▶ 0:06:29Chair Scott: As we have heard from expert witnesses and pvc meeks, staying active is one of the most -- one of the oldest ways to improve mental health and increase longevity. Too often congress will teaming on problems and never takes actions to keep the conversation going and put good ideas into practice. It sounds crazy, but that is the norm in washington, and I don't think any good members of the aging committee want to keep following this broken tradition.
▶ 0:06:58Chair Scott: I was excited to put the evening together with the ranking member at the urge of my good friend alabama senator tommy tuberville to ask an interesting question that perhaps only a coach might come up with, how can we take the lessons learned in sports medicine and the innovation that goes into injury prevention and enhance recovery for elite athletes and use that to improve the lives of american seniors?
▶ 0:07:23Chair Scott: Senator tuberville has lived his life on the football field and as he how much of sports medicine has changed over the years and how innovations keep athletes healthier and recover from injury faster. The rest of us probably don't realize that the healthiest tools for aging are being utilized on these islands of football fields, training rooms, and sports clinics around the country.
▶ 0:07:47Chair Scott: It is up to us to use our jobs in the senate to embrace innovation wherever it is found and the cycle of good ideas coming into washington. We will explore how the science and techniques developed for elite athletes can be applied to enhance the lives of older americans can enable them to stay stronger, recover more quickly, and maintain independence as they age.
▶ 0:08:10Chair Scott: Sports medicine with its emphasis on preventing injuries and promoting proper recovery are a renewed pathway for longevity to help address america's aging population. We must draw lessons from the best in the field, literally. The goal is not for seniors to become athletes, but to benefit from the same principles him injury prevention, rehabilitation, strength training, and recovery. These are tools for everyone whether you are playing under friday night lights or walking grandkids to school.
▶ 0:08:41Chair Scott: Florida has a vibrant senior population and some of the best collegiate and professional sports teams and I'm proud to support them. Today we will hear from medical experts with real-world experience in treating athletes and older americans. We will also hear from a former professional quarterback who knows firsthand how sports medicine can help protect against aging injuries and lead to a longer, healthier life. I would like to recognize ranking member gillibrand for the opening statement.
▶ 0:09:10Sen. Gillibrand: Thank you, chair scott, for today's hearing. What an exciting topic we get to talk about today. It is good to talk about innovative ways to incorporate sports medicine and how we care for older adults, and I'm interested in how we can increase physical activity and reduce falls for seniors gooda fall could change a seniors life.
▶ 0:09:31Sen. Gillibrand: One fall can take away a senior's ability to live independently, make an old american effort to leave the house, increase loneliness and social isolation. One fall can create a lot of other health programs -- I'm sorry, a lot of other health problems. I remember when my grandmother broke her hip. It is a common story.
▶ 0:09:53Sen. Gillibrand: When you break your hip, it changes everything and you really are afraid of going out, afraid of being active, afraid of doing all the things you used to do. We have to see what we can do. I know even as I age myself, I am 58, mobility is my number one concern. I have to make sure I have ankle mobility, knee mobility, flexibility, all those things. I know how important it is for anyone who is aging.
▶ 0:10:21Sen. Gillibrand: Preventing a fall is more important now than ever. The cdc released a report this month showing that death rates from falls for seniors aged 65 to 74 rose more than 70% in the last 20 years. But falls are not a normal part of aging. The good news is many things can be done to prevent falls and optimize physical wellness among older americans.
▶ 0:10:46Sen. Gillibrand: I look forward to working with my colleagues to support and strengthen programs that prevent falls and increase physical activity for older adults, including strengthening federal funding for programs including the older americans act and protecting agencies and entities that perform the work. I am proud to support programs to increase funding for the older americans act programs including leading the physical year 2026 letter for programs I'm proud to support the reauthorization reintroduced last week.
▶ 0:11:17Sen. Gillibrand: I look forward to hearing from our witnesses and figuring out how we can help people live active and fall-free lives.
▶ 0:11:24Chair Scott: Thank you, ranking member gillibrand. We are fortunate to have members of this committee who have really experienced in coaching good I would like to recognize senator tuberville to introduce the first witness.
▶ 0:11:39Sen. Tuberville: It is my pleasure to introduce Dr. lyle cain of birmingham, alabama, of the andrews sports medicine and orthopedic center, where he is an orthopedic surgeon. Dr. cain is a graduate of the university of alabama and university of alabama school of medicine.
▶ 0:12:01Sen. Tuberville: After graduation, he served as chief resident at the university of tennessee-campbell clinic in memphis before completing his fellowship on orthopedic sports medicine at the american sports medicine institute. He currently serves as the team physician for the university of alabama and is medical director for jacksonville state, tuskegee university, and the university of west alabama.
▶ 0:12:27Sen. Tuberville: He also serves as a consultant to the birmingham banks and nine high schools in the birmingham area. Additionally, Dr. cain leads an outreach program through the university of west alabama that provides medical services to more than 40 schools in the west alabama area. Thank you, Dr. cain, for being here, and we look forward to hearing from you.
▶ 0:12:50Dr. Cain: Thank you, chairman scott, ranking member gillibrand, and members of the committee for having me testify today. My name is lyle cain. I'm the managing partner of the andrews sports medicine group, as senator tuberville said. I've been attending physician for high schools, colleges, and teams including the alabama crimson tide for years. Roll tide.
▶ 0:13:17Dr. Cain: I firmly believe that the lessons learned while providing care for athletes of all ages, especially in intervention and management, can improve the healthspan of our aging population. As you know, the combination of increased lifespan as well as the demographics of the baby boomer generation have led to a dramatic shift in the number of senior adults in the united states, nearly 20% of our population currently 65 years or older. This has tremendous consequences for our health-care system both with increased utilization and increased cost.
▶ 0:13:46Dr. Cain: A true team approach to this individual using a sports medicine system as a model can help our senior population maintain a better quality of life as they age. What is a team physician? The american orthopedic society for sports medicine defines a team physician as someone who provides comprehensive health services for the care of athletes and active people of all ages. The team physician is responsible for the health, safety, and performance of our athletes.
▶ 0:14:14Dr. Cain: Our duties include injury prevention and risk reduction, acute injury evaluation and management during competition and training, chronic condition and illness treatment, coordination of care between providers, and performance optimization. In sports medicine we attempt to prevent injury by developing protective gear for each sport. We accomplish these duties through larger team providers. Sports medicine is truly a team effort.
▶ 0:14:42Dr. Cain: The modern sports medicine team includes certified athletic trainers who are the primary point of contact for most athletes, physical therapists, permanent care physicians, psychologists, chiropractors, sports performance specialists, certified strength and conditioning coaches and many others. Our relationship with athletes starts when we do the preparticipation physical on the athlete to assess their health and physical readiness to play.
▶ 0:15:11Dr. Cain: This is a crucial step and allows the physician and trainer to identify issues that predispose the athlete to future injury. We do a health history, through examination, and additional testing such as cardiac testing with echocardiogram, and development individual risk profile for each athlete. In our aging population, the annual examination can provide this level of risk assessment.
▶ 0:15:36Dr. Cain: The reality is that issues that put the senior adult at significant risk such as balance loss, muscle loss, cardiovascular fitness and endurance, and fall risk especially are generally not evaluated during the exam. Employing the athletic trainers, physical trainers, and health care providers to assess the risk could prevent future falls and associated health compromise in older population.
▶ 0:16:00Dr. Cain: In my own family's experience, my 90-year-old father-in-law has seen tremendous results and better balance by participating in a local fall prevention program provided by physical therapists. Why is fall prevention so important? Falls are the number one cause of injury death in the older publishing.
▶ 0:16:20Dr. Cain: Over 30% of adults who break a hip and of dying the first year after surgery, and even the patients that survive past the first year oftentimes never regain independence and require expensive care from rehab or long-term care facilities. It is estimated that falls alone add $50 billion annually to the U.S. health care system.
▶ 0:16:39Dr. Cain: The old orthopedic adage wisely states we are brought into this world through the pelvis and often leave through a fracture of the neck or femur, and that under underscores the risk of mortality from hip fractures. Many are preventable with physical activity, resistance training, and fall prevention. How do we implement this program? It definitely takes a team.
▶ 0:17:06Dr. Cain: The medical team should be empowered to treat this aging patient is an individual with risk assessment, medical optimization, fitness and performance improvement, just like we treat athletes. Primary care physicians are the gatekeeper for older patients, so we have to train these physicians in medicine. The american sports medicine institute and many programs like it train primary care physicians in nonsurgical care, but this requires an actor europe postgraduate training.
▶ 0:17:32Dr. Cain: Physical therapy visits are generally limited by insurance plans, many without fall prevention. We need to continue nih funding for this critical disease, especially in my home state of alabama. Just two weeks ago the american college of sports medicine exercise medicine program launched a program called the active aging initiative for older adults.
▶ 0:17:58Dr. Cain: This initiative is degrees physical activity by working it into routine health care examination and enhance collaboration between health care providers and exercise professionals. In closing, we give our athletes the best care possible to prevent injury and optimize performance. We should do the same for our senior citizens. Thank you.
▶ 0:18:15Chair Scott: Thank you, Dr. cain . I would like to recognize senator justice to reduce our next witness.
▶ 0:18:22Sen. Justice: Thank you, Mr. chairman, ranking member. I sit here and just think, not very often do I have this opportunity, because Dr. cain, I can't tell you the number of times I've been in the andrews institute, and I'm sure you know that. Dr. legg and I are long-lost friends and everything. And coach hasselbeck, I've watched you forever, and you are a coach and I love it in every way.
▶ 0:18:53Sen. Justice: That only leaves jennifer, the only one I'm not really in contact with, but jennifer, thank you so much for all you do in your wonderful state of massachusetts and everything. Coach beside me is wondering what in the world is he going to say, but here is what I would say, and this is all there is to it. My job right now is to introduce a man that absolutely is a superstar in our state. Dr. paul legg, believe it or not, we graduated from the same high school.
▶ 0:19:23Sen. Justice: He was probably a fire in his class that I was, but nevertheless -- probably higher in his class then I was, but nevertheless, a great man, incredible physician. The people of our state depend on this man like you can't imagine. And especially, I'm sure, the elderly, but many, many, many in our state have visited and been recipients of his unbelievable care. You know, doc, you know me and you know me really well.
▶ 0:19:53Sen. Justice: We had so many interactions with covid. For 8 years I was the governor, and through covid and all that, and a lot of, lot of, lot of situations where this man rose to the level of a superstar in my eyes in every way. I could -- there is no way I could be prouder than to introduce him today.
▶ 0:20:17Sen. Justice: West virginia university graduate, absolute graduate of the same high school that I went to, woodrow wilson high school, and absolutely a superstar in our state. Dr. legg, take over and take it from here, sir.
▶ 0:20:31Dr. Legg: Chairman scott, ranking member gillibrand, honorable members of the committee, my name is Dr. paul legg, and I want to thank you for the opportunity to offer testimony to the special committee on aging. Thank you, senator justice, for the introduction, and go flight goals. I would also like to thank my wife of 34 years for her support of me and my career.
▶ 0:20:59Dr. Legg: My daughter, son-in-law, and granddaughter are here today, and my daughter and son-in-law watching from south carolina. I'm grateful for their support as well. I would like to stay for the record that the opinions expressed today on my own and do not reflect the view or position of might employer. I'm a practicing orthopedic surgeon in charleston, west virginia, having spent 27 years in private group practice and the past two years as a hospital-employed surgeon.
▶ 0:21:30Dr. Legg: I am board certified by the board of american orthopedic surgery and have additional qualifications in sports medicine. For over 20 years I've been a team physician for the university of charleston for the ncaa division ii school with approximately 620 athletes. Sports medicine encompasses the prevention and care of musculoskeletal injuries and medical conditions encountered in sports.
▶ 0:21:52Dr. Legg: The lessons from the field, operating room, and research are applicable to maintain physical function and performance in competitive athletes of any age. The health outcomes of seniors improve by keeping them healthy, active, and injury-free as they age. Surgical techniques designed to return competitive athletes to the field of play can also benefit seniors with similar injuries.
▶ 0:22:19Dr. Legg: However, surgical techniques are only a small part of sports medicine's influence on senior health. The manner in which our athletes train and prepare offer many more lessons on improving the health outcomes of seniors. According to the 2022 report by national health statistics, only 13.9% of adult aged 65 or older meet federal activity guidelines.
▶ 0:22:41Dr. Legg: The environmental factors to low physical activity are many -- cars, sedentary jobs, elevators, computers. Since people get very few adequate exercise at work or throughout their days, exercise needs to be added as purposeful activity. Fitness is partly genetic and measured by how far you go on exercise test. Physical activity is behavioral and requires motivation and commitment.
▶ 0:23:12Dr. Legg: Increasing your physical activity will increase your fitness. For example, walking is a low-intensity exercise and appropriate start for most seniors. Physical activity and nutrition topped the list of the most common health issues encountered by seniors. As we age, our fitness declines. Exercise can prevent this decline in many patients. Spring training is one of the activity that can improve health outcomes for seniors.
▶ 0:23:39Dr. Legg: The established benefits of a regular strength exercise include strength and endurance, increased muscle mass, increased resting metabolic rate, and preventing disability. Both research and experience indicate that resistance training is safe for healthy older adults, for frail older adult, and individuals with disease. Muscle disuse is a preventable and reversible factor.
▶ 0:24:05Dr. Legg: Resistance training has consistently shown as feasible and effective means of counteracting muscle weakness and physical frailty. It improves bone density. It improves metabolic health, insulin sensitivity, as well as improving psychological well-being and reducing the risk for falls and fractures in older adults. So what behaviors can we encourage senior adults to help start and maintain exercise programs?
▶ 0:24:34Dr. Legg: The first step is making a commitment to increase physical activity. They have to establish protected time to forgo other activities and may encroach on the scheduled time. Set small and realizable goals for exercise. Also think about and establish long-term fitness goals. These barriers must also be addressed. That includes lack of understanding, lack of awareness, and unfortunately, lack of motivation.
▶ 0:25:04Dr. Legg: As I've seen in almost 30 years of clinical experience, health outcomes in seniors can be improved with lessons we learned from sports medicine and sports science. It is the planned and purposeful exercise and strength training used in preparation for competitive athletic events that provide a structure for exercise in senior adults. Advanced training techniques can also move senior adults from just physical activity and into increasing levels of fitness. Thank you, Mr. chairman.
▶ 0:25:35Dr. Legg: I look forward to answering your questions.
▶ 0:25:36Chair Scott: Thank you, Dr. legg . Thanks for being here. I would like to introduce our next witness, matt hasselbeck. He is a former nfl quarterback we spent 18 seasons in the leak, including leading the seattle seahawks to a super bowl appearance in2006.
▶ 0:25:54Chair Scott: After retiring from professional football, he became a well-respected analyst with espn, where he was watched by millions of football fans during "sunday nfl countdown" and "monday night countdown." he has been a global advocate for recovery and smart turning on and off the field. He brings a unique perspective of how the principles of elite athletic performance can help everyday americans stay active and healthy as they age. I look forward to your testimony.
▶ 0:26:21Mr. Hasselbeck: Thank you so much for the kind intro. My name is matt hasselbeck, and I'm here to share my insights on the significant role sports medicine has played throughout my athletic career and its ongoing influence in my life. I played quarterback for five years at boston college, followed by a lengthy nfl career.
▶ 0:26:38Mr. Hasselbeck: The nfl, if you don't know, is commonly referred to by players and coaches as "not for long." but with the help of a great sports medicine group -- teams, I was fortunate to play for 18 years with the green bay packers, seattle seahawks, the tennessee titans, and the indianapolis colts. I grew up as the son of a football player. After an all-american career at the university of colorado, my dad played tight and in the nfl for nine seasons.
▶ 0:27:05Mr. Hasselbeck: He played primarily with the new england patriots, but also the minnesota vikings, the new york giants, and the los angeles raiders, where he and his teammates won super bowl xviii. My brothers and I earned full scholarships to play college football, and my brother tim followed me as a longtime quarterback in the nfl. Most of our wives were prominent division one athletes as well, and my wife was no doubt the better athlete in college than I was. In the decade since my nfl career ended, I primarily work in this with media space.
▶ 0:27:36Mr. Hasselbeck: After spending eight years on espn on shows like " sunday nfl countdown," "monday night countdown," and "sport center<" I now work as an nfl analyst for fox sports on "the: coverage of -- colin cowherd show." I've also been serving as a -- high-school football coach the past four years.
▶ 0:28:07Mr. Hasselbeck: Last year we moved to tennessee so I could coach on staff with my father and brother where we coached two of my québec nephews, taylor and isaiah. Taylor is committed to play college football at the university of wyoming. Our son is a redshirt freshman quarterback at ucla and is battling for his own opportunity, much like I did at his age. During my 23 years of college and professional football, I only had one surgery. This is unheard of.
▶ 0:28:34Mr. Hasselbeck: I attribute this to many factors, one of which is the help of skilled athletic trainers and sports medicine teams. Many of my teammates took a react and survive approach to their health, while I -- want a proactive and thrive approach is a mindset that helped me. I attribute is set the advice, care, and expertise of athletic training staffs of my teams. Not only did they help me prevent injuries, but they contributed to helping me heal faster and return to play.
▶ 0:29:05Mr. Hasselbeck: Staying healthy is priority number one for an" of record -- for an nfl quarterback good injury prevention and prioritizing wellness were equally important to me as throwing touchdown passes. My coaches would tell us your greatest ability is your availability. Both during and after my nfl career I've been dedicated to making the game safer for future generations.
▶ 0:29:30Mr. Hasselbeck: I actively participated in the nflpa's mackey white health and safety of any and proudly served as vice president of the executive committee for six years. Our work successfully fostered a significant culture change regarding brain injuries and return-toplay protocolss in football. Upon my death I pledged my brain to science through the concussion legacy foundation.
▶ 0:29:52Mr. Hasselbeck: I serve as ambassador for the diagnosecte.org study for men over 50 which aims to develop a method to diagnose and differentiate brain trauma while patients are still alive. In this new empty nester era of our lives, my wife and I have experienced challenges of caring for our aging grandparents and parents. We have leaned through the lessons learned through athletics to replicate the best outcomes for them as they get older.
▶ 0:30:17Mr. Hasselbeck: For example, hoping my mom set goals for the activities she hopes to participate in with her grandkids when she is older means that we have to start prepping for that now. Much like you would do as an athlete. My mom would love to be able to play pickleball and ride bikes with her grandkids when she 75. Sometimes it is not that simple.
▶ 0:30:37Mr. Hasselbeck: Following a painful knee replacement surgery, my dad was waiting to get healthy enough for the next near placement surgery when he tragically suffered a cardiac event this april, which he did not survive. This heartbreaking event has left my mom a widow after 50 years of marriage, and she now faces new challenges, some of which are loneliness and isolation, that you must overcome. Sadly, as a family, we are also dealing with the significant challenge of my mother-in-law's alzheimer's disease.
▶ 0:31:09Mr. Hasselbeck: This illness has placed an immense hardship on our family, particularly affecting my father-in-law, who sacrificed his profession to become her full-time caretaker. In conclusion, that is equipped into who I am. I'm truly honored to be here today. The last time I visited this building was during my eighth grade class trip. I had a great time, I'm hoping I get to come back again.
▶ 0:31:31Chair Scott: Thanks for being here, and sorry to hear about your dad. Whenever your parents passed away, you wake up and think I've got to call one of them, and you can't call them. I would like to recognize ranking member gillibrand to introduce our last witness.
▶ 0:31:46Sen. Gillibrand: Thank you, chairman scott. I want to introduce jennifer raymond. Ms. raymond serves as the chief strategy officer at agespan, an area agency on aging in lawrence, massachusetts. Through her position as chief strategy officer, Ms. raymond oversees the evidence-based programs including the falls prevention efforts. Additionally, she holds a juris doctorate and has been recognized by the john a hartford foundation as a national practice change leader. Thank you for being here.
▶ 0:32:17Sen. Gillibrand: You can begin your testimony.
▶ 0:32:18Ms. Raymond: Chairman scott, ranking member gillibrand, and members of the committee, thank you for the opportunity to speak with you today. My name is jennifer raymond, and I'm honored to serve as the chief strategy officer for agespan, one of the area agencies on aging located in lawrence, massachusetts.
▶ 0:32:41Ms. Raymond: We are one of 614 aaas across the country helping older adults remain independent in their home. On behalf of these agencies, as well as the older adults in the family caregivers they serve, I want to first thank all of you for your ongoing efforts to meet the needs of our aging population through the older americans act. And thank you for your attention on the importance of physical wellness for older adults.
▶ 0:33:11Ms. Raymond: The consequences of physical activity among older adults are catastrophic. They include a decline in overall function, increased risk for chronic diseases, increased frailty, and a heightened risk for depression and cognitive decline. Yet despite these consequences, more than one in four older adults are physically inactive. The reasons for inactivity are many and varied.
▶ 0:33:37Ms. Raymond: A fear of injury, lack of confidence in their ability to exercise safely, and even a lack of motivation to begin exercise. Throughout this country, agencies on aging and their partners offer effective physical activity programs that both promote exercise and help individuals overcome those motivational and behavioral barriers that contribute to inactivity.
▶ 0:34:04Ms. Raymond: For example, in quincy, able to safely abandon her walker after improving her balance through an evidence-based program called a matter of balance. And maria a., who despite her frailty participates in virtual physical activity classes from the comfort of her own home thanks to the digital access program.
▶ 0:34:30Ms. Raymond: One of the most important benefits of increased physical activity for older adults relates to the prevention of falls. Falls can be detrimental in a senior's life. They can result in hip fractures, head trauma, other serious injury, and even death. They often reduce mobility, take away a senior's ability to live independently, and can make people afraid to leave their home, increasing loneliness and isolation.
▶ 0:34:59Ms. Raymond: Every year in this country more than 14 million americans 65 or older -- that is one in four -- suffer a fall. In 2021, emergency room departments reported 3 million visits due to falls. The total cost for these falls is over $80 billion a year. Of these costs, 67% is paid for by medicare, 4% by medicaid.
▶ 0:35:30Ms. Raymond: Today, many area agencies on aging partner with family health centers, primary care providers, and managed care to reduce falls risks. First, our health care partners screen and identify older adults who are at risk for fallss. Then they referred these individuals to networks of aaa's for falls intervention.
▶ 0:35:56Ms. Raymond: This intervention might include a physical activity program, it might include assistance with home modifications to address from hazards, and even the provision of medically tailored meals to make people more able and ready for physical activity. These referrals from our health care partners allow us to take a more holistic approach to addressing the needs of the individual and create a shared care plan to improve outcomes.
▶ 0:36:25Ms. Raymond: There is much we can do to support older adults and their desire to age in place, stay physically active, and avoid falls. To further these goals, we must support robust funding for physical activity and falls prevention through the older americans act, specifically titles 3d, evidence-based health promotion, and title 3b, support services.
▶ 0:36:54Ms. Raymond: Educate health providers about falls prevention through tools like the study program in which assists providers in integrating falls prevention into their clinical practices. Encourage prescription for physical activity and falls prevention by health care providers and allowing for appropriate reimbursement for effective interventions offered in the community.
▶ 0:37:17Ms. Raymond: And continued investment in research related to physical activity and falls prevention for all older adults, those with physical frailty, those with disability, and those with cognitive decline. If we are serious about a healthy america, we can't ignore the impact of physical activity and falls among older adults area agencies on aging stand ready to partner with health care, older adults, and family caregivers to address this challenge.
▶ 0:37:48Ms. Raymond: Investments today will not only allow older adults to thrive independently, but will also stem the cost for our health care system for years to come. Thank you again for the opportunity to speak with you today and for your support on this important issue. I forward to your questions and working together to support our country's older adults.
▶ 0:38:08Chair Scott: Thank you, Ms. raymond, thanks for what you do. We will start with questions. Senator justice, if you want to start. Sen. just is going well, I goods --
▶ 0:38:21Sen. Justice: Well, I could start with any of you, but I am intrigued by this. Dr. cain, you at the julie andrews institute, you probably have many, many stories to tell. With all that being said, I would like you just elaborate if you could on this.
▶ 0:38:42Sen. Justice: Over the years, you especially have seen so much progress being made towarda our seniorss and what can be done. So just elaborate -- in your words, your experiences with julie andrews are limitless -- with jimmy andrews are limitless, but absolutely in my opinion -- jimmy is a terrific friend, been a friend forever and a day. Please tell us more could Dr.
▶ 0:39:09Cain: Thank you, senator justice. Dr. andrews has been a great mentor to me and Dr. andrews retired two years ago and is in a state where he is trying to take care of itself more than used to. You have a great point, we have had great advances in sports medicine, taking care of teams and medicine in general the past 30 years. But the reality is in medical care of our older patients, was about time is spent dealing with complications on the backend.
▶ 0:39:42Cain: There is very little time spent on preventative care. If you take a typical primary care physician at -- that sees an older patient, they spend time dealing with heart disease and the cat is out of the back and they are trying to manage. The way we get on top of this entry disparities retreat our older patient -- is we treat our older patients just like younger athletes. Work on preventative programs, things like Ms.
▶ 0:40:09Cain: Raymond is doing, and spend more time during office visits talking about how to prevent disease and treat diseases that patients already have.
▶ 0:40:18Sen. Justice: Well, I know you're doing unbelievable work. I can tell you the many visits I've had there, you somehow someway passed me together and I've made this far anyway. Matt, I've got to ask you just this. Not ask Dr. legg wonderful questions, but Dr. legg and I have been around many, many times on many different things.
▶ 0:40:49Sen. Justice: Matt, I watched you play. You were a superstar. You have absolutely a family of thoroughbreds like you can't imagine. And through all of that, you have a message to pass on to all of us and all the different things that you know we can do better at. You took care of yourself. You took care of yourself in a really proactive way and you are exactly right, nfl athletes don't usually stay there long. And you stay there forever and a day.
▶ 0:41:19Sen. Justice: And made a contribution every single time you went on the field. But tell us more. Tell us more about really what we should be doing. I listened intently to all the different folks in your family and all their incredible accomplishments. Now I want to hear from matt. Matt, what do you think we really need to be doing?
▶ 0:41:41Mr. Hasselbeck: Well, thank you for your question. I really agree with what both doctors said about being proactive. Stability work, falling. In football, running backs don't want to fall because you are down. You practice balance all the time. You practice with your eyes open, you practice with your eyes close. That is something I would do as a quarterback. Something I do with my mom, she would do with her mom.
▶ 0:42:10Mr. Hasselbeck: These are lessons -- using some of the injuries that are coming from quarterbacks, and ankle sprain is an injury you have. We do what we call prehab, preventative rehab. We do the rehab as if we had an ankle sprain, high ankle sprain, before we had an injury. For even coming back from my one surgery come which I had in alabama, which was not convenient living in seattle, but it was great and successful.
▶ 0:42:39Mr. Hasselbeck: But one of the things we did with the athletic trainers, we practice falling. I went from being in a sling for many, many weeks to somehow get from the sling to back on the football field, getting tackled by guys like michael strahan. What are we doing in the meantime to get there?
▶ 0:42:57Mr. Hasselbeck: Practice, practicing falling was really a great return to play protocol that helps me coming back from surgery when I felt frail, felt afraid to fall, but doing it in a controlled environment is one of the things that gave me confidence, gave me athleticism, and got me back to feeling like I could go protect myself in the arena of athletics.
▶ 0:43:22Sen. Justice: Thank you, sir. I practice falling right now, but it's not on anyway -- but is not on purpose. Anyway, thank you so much.
▶ 0:43:37Chair Scott: Senator gillibrand .
▶ 0:43:40Sen. Gillibrand: Jennifer raymond, the importance of funding for programs that support older adults. You have discussed how agespan provides critical services for older adults in massachusetts. Those services include physical activity and fall prevention programs. Agespan and other area agencies on aging provides services through a partnership with the federal government. The service are locally run and tailored to individual communities, and the federal government helps with funding, research, and technical expertise.
▶ 0:44:09Sen. Gillibrand: Can you give examples of agespan programs that have received federal support and how those programs have helped older adults? Can you talk about what will happen to these programs if federal support disappears?
▶ 0:44:20Ms. Raymond: Yes, thank you. I think it has been over 50 years that area agencies on aging and people that we survive benefited from really good partnerships with the federal government through the older americans act, through title iii, we have those evidence-based programs like a matter of balance, enhanced fitness, all those things that allow us to provide programs to increase physical activity and reduce falls in a safe and
▶ 0:44:52Ms. Raymond: Effective way and the programs have demonstrated efficacy. But in addition to that, the older americans act through title iii be title iii b as allowed us to provide a wide range of support services. At my agency alone we serve 28 cities and towns and we received over 25,000 calls every year to our offices for information and referral.
▶ 0:45:17Ms. Raymond: These are not people who have a case manager, these are not people who are serving, but these are people who are wondering how they get services come wondering how they can help in applying for medicare those kinds of things. That information and referral support work is funded through the title iiib of the older americans act. In addition to that, I don't think we have to talk much about the meals on wheels program, but home-delivered meals, medically tailored meals.
▶ 0:45:45Ms. Raymond: This year were provided over a million euros to older adults who are frail dish over a million meals to older adults were frail and unable to receive nutrition and food services. Even beyond the older americans act, we have benefited and many community organizations have benefited from pilot funding from the administration for community living, or from cdc in order to implement these evidence-based programs in a way that can be effective and improve health outcomes but at the same time look at how they
▶ 0:46:18Ms. Raymond: Save dollars. There is a wide range of that we continue to support and five under the support of the federal government.
▶ 0:46:27Sen. Gillibrand: Thank you, jennifer. Dr. cain and Dr. legg, can you talk about what happens to older adults after you fall, and can you check about the importance of patient education introducing falls?
▶ 0:46:40Dr. Cain: Thank you, senator. Once a patient falls, there is to outcomes. One is they break something, they end up in the hospital, and they are probably never the same, honestly. The other outcome is they get lucky, they get scratched up, they go to the hospital, they check out, they go home. Very rarely do we do fall prevention with this patients, even once who are falling. We have our own families who are falling, parents and grandparents.
▶ 0:47:10Dr. Cain: You count your blessings that they made it and didn't hurt anything, but rarely do fall prevention programs become part of the treatment algorithm. For us as physicians, backing up a second and say we are taking care of all of these diseases and problems caused by balance and fall issues, why not prevent those. I like the program Ms. raymond is talking about. I think having the primary care physician as the point person to encourage that is important.
▶ 0:47:36Sen. Gillibrand: Dr. legg?
▶ 0:47:38Dr. Legg: When we talk about falls, we tend to worry about people who break their hips. That's a very serious injury. It creates fear afterwards. But I also see many patients who break their shoulder or proximal humerus or risk, which is sometimes just as devastating because they are immobilized, which throws off their balance and puts them at much higher risk for additional injury.
▶ 0:48:07Dr. Legg: Preventative programs are essential. We also have to look at how can we improve the thing that makes them at high risk for fractures, and that is bone density. How to improve that, test for that?
▶ 0:48:24Dr. Legg: A lot of it is encouraging the patient to get the testing done, and then encouraging them to be consistent, compliant with the medications that help, because they do help and they do reduce the risk of fractures. But once they have a fall, sometimes it is motivating them to overcome the fear that they have to be active again.
▶ 0:48:52Dr. Legg: Many of them often become scared and afraid of exercise and afraid of movement, which puts them at higher risk for medical problems.
▶ 0:49:05Chair Scott: Coached approval.--coach tuberville.
▶ 0:49:11Sen. Tuberville: 35 years of coaching, I saw a lot of injuries. I think there is tremendous improvement in surgeries over the year -- obviously or this coptic surgery -- or this coptic surgery. We did a lot easier and quicker back on the field. Dr. legg, Dr.
▶ 0:49:30Sen. Tuberville: Cain, talk about one other thing that is really improved and how much we need to continue to educate people and hopefully get more people in this profession is physical therapy. My players -- I would always tell them surgery is what is easy. Therapy is the hard part. Getting back on the field. Dr. legg, you first.
▶ 0:49:51Dr. Legg: Physical therapists are central to what we do sports medicine. They are also essential to rehabilitating our seniors who have any injury or surgery. I use the physical therapists very often with joint replacement surgery. As I become older, my patients have aged with me.
▶ 0:50:19Dr. Legg: People who I did arthroscopic procedures on years ago are replacing their knees and shoulders. The physical therapists are the ones who really get them back to movement and strength activity, because the replacement or shoulder replaced -- because knee replacement or shoulder replacement is a painful operation. Physical therapists teach them what to do, but they also encourage them to do it. Sometimes that is the hardest thing. But they are invaluable.
▶ 0:50:50Dr. Legg: My son played college football and needed the physical therapist on several occasions to keep him in the game. We need physical therapists, and they are invaluable in treating the patient.
▶ 0:51:09Dr. Cain: Thank you, coach. The other part of the equation that is important is athletic trainers. Certified athletic traders are the point person. Matt hasselbeck mentioned in his talk that they are the ones that prevented him getting hurt. The combination of the trainer and the therapist are critical in the model, and not only for treatment of injuries after surgery. They're the ones that do the grunt work.
▶ 0:51:35Dr. Cain: We as the physicians may see the player for injury evaluation and surgery, but these and the people that are with them every day. I think that is the model you need for the older population, you need those providers, atc's and physical therapists, in the system and keyed into where they help the older patient and follow through with those demands to make sure they are doing the exercises, to make sure they are doing them correctly, and to treat them just like you treat the athlete. The athlete is in the training room every day all day.
▶ 0:52:03Dr. Cain: Obviously we don't have the ability as we age to be trading all day, but you need someone to keep up with the person longitudinally and make sure they do what they are supposed to do. We have a critical shortage in athletic trainers. They have to get a masters degree now to graduate and be certified, and are not many kids going into it now. We have a critical shortage of trainers, we don't have enough physical therapists. Physical therapy visits aren't covered well by insurance. It is a big problem for seniors trying to get treatment.
▶ 0:52:30Sen. Tuberville: Matthew, Ms. raymond, if you would answer this question, and improvement I've seen over the years -- this is as much adults our ages anybody -- nutrition and supplements. It's been a huge improvement. Matt, your thoughts on supplements. I know you have taken many over the years, and you try to eat right, also.
▶ 0:52:53Mr. Hasselbeck: We can improve the cafeteria here, from what I saw, by the way. I would like to also add that when you get hurt, is very depressing. It's embarrassing, you feel isolated, and it's depressing. The athletic trainers are just a confidence giver to you. And a daily pep in your step person in your life. It is very important. They advise you also on the best way to recover. Hey, you can't do this right now.
▶ 0:53:24Mr. Hasselbeck: Well, what can you do? We can make better choices with our nutrition. Or maybe it is protein. I know for athletes protein is very important thing. I know for older people protein is very important thing. I can't speak enough -- I think about the best friends I had on my football teams. A lot of times it was a teammate, but usually there was an athletic trainer in there as well, because that was literally the person there every single day.
▶ 0:53:51Mr. Hasselbeck: To hear that there is a shortage, there is a lot of people that get into athletic training because they were athletes as high-school kids and they love sports, but genetically they cannot play professional. You can still get a super bowl ring is an athletic trainer if there is a pathway to study that in college and invest in that. I would be all for that.
▶ 0:54:12Sen. Tuberville: Ms. raymond?
▶ 0:54:15Ms. Raymond: [inaudible] >> put your mic on.
▶ 0:54:22Ms. Raymond: I knew I was going to do it. While you all were talking about athletic trainers and the role they play as part of a larger team, I think of the equivalent in our community-based organizations, this case managers, community health workers who are working with the older adult every day and saying, yes, I know you are frustrated that you are not able to play pickleball the way that you did last year because of your hip injury, but let's talk about walking, let's talk about
▶ 0:54:53Ms. Raymond: Doing something care exercises that will get the mobility going--some chair exercises that will get the mobility going. And by the way, we will talk about medically tailored meals that will add your ability to feel well enough to do that activity. I think that team approach is one of the key ways that we on the social care side also think of as really strong to support older adults in physical activity.
▶ 0:55:17Sen. Tuberville: Thank you.
▶ 0:55:19Chair Scott: Senator husted.
▶ 0:55:22Sen. Husted: Thank you, Mr. chairman. Thanks to all of you for being here today. My wife is a physical therapist coach so I know exactly how valuable they can be, because what I've witnessed is a former athlete and coach and also with a wife who is a marathon runner into her 40's and is a physical therapist is that things build on one another.
▶ 0:55:51Sen. Husted: An injury or sore knee, you don't walk anymore, you don't walk as much, you start to eat a little bit more, start to put on a little weight. These things can compound on you, just like healthy habits can as well. And so I would ask any of you who would want to respond to this, how do we reach people with this message?
▶ 0:56:14Sen. Husted: What are the most effective ways that you have found to help people understand -- and what age does somebody really have to start paying more because attended to the issues that will compound -- pay more close attention to the issues that will compound and make it more difficult that as they get older? Welcome all of you to comment or give your thoughts on that.
▶ 0:56:40Dr. Cain: I think our simple educational materials and public service announcement type things. I'm 57. When you are in your mid-50's you need to start thinking about this. It is not 65. You are starting to lose balance and your body changes physically. Not only can you not see very well, but your joints don't move as well and you got other problems.
▶ 0:57:06Sen. Husted: The effects of gravity for some reason get a lot worse as you get older.
▶ 0:57:08Dr. Cain: No doubt. There is a stat that is pretty well-documented that a simple physical education treatment program, balance training, fall prevention, not falling, adds 10 years to your life compared to not being physically active. If you have a simple public service announcement that says if you are physically active at this level, you are going to add 10 years to your life, think of all the people taking these supplements and doing longevity forces in all these things to live longer.
▶ 0:57:37Dr. Cain: That is the sum this method to live longer. -- that is the simplest method of to live longer. I think we have to educate people.
▶ 0:57:45Dr. Legg: This becomes important very early, senator. We know through studies that something we call sarcopenia, loss of muscle mass, starts at between the age 35 and 40. And it goes 5% a year. Really need to start early. We also know through some of the tests and which are older tests in the 1970's, Dr.
▶ 0:58:12Dr. Legg: Robert bruce, vo2 max for the most important muscle, the heart, and how we develop energy through our muscles, that's just a decline also. -- that starts to decline also. The good thing is that that can be improved and reversed until about age 70, and then it is very difficult after that to reverse much of the aging process to the heart.
▶ 0:58:40Dr. Legg: An activity is bad -- inactivity is bad. But we also know someone who is very sedentary, people who make those first steps interactivity get the greatest benefit from being active. The steps become a little more incremental as you go up, but it is just that first movement from sedentary to any kind of activity.
▶ 0:59:09Dr. Legg: When I have sometimes students or residents, I tell them that this into your senior patients, but you also have to be a motivational speaker. You have got some answers for them. You have just got to convince them that they need to do it.
▶ 0:59:28Mr. Hasselbeck: : can I just add quick we use this phrase all the time, sitting is the new smoking. Even as a professional athlete, you sit all day in meetings, practice for two hours. But getting up -- vo2 max training is important, but power walking, briskly walked is very important for someone in their 30's, 40's, 50's, having that foundational piece is super important.
▶ 0:59:55Mr. Hasselbeck: Doing that in groups, messaging, but also has friends, make that normal. Sitting all day is normal. Make power walking normal. That is the advice I would give my friends.
▶ 1:00:07Ms. Raymond: I would agree with much of what he said now. It is very exciting for us when we are able to take a more absolute approach and reach people before they happen diabetes, before they have copd, and be able to work with them on the kinds of behaviors that over meant that. It is -- that will prevent that.
▶ 1:00:28Ms. Raymond: It is very exciting that we get to work with family caregivers and see the family caregivers say I'm 40, 50, now is the time to start this physical activity so I can be more independent as I age. At the same time, we are coming across folks who are in their 70's and their 80's and even in their 90's that are looking for ways to be physically active. But they have chronic pain, so they worry that physical activity is going to exacerbate that.
▶ 1:00:59Ms. Raymond: We are able to have community health workers and case managers sit with the older adult who think they can exercise and talk to them -- who thinks they can't exercise and talk to them about is important to them, not what is the matter with them, but what matters to them. I remember an individual named george, diabetes, copd, chronic pain.
▶ 1:01:21Ms. Raymond: Did not feel like he could do anything, but is case manager asked him, what is important to you, and he said "I want to play with my grand children, and want that relationship with them that I had with my grandparents, and I can't do that now." that was the trigger to say let's start with the walking class, let's start with brisk walking, let's move on from there. Even though our goal is to reach people on the upstream, there are many powerful ways for us to encourage and support traditional older adults who want to be physically active.
▶ 1:01:51Sen. Husted: Thank you. Thank you, Mr. chairman.
▶ 1:01:55Sen. Johnson: Apologize for not being here earlier. We have a crazy schedule. Taking over from senator scott as chair. This is an interesting hearing. Being elderly myself, mentally I'm not elderly, but I certainly feel in my body. Dr. cain, can you talk about the importance of protein? It is one thing I'm hearing more and more about.
▶ 1:02:22Sen. Johnson: It's actually very difficult to eat as much protein as you see recommended. Can you address that issue?
▶ 1:02:27Dr. Cain: Sure. Thank you, senator. Protein has become the most critical element we know in nutrition to keep you healthy. We found over that super high-protein diane sare good for you -- super high-protein diets are good for you, and the more you eat, the higher muscle mass, the more energy you have. A lot of senior adults have a very poor appetite and they don't get much protein. Things like protein supplements, protein shakes.
▶ 1:02:57Dr. Cain: I encourage my patients all the time. There are studies about creatine, just a little part of creatine five, small scuba day can increase your longevity. Protein is really radical. It is hard dish purging is really -- it is protein is really critical. It is hard to get it from fish or meat. You almost have a supplement.
▶ 1:03:18Chair Johnson: I kidded my wife, she does all the health research in the family and she is buying supplements all the time. You don't need to eat a meal, you have got enough right there. Dr. legg, talk about nutrition vs. Supplements. Is equivalent? -- is it equivalent? Can you do it through supplementation? You read a different thing from different people and you are not sure what is the truth.
▶ 1:03:46Dr. Legg: The difficulty with many supplements is that supplements really aren't under the oversight of the fda. They are not tested in the same way as drugs are tested. We know that many supplements have a lot of testing. Dr. cain mentioned creatine. It is kind of the it supplement at this time.
▶ 1:04:12Dr. Legg: But it seems to be, one, very safe, and also a very good supplement to increase muscle mass. We also know that now it may help bones. And then if you take it long enough, it may help our brains also. Now, what I like to encourage people as far as nutrition is to be as unprocessed as possible. It's difficult these days.
▶ 1:04:42Dr. Legg: But food that is unprocessed is the best. I think that supplements are needed for areas of deficiency. Yes, protein is something that everyone needs. Now, testing can be done if you have certain areas that maybe you need vitamin d, maybe you need vitamin c. Those are very important.
▶ 1:05:07Dr. Legg: We know the heart benefits of omega fatty acids, those are also very good supplement for people to take. It's just really finding based on your diet and your activity what you may need. You can quote, that with -- you can coordinate that with your family physician. There is a lot of information out there.
▶ 1:05:35Dr. Legg: I encourage my patients to try to be as non-processed as possible with their nutrition, and then supplement in areas where they may be missing.
▶ 1:05:47Chair Johnson: Secretary kennedy is looking at that in terms of the maha movement. You mentioned that supplements do not have the same rigorous standards for testing. Are there testing labs -- when you are looking for a supplement, is there something that can guide you that you can be reasonably assured that this is from a quality lab and not some cheap import that might have questionable ingredients? Against, that is a serious concern.
▶ 1:06:14Dr. Legg: It I tend to have people get supplements from what I call reputable sources. I tell them to buy it at 8 -- I hate to say it this way, but a notable chain, maybe grocery store or nutrition store. I tell them to be sometimes wary of where they buy it online.
▶ 1:06:47Dr. Legg: There are certifying agencies for nutritional supplements, and they do give really a third-party look at what is safe, and even sometimes what can be effective. But I tell them to use reliable sources where they buy their supplements.
▶ 1:07:10Dr. Legg: Not to make this to personal but I actually had a pretty good exercise routine, I would go home and be watching the news, hop on the lifecycle or nordictrack. That worked for me pretty well, and then all of a sudden, is kind of hard with our kind of schedules. I literally was losing muscle mass.
▶ 1:07:32Dr. Legg: What I have decided to do is, for example, making curing coffee, it's about a three minute process, and there's calisthenics you can do. I've seen that has been incredibly helpful to me. I've seen for example on, they have different chinese methods, different types of exercises and they work very well. I would imagine you know something about exercise. Do you have a routine or something you can recommend for seniors?
▶ 1:08:01Mr. Hasselbeck: I would just say a couple of things, I would like to piggyback on the creatine in the protein. It is safe, as an athlete you're deathly afraid of testing positive on something like a substance or non-reparable source, but even that is dangerous. We always went by the nsf certification process, that at least gave you the strongest sense of what they are saying is in the ingredients is what is in the ingredients.
▶ 1:08:30Mr. Hasselbeck: But for us, just plain powder, playing creatine are pretty safe. To your question about the routine, I think as an athlete, we have it easy because we set goals. I played until I was 40 in the nfl. I was still playing when I was 40. My friends that were 40 were like, how are you doing it? I don't know, I think it is use it or lose it. I set goals every week, a goal I had to attain.
▶ 1:08:56Mr. Hasselbeck: Like I spoke about earlier with my mother, mom, what are you going to do when you're 75 years old? I want to be able to board and airplane by myself, I want to be yep to put my luggage up, pick up my grandkids. When you have those goals, it's easy to come up with what the exercises are going to be. I want to be able to get up out of a chair without using both hands to help me get up. Ok, well then I know the exercises we need to do.
▶ 1:09:25Mr. Hasselbeck: You can see a physical therapist, athletic trainer, your doctor, to help accomplish those goals, but to answer your question, setting goals is the number one way to accomplish it. My dad used to say this all the time. A goal without a plan is just a wish. So that would be my answer. Senator gillibrand, do you have any further questions?
▶ 1:09:50Sen. Gillibrand: Yes, we are filibustering, we will ask a lot of questions to keep you busy. For Mr. hass about, I've read about the stigma of seeking medical treatment, including preventive treatment, especially for athletes and older adults. Can you talk about what we can do to reduce these stigmas so that people can get the help they need?
▶ 1:10:13Mr. Hasselbeck: I think in particular with what our families going through right now, it is hard sometimes to ask for help, and when I was in the nfl, my first year in the nfl was 1998. At that time, if you ever had a concussion or a brain injury the athletic trainer, doctor, teammate or a coach said, hey, how are you? You would just say, I'm fine, no matter what.
▶ 1:10:42Mr. Hasselbeck: Even if you couldn't see straight, you were dizzy, you are throwing up, you would say I'm fine. That was the only acceptable answer if you were going to be tough. And we worked early hard -- my last year in the nfl which I believe was 2015, we sort of made it cool to be honest with the medical team.
▶ 1:11:01Mr. Hasselbeck: There was a little bit of distrust, like maybe they are not going to think I'm tough enough, or, I don't know what it was, but it was really hard to kind of change the culture in pro football, which we believe trickle down to college and high school, where it became normal too, if the doctor asked a question, or the athletic trainer, just be honest with them. That was really hard for our community to do that.
▶ 1:11:27Mr. Hasselbeck: I think I do see some similarities where if you are the caretaker of a loved one at home, maybe sometimes it's hard to just ask for help. But that was a tough thing for us. Even just the learning process, looking in the mirror through that process was one was a lot tougher than I thought as an athlete.
▶ 1:11:47Sen. Gillibrand: I remember reading a story about dehydration and how high school coach wasn't allowing the players to hydrate and a boy died because you were not perceived as tough enough. So I hope that that trend of, again, for the professional athlete, so it does trickle down to high school and college, is that your wellness is the most important thing for the players.
▶ 1:12:11Sen. Gillibrand: That part of the team's goal is to be sure you are 100% well, whether it is mental, physical, injuries, or the like.
▶ 1:12:20Mr. Hasselbeck: And I would just say, and the medical professionals here can speak to this better than me, but as a high school coach we are treated for heat -- train for heat illness and those types of things. I remember when my dad was playing in the nfl, it was seen as a sign of weakness it were -- if you were to ever give your players water rights. And now we know through science that that is foolishness.
▶ 1:12:46Mr. Hasselbeck: So I think as a player and someone who loves sports and the game of football, inviting the medical community to really help us learn and not just do things the way that we've always done it. And I would say the same thing for the aging community. I think we can start way earlier , at 65, if we want good outcomes when people are 70 and 75.
▶ 1:13:10Sen. Gillibrand: Smart. Jennifer, can you talk about some of the fall prevention programs and the importance of evidence-based program and how we can support the development of more proven interventions to help the seniors?
▶ 1:13:32Ms. Raymond: One of the evidence-based programs to get -- that gets offered widely across the country and our program is called enhanced fitness. Enhanced fitness is all about physical activity. This is a group class, up to 25 people in a class, it's run by a trained, certified leader who understands not only how to do the exercises, how to do them safely and how to look out for challenges that the older adults may be having while they are
▶ 1:14:04Ms. Raymond: Exercising. Balance, strength training, mobility, all of that being part of the program. But one of the things that makes the program work best is just what others have said, the goal setting component. How am I going to get from where I am in week one where I can barely do the stretching from a standing position, to where I want to be in week eight, and how do I do a little bit at a time in order to do that? That is an evidence-based program that has had some significant research behind it as well.
▶ 1:14:36Ms. Raymond: So it might cost around $1000-$1200 a class I'm not one class but the full evidence-based program, and retrospective cms study showed that people who participate in that program saved a health care cost of around $1000 a year. So you figure 25 people in that class, you are going to make up for it. That is what is incredibly important about the evidence-based programs in the federal support, we want to be good stewards of federal dollars.
▶ 1:15:05Ms. Raymond: We want to initiate and offer programs that have good outcomes that are going to help a person stay independent longer, that are going to increase their ability to stay strong, that are going to increase their ability to be mobile, but at the same time, or going to bend that cost curve over a long time.
▶ 1:15:35Ms. Raymond: >> thanks again, everybody for being here. How many hours a day do you have to spend time to make sure you are healthy? What is it take? And what is the difference? >> I spoke earlier about what I'm terming zone two training.
▶ 1:16:01Ms. Raymond: These are not necessarily my ideas, but I do believe that zone two cardiovascular -- is good for my heart health, it's good for brain health, it's good for muscle, it's good for bone density, it's good for all the things. So I think strength training at least two or three times a week, and breaking a sweat, heart rate over 100, I would say five to six days a week. That, to me, would be seemingly like the floor of what I would consider to be healthy exercise.
▶ 1:16:35Chair Scott: What do you do on your diet? >> high-protein, less sugar, very little sugar if you can, not a lot of refined carbs. A little bit guilty on that right now, but truly and honestly I think setting goals and having people in community holding you accountable and having fun with it, that's what I saw as an athlete. Even now as a former athlete, I've been to a few funerals lately and I've seen a lot of my former teammates. A lot of them are offensive lineman.
▶ 1:17:06Chair Scott: Those guys are having so much fun getting fit and losing weight, and they are on a roll with it. I do believe that the fact that they are doing it together is encouraging. I don't want to say competitiveness, but almost like you are cheering each other on in a way. That is inspiring, it's contagious, and has a multiplying effect, which is really cool to see.
▶ 1:17:31Chair Scott: Chair scott in your communities, if you were going to brag about someone who has a great program for a senior, which one would you brag about? >> I mentioned in my opening comments, in my commute I think the fall prevention programs have been helpful. I've had my own mother and father-in-law in these program's, one at 85 and one at 90.
▶ 1:18:01Chair Scott: Physical therapist, athletic trainers that are not bound to some of the time constraints can spend more time with the older patient, get them comfortable with the program, have ability to make sure they are safe doing it, things like wobble boards and balance maneuvers that can really make a dramatic impact on a patient's risk of falling. I think the fall prevention program is really the key to our community to try to keep people healthy.
▶ 1:18:29Dr. Legg: In my community, we have something which is a free and charitable clinic that started many years ago that has grown. Some of the new services they offer are nutrition, which we have at two different locations, and exercise classes at the same locations. The great thing for patients in the valley is they are free.
▶ 1:18:56Dr. Legg: Patients can learn about nutrition, learned about cooking, but they can also go and participate in an exercise class which includes aerobic exercise training as well as strength training. I work at this clinic, it is a well organized place. Is a great opportunity for people in charleston.
▶ 1:19:19Chair Scott: Where you live, is there anybody you could send a senior to that would be all-encompassing and say if you do these things, you are going to do what both the physicians talked about, you will live longer and be happier and all those things?
▶ 1:19:35Ms. Raymond: We do take a communitywide approach to this kind of work, so being able to partner with the federally qualified health centers, the family health centers, we're seeing a lot of folks who are at risk for falls and being able to partner with that physician group is important. Partnering with the ymca space programs. There are a lot of these kinds of programs.
▶ 1:20:02Ms. Raymond: The incredibly important part for us is that we are often the first folks that an older adult is seeing or coming to us at the senior center, so making sure we understand the wide range of community resources that are there is incredibly important.
▶ 1:20:17Chair Scott: Mr. hassle back, someone you would say it is 80 years old, you would say they have done it right. Who would you look at and say they have done it to stay healthier longer?
▶ 1:20:32Mr. Hasselbeck: Well, my grandmother passed away this past year. She was near 90, she had 12 kids. I think the great grandkids kept her very active. She was someone I would point to in my life you stay very active. She golfed with the women in her neighborhood. She is kind of infamous, she was a left-handed golfer.
▶ 1:20:57Mr. Hasselbeck: What I think just her daily activities, she stayed active cooking, she stayed active, like reaching down, picking up grandkids, holding them, passing them off. Those are activities and I think seriously, like I've talked with my mother about this. What are the activities that you want to be doing when you are that age? If it is that, like let's go get a dumbbell and let's practice squatting. A 30 pound dumbbell is probably like a 20 pound toddler.
▶ 1:21:27Mr. Hasselbeck: What are the activities, if you want to be able to do certain things, maybe we need to walk steps a bunch of times. Maybe we need to focus on walking steps sideways both ways, if you want to play pickle ball. Training like an athlete, but knowing that the exercise that we are trying to train for maybe isn't an athletic event. It's traveling on an airplane without me feeling like you need someone to help you. It's walking through a large airport.
▶ 1:21:58Mr. Hasselbeck: Maybe it is going for walks. Near the end of my dad's life, knee replacements for the thing that slowed him down. He was otherwise completely healthy, but the knee replacements kind of shut him down in a way. He couldn't do very basic activities. It was kind of tough. I think if we had been more proactive about that kind of stuff, like there's lifespan and there is help span.
▶ 1:22:27Mr. Hasselbeck: Sure, you live to 75, but how old were you when you stopped really living? I think that is the mindset, again, I took a proactive approach as a player, I saw players take a reactive approach to their career. They didn't play very long. And I played younger than anybody in my draft last. And I was a sixth round pick on the practice squad. So I do think that mindset is very, very important.
▶ 1:22:56Chair Scott: Tell us of an 80-year-old success story in your community, what would they do?
▶ 1:23:13Dr. Cain: I have a colleague who just retired two years ago, an orthopedic surgeon who operated until age 84. What he did was remain active, he exercised on a regular basis, and one of his favorite exercises was dancing.
▶ 1:23:33Dr. Cain: So that allowed him to stay sharp, both physically and mentally, to operate to that age , so to me, he was a success story. He is still vital. He is not operating anymore, but I was always amazed that he could carry on orthopedic surgery until that age.
▶ 1:24:02Dr. Cain: >> my own father-in-law is now 90 and play tennis well into his 80's. He is one of those guys that never sat still, was always active. When my kids were little, his grandkids, he was always playing with him in the yard, throwing the football, even in his 70's and 80's. He has been a pretty good mentor as far as what activity level can do for your health, your mind, your health span. Even at 90, he still wants to play tennis. He is stools super active.
▶ 1:24:34Dr. Cain: He still leaves the house -- he is still super active. I think that is really what we all want as we age, to be around our family, be healthy enough to be independent. For the most part, he is a good example of that.
▶ 1:24:50Chair Scott: Have either of you seen sports clinics that have really good senior care with it? Are your practices seeing many seniors?
▶ 1:25:03Dr. Cain: Our practice probably sees more seniors than athletes. A lot of it is dealing with new replacements and patients that are really in the long stage where we are trying to get rid of problems that have been going on for several years. I think it's hard to be proactive because patients usually don't come into the clinic lest they have a problem, to cs.
▶ 1:25:27Dr. Cain: We are associated with physical therapy and athletic training clinics that see patients for fall prevention, but most patients don't really seek medical help unless they have a problem. So we end up being on the opposite side most of the time, unfortunately.
▶ 1:25:41Dr. Legg: We see the same thing at our office. When I seek seniors, they are coming in for knee arthritis, hip arthritis, shoulder arthritis. We want to treat that to keep them moving, but that is the place where we see them. Now, we also see them at all stages. It is not a surgery. We do multiple nonoperative treatments to relieve pain, to keep them active.
▶ 1:26:11Dr. Legg: But that's the point we see an orthopedic office should see these patients, when they are coming in for the treatment of established arthritis.
▶ 1:26:22Chair Scott: I used to be in health care business, and one of the things I have watched is, there's not a lot of people that are actually trying to find the cause of the problem. A lot of that is because that is not how you get reimbursed. You don't get reimbursed to find the cause of the problem, you get reimbursed to do a procedure.
▶ 1:26:42Chair Scott: Have either of you in your practice found that, one, is the reimbursement system to find the root cause, and her people really willing to find the -- spend money to find the root cause of the problems?
▶ 1:27:00Dr. Cain: Some of it is just personal drive, encouraged by family -- family or friends or other physicians. Not to get too deep in the wormhole over medicare, but in general the reimbursement scheme makes it hard for physicians to devote a lot of time to preventive care because of the fee schedule is set in such a way that reimbursement goes down every year, cost go up every year, so unfortunately our time was senior patients probably
▶ 1:27:32Dr. Cain: Gets less every year, even if we don't mean to. So I think there are some barriers as far as reimbursement, I think most of it is just the perception of why you go to a doctor. Most people go to the doctor for treatment of a problem, not for prevention of a problem.
▶ 1:27:46Dr. Legg: The one area we do have some success, especially treating arthritis in the lower extremities, we now ask many patients for weight reduction prior to surgery. And often we have patients come back who have lost a substantial amount of weight, and cite my knees and my hips just don't hurt as much anymore. And they often delay surgery because of that.
▶ 1:28:16Dr. Legg: So we do that daily now, I'm having a discussion about weight reduction before surgery. But it is successful. And when people lose -- is -- a substantial amount of weight, I tell them you go to the front of the line, you're ready. You have worked hard. We know that it lowers surgical risks and improves surgical outcomes, but also people come back and say, I feel better.
▶ 1:28:46Chair Scott: You have coached younger people, right? So do you tell people at the age -- can you tell people who know who's going to take care of their body and their mind, unless they get us a private -- apprise injury is going to have a longer career in sports?
▶ 1:29:07Mr. Hasselbeck: No, I don't think you can tell that, but I do get the same exact questions from the parents of high school athletes as I hear when I'm talking to my parents and their friends. It is around supplementation, it is around nutrition. A lot of times it's a questions about protein powders, it's about creatine, and there really is a stigma around supplements because it is the wild, wild west. It's not regulated.
▶ 1:29:35Mr. Hasselbeck: You don't actually know what is going into some of these supplements. But I would also say that I think it is really important, if you have to supplement extra protein into your diet, you need to do it. Whether you are a high school athlete or you are the grandparent of a high school athlete.
▶ 1:29:54Mr. Hasselbeck: I also think with creatine, there is this thing out there were creatine makes you gain weight, and so on the same side, when you were talking about women, there is a pushback on creatine, but I think we would now agree in the medical community that creatine is really healthy and has great benefits for men and women. So it is ironic that they are the exact same question for teenage boys come is what I usually get, and for the advice I'm giving my mom and her friends.
▶ 1:30:26Chair Scott: So I take creatine and I do protein powders, the program -- I'm supposed to have more than I think 120 grams of protein a day. So eat more protein. I just wish there was more different varieties because you get bored of the same stuff.
▶ 1:30:48Mr. Hasselbeck: And I would just say one of the best quarterback coach as I ever had was andy reid. One of the things he would say, he would always just say, stay low in the pocket. I'm sure there were like 12 things he could've said to fix, but he just said state low in the pocket. It was a real attainable goal for me. When it comes to nutrition, I think the doctors might agree with this, if it is an attainable goal, I don't know if I can do everything, but I can do that.
▶ 1:31:18Mr. Hasselbeck: The protein goal and the exercise goal are two of the simplest, most attainable, and they fix a lot of different things. I know I've mentioned zone two cardio, good for heart health and brain health which are the main things that men in my situation are concerned about going forward.
▶ 1:31:35Chair Scott: How important is brain health as we age?
▶ 1:31:44Dr. Cain: In a lot of ways it's more important than physical health. Brain health allows you to be aware of your physical shortcomings, I would argue on your protein, if you're going to get 120 grams of protein, it's tough to do. At the fact that you're trying probably you are probably getting 100, so I think incremental gains are important.
▶ 1:32:09Dr. Cain: We know that protein for instance helps her cognitive help later on and certainly from a health care standpoint, as bad as it is to be broken down physically, I think it's a lot worse to be broken down mentally. So I think brain health is probably more important than physical health for most of us.
▶ 1:32:31Dr. Legg: Brain health follows physical health. There has been discussion on creatine today, and matt mentioned that people worry about weight gain, with creatine, we know that some of the older ways to use creatine included a very high loading, it was about 20 milligrams a day which caused a lot of gastrointestinal upset and water retention.
▶ 1:32:59Dr. Legg: Now we know that five milligrams a day is probably, or five grams a is probably plenty. You can get up to that was unique, but it's going to take about 20 days to get there. Not four days to get there.
▶ 1:33:15Dr. Legg: But we know as time goes, with the buildup of creatine, there is a muscular effect and there becomes a bone effect and then eventually the body can get to what I will call a steady state where there probably is some brain effect, when you get to that level and you've used it long enough.
▶ 1:33:40Dr. Legg: So it is a good supplement, and can be used by most everybody now.
▶ 1:33:47Chair Scott: Thank you for being here, thank you for caring. I hope our seniors take advantage of the information. But it seems to me, well have to figure this out on our own. Nobody's going to do it for us. But thank each of you for being here and thank you for what you do.
▶ 1:34:45Chair Scott: [captioning performed by the national captioning institute, which is responsible for its caption content and accuracy. Visit ncicap.org]