Empathy is a crucial component when working with older adults [PODCAST]

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“Empathy is more than just loving an elderly loved one. It is more than simply making the decision we may feel is best for our loved one. Empathy is different from sympathy. Empathy means putting ourselves in someone else’s shoes and making an informed decision. Empathy is seeing through our loved ones’ eyes, hearing through her ears, feeling her emotions, and thinking about her thoughts. It requires internalizing her feelings and acting accordingly. It is a crucial component when working with older adults.”

Mahesh Moolani is an internal medicine physician and author of Tough Decisions In Care Of Elderly Loved Ones (A guide for caregivers).

He shares his story and discusses his KevinMD article, “Empathy is a crucial component when working with older adults.”

Hosted by Kevin Pho, MD, The Podcast by KevinMD shares the stories of the many who intersect with our health care system but are rarely heard from.

Transcript

Kevin Pho: Hi, everyone, and welcome to the show, where we share the stories of the many who intersect with our health care system but are rarely heard from. I’m Kevin Pho, founder and editor of KevinMD. So today I have an internal medicine physician, Dr. Mahesh Moolani. He is a KevinMD contributor and is the author of the book, let me get this right, Tough Decisions in Care of Elderly Loved Ones: A Guide for Caregivers. So tell me a little bit about your story and what led you to write the book.

Mahesh Moolani: OK. Yeah, so I’ve been an internal medicine doctor for quite a few years now, 20-plus. And five or six years ago, I restarted seeing patients in nursing homes. And what I noticed is that a lot of families have real big trouble when they are discussing their parents’ issues or their spouses’ issues. Like, somebody has depression, and they can’t figure out it is depression; they think it is dementia because he’s getting forgetful. Elderly people get anxious, and they develop so many other health issues, like cancers and heart failure. So the family members, especially at end of life, do have so many problems.

So I came up with the idea of, why don’t I address it by writing a small book, where I address all the mental, physical, and health issues of the families, you know, of the patients. So that’s how the idea came about.

Kevin Pho: Well, I think it’s a tremendously important topic. I’m approaching my late 40s, and my parents are in their 70s, and these are conversations that people in my age group are coming up with right now. So, from your experience in your practice, what would you say are the top few issues that family members are dealing with when caring for their elderly loved ones?

Mahesh Moolani: Well, basically every family member I talk to, not every, but most, they’ll say, “Oh, Mom doesn’t listen, you know.” It is Mom or Dad or whoever, or “My husband, we’ve been married for 50 years, he never listens, he still doesn’t listen.” So, you know, we do not know how to empathize with our loved ones. I mean, this is how they are. And especially when they have some heart failure going on or some cancer, it is very difficult for them to start listening all of a sudden. You know, they are dealing with their own problems, and here we are telling them, giving them solutions, instead of putting ourselves in their shoes.

So what I have noticed is that a lot of family members do not understand the illness of their loved one, you know; they want to give solutions right away. And I do not think that is the right thing. I think the best thing is to put ourselves in our loved ones’ shoes, you know, what they are going through, and try to understand.

And so I see that a lot, especially depression, and loneliness is growing day by day, especially in the arena of social media. Elderly people, you know, those who have a social media connection, they are on social media. I see them a lot. A lot of my patients are connected with me on Facebook. But those who do not, they are very lonely. If you go to some church service or something, you’re fine, but otherwise they’re very, loneliness is a big problem. Depression is a huge issue. That’s what I see.

Kevin Pho: And I can only imagine that loneliness and depression are worse during the pandemic because of social distancing and the isolation and keeping younger loved ones apart from their grandparents. And I can only imagine how difficult it must be during this time. So, if you’re a family member and you’re caring for your older loved ones, what are some techniques? You mentioned earlier thinking of it from their point of view. I think in the excerpt on my site, you talked about empathy. Do you have any techniques that you can share? Any advice that you could give to caregivers about how they can put themselves in the shoes of their older loved ones?

Mahesh Moolani: Yeah, so the main thing is listening, you know. The more we listen, the better it will be. So, for example, you see your mom is struggling and she lives on her own. So, instead of going and changing everything in her home, just go and sit with her and offer help: “Is there anything I can do for you?” You know, or just spend time with her as much as possible.

And, you know, I know so many elderly people who are so independent. They don’t want help. Even when they get sick, even when they are physically incapable, they don’t want to be a burden on their kids. They don’t even want to be a burden on their spouses. You know, so they want to drive things themselves. So I think at that time, the best advice I would give is just to go and spend as much time as possible, and, you know, get their confidence. Like, “OK, I think my son or my daughter can help me, you know. Let me tell her to get some groceries for me, or let me tell her to take me to church,” or let me, you know.

Things keep on getting worse, because there are people who need help in cooking food, you know. So they cannot cook food. There are so many elderly people who are going hungry in this country, which is not a very good thing. But they don’t want to seek help, and children or their other loved ones do not know how to help them. They’re not asking for it. So, by spending time, we will understand their problems. And the more time we spend, they will get our confidence also.

And this is how I think it should be done, in a very simple, easy way. It should not be forced: “Mom, let me help you. Let me take you to church. Let me take you shopping.” “OK, Mom, I’m free from 3:00 to 5:00 today. So I’ll be with you, you know, and we will spend time together.” And in that time, if Mom needs some help, you know, you see what is going on. And spend as much time as possible, and then things will open up. And then Mom will tell you what to do and what not to do, and things like that.

Kevin Pho: All right. So you’re an internal medicine physician, just like I am, and we’re obviously going through this difficult time during the pandemic. How has this changed your practice? And what have you seen, especially with the elderly in your community?

Mahesh Moolani: Oh, so I’m doing mostly telemedicine. I would say not mostly, more like 99 percent of it, except I went to give a knee shot to one of my patients, you know. Otherwise, everything is telemedicine.

And the most interesting thing which I noticed is that many elderly people, even though they have smartphones, do not know how to connect. They only know how to call or do Facebook, you know. But there are so many who do not have a smartphone, and those who have a smartphone don’t know how to connect with the doctors. We can send them the link; they don’t know what to do with the link, you know. And if I call them, they don’t know: “Oh, Dr. Moolani, I think I have a FaceTime.” “What type of FaceTime? You have an iPhone?” “No.” So after a couple of questions, you know, you come to know, OK, they don’t even have a smartphone. They have a flip phone.

So many elderly people are struggling because of that, and they want to go to the doctor’s office, although they are scared also. So this has changed a lot. The dynamics have changed a lot for elderly folks, and I have noticed that many of them, I would say in my practice 30 percent of the elderly folks, have trouble with access to the health care setting, you know, like telemedicine. Even telemedicine, they have a problem. So I just end up calling them and just talking on the phone, with no video or anything. So they are, I don’t think, pretty satisfied with that. I don’t think they get that much satisfaction. They’re always asking me, “OK, when will I be coming to your office again?”

So, you know, I was thinking telemedicine can be a solution, but telemedicine can only be a solution if we can provide the good tools to our patients. And internet will be a big issue. Many elderly people have a limited budget. They don’t even have internet. So telemedicine is good for millennials. It’s good for people under 50. But not for those above 65, I think.

Kevin Pho: And you know what? I’m seeing the same thing, too. You can’t imagine how many people just want to come in to the office and have a face-to-face meeting, just for an annual well visit, just for managing their hypertension. And these are things that could easily be taken care of over a video chat, over the phone. But when I have the opportunity to see patients in the clinic, the elderly really grab that opportunity because they do value that face-to-face visit. And even in the middle of the pandemic, there’s a good proportion of them who are still willing to come in and see you face-to-face. And that, to me, is just amazing.

Mahesh Moolani: Yeah, what is very interesting, I think, that I noticed is that for many elderly people, it is their social time, also. So they love to talk to the doctor. They want to be connected to the doctor. This is the human touch, you know? It doesn’t come with telemedicine. I mean, I think telemedicine has a role, but that human touch, my patients still talk to me more. But if it is a completely strange doctor talking to a patient whom they’ve never seen, I don’t think the satisfaction can be as great.

I think my patients still get some satisfaction because they know me. If they do not know me, I think you cannot be 100 percent satisfied with that. It is till you sit with somebody across the table, and “Oh my gosh, you know, I like this guy.” You share your stories and kids and so many things. I mean, I discuss their family life with them, you know; many of them are farmers. I discuss how many pigs they have, how many cows they have, and all that, you know. So they like that personal thing. So I think that personal thing can be developed when you are in the same room.

Kevin Pho: Yeah. So, just so you can share with the audience, tell me a little bit about your practice. Where do you practice?

Mahesh Moolani: I practice in Owensboro, Kentucky. It’s a small town, 60,000 people. I do primary care, and I see patients in nursing homes. Right now, I’m seeing patients in three nursing homes. So I’m medical director at a couple of nursing homes, and, not assistant medical director, acting medical director at another one, because that medical director is on leave. Yeah, so that’s why I’ve become more passionate about this elder care business. Even my son is into this now, and he’s not even a physician.

Kevin Pho: So, in the nursing homes specifically, how has the pandemic increased the isolation and loneliness among the nursing home residents?

Mahesh Moolani: Oh my gosh, that affected the nursing home population the most, because there is a no-visitor policy now. And because of the no-visitor policy, this has become tremendously tough on them. And, you know, those who can think, though; if they have real bad, severe dementia, those people don’t understand what’s going on. But those who do not have dementia, those who have very good memory, those who can still move around a little bit, you know, they are confined to their rooms. They are not going to the dining hall. They are not seeing their relatives. Some of them have spouses, and they are not even seeing their spouses. And I think that is affecting them a lot.

And with everything opening up, I do not know when we are going to open up the nursing homes, and to me, it is a big problem for the nursing homes and nursing home residents. And it is affecting them a lot.

Kevin Pho: Sorry. So what do you anticipate is going to happen, say, in the next three to six months or so, as some states are opening up more so than others? Look into your crystal ball. Can you give a prediction in terms of what’s going to happen to these nursing home residents in the next three to six months?

Mahesh Moolani: So I think that everybody will come up with creative ideas for how to meet their relatives, you know? Like, they can go out in the parking lot, or there is a meeting place outside. They can go outside and meet their relatives 6 to 10 feet away. I think that can happen, and now it should start happening. There should not be touching or kissing or hugging, you know, things like that. But I think that we can start very soon. We don’t even need a crystal ball for that. At least this way, the residents will have their relatives and friends visiting them. They don’t have to. We should have a time for that: “Look, this family has half an hour, the next family has half an hour,” things like that. I think that would be the best thing for these residents till we open up. You know, we do not know when we are going to open up real good.

I see it in the flu season a lot, you know. All the nursing homes have four, five hallways. So, one hallway has flu, we shut that hallway up, you know, so this is not a new thing for them. But we have never shut down like this for months. So this is going to have a mental effect on everybody, even the nurses. But some of them have said, “It is good.” Others are saying, “Well, our work has not reduced, because the families call us on the phone now, and they call more often.” So it’s a mixed bag of things, but for the residents, it’s not good.

Kevin Pho: Yes. So it’s definitely going to be a concerning time going forward. I think everyone’s doing this for the first time. There is no playbook for a pandemic, so, as I tell all my patients, we’ll just have to take it one day at a time, obviously. So tell me the overall message that you want to share with the KevinMD audience.

Mahesh Moolani: So, yeah, as far as elderly patients are concerned, I would say more empathy is needed. And that’s what I would say towards the elderly population. And the new buildings, whenever the nursing homes are made, I would say we have to make them really friendly towards the families. And that’s all, you know. Most of the other people know all the message, but my business is elderly people, so I try to stick to that. I do get into other things, and a lot of other things, but for now, for this thing, yeah, that’s all I would say.

Kevin Pho: Well, thank you so much for doing what you do, and thank you so much for joining the show. Once again, this is Dr. Mahesh Moolani. He’s the author of Tough Decisions in Care of Elderly Loved Ones: A Guide for Caregivers. And if people want to find out more about the book or find out more about you, how can they reach you?

Mahesh Moolani: They can access the website elderlylovedones.com. We are still developing it, but there is some good information there. And they can connect with me on Facebook or LinkedIn. I try to write something medical daily on LinkedIn.

Kevin Pho: Perfect. Well, again, thank you so much for the time, and thank you for doing what you do. Take care.

Mahesh Moolani: Thank you very much. Thanks. Bye.

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