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Reimagining Health Care

Our Influencers in Aging Dr. Jen Gunter, Nii-Quartelai Quartey and Dr. Justin Golub talk about the future of health care and what must change now for older Americans

By Kathy Ritchie
A photo collage of two medical workers embracing wearing PPE. Next Avenue Influencers in Aging

What does the future of health care look like for older Americans? What should it look like? It's clear that it must be accessible and equitable, that we, as a society, must do more to reimagine our current health care systems that work for some, but not many. 

As one of our Influencers, Dr. Justin Golub, an associate professor of otolaryngology/head and neck surgery at the Columbia University Vangelos College of Physicians and Surgeons, in New York City, told Next Avenue, "Traditionally, health care was mostly focused on preserving life and living longer, which is very important. But there is a shift, particularly in older adults, to improving quality of life."

That sentiment was echoed and elaborated on by Nii-Quartelai Quartey who served as AARP's senior adviser and national LGBTQ liaison in Washington, D.C., until November and is another of this year's Influencers in Aging. (He's now a guest lecturer at the Pepperdine University Graduate School of Education and Psychology.)

He dreams of seeing a movement around longevity as a justice issue. That means addressing a person's entire life experience and ensuring that any adverse childhood events do not go unchecked, because, Quartey says: "Over the course of a lifetime, they really can have a devastating effect on our ability to live a long and prosperous life."

We also need to shift how we talk about not just aging, but about how the pandemic has fueled innovation.

We have seen an uptick in the use of platforms like Zoom to help reduce feelings of isolation and loneliness and educate people about the COVID-19 vaccine. And we've seen a rise in telehealth, which helped people get medical care regardless of where they lived.

Simultaneously, there has been groundbreaking work and thinking about menopause recently. Influencer in Aging Dr. Jen Gunter, based in the San Francisco Bay area, is a fearless leader in the space of women's health whose new book, "The Menopause Manifesto," is already a bestseller and for very good reason. Gunter strives to give her readers the most accurate and up-to-date information they, frankly, deserve when it comes to their reproductive health.

She also strives to rid that shroud of shame that many women feel when it comes to their anatomy. Gunter envisions a world where everyone is taught what she calls reproductive biology education.

"Wouldn't it be great if the first thing that we could prescribe is education on a subject and learning more? Because how do you have informed consent if you don't have enough information?" Gunter asks.

All three Influencers are health care visionaries. They see the need for solutions and each, in their own way, are working to move-the-needle for more equitable and accessible health care.

Dr. Jen Gunter

Dr. Jen Gunter wants every woman with ovaries to experience a "feminist menopause." What does she mean by that, exactly? 

"To me a feminist menopause is being educated about it, educated about your options and not viewing it as a disease," Gunter says.

A person standing up on a stage speaking into a microphone. Next Avenue
Dr. Jen Gunter is an internationally bestselling author. Her most recent book, "The Menopause Manifesto," offers readers a refreshingly honest look at subject that remains taboo for many.  |  Credit: Meg Matera

Seems pretty obvious — simple, really. But for Gunter, an international bestselling author, obstetrician and gynecologist and vulvar and vaginal diseases expert, demystifying how our society views menopause has become her mission.

And thank goodness for that. 

Of course, change requires a tremendous amount of honesty and introspection. That is to say: Why are we so weird about menopause?

"We still have so much shame because, obviously, there are lots of people who can't say the word 'vagina' or 'vulva' without choking on it, right? It's just a body part. The reason why we think of it as shameful is because we think women having sex is shameful," says Gunter.

But it's not just shame, it's also how our society judges women.

"And so, I think that until we stop judging, it's going to be pretty hard to do away with the shame because it's all tied into it," Gunter says.

Something else, she says: "We do a very bad job of explaining how the body works." Gunter says the proof is right in front of us.

"I think the pandemic has really shown us that most people don't know how their immune system works. I think people know even less about their reproductive tract because that is, of course, shrouded in shame," she notes.

And if we don't talk about those things that make us uncomfortable, like menopause, the less we'll know what's happening to our bodies when we enter perimenopause or premenopause.

Time to Change the Beat

All of it — shame, judgment, an inability to say the word 'vulva' without blushing — prompted Gunter (who also wrote The New York Times and USA Today bestselling book, "The Vagina Bible" in 2019) to write "The Menopause Manifesto" because as it turns out, many women seem to know even less about menopause and the events leading up to their final period.

"When you know how your body works, you don't know how much other people don't know," she says. "You kind of assume, I think, in the same way a mechanic assumes that everybody knows what fuel injection is — okay, I have no idea. So, I think you get to this point where you don't realize how low the basic knowledge is and how much shame there is."

As she writes in her introduction of her new book: "The absence of menopause from our discourse leaves women uninformed, which can be disempowering, frightening, and makes it difficult to self-advocate."

"The menopause transition is really puberty in reverse. Just like things were irregular at the beginning, they get irregular at the end."

One way to change that, says Gunter, is to rethink how we educate young people about how our bodies work. So instead of focusing on sexual education as a means to prevent pregnancy, "we should have a comprehensive biology education," she says. "We should be teaching not only that puberty happens, but that menopause happens. And you know what? It's not a sign of failure." 

Gunter also wants to see more doctors talking about not just menopause, but perimenopause. "The menopause transition is really puberty in reverse," she explains. "Just like things were irregular at the beginning, they get irregular at the end."

And there are at least two myths that surround that period of time:

Myth No. 1: "People think all the symptoms should start after menopause," says Gunter. "But the majority of the symptoms, or the worst symptoms, often are during the menopause transition. And once you get through that phase, things are generally much, much easier. Hot flashes certainly might persist, but a lot of the hormonal chaos is gone."

Myth No. 2: Those symptoms — such as mood swings or hot flashes — mean that there's something wrong with your body. 

What is important to know, Gunter says, is that symptoms like hot flashes don't have to be tolerated. "We have modern medicine for a reason. So, there's no reason to not take advantage of it. And certainly we don't want people to suffer or end up with medical complications," she notes.


A Deep Dive Into Menopause

Gunter's 357-page "Manifesto" is a meticulously-researched book that tackles everything from the history of menopause — for example, even the ancient Greeks were obsessed with menstruation and detailed the average age of a woman's last period — to the use of language. 

Gunter writes that in cultures that don't use the word 'menopause,' women "may suffer less during their menopause transition." She also dives into hormonal changes, bone health, even the origins of menopausal hormone therapy (the first documented use, she writes: 1887).

Book cover of, "The Menopause Manifesto" by Dr. Jen Gunter. Next Avenue

She also explores the evolution of menopause. "So, the Grandmother Hypothesis is — there's excellent data to support it — the idea that menopause serves a purpose for society,' she says.

"Because you have to think, why do we have menopause? We have everything for a reason," she explains. "We have an appendix for a reason. We have wisdom teeth for a reason. Everything started for a biological reason, right? We menstruate for a reason. We have heavy periods for a reason. All these things exist for biological reasons."

And this idea that women either didn't live long lives — Gunter says if a woman made it to her 40s, she was very likely going to make it to her 60s — or simply were not strong enough to "hack it," as she puts it, thousands of years ago is simply wrong. 

So what's the evolutionary edge? "Imagine having another pair of hands, but not just another pair of hands that knows how to do it, but another pair of hands that isn't encumbered with child rearing herself," she explains. 

"A lot of the work came from Dr. Kristen Hawkes who studied the Hadza people in the 1980s, in Tanzania. And they are a tribe of people who had resisted modern civilization," says Gunter. "And you know what happens when a Hadza woman is breastfeeding and can't run around in the later stages of pregnancy? The grandmother is spending thirty-seven hours a week foraging for food. The grandmother is providing the bulk of the calories for the family unit."

Menopause and grandmothers for the evolutionary win. But truly, it's that kind of insight, research and reassuring information that so many women need and why Dr. Jen Gunter is a health care visionary. 

Two Questions About Aging for Dr. Jen Gunter

If you could change one thing about aging in America, what would it be?
Abolish the stigma. It's ridiculous. It's also very patriarchal as the stigma is disproportionately felt by women.     

How has the COVID-19 pandemic changed your perspective on aging?
It has heightened the medical risks that accompany aging, as COVID-19 disproportionately kills those who are ages 65 and older. This might sound depressing, and in a way it is, but it also prompted me to engage in more preventative care, which is good!

Nii-Quartelai Quartey

At Next Avenue, we like to think we know all of the movers and shakers in the aging space. Though occasionally, we rely on others to introduce us to new voices, especially when it comes to our Influencers in Aging. That's how we first heard about Nii-Quartelai Quartey, the former senior adviser and National LGBT liaison at AARP in Washington D.C. and now guest lecturer at the Pepperdine University Graduate School of Education and Psychology. He was nominated by Jason Resendez, the executive director of the UsAgainstAlzheimer's Center for Brain Health Equity and a 2020 Influencer in Aging.

A person wearing a purple suit and sunglasses smiling. Next Avenue
As AARP's former senior adviser and national LGBTQ liaison, Nii-Quartelai Quartey was a voice for many older LGBTQ+ Americans.

Resendez cited Quartey's "intersectional approach to aging [and] deepening connections with the LGBTQ+ community, who have historically been overlooked in too many policy conversations and interventions." His leadership, Resendez added, "has built bridges between traditionally marginalized communities in the aging movement to improve care and increase visibility for older Americans of color."

Quartey's fierce advocacy on behalf of LGBTQ elders was on full display during the pandemic where he was AARP's COVID-19 vaccine education and multicultural engagement lead — a critical role during the early days of the vaccine rollout. It meant hosting dozens and dozens of virtual town halls and partnering with LGBTQ organizations to reach this especially vulnerable population.

Quartey talked to Next Avenue about his work, his big dream and what it means to make "longevity a justice issue." Highlights:

I want to dive in with the impact of COVID-19 on older adults, specifically LGBTQ elders. Even before the pandemic, it was difficult to get the public to pay attention to the needs of this population. What have you seen during this time?

I would be remiss if I didn't mention that, for a lot of LGBTQ older adults, the COVID pandemic harkens back to the early days of the HIV/AIDS pandemic. In terms of the public health response, in terms of some of the anxiety around access to care — in this case, access to the intervention, which would be the COVID vaccine, being able to trust that intervention.

The impact of the pandemic, in terms of social isolation, has made an already existing challenge even more challenging.

We know from our own AARP research, that over seventy-five percent of LGBTQ older adults have to contend with social support networks that dwindle as they age and they really feel the effects of that.

And so, the social isolation that the pandemic has exacerbated has made this even more challenging for LGBTQ older adults. 

As we talk about reimagining health care from your perspective, and everything that you've observed in this last year, what should change? And what must change in terms of health care for older adults, but also LGBTQ older adults?

I am inspired in some ways, and generally optimistic, about the attention that the care economy is getting at the moment.

You know, AARP has been working on caregiving issues for a very long time. And, more recently, we have been doing more work to understand some of the unique caregiving challenges in multicultural communities: some of the challenges that African Americans and Hispanic/Latinos and AAPI [Asian American and Pacific Islander] folks experience, and even more recently LGBTQ folks. 

In fact, there's some research that we're preparing to release from our Public Policy Institute that shows that of the forty-eight million family caregivers [that care] for an adult in the U.S., about eight percent self-identify as lesbian, gay, bisexual, transgender, queer or questioning.

You know, folks are feeling more comfortable raising their hands and coming out in general, and that means also coming out as caregivers. 

As someone who is really trying to think outside the box in terms of how you develop your educational campaigns, your outreach campaigns and talking to different different generational cohorts, what is your goal in the next five to ten years? What would you like to see? And you can dream big here. 

If I were dreaming big, my big dream would be for us to create a movement around longevity; that views longevity as a justice issue [and] not as a personal goal or the result of making healthy choices over the course of a lifetime.

But really, for folks to more clearly connect the dots and understand some of the challenges that some of us experience as youth. When those challenges go unchecked, over the course of a lifetime, they really can have a devastating effect on our ability to live a long and prosperous life.

And so from my perch, if you are LGBTQ, if you are like me, and you are a Black gay man, there are certain challenges over the course of one's lifetime that... can actually disable my ability to live a hundred-year-life.

And so, my hope is that gerontologists and activists working across movements will begin to work together in ways that we haven't before to address longevity as a justice issue.

This really feels like big work. So how do you take something as big as this and bring it down to boots on the ground? What steps do we need to start taking to make that happen? Because I think that [longevity as a justice issue] is a really beautiful concept. But what needs to start happening?

In thinking about your question, I'm thinking of a gentleman by the name of Willis Edwards. He was on the Board of Trustees for the NAACP; he was a mentor of mine when I was a student organizer at the University of Southern California. And one of the organizing principles he taught us then, and I still apply now is, 'Do what you can, from where you are, with what you have.'

And you're right, it feels like big work, because it is big work. It feels like big work because this is a very transformative period of time — not just in U.S. history, but in world history where the opportunities that technology allows for, the opportunities that this information age allows for all of us to become a quick study on just about anything and to act quickly.

And so, I encourage folks to start from where you are. There's narrative change that's a part of this work; there's legislative change that's a part of this work; there's cultural change that's a part of this work. And if we only just start within our own organizations, if we only start with our own audiences, you know, Twitter and Facebook and Instagram feeds, if we start where we're at and spread the word, pass it on, I think it can make a big difference.

But we need everybody, as many people as possible, to commit to sharing credible information that can help to make the world a better place and help to improve the lives of our neighbors.

Two Questions About Aging for Nii-Quartelai Quartey

If you could change one thing about aging in America, what would it be?
If I could change one thing about aging in America, I would shift the mindset so it's less about aesthetics and more about bringing the things that bring us joy into focus: family, life lessons and memories of great adventures of the past, present and future. 

How has the COVID-19 pandemic changed your perspective on aging?
The COVID-19 pandemic has served as a painful reminder of the need to shift mindsets toward advancing longevity as a justice issue. Too often, longevity is presented as privilege to the individuals who have successfully prioritized health and wellness. When we go beyond the surface, we can see through available data that COVID-19 didn't just cut short the lives of folks in good health, it took the lives of too many folks of color and seniors that...couldn't afford for the healthy choice to be the easy choice. We can do better and we will do better on my watch. 

Dr. Justin Golub

Dr. Justin Golub has a lot to say about ageism in health care and what health care could look like if we, as a society, invested in quality care for older Americans.

A doctor wearing scrubs with arms crossed. Next Avenue
Dr. Justin Golub is shining a light on ageism and hearing loss. He says when a young child comes in with hearing loss, they're treated and it's often covered by medical insurance. When he sees the same condition in older adults, he says it's almost never treated.  |  Credit: Photo by John Abbott © Columbia University photography

Golub, an associate professor of otolaryngology/head and neck surgery at the Columbia University Vangelos College of Physicians and Surgeons, in New York City, is particularly vocal about ageism in the context of hearing loss. 

"When kids come in with hearing loss, we recommend treating it, and parents do it," he says. "And the kids wear their hearing aids and they do well in school and everyone's happy." 

But when he sees older adults with the same degree of hearing loss, he says, it's almost never treated. 

"And everybody's okay with that, except me," Golub says. "It just doesn't make any sense. You have two different people that have the same condition and they get completely different treatments. That's sort of the definition of a disparity, when there's a double standard — double standards are almost never right."

A Not Uncommon Problem

Ironically, age-related hearing loss is quite common, yet the use of hearing aids is incredibly low, which is remarkable considering that age-related hearing loss is associated with depression, cognitive decline, falls and hospitalizations.

So, why are we failing to treat this treatable condition?

The problem is multifactorial, says Golub. Stigma is number one on the list.

"Every day, I'll see a dozen or two dozen patients where I go over the audiogram, which is the hearing test, and I say, 'Look, you're 66, you have a little bit of age-related hearing loss in the high pitches. If you'd like, you could consider a hearing aid. I think this would help your communication.' And the response is always, 'Oh, I don't have hearing loss.'"

Of course, it's not like people are in denial of certain facts, he says. Rather, hearing loss can happen slowly over time and people tend to get used to that hearing deficit. 

 "That's another reason why people don't treat, because hearing aids cost a lot." 

Number two, he says, is this false perception that age-related hearing loss is innocuous and that it's so common that it's almost considered normal, which isn't the case.

"Almost everyone will have cataracts when they get old, almost everyone will have arthritis when they get old, but we treat those things," Golub says.

And number three, he says, is cost.

 "That's another reason why people don't treat, because hearing aids cost a lot," notes Golub. In fact, hearing aids can cost several thousand dollars and Medicare doesn't cover those costs, which means that for many older adults, these life-enhancing devices are simply out of reach. 

A Not So Far Off Solution

The good news is that change is afoot, since Congress passed the Over-the-Counter Hearing Aid Act of 2017.

"What this means is that people can walk into a drugstore [without a prescription from an audiologist], hopefully, within the next year or so, and pick up these over-the-counter hearing aids," he says. "These products that are branded and labeled as hearing aids, that are regulated by the FDA [Food and Drug Administration] to be safe. And they can stick them in their ears and quickly program that with their phone."

"And we have this technology to allow people to enjoy their senses until the last drop of life. It's just a shame that we're not doing a better job of achieving that."

And the cost will be significantly lower than what can be purchased at a doctor's office. These over-the-counter hearing aids are not a panacea for age-related hearing loss — they will only treat mild-to-moderate hearing loss — but it's a step in the right direction.

Something else these OTC hearing aids could do? Reduce stigma, at least among people in their 50s and 60s who might feel more comfortable wearing hearing aids made by consumer tech companies like Bose or Apple, with the status those brands convey.

Ultimately, Golub's work and purpose is to improve the quality of life of all of his patients, regardless of age, but especially older adults who, in many ways, are a marginalized group. And he hopes more physicians, of all practices, will take the time to learn more about age-related hearing loss so they, in turn, can educate their patients of possible interventions.

"Think about what you like to do in life — much of it is connected to being able to see and hear and touch and smell the world around you," he says. "That's what makes life fun and worth living… And we have this technology to allow people to enjoy their senses until the last drop of life. It's just a shame that we're not doing a better job of achieving that. And, so that's what I want to work on."

Two Questions About Aging for Dr. Justin Golub

If you could change one thing about aging in America, what would it be?

Most of the beauty, joy and meaning of life is experienced through our senses. These precious senses, particularly hearing, decline with aging. Unfortunately, there are cultural, political and economic barriers to treating age-related hearing loss with devices like hearing aids. This must change.

How has the COVID-19 pandemic changed your perspective on aging?

With the pandemic, anyone who wanted a modicum of socialization had to embrace technology. Technology was big before the pandemic, now it is even bigger. Aging should incorporate, not reject, new technology as a way to stay engaged whether there are mobility, health or future pandemic-related barriers.

Kathy Ritchie
Kathy Ritchiehas spent more than a decade talking about aging issues, first as a caregiver for her own mother who had frontotemporal degeneration; then as a reporter at the NPR-member station in Phoenix. She was the former Health and Caregiving editor at Next Avenue and, most recently, oversaw the series, "Aging with Disabilities in America." Kathy's personal experience has given her a professional purpose, and over the years she has reported on the myriad challenges and experiences of older Americans. Many of her stories have aired on NPR's national magazine show, Here & Now. She also produced a four-part podcast about life after dementia. Read More
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