted for some adverse event, and then end up going to what we now call rehab, uh, in a residential setting, which is often a wing now of a long term care setting, or maybe an acute care hospital.

And then from there, the, the, the [00:35:25] statistic is alarming about how many people end up in long term care as opposed to going home. We just need to intervene. 

Mike Koelzer, Host: Once they go in there, then they get kind of stuck there because everybody gets used to 'em being there, kind of thing used to 

Tom Hartwig, PhD: them. And the family might be exhausted if it's, you know, been.

Emergency medical situation or a long time development. There might not be many families. 

Mike Koelzer, Host: If they maybe just would've had a breather, maybe we kind of could have recovered both emotionally and physically and then give it another shot in the 

Tom Hartwig, PhD: home. Well, you know, another interesting thing Mike, about home care is the number of children, uh, in this generation is about half roughly.

Of the number of children a generation ago, which was about half of the generation before that. Now those are, those are gross, uh, generalities, but generally true. Well, the number of caregivers just decreased each time by half too. And let's assume that of the half that existed through those generations, normally like in all families, one or two, there may be issues.

There may be geographical distance, especially these days. Uh, Geographical, there might be, there might be issues in which they're emotionally, psychologically alienated in the family. So the number of family caregivers has gone way down. It's not gonna happen in this economic environment, but I'm a big, uh, supporter of subsidized family, respite care.

And by that, I don't mean. Paying to take care of one's own relatives, because that then steps all over a remarkable value in this country and elsewhere about family care. I mean, as a last resort, if there's nobody else, if the resources aren't there and if it means somebody's gonna have to leave their home as opposed to spending a son or daughter to do the shopping and drive in from, let's say Lansing to grand rapids.

I, if there's $50 a week in the family, respite care. It's a much better plan for the society economically, but also in terms of our values, 

Mike Koelzer, Host: what's something that could kinda get under your skin a little bit, as you see something that, you know, could have been better 

Tom Hartwig, PhD: It's people that will make judgments about either advanced age saying, well, yeah, I would've asked him to go canoeing, but I didn't.

They'd be capable, you know, ask 'em to go canoeing and sit on a rock. If they're not capable of getting in the canoe and enjoy the outdoors and watch, you know, watch the fun along the 

Mike Koelzer, Host: river. What message would you like to get across to pharmacists as far as how they can make it? Someone's day is easier for an aging population, how they can maybe just make their day a little bit easier by talking more clearly or by being more patient or this or that.

And then secondly, I'm gonna say a younger pharmacist cuz I'm. Tired and lazy, but if you had a younger pharmacist who owned a business, what's gonna, boom, where should they be focusing and so on. So the two questions, one is how day to day can we interact better with people that are aging. And then secondly, where is that business opportunity?

Well, 

Tom Hartwig, PhD: Let's start with training. I was on the Ferris foundation board. For, um, six years. And as you know, uh, in addition to Purdue, I might add it is just a fine pharmacy school. And the Dean of pharmacy became a friend back then and we were, he did a nice job. Educating me about pharmacy and training a pharmacist that said, I think it starts there as you know, one is just in addition to technical aspects of pharmacy, get some knowledge about some, many of the things you and I have talked about today, but the stage and overlaps of human development, um, also train pharmacists at there.

And then it's also available in what I call the field once they're out and in the pharmacy, in the communication, challenges and opportunities they have with older people, you know, direct eye contact, watch the behavioral stuff. If you're comfortable with hand to hand contact. Um, and, uh, because touch being one of the senses, uh, stimulates, uh, the channels by which communication occurs.

So to train them about communicating, not only. Uh, people of advancing age, but also, uh, uh, people that may have linguistic, uh, challenges of one type or another, or sensory challenges, vision, and 

Mike Koelzer, Host: hearing. What's an example of that touch, you know, our pharmacy setup. What's an example of that? 

Tom Hartwig, PhD: Yeah. Well, I saw it at K pharmacy.

I saw it six months ago, elderly woman. She was very distressed. She was coming in to get her prescription, the, the. Uh, gave her the prescription and said, in addition to talking, uh, with the pharmacist, uh, however that occurs, uh, is there anything else we can do for you today? Or, you know, is there anything else we should be talking about and lift it [00:40:25] open ended?

That sometimes opens a door to, yeah, my husband's, you know, this bruise, um, or my wife pinched me or whatever. So, uh, one is that, you know, to reach out to the other thing. It's funny that we're talking about. I went to my dermatologist the other day and they had to remove the growth. In my hand, it was an ugly procedure.

And I thought, well, here, I'll put it up on this steel table. He took my hand and did the procedure. He was holding my hand now. Okay. We'll argue about the sterility of that, but I'll tell you that meant a lot. So there are things like that, that he didn't learn back in medical school. The other is, um, to be really astute about end of life issues and ethics.

Um, and I think most pharmacists from my experience are, and they're often as you well know better than I, not the primary agent at that point, but they're in the care linkages to the person, uh, and pain control and palliative care is calm is comes so many light years. I think pharmacists and training should also spend some time on, uh, let's call geriatric medicine.

Let's use the term specific diseases like dementia, sexual function or dysfunction arthritis. I think that that goes a long way. In terms of the business side. That's what our maturity marketplace initiative does. You often hear people say, well, I'll. A big box store. I won't use names and boy, I can get it for 15% less.

Okay. Fine. Well, I can get someone from K that if I'm injured on my bike and can't get out, will drive it up, put it at my door, ring the bell and wait until I answer and talk with me. Not just stick it in the mailbox. Um, and so I think about starting a business, um, how you lay. Your pharmacy physically is important.

So let's go back to how people define homes. So it's welcoming and it's functional. Uh, some of us, uh, inherit the structures we got, but there's a lot we can do with Thor design these days. Uh, not just in terms of mobility, but just in terms of it being welcoming. Same with shelf height. I mean, just either get a consultant.

We do some of that or. Just close the door some Saturday with your kids and say, let's walk through and determine, you know, if I'm 85 in a Walker, how could this place look different? And when I walk in, will I be encouraged or discouraged? Will I be, will it be a happy, challenging place or sort of. Sad place.

Um, I think that could go a long way. And the other thing I think is in the delivery system, I think Kay does, um, and I'm not just using that cuz you're on the end of this microphone. Uh, if I was talking with Coco's, uh, or Sam's pharmacy, I'd be talking a bit about K because I, I don't know if you've done this.

You don't need to respond to that, but training people who deliver is critical, what to look for. I mean, it's fine to be retired. It's fine because clearly there's a role. I mean talk about, uh, the value of aging. Uh, people gain a great deal by being retired and delivering and having interactions with people, whether it's food or pharmaceuticals as you know, but, uh, training them what to look for with.

With abuse. If, um, postal is stacked up, uh, and you think somebody's home because they wanted a home delivery and what to do, um, and also how to communicate to people, training people that are delivering, and then also training them in the value of your business. Uh, this, the, the lady I'm talking to you about, I think she was retired, she must have used K pharmacy and how much she liked working there.

Six times in 10 minutes, maybe. And I was impressed. It wasn't marketing. I didn't feel like she was pushing a brand. She liked the pharmacy. She liked the environment. And that meant a lot to me. That 

Mike Koelzer, Host: must have been when I was on vacation. 

Tom Hartwig, PhD: If we talk about pharmaceutical care, um, let's say my internal medicine, uh, they primarily have you on K on record as my pharmacy.

You don't get any information about my care. I understand ethics. I understand HIPAA as you do, but is there any conversation going on about the pharmaceutical care being linked into the access to patient information to a, um, a medical team? Like my cardiologist can access everything 

Mike Koelzer, Host: as far as actually getting the medical information.

Not really. I mean, we can determine by what [00:45:25] medicines they're getting sort of, but then the problem is vertical integration. Now you've got, you know, CVS owning this and this and that, and they also own their own, you know, mail order company. Well, then we don't know what medicine they're on from the mail order.

If we fill something, it will look for interactions against something and then you'll find out, oh, you're also on this, but we don't see that just by looking at their profile. And then on top of that, you've got these. Pharmacies with vertical integration that are also selling the specialty drugs. And my definition of specialty drugs is a drug that makes a lot of money for the insurance company.

And so that's only 2% of the number of prescriptions, but it's about 50% of the pharmacy's overall revenue, you know, the overall purchases of products in the US, 50% of specialized products. So there's so many products we don't even see and. Yeah, seeing those, but on top of that, seeing their medical chart, we.

See that, but like I said, there's ways to dig in that, but that would sure be helpful. Okay. Gotcha. Well, Tom, what a pleasure talking to you. Thanks for all you're doing for us old farts. I'm 55 now, you 

Tom Hartwig, PhD: know? Yeah. You youngster, your age is somewhat relative until you're ill and then it's not relative anymore.

Mike Koelzer, Host: keep up the fight cuz uh, everybody in this world from zero to 120 has a lot to offer. So I appreciate you standing up for that segment. No, 

Tom Hartwig, PhD: uh, I've enjoyed it. I've enjoyed our relationship. Thank 

Mike Koelzer, Host: you. We'll talk to you soon. Take care. Bye-bye.