Hello, everyone. This is your host, Susan Rosin. And my guest today is Jacob Kendall. And he has a really interesting history and a really interesting view. And I'm not exactly sure what the other word would be, but with both his own experience and with us, older people. So Jacob, welcome. And Tell us a little more about yourself. Yeah, thanks, Susan. I'm glad to be having this conversation. I appreciate the opportunity.
I typically boil down my description of myself to two primary parts of my identity, if you will. One is on the personal side, but it does affect what I do professionally, and that's that I've had two open heart surgeries. It was a congenital valve disorder that runs on my mom's side of the family, and so they saw it at age three. I have lifelong experience navigating our overly absurd labyrinthe medical system and obviously how it affects my own morbidity and mortality.
Then definitely the professional side, my formal training is what I say is truly interdisciplinary, which is the most important thing to me about my training across the natural and social sciences and humanities with some theology as well. I've studied and have degrees in biology, social work, public health, and my PhD is technically interdisciplinary aging studies. That's way too many silvals.
I just say gerontology because that's what gerontology is anyway, is the interdisciplinary study of aging. I'm currently working on a degree in theology. There's obviously a lot of overlap between chronic disease and aging. Most chronic diseases are conditions of aging. Without question, my own personal experiences have informed my professional journey in focusing on aging and focusing on chronic disease. I consider myself a chronic disease advocate. I speak and do workshops on that.
Specifically with gerontology, I refer to myself as a public health gerontologist, which I'm betting we'll get into at some point. That's a brief summary of me. Well, that's a lot to have done in the short life that you've been around. I know it's been... I'm sure it feels like a a lot longer. Sometimes it does. Yeah. But yeah, no, you've accomplished quite a bit. I'm very impressed. Tell us a little bit about your own...
Well, it's not a disease, your own experience with all of the surgery surgeries and all of that, because like you say, that's something that especially older people start really getting into. I think having your viewpoint on it would be very valuable. Yeah, there's obviously so much that I could say. One thing that comes to mind, you are correct. I'm in a Facebook group of people who have had these kinds of surgeries. I obviously have looked on WebMD and other things way too much.
But I also read scholarly articles. A common question comes up of, Well, the survivability after getting a valve replacement is not that high. But you have to remember that the vast majority of people who are studied are older adults. It's much more expensive to follow people who had these surgeries in their 20s and 30s. I just have to remind myself and put things in context that there are relatively few people who have had them at my ages.
Because of these surgeries, both my wife and I have life insurance policies that we got soon after we got married a few years ago. Mine is much more restrictive than hers. When it started, it was at 22 years because that's the most they were willing to give me because of my surgeries. I often joke that when I'm around in 23 years, I would love to call them, and it would love for it to be the same person. I have to consider these different things and put things into proper context.
I also do think that it helps me be able to relate to other people with chronic disease, most of whom are older adults. Obviously, I can't claim the identity of being older, but I definitely can claim a lot of the health-related stuff. I try to use that to relate to older adults who have chronic disease. Absolutely. It's Yeah. I think older people, like most people at different ages, I mean, teenagers are the same way, right? Well, you don't understand what we're doing, right?
You're just an old guy or you're just a young guy, or whatever. But I think that one of the things that you point out or bring up is that it's really the same experience going across all the ages. It's just the specifics that change. Yeah. There are various perspectives that scholars take on aging, and I tend to adopt the lifespan perspective, as in, technically, when you're born, you begin aging at that point. I don't know if you're familiar with AiCEs, the Adverse Childhood Experiences.
There's a lot of research on those. The things that happen to us in early, especially if they're very adverse early childhood, can affect us decades later. I find the lifespan perspective of aging to be really useful. That prevents us from simply putting people in the boxes, and it helps us be able to realize, you know what? Even people at different stages of life cycle, there's some relatability there. Yeah. Oh, no, absolutely.
I think that's one of the things that Well, I think, I don't know whether it's just human beings or it's just our society that tends to like to put people into boxes. Yeah, for sure. Which is not helpful. Yeah, that's another topic I know we could go very deeply into. We live in a very polarizing time. So what you just said is far too true, unfortunately. Yeah. No, it's done nothing but get worse, at least in my lifetime. Yeah, agreed. I've been around for a while.
I'm getting to be one of the older ones these days. Well, even that definition, there's a lot of debate about whether that should change. Of course, our technical age for older age is 65 because that's our pensionable age, and the United Nations sets it at 60 for worldwide. But my research in the PhD program was to, and I'm still doing some research on it, is to study aging in rural Malawi, which is a Southern African It's one of the poorest countries in the world.
There was a lot of research showing that disabilities and morbidities set in for people in Malawi at younger ages compared to people in settings like ours because they rely so much on subsistence agriculture. It's just they have much higher infectious disease burden, so these things affect everyone. I actually said I defined older adults in my research as 45 years and older. I tell people that here and they're like, Whoa, that's That's young. But it's different context, right?
There's a lot of debate whether we should increase that age, what defines older age here for economic reasons and other reasons. It's getting to the point now where people live an entire third of their lives in retirement. Yeah. Oh, no, exactly. With Medicare and all of those Those issues and the... Anyways. Yeah. Well, that is part of the problem, right, overall, in a lot of ways, is that we're still living with a culture and... It's not government, but that people are old at 60.
Yeah. And there's so many people who don't even want to stop working at 60, let alone 70. Right. Where it used to be... Yeah. No, no, go ahead. Well, and that's just talking about economic productivity. Yes. But I mean, what we're seeing now is people who are in younger, older age are providing caregiving for their parents in older, older age. And so you put all this together, basically the dynamics are changing. Yes, Absolutely. Yeah, for sure.
And unfortunately, we're not doing real well at changing to go along with it. Not us, but I mean, our whole culture. Yeah, I know. That's a whole nother discussion. Okay. Tell us a little bit about your studies in gerontology and all of that. How does it relate to us? How is it what you're doing helping us? Yeah, absolutely. One of the first things they told us in the PhD program, it's a little bit different than if I were to go get a doctorate in biology or sociology, which is disciplinary.
There's nothing wrong with doing that. I'm glad that we have those true experts. I personally would rather be a Jack of all trades, so I like it. On day one of the program, they said, The most important thing that you're going to have coming out of this program is to be able to facilitate dialog across disparate disciplines. It's more than molecular biologist and geneticist working with one another.
Let's try to connect the dots between that and psychology and cognitive neuroscience and sociology and demography and epidemiology and history and ethics and architecture, all related to aging. I love that. I love connecting the dots across these wide swathes of knowledge. Of course, yes, I acknowledge that I have to sacrifice expertise in one particular area to do that. But we need both disciplinary and interdisciplinary folks.
I took courses in all those things when I was in the program, but we still had to focus on one topic specifically.
Where that gets to my own professional identity, I mentioned earlier, I think I did, that I consider myself a public health gerontologist And so to get to your question of the functionality here, how does this actually play a role in addressing some of these issues, I was trained by a demographer, and so my comfort spot, and I have a social work degree, but I never wanted to be a therapist. I never wanted to work one on one or be a clinician.
My comfort spot is really analyzing what these issues are from a bird's-eye view. We have to be able and willing to zoom out beyond just the individual art event. Speaking of our society, I would say that American individualism has run amok. A common response I hear when I talk about, Well, our healthcare system is embarrassing, and we really need to take a look at revising it.
Of course, most other post-industrial countries have universal or socialized or national health care, whatever you want to call it. We're the only one. I think we're the only one that doesn't. But a common response I get is, Well, I don't want to lose my individual choice in choosing my provider. I always have two internal responses to people who say that. First of all, there's no way you have chronic disease. There's no way.
Two, the whole thing about having individual liberty in choosing your provider is an illusion. Let me give an example for me personally, and I think that this is indicative of how thinking and being able to zoom out can help older adults and families and whatnot. I live in one of the fastest-growing areas in the US. This is a rapidly-growing area. You don't have to drive in this area for more than five minutes to see evidence of that.
There are constantly neighborhoods and apartment complexes going up. We've only been here for, I think, three years, and we already see some evidence of this, how this area lacks infrastructure to handle that population growth. Last year, we had a long water shortage. Okay, that's one example. For me, I have many different providers. I have cardiologists, electrophysiologists, neurologists, colorectal surgeon, physical therapy, pain doctor, et cetera.
Dental health is really important to protect my valve. So all these different providers. It became clear over time from having constant visits and regular checkups and whatnot that, wow, I have to schedule these appointments many months in advance, or they'll tell me, Oh, yeah, their schedule is all filled up and whatnot. It didn't take too long to start to connect dots.
If you just focus on the individual level, then of course, it's easy for me to get frustrated that I have a hard time scheduling an appointment with a doctor. But if you zoom out just a little bit, you realize that the fact that there is rapid demographic growth here is tied to decreasing access to health care. Those two are directly related, but you can't know that until you zoom out and look at the larger level.
That's just one example of what I mean when I say public health gerontologist, we have to be willing to zoom in and out to these different levels and don't get mired in the individualism, which is so deeply embedded in our bone marrow to focus on the individualistic level. But we are going to fail to address these problems if we get stuck there. Yeah, absolutely. Unfortunately, at least for the US, is that medical care is big business. It's not medical care as such. It's big business.
If they can't make any money, then they're not going to be there. That's one of the downsides of our country. I think it's a massive downside. I mean, human, our bodies, essentially are treated like commodities here. Oh, my gosh. Our system wants us and needs us to be sick, and there's no incentive for people at the top to make these changes. I'm going to be honest.
Yeah, I'm a chronic disease advocate, and I definitely spend a lot of my time working on trying to make these changes, but there are definitely a lot of moments when I just have to sit with the fact that health care seems like a very intractable problem. Oh, yeah. No, absolutely. I totally agree. I totally agree. I'm I'm pretty healthy. But even so, you go in to see the doctor and you get 15 minutes. And that's it.
It's like you have to prioritize what your issues are and you can't go in very often. Yeah. And I'm on Medicare, so you can tell that they know that there's this aging population because they're all zooming in on Medicare. Yeah. Most health insurance companies base their policies on what Medicare and Medicaid do. Even though we have a system that relies largely on private Health Insurance. Focusing on Medicare and Medicaid and improving that would have a lot of ripple effects out.
We're very resistant to that because we're not a welfare-loving society. These are These are going to be major issues moving forward. Yeah. No, I totally agree. The other issue that comes out of that as well is that I think that that whole cadre of people getting older are actually in better shape than their parents were at that age. But what comes as a big surprise to them, number one, is the cost, and number two, is really the lack of care. And I think that's going to be huge.
It's going to be huge because as everybody knows, there's this big elephant that's going through the snake. The pig and the Python is actually one of the common terms used. Yeah, that's exactly what's happening demographically. Oh, no, exactly. Because I'm at the tail end of the baby boomers. I'm 69. So I see all these other things, my older brothers and my husband, who are older than I am. I'm just watching it going, Oh, shit. What happens when I get to where they are?
Oh, my God. I think, Oh, shit, is a very apt phrase to use. I want to take the time to point out, and this, again, is why I think we have to have interdisciplinary perspectives in medicine. I've already said, and it seems like you agree that the medicine or health care is way more than just individualistic, but it's also way more than medical, right? Yes. A lot of the reasons that people have higher quality of lives is you're right. We're healthier than our parents and their parents were.
But a lot of that is Because of things going on outside of the medical system. We realize that we need to be exercising. We realize that we need to be eating more healthily, et cetera, et cetera. Those are nonmedical things. Medicine is not about preventing things. We're getting better at that. But the other thing I want to mention is, none of this, whether it's aging as an individual or aging as our population, both of which are occurring, none of that happens in a vacuum.
I wish that more people realized that any of these issues with aging, chronic disease, our medical system, they all intersect with every other issue. I'll mention one. It's one of my favorite examples to give is immigration. Of course, that's a hot button topic. I'm not getting into that here, but I want to mention one way in which this is clearly related to the fact that we're experiencing population aging.
One of the main industries that many migrants, many of whom come from Latin America, one of the main industries that they go into is home health care. Of course, Americans want to die in their own homes and not facilities, which is totally understandable. So do I. For those who can afford not to have to go into a facility, not to have to go into a nursing home, et cetera, the most expensive option, but the one that's best, to pay for home health care.
A rapidly growing percentage of home health care persons are immigrants from somewhere, usually from Latin America, oftentimes from Africa as well. When my dad was debilitated from a stroke, most of his caregivers were from another country. We can compare it to a place like Japan, one of the oldest countries in the world, one of the highest life expectancy in the world.
They're very quickly, like a speeding train, headed toward a a really serious demographic issue because they're very monocultural. They're super unfriendly to immigration there. We're relatively friendly to immigration, believe it or not. They are extremely unfriendly to immigration to the point that they have a big problem with how they're going to provide for their older adults right now for their aping population, because who's going to do that?
They're having fewer children, and so they don't have children and grandchildren to care for them. There actually are a lot of politicians there who are like, We need to open up to immigration or whatnot. So my point is, without getting into the politics of these issues, I simply want to show- Not whether it's good or bad or whatever. I simply want to show that these issues interact with one another. That's my point. And aging does not occur in a vacuum.
And again, if we fail to see that, we will fail to address these problems. Yeah. Oh, absolutely. And The interesting thing as well is that the whole baby boomer generation was out in the streets trying to make change, or a good percentage of them, let's put it that way. I think, A, there aren't that many of them left, and B, the ones that are left are so tired of having to fight against all of this. Yeah. That they're like, You know what? You take care of it. You don't want us to help?
Not a problem. We'll go off and spend the rest of our lives doing something else. I would love to be in a society where they can just go off and spend time with grandchildren or travel or whatever. We don't currently live in that society where enough people can realize that aspiration, but it would be great if they could. Oh, yeah. No, absolutely. But they're very tired of having to push against it, not just for themselves, but for their families. It'll be interesting. I don't know.
I think the next 10 or 15 years are going to be a very interesting time with a lot of changes, and I don't know which way it's going to go, but I think it's going one way or the other. Technology and communications are advancing rapidly, which comes with both its good and bad side. There's a concept I usually see it referred to is intimacy at a distance, which with all the migration that's going on, people are moving, is really good.
But basically that because of advances in communications, it's easier to maintain attachments to people who geographically live distant from you. Zoom and FaceTime and things like that are the kinds of things I'm talking about. There's no way to... Let me rephrase it to use positive language. We have every reason to believe that advances in things like AI and other things like that are definitely going to be tied up with our health care and aging and things like that.
There's no way that they're not going to be. Oh, yeah. They are to a large degree already. People don't even realize how much. That's a whole different mess. But it's going to be interesting. It's going to be very interesting. I think the next 10, 15 years are going to be a lot of changes. We don't know what. It's It's going to be interesting regardless, but that's a valueless additive. What I don't know and why it's going to be interesting is because I don't know which direction it's headed.
I think we have a real opportunity to make some positive changes, but I also think that many people wouldn't be surprised if it goes the opposite direction. And again, that's what makes it interesting. I don't know where we're going to go with it. We do have an opportunity to do something positive, though, and face these issues. We've seen examples of the past of other societies responding to predicted and inevitable demographic changes. So we'll see. Yeah. Oh, no, exactly.
It's going to be an interesting time. As they say. Isn't that a... Excuse me, what's the right word? Wasn't that a thing that they used to say that we're... I can't think of what it is. Not a good blessing, the opposite. What's the opposite? Curse, maybe? Yeah, that that's a curse that they used to say, may you live an interesting time. Yeah. Sometimes no news is good news, but we're not without news these days. Yeah, exactly.
Do you Can you have maybe three or four things that you want to just touch on that people need to watch out for or learn more about for those of us that are older? Yeah. What I do is do talking and workshops and maybe get into some writing in the future on, one is the interdisciplinary piece and how we have to have that, but the other is more on the local individual level is demystifying health care. Over time, I've dealt with all the bullshit of health care.
Push came to shove, and so I want to shove back. But I've figured out these strategies, some things that have been useful for me. Like you said, if you have a 15-minute visit with a provider, squeeze all the juice you can out of it. I've just picked up some of these strategies that have been both helpful for me as a patient and in a caregiving capacity. That's great. It helps keep me centered, knowing or believing that health care at a larger scale is an intractable problem.
But at the very least, we can, as individuals, practice better self-advocacy. It can be easy to get to a place where you feel downtrodden and in despair about the intractable nature of our health care system. But there's still some things we can do at the local level, or at least with ourselves and our loved ones that are good strategies. That is something that I speak on. I do come in with more of a public health perspective, like I said, and that's my sweet spot.
But I still want to realize, you know what? Let's also focus on some things that you can do as an individual, even amidst, like I said, the intractable nature of the problem at a larger scale. I often find myself wondering, we definitely can do more at the individual and family level. But as we keep going up the ladder and zooming farther out. Eventually, we reach a point where it's a brick wall, and I'm wondering where exactly that brick wall is.
I used to get really frustrated with physicians and providers until I realized that they are just as frustrated with health insurance companies as we are. I don't think that they're largely to blame. Of course, you have someone who just don't seem to care about, they don't want to talk to you. It's the last thing they want to do, and they just want to rush out of the room. But that's more of a personality thing. That's not a product of the system.
Obviously, finding physicians, as my brother put it, my brother was recently diagnosed with Crohn's disease. We have a lot of chronic disease in my family, and he said he prefers providers who are curious rather than judgmental. Interesting. To what degree we have any choice in that. Find providers who are curious. I think that's really a great insight.
I've stopped putting a lot blame on physicians themselves, and I've started to realize that you have to zoom out even more to really realize what the source of the problem is. I don't know where the real solutions are going to come in, but I would say that there are some strategies we can do to squeeze more out of our own individual care. No, I would agree.
I think one of the things, just as an example, that I found is that before I go in, either to talk on the phone or actually go in in person to see my doctor, I make myself a list so I don't forget all of these things are what I need to talk about, and I get it down so that I can get it into my 15 or 20 minutes. Because otherwise, you can go like this and then you don't get You don't get much of what you're questioning. You don't get many answers. Yeah.
I have the Notes app on my iPhone, and I have a note that is questions I want to ask my next medical provider. Whenever I think of one, even if it's five months away before I'll see them, I try to remind myself to go ahead and put that question on now because I'll forget it. Then five minutes after I walk out of the office, I'll be like, damn, I wish I had remembered that. Oh, I forgot. Oh, I forgot to ask about that. Oh, I forgot about this. Yes. I also help my mom.
She's been surprised sometimes when I relate. She also has the same heart disease. Like I said, my mom's side of family. We're both constantly going to see providers, and I'll relate a story of, I just got out of the point with the cardiologist or whatever, and I tell her how it went. She's like, You said that to him. I'm like, Yeah, you're damn right. I'm going to advocate for myself. I've also helped her and helped other loved ones.
Hey, dude, Try this little thing and see if it see if it squeezing a little more juice out of that. Good. Maybe you need to write a book. You're not the first person to tell me that. I go back and forth on what's the best way to make some inroads? I have people tell me to start a podcast. I have people tell me to write a book. I don't know the answer to that. If you figured it out, let me know. Yeah. Well, podcasting takes a bit of time.
Unless you got a lot of people to do everything and all you have to do is go in and talk, you're fine. But otherwise, meh. Yeah, that's the impression I get. Yeah, exactly. Which makes me appreciate more that there are podcasts like this one. I appreciate you having these conversations, and I'm sure that this helps a lot of people out. So I'm glad just to be a part of this conversation today. Oh, Well, thank you. Yeah. Thank you.
I enjoy, in case you haven't figured it out, I enjoy talking to people. It drives my husband crazy because I talk to anybody, anywhere about anything. So just interest. Excuse me. I'm always interested in finding out new things that people are doing, like a lot of the stuff that you're doing are things that I don't necessarily... You think, Oh, this big, huge subject. But It's like everything. There's always little things in it that make it up. And that's where the interesting things are.
Yeah. And I think that you're doing that is a good model for especially younger people to see. I don't know if your audience has many younger listeners. I hope that it does. It has some. But that's good because I think a lot of younger people have this notion, which essentially contributes to ageism, that older adults don't want to continue learning and they don't have interest. But that's just not true.
So I think that you showing that you have interest in these other topics is a great model for the fact that I think that's true of many people at all ages. And You should continue learning. That's a great thing. Yeah, absolutely. I totally agree. So unless if you have anything else that you want to wrap up with or if we've come to that point now, I will close off the podcast. What do you think? Anything else you want to throw out there? No, I think we covered some good points.
Like you said, any one of these things, we could go down a much longer path, and I look forward to staying in touch. My website is jacobevinskindle. Com. That's where I talk about the speaking that I do, but otherwise, I enjoyed the conversation. Thanks very much. Yeah, No, I appreciate you being on. I will get Jacob's information and put it in the show notes. So if anyone does want to reach out, go to the show notes and you'll have all the information there. Okay. So, excuse me.
Thank you, number one. And I will finish up as I do on all of my podcast, which is that neither of us are doctors. This is not to be seen as medical advice. And I will be seeing everybody else next week.