Healthy Hearing, Healthy Aging and the 5M’s of Geriatric Care with VA Audiologist, Steve Huart, AuD

Brian Taylor 0:10
Hello and welcome to another episode of This Week in Hearing I’m Brian Taylor and today our topic is healthy hearing, healthy aging and the 5 M’s of Geriatric Care. And with me to discuss this important topic today is Dr. Steve Huart. Steve’s an audiologist at the Rocky Mountain Regional VA Medical Center. And Steve and I have known each other for a long time. I really respect his thoughts and his opinions on all aspects of Audiology. And we’re really great. And we’re really lucky to have him with us today. So welcome to the broadcast, Steve.

Steve Huart 0:44
Thanks Brian. Glad glad to be here. Appreciate the invitation and feeling’s mutual. Yeah,

Brian Taylor 0:49
so yeah, it’s we’ve wanted to have you on now for a while to talk about this topic of healthy hearing, healthy aging. And I think, a good place to start. Maybe before we dive into the topic, just tell us a little bit about your background as an audiologist and some of the travels where you’ve been where you are now.

Steve Huart 1:11
Well, I’ve been been an audiologist since the 80s. So going on the fourth decade now, most of most of my career has been clinical. I was trained at Mayo in Minnesota, then worked at a clinic in Wisconsin for about 10 years, before I returned to Mayo, worked there for another 10 years, then did a brief stint in the industry, working, as you will know, with Amplifon for a little while, and then for Cochlear for a couple of years as kind of an educator talking to hearing aid audiologists about what would be a good cochlear implant candidate. And after a few years in industry, I decided I missed the clinic and had the opportunity to join the VA down in Tucson and I am a Navy vet. So the opportunity to be a veteran serving veterans and back into clinic was really appealing to me. So that’s what I’ve been doing for the last 13 years now.

Brian Taylor 2:08
While great on behalf of everybody, at least we can hearing thank you for your service. And your most- right now you’re an audiologist at the Rocky Mountain Regional VA, right? Correct. Okay, so let’s, let’s dive in. I know this is a topic that’s near and dear to your hearing, healthy hearing healthy aging. Tell us about those topics and how they fit together.

Steve Huart 2:30
Sure, when you’ve been an audiologist, as long as I have the topic of healthy aging becomes more and more pertinent. So yes, definitely near and dear to my heart. But healthy aging, I mean, it’s it’s a huge topic, full textbooks and conferences are dedicated to that. So it’s really hard to summarize that in a kind of interview like this, but I’ve got some operational definitions that that I I like to use. First of all, hearing, healthy hearing is easy. The way I personally define that is just being able to hear well enough to- either with or without hearing aids or assistive technology to actively participate, to participate in the activities that you need to do. And maybe even more important than the activities that you want to do. So if you’re actively engaged and your hearing doesn’t prevent you from doing things, then that’s healthy hearing. And healthy aging, obviously is a lot harder to define. Again, I think if you can do the things that you need to do to take care of yourself, you can do the things that you enjoy doing in your life, then you’re aging pretty well. But for purposes of this discussion, I think healthy aging is again just able to do the things that you need to do and want to do

Brian Taylor 3:57
want to do. Yeah. And we’ll we’ll make sure there’s a schematic of this in the broadcast. But one of the ways that I visually try to demonstrate healthy aging is I have a picture of Tom Brady, when he’s 43 years old. And he’s the same age of a quarterback named George Blanda, who was 43 years old in like 1970 when he set the record for the oldest quarterback to throw a touchdown pass in a playoff game. And Tom Brady looks like he’s about 25 and George Blanda looks like he’s about 65 Even though at the time of that at the time of each picture, they’re both 43 years old. So it kind of shows you I think, the value people place in healthy aging today and the fact that they want to take care of themselves. So anyway, it’s a hot topic either way, hear a lot about it everywhere. So we’re glad to have you here talking about it. And the other part of our title was the 5 M’s of Geriatric care. So maybe so that we’re all kind of grounded in the term geriatric, who is a geriatric and maybe what makes them different than other younger patients?

Steve Huart 5:10
Geriatric, what is the geriatric question? All the tough ones today Brian, you know geriatrics is extremely difficult to define just as you mentioned, you know, in today’s or in the 60s or 70s, you might call Tom Brady a geriatric and here in 2023 not quite so much. You know, I’m, I’m the Merck manual has an interesting definition of geriatrics and state right out that it is not easy to define the group precisely. And they suggest that people prefer the term ‘older’ over elderly. Well, you know, when I read articles now they talk about older adults over 65. And having crossed that bridge, I don’t particularly like older or elderly. So, Age of ageism is kind of a hot topic right now. And, you know, we need to be careful about having these prejudices or preconceived notions of who’s old and what is geriatrics. There really is no set age for a geriatric patient, like you just said, Brady versus Brant. Brandon, thank you, brands are

Brian Taylor 6:27
sure Blanda – Brady vs Blanda

Steve Huart 6:31
You know, I like to I like to mountain bike. And because I live in Colorado, and I don’t hit the trails now, like I did before, but I hope that when I’m at I’m still, if at least if not, I’m able to mountain bike and still go hiking. So you know what’s old, and what’s geriatric, it depends on again on what you’re able to do. Yeah. Another thing that in the Merck manual that they talked about, the definition is that it really is not a function of age, as much as it is of health status, a lot of your listeners are probably familiar with the PACE program, face stands for program of all inclusive care of the elderly. And if you’re 55 years or older, like qualify for nursing home care level of care, then you’re considered a geriatric patient, and you can participate in the PACE program. So you know, you can be 55 or you can be 105. And it depends on how you’re doing or how well you’re aging as to whether or not you’d be considered a geriatric patient.

Brian Taylor 7:33
And I think what I hear you saying, Steve, is that it’s not about chronological age, it’s about more about functional status.

Steve Huart 7:40
Absolutely. Yeah. So of course, no two people are the same. So it does depend a lot on what you do and how well you have aged and what’s your overall health status.

Brian Taylor 7:55
That brings me to the next topic that I want to talk to you about. And this is something that I know you’ve talked about, and I’ve seen it, I’ve seen it written about the one that the one article that comes to mind was written by Barbara Weinstein a year or two ago about the geriatric five ends. So maybe before you tell us about each of those ends, where does this concept come from?

Steve Huart 8:19
There article, your references a great one. That was in 2021. As a matter of fact, Barbara Weinstein did that article and I would encourage anybody listening today to track that down just Google Weinstein and geriatric 5 M’s and it probably come up. As far as I can tell from literature. Brian Jurek five homes came around. And they were introduced in about 2017 by a group of geriatricians, Dr. tinetti is a geriatrician who’s in charge of our she’s at Yale University, and a couple of guys out of Canada named Molnar and Wang. And they introduced the concept you had a geriatric conference in, in Canada at the time. And they define it is a framework for caring for older adults that maps to the current core competencies in geriatrics. So what they’re, what they were trying to do is come up with something that it’s easy to remember and kind of repackages what they call the geriatric giants, the things that are important when you’re providing health care to an older population. And they go on to talk to talk about it a little more detail that it’s something that’s simply conveyed to the five M’s are so people like us people who are not in the geriatric field, understand a little bit more about what geriatricians do. What’s important to the population that they serve and what they bring to the table and the things that they focused on when they’re treating older, older adults. Well, it’s

Brian Taylor 9:55
interesting. I didn’t realize it was 2017. It’s relatively new. It’s very new. Yeah. Yeah, so it’s good to talk about it. So tell us about the five Ms, which what what is each of the five M’s, if you could describe, describe them for us? Sure. Before I

Steve Huart 10:10
do that, though, you’re right about being new. I actually talked to a group of clinicians at the Rocky Mountain geriatrics conference that was held here in Denver, at the end of last year. And the first question I asked was, how many of you familiar with the five M’s and a lot of people were not?

Brian Taylor 10:26
That’s why we had the on the broadcast.

Steve Huart 10:28
It’s, I think it’s really applicable. I think it’s very timely for us. Now, you know, now that you can buy hearing aids online and do a hearing test on your cell phone, we have to find things that make us relevant anymore. Exactly. The the 5 M’s is really, really fits into that model very nicely. So there are five there are five of them. And the first one is mind, mobility, medications, multi complexity and what matters most. And they’re fairly self explanatory. The mind is all about cognition, mentation, dementia, delirium, with depression, things like that. And what makes it important to us is, you know, cognition and how hearing relates to cognition and the correlation between cognitive decline and hearing. So it’s really easy for audiologists when talking about the five M’s to plug themselves into that, that M that mind, the mind M, and the next one is mobility. So of course that talks about gait and balance and prevent the falls. And clearly you know, there are a lot of audiologists, maybe someone listening today who are vestibular specialists. So it’s easy. Again, it’s easy for an audiologist to start talking to people about balance and hearing and how the two are related. And, you know, I think as audiologist right away, we start when we talk about balance, we start thinking about the vestibular system. One of the things I try to emphasize when I’m talking to other providers who you know, really don’t want to get that deep into the weeds about the anatomy and physiology of the semicircular canals and how that affects balances. The basics how hearing affects balance, how people if they’re concentrating, if you know, if they’re working harder to hear, they’re not paying attention to their surroundings, and you know, they can step off of a sidewalk and break a leg. I was working with a geri- psychologist here at the VA. And I was talking about this topic. And she said, Well, what if somebody’s got a dog and the dog walks up behind them, and they can’t hear the dog and they trip over the dog? Beautiful, beautiful, this woman gets it. It’s fun when you work with another specialist who goes, Oh, yeah, I see the connection. medications. The third AM, medications is huge. We did an analysis, we did a review chart review here at the VA. And I’ll talk a little bit more about that in a minute. Over 600 charts, and geriatric patients are on a lot of medications. And there’s a lot of things we don’t know is I talked to other farmers to pharmacists about this. You know, we know we know as audiologists, what medications are ototoxic. But when you start talking about people taking 5-10 15-20 different medications, nobody really knows how they interact to affect their hearing, certainly their cognition and their understanding. And even more fundamental than that, think about, think about your grandma, your grandpa was sitting in a doctor’s office and the doctor saying, Okay, you have to take this medication in the morning, you have to take this one with food, you have to take this one twice a day, break this one in half and mix it up with food, take this one on an empty stomach. And if there’s a hearing loss, it’s huge. And there’s plenty of data out there that talks about medication errors, and the things the negative things that happen to people in hospitals and medical settings because of a communication breakdown. And of course, the biggest communication breakdown is hearing. So that’s an easy one for audiologists to fit right in to multi complexity. geriatric patients are older there, they have a whole host of medical issues that they have to deal with. So that’s one of the reasons patients become geriatric patients. I mean, see a geriatric specialty is because they’re no longer the routine. Let’s go to your family doctor and get an annual checkup. They’ve got all kinds of different system problems. So it takes somebody with special training and geriatrics to really provide the best care for that population. And so hearing loss can contribute tour or even cause some of those multi complexity comorbidities that we talked about. And again, he started talking to physicians or psychologists or physical therapists about the the complex conditions that their patients have and how hearing contributes to that. And it’s a good place for audiologists to be but the one I liked the most is what matters most. It’s the last of the five M’s and we we do a lot of interdisciplinary activities here and anytime we get the chance, the audiology team that participates in that, to talk about these geriatric patients. Everybody focuses on the big things, controlling pain, hypertension, diabetes, and really hearing loss kind of falls off the radar screen a little bit. It’s just not the most important thing. But when you’re talking about these people that are 80-90 years old, they’re not doing the things that they used to do, they don’t really have a whole lot to look forward to the risk of sounding blunt. But what matters most to a lot of these people, if you really sit down and ask them, Is it they’d like to do things like watch TV, they like to watch their ballgames you’d like to watch your sporting events, they like to visit with their family, they like to talk to their family on the phone, if they’re still able to go to the Elks club, or the VFW or the Legion and they socialize. So really, the last quality of life enhancement that a lot of people have at the end of life is their ability to communicate with people. So any chance I get to talk about the five M’s, I really emphasize that one from an audiology audiologists perspective, I think it’s probably the most important of the five and

Brian Taylor 16:07
yeah, no, that’s well said. So, as a follow up, I’m kind of curious, how do you incorporate? How do you fold into? Or how do you apply the five M’s in your practice? Now, I’m curious, not only with patients, but also maybe you’ve already mentioned some of the other medical specialists that you might collaborate with? How do you fold it into communication with other medical specialties.

Steve Huart 16:35
That’s where most of at least my energy goes, since I got involved with the Grek program here at the VA. That’s where I spend a lot of my, that’s where I live, I spend a lot of my time and energy work working with people who are treating geriatric patients. And the way we the way we use the five M’s is, we focus on the hearing loss comorbidities. And AAA has a great handout. I don’t know if any, if any of you seen it, you can get it off the AAA website. And it lists the seven comorbidities, adult carrying loss. And it is beautiful. It’s a nice little infographic, it’s got a nice picture. And on the back of it, there are references. So it’s evidence based. But the the neat thing about that is when I’m talking about comorbidities like cardiovascular disease, chronic kidney disease, diabetes, and cancer, now I can talk to health care specialists in their language, I don’t have to try to impress upon them, you know, no matter how objective I try to be when I’m talking about hearing loss and how important it is. Other people go, Yeah, well, you’re an audiologist. That’s like asking a lawyer if you need an attorney. So I really try to put in language that’s important to them, you know, if you’re, if you’re an endocrinologist, and you’re treating people with diabetes, and I can say, well, the CDC recommends that diabetics get a hearing test every year than not got their attention. Well, I didn’t know that really? Hearing loss. Is that common in people with diabetes? Yes. So to me, the beauty of the five M’s is the fact that we can tie it to each one of those comorbidities like I said, cardiovascular disease, cancer, you know, cancer, obviously, chemotherapeutic agents, but again, quality of life, these people are sick, they want to be able to hear their health care providers, they want to be able to hear their family members. Diabetes. It’s just, it’s just a real nice Radiosondes. Between.

Brian Taylor 18:44
Yeah, so it makes it easier, I think, to communicate with other medical specialties when you have those five ends sort of as a framework. It sounds like,

Steve Huart 18:52
right? Yeah. Okay. You mentioned people, people like that when you’re talking to them in their own language. Right, right. So if I’m talking to an internal medicine specialist about hearing loss, that’s not their language. If I’m talking to an internal medicine specialists about fall risks and cardiovascular disease and diabetes and how hearing loss connects to that, speaking to them in their language, they get that and they’re more likely to pay attention.

Brian Taylor 19:20
Hello, will try to link that handout that you mentioned from AAA, in the notes here, so people, anytime

Steve Huart 19:28
I go, I go speak if I do have an opportunity to sit down with a group of health care providers, whether they’re physicians, nurses and nurses eat this stuff up. Psychologists, physical therapists like anything outside of audiology, I always bring that infographic from AAA, and it’s up my handout and I let them take that with it with them when they go.

Brian Taylor 19:47
Good to know. You mentioned something called the GRECC, I think I know I’ve seen that in some of your presentation. So tell us more about the GRECC what is it and what have you learned from it?

Steve Huart 19:58
Good question. GRECC is an acronym. It stands for the geriatric research, education and clinical centers. And if, if you’re in the VA, and you don’t know about the GRECC, maybe you should, but not all, not all, VAs have GRECCs. Those are 20 of them around the country. But I think it’s really one of the feathers in our cap. It’s just a, an excellent program, Kaymer in 1975, Congress actually dictated that this GRECC should be there should be GRECC’s, and they’re established to improve health care and for older veterans, and there’s three, three missions, build new knowledge, improve health care for older veterans, and provide training and education. And I’m not a hardcore researcher, I’m a clinician I have been my whole career, and not creative and smart enough to come up with a whole lot of innovative practice models, but providing training and education, I can wrap my head around, because I’ve been a clinician for a long time, got a lot of experience. And I can share that with people. So I really focus on that third mission of the GRECC. And like I said, there are 20 of them around the country. And each grec by mandate has to be affiliated with an academic institution. So here in Colorado, the University of Colorado is just across the road. So we collaborate and research projects go back and forth, and patients go back and forth, and providers go back and forth. And it’s, it’s just, it’s just wonderful. I didn’t know what correct was, before I got involved with the VA. And as a matter of fact, didn’t know what the GRECC was after I was in the VA, until five years ago, again, by mandate GRECC have to have allied health representation so that they can train the specialists on a broad range of services that are available for older veterans and improve the quality of care. So somebody reached out to me and said, hey, the Office of Academic affiliations, funds, some of our trainees in the VA. And somebody reached out to me and said, Hey, our GRECC has money for a student and we need allied health professionals represented in a Greg so would audiology be interested in participating? And so like I said, That was five years ago. And and it’s since then it’s just great, because here, each VA is different. And you can there’s a great website that you can go on and you can look at each one of the different GRECCs so depending on where you live, if you want to explore it, you can find one close to home. But here we have geriatric fellows who are part of our program. We have Jarrow psychologists, physical therapists, speech pathologists, pharmacists, and social workers in us. So there are seven different specialties. And there are all kinds of different activities that go on throughout the course of the week and the year. There are lectures every Friday. There are interdisciplinary case conferences, which are kind of like Grand Rounds. And those are a lot of fun because all of the all these different trainees in different disciplines come together and sit around a table and base. The directors like I pick a case for Audiology and the senior clinician and pharmacy or geriatrics will pick a case for for their specialty. And then we’ll take turns presenting those cases. And each one of the individual discipline trainees has to present that information. And they don’t know anything. Social Worker doesn’t know anything about audiologists. So when they have to present audiology information, it forces people to ask questions, and it’s just a really cool learning experience.

Brian Taylor 23:53
If I’m a non VA audiologist, and I wanted to look at some of the publications from the GRECC for some of the research from the GRECC, would I be able to find that online?

Steve Huart 24:04
Yeah, just Google, GRECC. Yeah, well, and the people are not – sorry brian

Brian Taylor 24:10
G R E CC. Right?

Steve Huart 24:13
Right. You know, a lot of the people are not because of the university affiliations. So it’s limited the VA. And it’s really not at all audiology, specific. In fact, in 2021, GRECCs trained over 2000 trainees, and those are physicians, residents, fellows, psychiatric psychiatry, residents, psychology residents, and all the other healthcare disciplines and then over 500 allied health professional trainees, as well. So I mean, it really is a multi specialty, interdisciplinary project. Very nice.

Brian Taylor 24:57
Well, now that we’ve been chatting now for going on a half an hour. My last question to you, Steve is how does an audiologist, maybe an audiologist that’s not affiliated with the VA or government services? What would your recommendation be for them? Who kind of apply the geriatric five M’s to raise their own standard of care with this population? What’s your advice to them?

Steve Huart 25:24
Easy, I’d learned learn what the five M’s are. I mean, it’s pretty, pretty easy. If you get into the literature, there’s a little mnemonic device, it’s to hand it’s got mind mobility, medication, multi complexity, and what matters most. So I mean, it’s pretty easy to memorize those five. And then, if you don’t, you don’t have to memorize the seven comorbidities, but get that handout, keep that sucker folded up in your pocket. And whenever you have an opportunity to talk to healthcare providers, you don’t find the comorbidity that’s in their wheelhouse, so you can capture their interest, and then relate it back to the 5 M’s and and start to talk about how hearing can what you bring to the table. You know, it’s all about interdisciplinary collaboration and, you know, helping provide the best care and most people get it every once in a while, you’ll run up against somebody who says, I’ve had physicians telling me Well, I’m not going to look into yours, because I don’t have enough time. You know, you win a few you lose a few, right, but, but most people get it. And when you break it down and talk about things that are important, and you know how five M’s are so simple. How can you argue with that, you know, how can you argue that cognition is not important or, or mobility, you know, if you’re not mobile, you can’t do anything and all the things we talked about. Yeah, it’s

Brian Taylor 26:46
great, how it all fits together and how hearing is such an important part of it.

Steve Huart 26:50
Yeah, it really does. But I’d really like to see Brian, I have the opportunity and since you asked this, almost all of the specialties that I work with have some kind of a certification in geriatrics. Audiology doesn’t. physical therapy does. medicine does, of course, geriatricians psychology social work. So many specialists have a certification in geriatrics. I’d love to see audiology come up with something like that, like board certification for cochlear implants, board certification for pediatrics. A board certification for geriatrics makes so much sense to me, since so much of what we do is with that population. Yeah, it

Brian Taylor 27:29
sounds like a call to action. So if there’s any AAA board members or advocates out there, you know, why not have a certification for geriatrics? I mean, it is the largest population that we see is relative to pediatrics and others, so why not? It would make sense. You know, especially in light of OTC and those kinds of things, you know, why not have a way to stand apart with a specialty. So, that’s great advice. Maybe we can get some attention by having you on the broadcast here to talk about the five man’s and how they relate to seeing geriatric patients. So Steve Huart, audiologist at the VA Medical Center in Colorado. Thanks for taking the time to be with us. I appreciate it.

Steve Huart 28:16
Thanks, Brian. Thanks for having me.