General Archives - South Sound YMCA

Navigating The American Health Care System as An Older Adult

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

I have spent 43 years in the American healthcare system, as a clinical Nurse, clinic administrator and hospital COO. When I entered healthcare in 1982 records were kept on paper, a patient chart was a few pages thick and hospital admissions were published in local newspapers. Things have changed.

Over the course of my career one of the biggest changes I have witnessed is healthcare moving from a human service provided and governed at the local level to the rise of regional and national for profit health care systems such as HCA and Tenet. Though most hospitals remain non-profit, approximately 36 percent are now for profit up from less than 10 percent in 1982.

I have also been witness to near unbelievable transformations in technology, from MRI and PET scanners to robotic assisted surgery and recombinant DNA medications. Technology has not only improved the quality of healthcare but also safety and accessibility. However, it has come at a literal cost.

The ever-increasing cost of medical technology has been one, but far from the only, cause of escalating healthcare costs. The aging of the American population and associated demand for healthcare services also has increased costs of staffing, education, buildings and information infrastructure.

As the American healthcare system has grown so has its regulatory oversight as well as billing/reimbursement processes. Both of which play their own role in increasing costs while at the same time helping ensure the quality of, and payment for, healthcare services are at par across the nation.

With all that said, most health care consumers feel that access, quality and cost of care is getting worse, not better. As I write this in May of 2025, there does not appear to be a clear national path through this escalating quagmire of increasing costs, decreasing access and stalled quality of care. Doubtless, what we are currently experiencing in our healthcare systems will be with us for the foreseeable future.

At the same time, please be assured the vast majority of American healthcare workers and providers are skilled, dedicated and focused on service to others. However, they are limited by the systems they work in. As patients and healthcare consumers how do we successfully navigate our current national and local healthcare systems while maintaining a high level of self-advocacy and results?

I suggest recruiting your own healthcare team, with you as team manager. First, you probably have professional resources available you don’t fully use, pharmacists are an example. They are an excellent consulting/educational resource, they provide injections/vaccinations and are strong advocates. You need a pharmacist on your team, preferably one at a local pharmacy who knows your name.

If you attend exercise classes or work with a personal trainer you also have these professionals readily available as team members. Typically group exercise leaders (yoga, dance, Pilates etc.) and trainers are well versed in the body’s response to exercise and stress and are often underutilized as consultants. Build a consulting relationship with your exercise instructor or trainer, ask them questions and you will be surprised at the value they bring to your team.

A readily accessible medical provider is a must-have team member, with options available from in person to online. Considering today’s access issues, I suggest finding an urgent care clinic that works well for you. Granted you will probably see a different provider each trip, but if the clinic suites you overall, and you go there routinely for minor health issues, e.g. lingering colds, sore throats etc., they will become important immediate care team members.

A medical provider who helps manage your general health is mandatory, especially if you have chronic health conditions such as diabetes or high blood pressure. This may be an MD, DO, Nurse Practitioner, or Physician Assistant that 1) you trust 2) communicates clearly 3) follows up thoroughly/quickly and 4) develops a successful track record of listening to your needs and responding appropriately at each visit. You may have already been their patient for 25 years or you may be currently searching for the right provider, the point is to have a general medical provider on your team who consistently has your best interest at heart and fulfills their obligation to you in a way that meets your expectations and needs.

Specialists are also team members, Neurologists, Orthopedists and Nephrologist being examples. If you are not satisfied with a specialist referral, ask your general provider for a new referral. This may slow access as the new referral is processed but can gain time on the recovery end by assuring you have a specialist who successfully meets your needs. Specialists are important team members and their communications with your general provider is an important part of being on your team – always ensure they send medical records to your general provider.

There are also growing numbers of independent health care professionals who are available either face to face or online. Dieticians, Nurses, Exercise Specialists and Nutritionists are some of the professionals who can be added to your team as consultants and advocates. These services are available on an as-needed basis but are being used more frequently as permanent team members to help navigate care, give professional advice/education, and provide advocation or help develop good self-advocacy skills.

As team manager it is important to have your health care information and data readily available. I recommend becoming your own health records manager. As you add team members, access specialty care or find yourself visiting providers outside your general healthcare system 1) sign up to the patient portal of each clinic or provider 2) download and print your healthcare information from all providers [including your general provider] as it becomes available 3) keep these records at home 4) ensure your general provider has copies of any record outside their system by either delivering printed copies or sending electronic copies.

There are many paths to becoming a good self-advocate and healthcare navigator, these are only my suggestions. However, from years of seeing navigation success and failures I feel an organized team approach gives broad continuity of care and provides access to information from multiple sources to be used in thoughtful decision making. All together an organized team-based plan will help ensure your voice is heard and your healthcare needs are met in a safe, efficient manner.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

In this fourth, and last, article in our brain health series, we are looking at how nutrition and exercise can help our brains. In consideration of processing speed, cognition and memory what are things we can do on a routine basis to make our brains happy? There are quite a few actually, and since they make our brain happy, they will make us happy as well. A happy brain rule of thumb to remember is, anything that is good for your heart is also good for your brain.

Brain Food

Brain nutrition is worth its own section, because it is that important. You have probably heard of the Mediterranean diet https://my.clevelandclinic.org/health/articles/16037-mediterranean-diet . This diet is the proven go-to to prevent or manage most chronic and inflammatory diseases and it is also the base nutrition of a happy brain. For any diet to work it must be sustainable and maintainable for all involved, including family members. The Mediterranean diet has a great variety of foods which should help keep you and your family members interested, while at the same time focusing on more plant-based food and good fats. Please see the link above for details, but essentially the diet is:

Whole grains, to included whole wheat bread and brown rice.
Lots of extra virgin olive oil.
A change to less red meat and more fish and poultry.
A wide variety of vegetables to include potatoes.
A slight step away from sweets and sugary drinks, but this is the Mediterranean diet after all so one must always consider the occasional gelato and tiramisu.
About every fruit you can imagine and near limitless seeds, nuts and beans.
Even a moderate amount of wine with meals.

Along with the Mediterranean diet, daily coffee and tea (about two and half cups of coffee or 200 mg of caffeine) has been shown to be brain friendly as well, especially when it comes to solidifying new memories. In the vegetable category the foods research suggests are most brain healthy are leafy greens such as kale, spinach, collards and broccoli, due to the high concertation of vitamin K, folate and beta carotene.

As you recall the brain is mostly fluid, so avoiding dehydration is as important as maintaining adequate hydration. As we age, we can become more vulnerable to dehydration, https://www.ncoa.org/article/how-to-stay-hydrated-for-better-health/ some of these reasons include medications, body composition changes (decreased muscle mass), and a change in thirst response – we don’t realize we are dehydrated as early as when we were younger. Daily routine fluid intake for older adults should be nine cups of water per day for females and fifteen cups of water per day for males. Keep in mind all fluids count except alcohol (which can dehydrate you), to include coffee, tea and soups. Regarding exercise, an extra liter of water after exercise is suggested along with a fibrous snack such as an orange or banana to help slow absorption.

Brain Supplements (in case you are interested) – DO NOT BEGIN TAKING SUPPLEMENTS WITHOUT FIRST CONSULTING YOUR MEDICAL PROVIDER. ALWAYS CONSULT YOUR MEDICAL PROVIDER FOR DRUG-SUPPLEMENT INTERACTIONS BEFORE TAKING ANY SUPPLEMENT.

As a Nurse I do not prescribe nor suggest taking particular supplements. With that said, the worldwide supplement business is a massive $360 billion a year industry that does not always have your best interest at heart. Always research and think through considering taking any supplement, and do not rely on your neighbor, Instagram or the sticker on the back of a package for sound advice – consult a health care professional.

Yes, there are supplements medically proven to help cognition and brain function https://pmc.ncbi.nlm.nih.gov/articles/PMC10746024/ . Folic acid (part of the vitamin B group) and vitamins B6 and B12 taken together over an extended period (up to 24 months) have been shown to improve cognitive scores and reduce some amyloid proteins. Also, magnesium, vitamin D, vitamin C and DHA (an omega 3 fatty acid found in cold water fatty fish -salmon is an example) taken together has been shown to improve memory and augment cognition – please see the linked journal article above for details.

HOWEVER, the main issue with all over-the-counter supplements is lack of regulation – the FDA does not oversee product testing or ingredient accuracy of supplements. In other words, you are not assured of the dosage nor bioavailability of over-the-counter supplements. I suggest talking with your medical provider to determine the correct supplement, its dosage and timing and then ask that those supplements be prescribed to you. This can be (but not always depending on your insurance) a more expensive route, but you are then assured of the quality, dosage and bioavailability of the supplement.

Exercise – Consult Your Medical Provider Before Beginning or Changing an Exercise Program.

Your brain, though it may initially rebel, likes being challenged physically as well as mentally. You need to exercise at least three times per week, with a goal of five times or more per week for a minimum of an hour each time. The trifecta of exercise is a motion practice (yoga, tai chi, pickleball), a cardio practice (walking, running, swimming) and a resistance/weight training practice – yes, you need to lift weights.

Start slow, seek guidance from a personal trainer or a senior exercise specialist and be open minded (pun intended) to types of exercise you haven’t tried before. Explore the different classes and group exercise sessions at your local SSYMCA branch, don’t be afraid to ask questions and work with your trainer to get past any feelings of intimidation– everyone starts their exercise journey at the beginner level.

There is not a form of exercise that is more brain friendly than another, all exercise either challenges or sooths (or do both) your brain in one way or another. There are the neuro-cognitive challenges of fast-paced courts sports such as basketball and pickle ball. The Zen of yoga, Tai Chi and lap swimming presents an opportunity to calm your mind as well as challenge your body. Weightlifting is often unrecognized for its own unique Zen, while sharpening focus and neuro-cognitive connections. The main point with brain happy exercise is – start goal focused exercising regularly across multiple disciplines to build an exercise program that best meets your personal needs.

When considering a weight training program, a personal trainer is a good choice to help you begin in a safe manner and help move you toward quality exercises which best fit your goals and limitations.

Slight, but sustainable, changes to both diet and exercise can make a difference in cognition, brain function and processing speed. Challenge yourself, try different things, and experiment with combinations. When you get bored or plateau, do it all over again – there is no right or wrong way to begin a fitness/happy brain journey.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

This is our third in series of columns on brain health, this month we will explore memory. It goes without saying that memory is a vital human process, for example social interactions would be limited if you couldn’t recall who your family members are, plus it would make Thanksgiving awkward. We use memory for problem solving, like answering test questions or assembling Ikea furniture. It keeps us safe through planning and navigating familiar and unfamiliar places and avoiding things that previously harmed us. In a large sense we are our memory, and our memory is us.

There are three types of memory:

Sensory memory, or sensory register, is a quick (0.2 – 2 seconds) collection of information from our senses. Once the information collection is complete it moves to either your short-term memory or other parts of the brain for memory storage. Those memories are brief. Our capacity for sensory memory is huge, because we are usually using multiple senses at the same time. Sensory memory ensures we are aware of what we are immediately experiencing, it helps keep us safe and at the same time enjoy the world around us. Some examples of sensory memories are:

The melody of a song continuing after the song has finished playing
Continuing to feel the touch of someone after they let go of your hand
The taste of food after you have finished eating
Seeing the colors of fireworks after they have faded
Continuing to smell bread after walking out of a bakery

Short term memory https://www.ncbi.nlm.nih.gov/books/NBK545136/ , or active memory, temporarily holds information from seconds to minutes and this information is (supposedly) easily accessible. While sensory memory stores experiences, short term memory stores information you have learned. Short term memory receives and process sensory information and converts short term memories into long term memories. On a good day you can hold five to seven items in your short-term memory, like a phone number or a license plate number, for about 15 to 30 seconds. After that the information is moved to your long-term memory. However, there is a difference between working memory and short-term memory. Working memory is temporary story of information you can change, or manipulate to help with reasoning, learning and understanding while short term memory is a temporary storage space of unchangeable information, not unlike a sticky note. Short term memory is an essential part of your cognitive functioning. It may be temporary storage, but it has an important role. For instance, by the time you finish reading this sentence, your short-term memory has already removed the previous sentence from its temporary storage space to make room for this sentence.
Long term memory https://www.ncbi.nlm.nih.gov/books/NBK549791/ is a nearly permanent storage space for learned information and experiences. The main function of long-term memory is to be an archive – to make short term memories more permanent. There are two main types of long-term memory:

Explicit memory is the storage of facts, events, and locations. You are always adding to this storage space and recalling this information as needed.
Implicit memory is the storage of learned skills, habits and relationships. You are not consciously aware of when you are learning this information, but you can recall it at any time.

Together these two areas (and their multiple subareas) allow us to learn and perform tasks, relate to past experiences, make connections, adjust to our environment, and recall how to tie your shoes and turn on your phone – along with a yet-to-be fully understood multitude of other functions and processes. An astounding number of memories last years or decades and some a lifetime.

We have previously discussed things can affect all three memory types such as poor blood flow but other conditions impact memory as well such as traumatic physical injuries, acute and chronic disease, and psychological/emotional trauma https://www.nia.nih.gov/health/memory-loss-and-forgetfulness/memory-problems-forgetfulness-and-aging .

How can we exercise our memory? Every activity listed above is a memory exercise, and we can also add the following:

Focus – be aware where you set your car keys or phone down. Reduce distractions (both internal and external), the object is to seamlessly move information from sensory to short term to long term memory.
If you don’t already, start journaling – on paper using a pen. If you already journal, make it a daily practice.
Put puzzles and Lego projects together – activities requiring you to remember instructions/sequences and placements.
Play memory games such as Sudoku, do a daily online cross word, play online word games such as Wordle, Strands and Letter Boxed.
Play chess, checkers, even video games.
Memorize your shopping list, begin by memorizing five items then work your way up.
Become and stay organized in your home – make a happy place for everything.
Stay physically active, exercise regularly – at least three days a week for an hour or more.
Learn new skills – a new language or musical instrument.
Listen to complex music (to suit your taste) such as classical and jazz.
Learn new physical activities – dance, Taichi, yoga, pickleball, martial arts.
Stay social, which has different meanings in these modern times, and stay connected to others.
Read books, the kind made of paper.
Improve you sleep patterns and sleep time – we could do an entire series on this subject alone – but research, explore and experiment with new ways to help you sleep.
If you don’t already, meditate daily. If you don’t meditate or haven’t in a while explore the numerous apps out there to help you ease into a daily practice.
Take your medications as prescribed and explore all available resources to help manage chronic health conditions.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

We are continuing our exploration of brain health this month by looking at cognition and how we may be able to improve our cognitive abilities in daily life.

Cognition collectively means the processes taking place in the brain, including thinking, attention, language, learning, memory and perception – in other words, everything that connects us to the world and the world to us. When we experience a change in cognition, we also experience a change in self and in how we perceive the world. I think we agree anything we can do to maintain and, perhaps, improve cognition is in our favor. But before we enter that discussion let’s look at some of the things that can affect cognition.

Mild cognitive impairment (MCI) https://www.mayoclinic.org/diseases-conditions/mild-cognitive-impairment/symptoms-causes/syc-20354578 is described as having symptoms such as, simple (but habitual) forgetfulness, difficulty following directions and tracking conversations. There is no single cause of MCI, instead MCI is caused by a constellation of conditions to include genetics and living/working/social environments. Aging related brain shrinking, especially in the area of the brain that controls memory, brain fluid retention and decreased blood flow are some diagnosable causes.

Some studies https://pmc.ncbi.nlm.nih.gov/articles/PMC9013315/#S16 indicate up to one third of all adults over the age of 65 have a range of cognitive issues from MCI to dementia. However, having MCI is not always a path to dementia or Alzheimer’s. In fact, in some cases, MCI can be improved by making lifestyle and environmental changes.

A medical condition https://pmc.ncbi.nlm.nih.gov/articles/PMC8090478/ getting recent attention as one of the causes of MCI is metabolic syndrome (MetS). The combination of type 2 diabetes, hypertension (high blood pressure), hyperlipidemia (high cholesterol) and, in my opinion, chronic depression are the diagnosis’s which make up MetS. Any of the four diagnoses’ can, over time, affect brain performance, however the four together present a greater combined risk.

Type 2 diabetes causes blood to become thicker, due to increased sugar, which blocks off tiny blood vessels in the brain. High blood pressure causes micro tears in the same tiny blood vessels leading to blood clotting in those vessels that also block blood flow. High cholesterol increases the number, and type, of fats circulating in the blood and (you guessed it) interfere with brain blood flow to include blocking microscopic blood vessels. Lastly, and again this is only my opinion, though it is not a metabolic condition over time chronic depression changes brain chemistry in both availably and utilization leading to areas of the brain not having the right balance of brain chemicals and/or not using brain chemicals correctly.

Reduced blood flow is not the only cause of MCI but some of the factors causing reduced blood flow are, in part, manageable. Some modifiable causes can include medications (do not stop or change the dosage of any prescription medications without consulting your medical provider), vitamin deficiencies, thyroid disorders, reducing emotional and psychological stress, sleep disorders and changes in sight and hearing. There are things under our control that may improve cognition and lessen MCI, but how do we incorporate cognitive improvements into our lives?

The first and easiest brain friendly choice you can make is – take your medications as prescribed. If it has been a while since you reviewed your medications with a medical provider schedule an appointment to do so.
If you have MetS, or any of its individual medical conditions, stay on the treatment plan given to you by your provider. If the treatment plan is difficult to follow, consult your provider.
Schedule an annual eye exam, and a semi-annual hearing test.
Stay hydrated, remember the brain is 75% fluid. Current fluid recommendations https://pmc.ncbi.nlm.nih.gov/articles/PMC7694182/ for adults over the age of 65 (with good daily nutrition) is 1.6 liters (7 cups) a day for females and 2.0 liters (9 cups) per day for males. When exercising these numbers should increase.
Take charge of online information/make your own algorithm. Limit/schedule screen(s) time, modify your news feed and social media, delete/block triggering information, turn off/manage notifications, as scary as it may sound – switch off your devices for brief periods and slowly (re)learn to embrace quiet.
Exercise regularly. Exercise at least three days per week for an hour a day, mix up types of exercise – walk/dance/swim/yoga/run/pickleball/lift weights (yes you need to lift weights), schedule exercise times, consult a trainer to help get started, and make exercise a disciplined part of your life.
Now is the time to learn something new. Try a new sport/activity – hiking/archery/kayaking/Tai Chi/fly fishing, learn an instrument, make art, start writing/blogging, take online classes, go after a certification in something interesting, become an observer and teacher.
Reacquaint yourself with relaxing/de-stressing. Remember when people did nothing for the simple enjoyment of it? Read books – the kind with paper pages.
If you have a deck/porch/patio try sitting on it – in a chair, with no devices, go for a walk – just a walk, or sit and breathe and get comfortable with your own thoughts.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT

By: Brad Hankins

Consult Your Primary Care Provider Before Making Changes to Your Medications, Diet or Beginning/Changing an Exercise Program

In the next several columns we will explore brain health and those things we can do to keep our brain healthy. I would first like to write two words, so we don’t have to be afraid of them – dementia and Alzheimer’s. It is extremely unfortunate when individuals and families are touched by either, and both can be frightening to consider. However, there are choices we can make to help to improve the health of our brain, regardless of age.

Let’s start with a page from the brain owner’s manual:

Our brains weigh approx. three pounds and are about 2% of total body weight. At the same time 15% of our blood flow goes to our brain (approx. 1.5 pints per minute), and our brains consume 25-30% of our daily calories.
Fluid makes up approx. 75% of the brain, by volume.
There are 170 billion brain cells making up 86 billion individual neurons (nerve cells).
Your body creates 750 to 1500 new brain cells each day (about one per minute).
The brain is approx. 60% fat, making the brain the fattest organ of the body.
Most brain fat is used in myelin, which insulates each nerve from the others. This is the same as insulation on electrical wire prevents the inner metal part from touching other wires.
There are approx. 180 separate and distinct areas in each hemisphere (half) of the brain.
You are both left brained and right brained. Each hemisphere is separate but connected to the other. Each communicates with the other, sometimes directly and sometimes in consult.
Our brain cells use a combination of electrical impulses and chemical reactions (dopamine, serotonin etc. – there are over 60 different brain chemicals) to communicate.
Brain impulses travel at speeds up to 400 feet per second, or over 250 miles per hour.
If all the blood vessels in our brain were connected end to end, they would be approx. 100,000 miles long (a distance almost halfway to the moon).
The two main brain fuels are oxygen and sugar.

Our brains are a very complex and busy place.

This may help in a minute-a bit is the smallest unit of digital information, it is equal to answering a single question yes, or no. A byte is 8 bits of information, a gigabyte is one million bytes and an exabyte is one billion gigabytes.

Our brains processing speed (how quickly our brain can take in, interpret and respond to information) is a maximum of 120 bits per second. We typically reach this limit processing word recognition, interpreting speech, processing images and reading. When we are in conversation, we can usually process what the other person is saying at a rate of 60 bits per second – on a good day. This is why when two people are speaking to us at the same time it is difficult to understand, let alone retain, what both are saying – we have exceeded our maximum 120 bit per minute processing speed. Interestingly this is the same reason when driving you instinctively turn the music down when traffic gets heavy, and it suddenly starts raining – you have hit your maximum 120 bits per second and need to reduce information input to devote all available processing speed to not becoming a hood ornament on a Kenworth.

We take in a tremendous amount of information per day, and with each passing day our exposure to information increases. Each day we can process up to 3.4 gigabytes of information, or information equal to 100,000 words every 24 hours – though much of that information is in the form of TV, podcasts, TikTok videos, and scrolling through Facebook posts about kittens. And we live in a world of 300 exabytes (300 followed by 18 zeros) of available human-made information. Google alone contains hundreds of billions of webpages and has well over 100,000,000 gigabytes of directly searchable information.

In 1925 newspapers were the main source of information, a daily newspaper of the day contained an average of 25,000 total words. Only 19% of American homes owned a radio and the concept of national radio stations was still developing. Most information came from local, or regional, sources. Currently you can check the weather in Shanghai in less than a second and practically every news source on the planet is immediately available at the touch of a screen

We have the same brain function our grandparents had in 1925, with the same 120 bit maximum processing speed. But we are processing many times that amount of information in the same 24 hours. For those of us old enough to have lived from newspapers, radio and primitive TV to laptops, iPads and cellphones, our brains have made huge adaptations in the ability to process information. And all this information, along with the technology that supports it, adds to the difficulty of processing day-to-day activities. Like trying to open one of those thin, stuck together plastic bags every time you want to buy a tomato.

As we are limited to how much we can process, choosing what to process becomes important. There are times we are on auto pilot (have you driven to the store but can’t remember details of how you got there), but most of the time we are aware of the increasing input/stimulation around us. Focusing on this awareness, or at least occasionally checking in with yourself, and self-responding early to escalating input can go a long way in making your brain, and yourself much happier.

I would enjoy hearing about your fitness journey, please feel free to email me at hankinsb@ssymca.net.

Brad Hankins RN, CPT