Episode Transcript
[00:00:01] Speaker A: There's a futurist by the name of William Gibson, and he is said to have said, the future is here. It's just unevenly distributed. And so even when my father was going through it, I think there was a future that he wasn't experiencing at the time, which really kind of propelled my interest in trying to see that more people experienced a future that I knew could be there.
[00:00:35] Speaker B: Welcome to the Age of Aging, a.
[00:00:37] Speaker C: Podcast about living well with an aging.
[00:00:39] Speaker B: Brain produced by the Penn Memory Center. I'm Jake Johnson.
[00:00:43] Speaker D: And I'm Terence Casey.
[00:00:45] Speaker B: So today's episode is about the healthcare system.
And as I've learned, Philadelphia feels like such a healthcare town. It's really such a presence here.
What was it like during the pandemic to be working here? And what did you watch?
[00:01:04] Speaker C: Kind of change in real time?
[00:01:06] Speaker D: Yeah, sure. Philadelphia is well known within and around the city as an EDS and meds city, because really, so much of the business of Philadelphia is on higher education and health care. And obviously working at Penn and within Penn Medicine were very much part of that machine.
When it comes to Covid, I don't need to rehash what happened on a global scale, but for us specifically, our work changed immediately. And for the long term, there was an adjustment in reimbursements, where clinicians could be reimbursed for virtual visits the way that they are for in person visits. And that was a pivotal moment for healthcare in the United States because we were actively discouraging people from going to a doctor's office, and yet it was so vital that they still have appointments with their doctors. But we had the added problem of working with a patient population that was older, unfamiliar with virtual meetings almost entirely. And those are the ones without cognitive impairment. When trying to conduct a cognitive evaluation of a patient, you want them to be as comfortable as possible, and yet here we are, thrusting them into a completely virtual world. And then our social support programs had to become virtual as well. Here we are five years later. People have learned to really strongly embrace virtual meetings and virtual presentations.
We routinely hear from caregivers and research participants asking if our events will be streamed or recorded. Will they be able to participate virtually. For a lot of our patients and research participants, in person events are no longer an option.
[00:03:00] Speaker B: I ask about COVID because it really did change everything, and in a lot of ways, it sped up a lot of things. And then I think it also showed a lot of flaws in the systems that we have, with a lot of older people becoming isolated. I remember my grandmother had been going to choir for probably her whole life. And I think during COVID she stopped and was living alone. And that really struck me in terms of how important something like social enrichment is, especially for older adults.
So for this episode, you know, you conducted both of these interviews that we're going to hear, and one of the interviews that you did was with the chief medical officer at Penn Medicine, Dr. P.J. brennan, who opened this episode with a.
[00:03:51] Speaker C: Quote from William Gibson.
[00:03:53] Speaker B: Do you want to talk a little bit about why you chose Dr. Brennan and then Dr. O' Brien for an episode about the healthcare system changing?
[00:04:04] Speaker D: So for this episode, we picked Dr. P.J. brennan and Dr. Kira O' Brien, and the Penn Memory center team works with both of these clinicians, but in very different ways. Dr. Brennan is the chief medical officer for the health system for Penn Medicine, and he is involved in how I typically describe the 30,000 foot view of the healthcare system.
But Dr. Brennan is one, at least largely responsible for the vision of Penn Medicine. What are our priorities and what is the identity of the health system? And then how do we adapt to both internal and external changes to make sure that the health system is not just surviving, but thriving and adapting? And he obviously had a great impact on the health system during the COVID years, but our relationship with him had gone back well before my time, even at Penn Memory Center. His father died after living with Alzheimer's disease about 15 years ago, and he worked very closely with the Alzheimer's Disease Research center at Penn to launch a fundraising event to support researchers working with older adults or neurodegenerative diseases like Alzheimer's disease.
So Dr. Brennan was the natural pick for one conversation of this. Dr. Kira O' Brien, who's an assistant professor of neurology, sees patients at the Penn Memory center, but she's also a great researcher within the Penn Program on Precision Medicine for the brain, which is Dr. Jason Karlowich's lab. And she is spearheading an effort that is technically outside of the Penn Memory center, but is very closely related to that we're going to get into in this episode called guide. And GUIDE is an acronym. It's a Medicare reimbursement program. I'm sure we get into some more specific details in the episode ahead, but largely what it is is a program to support caregivers and patients to help extend the time that they can remain at home and age of place rather than have to be in the health system as much. It's a lot more complicated than that. But Dr. O' Brien is very involved in the minutiae of getting that off the ground. And it will go live on July 1st, shortly after this episode airs.
[00:06:34] Speaker B: Okay, great. Yeah. Well, I think we can just jump.
[00:06:37] Speaker C: Right into the episode then.
[00:06:39] Speaker D: Great. Look forward to it.
[00:06:48] Speaker A: When you've been in a role as long as I have like this one, you get to see the cycles of healthcare, so to speak.
[00:06:58] Speaker C: Dr. P.J. brennan is the Chief Medical Officer and Senior Vice President at Penn Medicine.
[00:07:03] Speaker A: I'm an infectious diseases physician, trained here at Penn Infectious Diseases and joined the faculty. Thereafter. I spent the first half of my career fully engaged in teaching, education, and research, and then moved to an administrative career and have progressed through the ranks to become the Chief Medical officer for the for the health system, which is a position I've held now for 20 years. I'm in my 20th year in that role.
[00:07:25] Speaker C: In his long career, Dr. Brennan has seen the healthcare system take on many changes and has himself been a major part of those changes.
Dr. Brennan was key in leading Penn Medicine through the COVID 19 pandemic, a massive shift that he said only revealed existing problems in the system when it came to caring for older adults.
[00:07:45] Speaker A: So the pandemic was just a heartbreaking period where there was so much isolation for patients that were the most acutely ill and the most acutely ill were oftentimes those over the age of 65 years old. And, you know, some of those, those individuals had cognitive decline, which exacerbated both their, their medical and their mental health conditions.
[00:08:06] Speaker C: The U.S. health care system is once again changing, especially when it comes to taking care of the oldest people in the country.
We say it so much on this podcast, but the world is getting older and this longevity means more people with dementia, more people or some form of cognitive impairment. We will have to find new ways to care for this population because US Hospitals are just not built to care for older individuals. And more adults in the hospital system will only put more stress on an already overstressed system. And from the perspective of the patient, oftentimes a hospital is one of the worst places a person with dementia can be.
[00:08:42] Speaker A: An acute care health system is not built for older Americans very well, and certainly not for people living with dementia. The placement of a patient in a new acute care environment with lots of bells and whistles and lack of familiarity with the surroundings can really exacerbate nascent signs of dementia and really severely worsen more advanced evidence of dementia.
[00:09:09] Speaker C: Already in the dementia and Alzheimer's space, we're seeing the system change rapidly. The most notable of these changes is the development of the anti amyloid therapies Donanemab and Lecanemab approved by the FDA in the past two years. If you're interested in learning more about these treatments, you should go back to episode one of our second season titled In Sickness and in Health. We break down everything you need to know about both drugs there. To sum it up though, these treatments target what researchers have identified as the most prominent physical signs of Alzheimer's disease in the brain, called amyloid plaques. This development is significant for a few reasons.
First, if someone has Alzheimer's disease, there's an actual treatment that they can take to potentially slow down the progression of the disease.
That was not possible before two years ago.
Second, the Penn Memory center and clinics across the country actually have a treatment.
[00:10:03] Speaker B: They can give people.
[00:10:05] Speaker C: Prior to this, doctors could prescribe medications to treat the symptoms of Alzheimer's disease and refer social services to patients and caregivers, but there was nothing they could prescribe to address the actual progression of the disease.
Financially, this has posed a problem for the Penn Memory center as well. In a private healthcare system like the one we have in the US Treatments are a key part of the business model, meaning that the center was ultimately operating at a loss and its services were supported through philanthropy.
Medicare also only covers the cost of a 30 minute doctor's visit, but specialists at PMC usually see patients for an hour, meaning that the center was covering those extra 30 minutes.
Anti amyloid therapies might mean the difference between clinics like PMC losing money and actually expanding their services.
Having therapies to prescribe might also help with the stigma around Alzheimer's and dementia generally. Here's Dr. Kira O' Brien, Assistant professor of Neurology at the University of Pennsylvania, on why doctors own stigma might prevent them from diagnosing a person with a dementia causing disease.
[00:11:10] Speaker E: I remember one person saying, you don't want to tell this person that in 10 years they're going to be living in a nursing home drooling with dementia. And so from their perspective this would be an uncomfortable topic to discuss. It would raise a lot of anxiety on the part of the patient and their families and so they just don't talk about it. I mean, similarly to oncology, actually I think cancer used to be a topic that they didn't want to talk about, but we need to move in the direction of oncology and say it's important to have these conversations.
This can have a meaningful impact on patients lives and early detection truly is better. I think the advance in treatments probably had a Huge part to play. And I'm hoping with anti amyloid therapies and whatever other treatments come down the pipeline, we will move in a similar direction.
[00:12:02] Speaker C: Another major development in the field are new blood biomarker tests, which allow clinicians to identify signs of disease through a simple blood test.
[00:12:11] Speaker E: The treatment landscape really spurred movement in the biomarker development field. So we had biomarkers that existed like amyloid, PET scans, tau PET scans, spinal fluid biomarkers that we were using in research, but we weren't really doing it clinically because it wasn't going to change the patient's career. But then with anti amyloid therapies like lecanemab or donanemab, we now have to have biological proof that the target of those therapies, the amyloid protein, is present. PET scans are still expensive spinal fluid testing, while it does get reimbursed, it's an invasive procedure and most patients don't like that, even though it's very safe and well tolerated. So we have been looking for an easier test to get, basically. And so that really led to advances in blood biomarkers. So blood tests for Alzheimer's disease, so we can detect forms of amyloid, we can detect tau, which is the other major protein associated with Alzheimer's disease.
So I think in the future I could envision that we use these blood biomarkers as a screening step to see who really needs to go on and get confirmation with amyloid, PET or spinal fluid.
[00:13:27] Speaker C: Another flaw in the system when it comes to addressing people with dementia is that most people are not diagnosed by specialists, but rather primary care physicians.
[00:13:36] Speaker E: When patients are coming in with these complaints, they often first go to primary care.
Primary care providers are incredibly overworked. They have so many conditions they need to manage.
They don't receive training in how to identify and diagnose cognitive impairment, how to talk about the diagnosis, and then they are horribly under resourced. So a lot of primary care providers don't have access to the things we have in the memory center, like social workers, caregiver education and supports. So without that, it becomes almost impossible to deliver a diagnosis and provide appropriate care for someone experiencing cognitive decline.
We would love for everyone to have the type of care that we deliver at the Penn Memory center, but there aren't enough dementia specialists to be able to do that. So that's also a huge challenge. So we've been exploring ways to care for these patients, support their families, but not necessarily need to bring them in for a clinic visit to do all that on the specialist Side this is.
[00:14:43] Speaker C: The other major shift in the healthcare system when it comes to the care of older adults.
In July of 2024, the federal government began enrolling for a pilot program titled guide, which stands for Guiding an Improved Dementia Experience.
Essentially, GUIDE is a package of dementia care services, including an annual examination with a dementia specialist, a written care plan, a 24, 7 support line for caregivers, as well as caregiver training and education.
While the Penn Memory center offers many of these services, what makes GUIDE truly unique is the way it helps the caregiver and patient navigate the healthcare system and reimburses institutions like PMC for providing this bundle of services.
[00:15:29] Speaker E: The GUIDE model is an alternative payment model. So rather than traditional fee for service, GUIDE provides bundled payments for a set of dementia care delivery services.
So any month that we provide these services for a patient, we get reimbursement. The services included are comprehensive assessments.
So staging of dementia, assessing for caregiver burden. But then there's a huge care navigation infrastructure. So the care navigator is someone who acts as the first point of contact for the patient and the caregiver. They perform regular outreach. So in our program it would be monthly outreach to the patient and the caregiver to make sure we are addressing their needs, see if there are any new concerns that have come up since the last check in. And then they also provide support around care transition. So let's say the patient is hospitalized and they come home, the Care Navigator would reach out, make sure that they have all their like medical equipment that they need, make sure we go over their medication list, figure out what's changed and then help coordinate any follow ups as necessary. The Care Navigator is also the liaison between the patient and the rest of the care team. So that can also be a huge hurdle for patients is just navigating the healthcare system. So the care navigator will connect them to the clinician or the social worker or whoever else could help them out with any of their concerns. The other piece of this is caregiver education and support. So caregiver training classes like how to deal with agitation and patients with dementia support groups, one on one counseling. These are all things that the Penn Memory center was doing but not getting paid for through traditional reimbursement. It was all paid for by philanthropy and with that you can't expand these programs. So we weren't able to serve all the patients who needed these types of supports, but now we hope we can.
[00:17:30] Speaker C: Under guide, Medicare will also cover up to about $2,500 for respite services like in home care and adult day centers. And while this isn't much, this money is meant to get people started with these services and ultimately lessen the load on nursing homes and hospitals. Some clinics across the country are already enrolling for guide, and Penn Medicine will begin its enrollment process in July of 2025. If you want to learn more about the services guide offers and your own eligibility, we will link to more information in our show. Notes For Dr. Brennan and Dr. O' Brien the guide program represents a step in the right direction for the US Healthcare system moving forward.
In a country where the elder population continues to grow rapidly and technology continues to innovate year after year, healthcare will have to decentralize, become more collaborative, and further support older adults and caregivers so they can live as healthy as possible as they age.
[00:18:28] Speaker A: There's a futurist by the name of William Gibson and he is said to have said, the future is here, it's just unevenly distributed. And so even when my father was going through it, I think there was a future that he wasn't experiencing at the time, which really kind of propelled my interest in trying to see that more people experienced a future that I knew could be there.
So I think that we have moved forward in so many ways. I think there's much greater appreciation for the burden on family caregivers, the burden of the disease itself, and the potential that we have as providers to alleviate that suffering. So I'm optimistic about particularly being here at a place like Penn and seeing the people of such deep commitment that it makes me want to, you know, continue to be engaged and support them.
[00:19:27] Speaker C: One of the things I really liked.
[00:19:28] Speaker B: About what PJ said at the end right there, was the recognition of the importance of family caregivers, especially in relationship to what it means for the healthcare system going forward. Taking care of those with dementia we focus a lot on caregivers in this podcast because we see them as such an integral part of care for older adults and people with dementia. As we've talked about many times before, they often know the person with dementia very well.
[00:20:01] Speaker C: They're very attuned with that person.
[00:20:02] Speaker B: They take them through their daily life, and then it's also a role that has just been historically not recognized as a job or compensated in the way.
[00:20:12] Speaker C: That I think that they should be.
[00:20:14] Speaker B: So hearing that from Dr. Brennan made me feel very hopeful about the way that caregivers might be treated or compensated in the future going forward as the healthcare system goes under. All of these transformations and changes we.
[00:20:30] Speaker D: Talked about in the Beginning of the episode. And then Dr. Brennan spoke a lot about the role of COVID and how it impacted Penn Medicine and beyond. One of the main takeaways from that was that caregivers provide care. It sounds silly when you actually say it out loud like that, but family caregivers who are unpaid are not visitors. They're not just sons and daughters. They're providing care to these older adults, whether they're in their home or if they're in a hospital system or a long term care facility or so on. And what we learned within the research of P3MB and within the Penn Health system is that family caregivers are part of a care plan and part of a treatment plan. And as Dr. Brennan described and as Dr. O' Brien has described now, they are part of the formal reimbursement structure.
It's not a lot of money. The reimbursement for caregivers was something about, I think, $2,500 for a year. That does not go very far. I'd love to see that number be higher in the future.
But this is the first time that caregivers are treated by the Medicare system as part of the treatment plan.
[00:21:49] Speaker B: So this is a pretty dense episode in terms of information.
Do you mind just kind of going through and breaking down some of the changes that we talked about in the healthcare system?
[00:22:03] Speaker D: Yeah, there were a lot of different directions, and I think that shows our point that we wanted to acknowledge that this is a transformative time in the care of older adults. And there are a lot of little things that add up to some key summaries. And I think more than anything else, what boils down to the business model of care for those living with Alzheimer's disease and the introduction of guide.
So on the business model front, there are now two treatments available for those diagnosed with Alzheimer's disease by the Penn Memory center or other neurologists at Penn Medicine.
And when a patient receives those drugs, they are billed from their insurance, Medicare, and then the Penn Memory center is reimbursed.
And for the last nine years that I'd worked here, the way that that worked is the clinicians were reimbursed for the clinical visit alone. I think the reimbursement is for a 30 minute clinical visit. And our visits tended to be about an hour, plus we had neuropsych testing, plus we had a meeting with a social worker. And all those things happened at a loss. As far as insurance reimbursements were concerned. The rest was covered by the philanthropy.
And that has been great. And it has worked. And thankfully, we have plenty of philanthropists in the Philadelphia area and beyond who are very interested in supporting this work. But it's not a long term solution. And having a true business model through properly structured reimbursements of these treatments, is how you get sustainable growth.
Because one of the other main issues that we have here is we do not have, we being Penn and we being the United States of America, do not have enough Alzheimer's disease specialists to prescribe this medication, not to everybody who wants it. Our waiting list at our clinic is months long, if not a year, depending on what time. Here people are trying to get an appointment.
So we needed a business model and now we have one. The next step is to make sure that Alzheimer's disease specialists aren't the only ones seeing Alzheimer's disease patients or diagnosing older adults for the first time with Alzheimer's disease or other causes of neurodegeneration.
So that's another item in play here that Dr. O' Brien, Dr. Karlowish and all the other what we're calling Alzheimer's specialists at the Penn Memory center are training the rest of the health system to better diagnose patients. When we get to a point that a primary care physician working with an older adult can accurately diagnose someone with Alzheimer's disease and eventually prescribe them one of these anti amyloid therapies that we've been discussing, we're going to be able to help many more patients than we are now tenfold. So the third point that I would bring up is just the importance of getting that accurate diagnosis. And the introduction of blood tests is really going to change that. We talked about that in the last episode. We had the clip of Dr. Koller, which is an interview on Science Friday. But being able to get from a blood sample an accurate diagnosis of amyloid in the body that can be read as an indicator of Alzheimer's disease will speed up the diagnosis process. It will make it more accurate and it will make it more accessible to more patients and PCPs.
Now, with available treatments, there's a very clear action to be taking at the early stages of the disease. And then with the introduction of guide, there's a system to support both patient and caregiver and other family members as well. I know you did a great recap of GUIDE earlier in the episode. It's a complicated topic. If you're in it, you'll better understand it because it's a system that will be catered to individual needs. But at its core, GUIDE is just a reimbursement plan for a bundled service for patients and caregivers. And what I think is sort of the most helpful aspect of it is the role of the care navigator, almost a concierge, if you will, to the health system for adults living with cognitive impairment in their caregivers.
That is going to be a great stress relief for our social workers who are fielding a lot of those calls right now. It's going to be a great stress reliever for the caregivers who are trying to find the best options for their family member. And it's going to help Penn and Penn Medicine fully understand what they're facing in terms of a patient population and their needs.
So I know that the summary was almost as long as the episode, but ultimately it boils down to having a business model, the importance of an accurate diagnosis, having more clinicians who can accurately diagnose patients, and then, of course, the role of guide, which will be kicking off in just a couple of weeks here at Penn Medicine.
[00:27:13] Speaker B: Yeah, and I think what you're saying, you know, there's a lot of great things, there's a lot of progress. And I think it reminds me of the William Gibson quote that Dr. Brennan quotes at the end where he says that the future is here, but it's unevenly distributed. And I think from the perspective of the healthcare system and healthcare workers, there's a lot of new research, new technologies, innovations coming, and it's about how do we get these to the people that need them?
And then I think from the perspective of the patient and the caregiver, this all is just very, at least for me, it feels very opaque, the healthcare system sometimes trying to understand what my next steps are. How do I get diagnosed, how do I get treatment? What do I do now? I think there's a lot of questions like that. And I think that something like a care navigator is just so important for helping people actually understand what they should be doing next. So I think that there's real optimism here and there's real hope here. It's just going to take a lot of change in the next coming years.
So should we transition there to the beautiful question? All right, so last week's beautiful question was, what is something in your home that you treasure? And some of the answers from last week's question are also from the thank you lunch that we had in early May.
So I will play those for us now.
[00:28:37] Speaker F: My name's Anthony Thomas and my cat, Ripper.
I treasure our daily interactions. Every day is like a box of chocolate because this starts as soon as I stir.
He stands on my chest, looks me and die.
He waits for me. We go downstairs. The day starts with I have to give him specific treats and from there we have to have playtime. And I seem to be his favorite plaything because as I walk through the house, I get ambushed at any time. He doesn't like to be here.
He doesn't like to be pissed out. But if I'm sitting reading, watching tv, he comes and just collapses next to me. Finn just goes to sleep.
[00:29:21] Speaker D: My name is Fred Samaha.
[00:29:23] Speaker F: I happen to be a neurologist.
[00:29:26] Speaker D: With regard to something to treasure in your home today, it's a piano.
[00:29:31] Speaker G: In my youth I played as an orchestra.
[00:29:34] Speaker D: When I moved here, I was in medicine for many years. Then I retired and then I bought a piano.
[00:29:42] Speaker A: Jen Giroud, BAAL I have birds and some fish. And to me those are the things.
[00:29:51] Speaker F: That I would say my treasures at home.
[00:29:53] Speaker A: Two parakeets, one blue, one green and we call them blue and green and.
[00:29:59] Speaker D: Then five little fish in an occlusal inquiry.
[00:30:03] Speaker H: Janet Johnson I would say our first collection of first edition books and ones that are autographed, particularly where we were able to meet the author in person.
A collection of Robertson Davies, who is the poet laureate of Canada and has written wonderful, wonderful books. A number by Joyce Carroll Oates, the Truman Capote, A Christmas Story. Just terrific to have. So we have a large collection and enjoy the books whether they're autographed or not or first edition or not. But we have managed to collect quite a number that are so we enjoy that.
[00:30:44] Speaker G: Julie Jaffe I have a lot of artwork, but what I really love is my kitchen windows.
I have a sink. I live in houses in center City Philadelphia that are all connected. And when I look out my kitchen window, I'm standing at my sink and I see a brick wall from my neighbor. It's a big high window and I had it extended and I have three shelves and I've got plants on the window. I have all sorts of plants so that when I look at my when I stand at my my sink, I see some blue leaf flowers. I see a cactus. At night I have a little candle with fake flames that I use batteries in the candle and they shimmer. I come into the kitchen and I smile because I have this wonderful window that extends out into itself.
[00:31:39] Speaker H: Tracy Allman and I treasure our secretary is it's a furniture piece that we have passed down through our family.
It belonged to my great grandmother and it is a beautiful piece of Furniture. And on top are my father's ashes.
So the connection to me and that piece in our home is beautiful. And I love the way it opens up.
Reminds me of the old days, where you sit back and you write where it opens up. There's a chain connected to it. So it's a beautiful piece of furniture. So that's what I cherish in my home.
[00:32:13] Speaker B: And this week's beautiful question is, what is something you think you could teach someone?
I can go first for this one.
It's kind of an existential question, because you start to wonder what you actually know enough to teach someone. And it's a little scary how little I can think of. And the thing that I somehow came to was body surfing. When I was a kid, I used.
[00:32:38] Speaker C: To go to the beach very often.
[00:32:40] Speaker B: I grew up in Brooklyn, but I grew up in a part of Brooklyn that was kind of South Brooklyn. You could drive or take the train to the beach a lot in the summer. It was very common for my parents to come home from work, and I was an only child, and I was just sitting at home all day doing nothing. And we would go to the beach. It's about 25 minutes in the car.
And I did a lot of body surfing. It was kind of a thing that.
[00:33:05] Speaker C: My dad taught me when I was a kid.
[00:33:08] Speaker B: And every year I go with my dad's family to the beach, and you can see all of us trying to body surf. It's very silly, but it's very relaxing and very fun, and I think I could probably teach somebody how to do that.
[00:33:21] Speaker D: We're at the beach this weekend, and our firstborn loves trying to body surf. And he's actually, I say, trying to. He's quite good at it. He's better than I am. But he also seems immune to cold water. So I was not as active at trying as he was because I got about a third of the way out before I decided, you know, I can watch from here, let you go.
[00:33:42] Speaker B: I think it's a trait that's in young. I used to be able to do that as well. Not anymore.
[00:33:48] Speaker D: My answer to this is sailing. And it's been a long time since I have taken a real sailing lesson. And I won't pretend to remember a lot of the.
The tactics of sailing. But I think more importantly, when people go out on a sailboat, their issue is with the experience of being on the boat and the stillness and the nothingness of it. And I like to think that if I'm on a boat, I can at least get us back to shore as we need it or keep us from flipping. I think that's sort of the bare minimum of sailing. Know how, but more importantly can help teach someone how to appreciate using that time of the quiet, even the stillness when the wind is low, to think of it not as trying to get to the finish line, but appreciate the quiet and the stillness.
So that's where I'm going to go is not teaching someone how to sail, but how to go sailing.
[00:34:52] Speaker B: My poor dad is probably listening, wishing that I could teach someone how to sail.
[00:34:57] Speaker C: I, I probably, I got the basics.
[00:34:58] Speaker B: I went to, I went to sailing camp and I sailed a lot with him as a kid. But yeah, that's a great one. All right, so if you want to answer that question, you can call 571-449-6474 and the question is, what is something that you could teach someone?
[00:35:21] Speaker D: Thanks for listening to this episode of the Age of Aging.
The Age of Aging podcast is supported by the Penn Memory center, the University of Pennsylvania Alzheimer's Disease Research center, the Institute on Aging, and the Penn FTD Center.
[00:35:35] Speaker B: Contributors include myself and Terence Casey, as well as Nicolette Calcavecchia, Dahlia El Said, Jason Karlewish, Emily Largent and Megan Sharp.
[00:35:45] Speaker D: More information on the stories you heard today can be found in our show Notes and on our website, pennmemorycenter.org.
