Living well with chronic pain - Mayo Clinic Press (2025)

In the United States alone, up to 30% of older adults suffer chronic pain. It can be debilitating, impacting function while also increasing social isolation.

On this episode of Aging Forward, we talk with Dr. Jake Strand about how older adults experience chronic pain, misconceptions about pain management, and different approaches to relieving pain and improving quality of life.

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Dr. Christina Chen: This is “Aging Forward,” a podcast from Mayo Clinic about geriatric medicine and the science of healthy aging. Each episode we explore new ways to take care of ourselves, our loved ones, and our community so we can all live longer, fuller lives. I’m Dr. Christina Chen, a geriatrician and internist at Mayo Clinic in Rochester, Minnesota. In this episode we are talking about chronic pain and how to live well in the face of it. Our guest today is Dr. Jake Strand, a palliative care physician and the current chair of the Mayo Clinic Enterprise Center for Palliative Medicine.

Dr. Strand has been recognized for multiple educational initiatives, and his teaching and research – particularly some of his innovative work currently with the advanced prediction models using AI and machine learning. Welcome, Dr. Strand.

Dr. Jacob Strand: Thanks so much, Dr. Chen. I’m delighted to be here.

Dr. Christina Chen: Dr. Strand, we would just love to learn more about what you do as a palliative care provider – I still struggle sometimes when people ask, what is palliative medicine? It’s kind of a foreign concept for them still. How do you describe that to people? How does this differ from other forms of medical care?

Dr. Jacob Strand: It is still something that we explain a lot. Really what we’re doing is working as an extra layer of support for a patient with a serious illness to help manage pain and other symptoms that are affecting their quality of life. Those can be physical symptoms, psychological symptoms, but also attending to their spiritual needs, their community-based needs in order to help them live as well as they can for as long as they can with the best quality of life. And it’s something that we offer really for patients who are going through curative intent types of treatments, and for patients for whom they will live with this condition for a long time.

The other part of our role is to allay their fears that this represents a major change in their care. Really it’s an additive form for their care. Our job is to also be a sounding board for patients and family members for those questions that are sometimes hard to ask and really be a neutral party in talking through that and supporting them through those decisions and those discussions.

Dr. Christina Chen: How many people in your practice would you say have chronic pain?

Dr. Jacob Strand: Pain is the most common condition that someone will get referred to see me or one of my colleagues in palliative care, whether it’s in the hospital setting or whether it’s in the outpatient setting. The big reason for that is that for a lot of chronic conditions, pain at some point, rears its ugly head. It’s a condition that many will face in patients who have a very serious illness, maybe an illness that can’t be cured, but can be simply treated over a long period of time.

Also for a lot of us, just as our bodies continue to get older, we experience more breakdown of the body in a natural way. That can sometimes also result in pain.

It’s a really common thing.

Dr. Christina Chen: That leads perfectly to my next question, because the prevalence of pain, as we age and start to develop issues like arthritis and neuropathy, the prevalence seems to be increasing just yearly.

Dr. Jacob Strand: That’s exactly right. We see it probably most acutely in illnesses like cancer, heart failure, chronic obstructive pulmonary disease or other lung conditions. Certainly, pain increases the longer people live with that illness. As people age, we develop pain from all sorts of conditions and then have to figure out what is the impact of that pain?

This is a really important point in thinking through how we define pain. Because for many, many years, unfortunately, in the healthcare setting, pain was largely ignored. We saw, particularly in patients of different socioeconomic backgrounds and racial and ethnic groups, it was ignored and unfortunately continues to be downplayed in our healthcare system.

What has changed is that pain became this additional vital sign that was really pushed for recognition. Now you can’t walk into a clinic without someone asking you to rate your pain from zero to ten. That’s good in some ways. It’s good in that it allows people to voice the degree of severity, but what it doesn’t do is help us figure out how much that pain is impacting their function and quality of life, which is really what we’re all after.

Dr. Christina Chen: It’s being more recognized now. We’re asking more about it. I feel like there’s still quite a bit of misconception around pain management and perhaps allowing people not to be as truthful or open to admitting how much pain they’re in. Can you share some of that?

Dr. Jacob Strand: Thank you for bringing that up. We see that lack of recognition or lack of discussion about it on both sides. On one hand, we might screen people for it, but then we may not take it as seriously for some patient populations as we should.

Then there’s the other side of that which is that patients may feel disincentivized to talk about their pain.

They don’t want to be seen as a difficult, complaining patient. They may not feel like their calls for pain control are going to be believed. They may also worry that they are going to be seen as a drug seeker, or someone who just wants medications. I have patients who actually don’t want to tell us about their pain levels because they’re worried that all we’re going to do is prescribe the medications. Part of that, is really the role that opioids play in pain management.

The opioid epidemic and the appropriate recognition by people in the community and the lay press for how devastating it has been for so many people has also continued to muddy the waters about pain recognition management and the impact on quality of life.

Dr. Christina Chen: How do you approach breaking down some of those barriers? I’ve had so many people come into my office. You can clearly tell that they’re uncomfortable. And they don’t want to talk about it and they feel like it’s an added burden to the conversation. What’s your approach towards just breaking down that stigma?

Dr. Jacob Strand: Part of what I start my visits with is, let’s list a couple of things that you want to make sure we address today that are affecting how you live your life and your quality of life day to day. Really getting that patient voice and generating that list.

Then I think you hit on an important point. Observation is still really important, whether it’s through video visits or whether it’s in-person visits, and just saying you look uncomfortable. Is that something that we should talk about today?

Sometimes if it is clear that they’re uncomfortable or it feels that way and there’s a

reticence to talk about it, it’s also just laying on the table. One of the reasons we ask these questions is to really figure out what’s most important to you as you think about the way you live your life on a day to day basis. And if there are things that we can do to help you live your life better than we want to partner together in doing that.

It’s not necessarily going to be pushing a medication or a specific agenda, but just to understand what you live through on a day to day basis.

Dr. Jacob Strand: One question that can be helpful in talking about this is just telling me about a normal day. What do you do? And how does that compare to what you did 10 years ago? And could it be better? Those are some things that sometimes setting the groundwork for a closer partnership can be useful in our practice.

Dr. Christina Chen: I love that. Just backtrack a little bit, earlier you mentioned defining pain that’s critical, but also defining the type of pain they’re experiencing because there’s so many different variations of pain. A lot of us don’t realize that it’s not just arthritic inflammation. There’s many other layers of that – there’s acute versus chronic and we have to distinguish and define those two. I’m still recovering from a judo injury from two weeks ago, and it’s like, “Okay, it’s finally getting better, but learning to live with something that extreme every single day?”

Dr. Jacob Strand: Yeah.

Dr. Christina Chen: That must be extremely challenging. What leads to this chronic day to day pain experience?

Dr. Jacob Strand: Such a good question. You hit on something important, which is that I have not met a person yet who hasn’t experienced some form of acute pain, whether it’s like you said, a judo injury for those who are less athletic, running into something.

That acute pain can last minutes, it can last hours, days. I think what we start to see when people talk about chronic pain is where that initial injury or an injury that keeps continuing over and over again extends many weeks to months. That’s a classic definition of chronic pain is that something that was initially acute has continued for many weeks to months.

Again, there can also be the residual of something acute. If you have an injury you may undergo surgery and that fixes the underlying problem that was causing the pain, but there is ongoing residual injury that people experience in both an intensity of discomfort, but also an impairment in function.

Those are some questions that hopefully clinicians of all stripes are asking people when they come, what led to this. Talk me through that. We also know that some types of chronic pain are more impairing than others. There are people who have experienced major surgeries and live with some residual pain and yet continue to function very well. They have figured out ways to cope with that pain and it becomes, like you said, something that they deal with on a day to day basis, but it doesn’t impair their function to the degree that it does for others.

Sometimes we have no good reason to understand why that takes place for some patients. One example that I give is I take care of a lot of patients with advanced forms of cancer and I have patients who walk into my office and I review their scans and I see that they have cancer in so many different bones in their body.

Dr. Jacob Strand: I’m predicting that they’re going to come in with significant pain and they are walking around, they’re functional, they’re taking Tylenol once in a while. And their biggest concern is actually difficulty with their sleep, or with their relationships. They’re not related to pain.

Then I have patients who have a new diagnosis of cancer and maybe only in one spot and that spot has become so debilitating that they can’t get out of bed.

A lot of this can be challenging because the human body is quite unique in the way that people experience pain. It’s hard to predict from a single test or a single experience. Maybe the last thing I’ll say in that regard is that it’s not just these physical properties. We all bring to our health experiences a number of factors that influence pain physicians and health care providers often lump into psychosocial factors. But we know patients with untreated mental health concerns like depression and anxiety experience worse pain.

There are actually different spiritual backgrounds in which they might experience pain differently because of the way they view that source of pain and the importance of it in their processing of an advanced illness. It also is incumbent upon us to ask not just the timeline and maybe why this is happening, but also what are those other factors in that person’s life that are influencing how they might be experiencing that pain in that moment.

Dr. Christina Chen: Do you find that older adults experience pain differently or perhaps they behave differently? And what are some signs that for them pain may not be as adequately managed?

Dr. Jacob Strand: Certainly our older adult population, as they are going through the aging process, have likely experienced pain numerous times before, and a lot of people have figured out adaptation mechanisms to be able to cope with that. Back to my own grandfather who had any number of bone fractures, had prostate cancer, and had surgery and then had radiation, and then had neuropathy from that and still was climbing around on the roof, at age 92, and then fell off the roof, and had another acute injury.

Pain for him was something that he figured out ways to manage and it bothered him only when it prevented him from doing the really important stuff like, he accepted this limitation over time, and said, “Yeah, I’m getting a little bit older, but if it doesn’t allow me to do these activities, then I’m really frustrated.”

Other people internalize that in a very different way. They internalize that and it becomes something that they think, as you talked about in an earlier example, they don’t want to talk about. They don’t want to express themselves, and you see it borne out in just a retreat from daily function. Maybe people are spending more time in bed or in a chair.

They’re not doing those activities that they used to do, that withdrawal from their social circles, or from family get-togethers, or other activities might be representative of untreated pain that we just haven’t been smart enough to ask the right questions to understand.

For folks who have trouble actually describing their pain because maybe they have communication difficulties, they’ve had a stroke in the past, they’ve had memory loss that can come out in behavior changes. This is where I lean on colleagues like yourself to really be more thoughtful about how we ask those questions and how we screen for pain because there are ways to screen for pain when patients can’t actually answer those questions.

Dr. Christina Chen: I love that you mentioned the issues with people with dementia or cognitive impairment especially in long term care facilities and they did a good study on this a while back in​​ BMJ, where they showed if we just give people a tiered, structured approach with pain management, their behavior settles down. We’re not asking about it because we don’t really know that they’re sitting there in pain.

I also recall a pain specialist who went through some physiologic changes with aging, and he mentioned that as we age, our pain threshold sort of increases, but the tolerance decreases. What I mean by that is as we age, the pain experience changes such that it takes more to experience pain. The threshold increases. But the tolerance decreases, meaning that once we get to that threshold and experience that pain, it’s much more intense, much more uncomfortable, and more painful. You can see people sitting around with a broken hip and they won’t complain, but they go through surgery.

They’re in so much pain afterwards. There’s a lot of physiological, really important nuances there.

Dr. Jacob Strand: It’s a great point. You really hit on the head that if we aren’t asking the question, or we can’t ask the question for the reasons you mentioned, we still have to be really suspicious that there could be something when we’re seeing behaviors that are either out of the norm or that again are impacting their function and quality of life.

You’re gonna hear me say that probably over and over again, that a pain level is just that. It’s a number. But it has to mean something. That’s where thinking about what that function looks like. We often uncover a lot of surprises as you appropriately note.

Dr. Christina Chen: When I see people in pain it breaks my heart to see them suffering every day. They’re pleading to make it go away and make it go away quickly. But in most situations, it takes time.

Dr. Jacob Strand: Yeah.

Dr. Christina Chen: As you’re approaching that type of situation, how do you effectively guide your patients – like what’s the first few steps you take to get them on the right track?

Dr. Jacob Strand: The first thing is just good old-fashioned communication, and that sounds a little glib. It’s not meant to be, it’s that we jump right to how I can fix it. As opposed to what is this gonna look like going forward?

Of course, we don’t hold the keys to the future, but one of the things that I talk about is if this is something that just recently happened, if we can get this pain under better control, what are the things that you’re going to be doing? What is pain standing in the way of? And that way we can judge our success if we got there.

The patient says, “Gosh, I really struggle to bend over and pick up my grandchild, or I want to be able to walk down to the common room for mealtime. Those are some things that pain is limiting me right now.” Then we can try to think it through, especially if we think there’s a reasonable expectation for that to get better. If we aren’t meeting that level of functional improvement, what else do we need to do differently? And what’s that approach that we need to take to try to get that person back to a previous level of functioning?

For folks who have had pain for a long time, or that we think pain is likely just to continue to get worse over time, then it’s a similar expectation setting that we don’t have a way to make the pain go away completely. But let’s think through what life can look like when we have more tools to manage that pain and really you hit on an important term, suffering. What way is this pain contributing to suffering? And can we relieve that suffering in some way that allows you to have some improved quality of life?

It’s really in the beginning about expectation setting. In my practice, over the last dozen or so years here at Mayo Clinic, we see that most people take to that really, really well. I would say in general, our experience is that with good conversation and clear communication and bi-directional communication, not just me talking at our patients, we can get to a space where people feel like there can be an outcome that they understand and can process and can cope with, even if it’s not ideal.

That’s the first kind of chunk. Really setting those expectations. And what do we want to shoot for in terms of functional improvements? I think that’s the first step.

Dr. Christina Chen: I love that approach because I think it takes a step back to look at the person as a whole and to understand them in a way that’s meaningful because to your earlier point, sometimes it’s hard for them to express it because the first thing that they anticipate for us to do is to push the meds and we’re not doing that.

We’re going to take a step back to say, “All right, let’s focus on the bigger picture here. Then maybe medications can be part of that equation. How do we do that safely? How do we do that while reducing the risks and optimizing the benefits? What’s your approach to that?

Dr. Jacob Strand: This sometimes comes across as being cliched, but the non-medication things always come first. The reason is because those are things that are going to continue, hopefully, even when medications may no longer be needed, or the same medicines aren’t needed. What are those activities that we can do to help people improve their functional capacity?

Exercise – in whatever way we interpret that word – is the first thing that I talk about. For a lot of people, that is doing some basic mobility in a chair, and if that’s what we can accomplish, for a lot of people, that’s important because it’s about personal dignity and transfers.

Those are basic things that are really important. If that’s what our goal is, then let’s start there with trying to improve some core strength and even just trying to relieve stiffness for people who may not get out of bed because they’re somebody who was sitting around with a fractured hip. Maybe they won’t walk again, but being in bed and being stiff and uncomfortable for the rest of your life is really awful.

What are some things we can do to reduce stiffness and improve flexibility, even in limited situations, all the way to folks who are stepping up their activity and walking five minutes a day to the week after that, walking seven minutes a day and so on and so forth.

Dr. Jacob Strand: Really about taking that whole person and figuring out what the level of exercise and activity and flexibility that we can achieve. Sometimes that’s very basic. We can print out some things in the office and we can practice it together. Sometimes it’s really helpful to see a physical therapist and an occupational therapist who can give people a rundown on here’s what you can do safely and then sometimes there are folks who benefit tremendously from aggressive physical therapy.

Even for conditions that maybe we can’t cure. I have a number of patients who, after a diagnosis of benestatic cancer, we’ll try to really aggressively rehab them to maintain that strength because it’s also a way of relieving pain around the areas that maybe the cancer is getting into.

It’s really starting with some of the exercise and flexibility pieces. Then there are so many other therapies that we don’t think enough about. Some people kind of categorize them as integrative medicines or alternative therapies. I don’t like that terminology. These are just different approaches to achieving functional goals.

Acupuncture, acupressure, massage, different movement-based philosophies can be really meaningful for people to try to integrate.

Dr. Christina Chen: I just want to put a quick plug in for acupuncture as someone who is trained in this practice. It has helped so many people with chronic pain, not just cancer-related pain, but migraines and back pain. Medicare does pay for the indication of back pain, but also for day-to-day things like arthritis or hot flashes for women. There’s a lot to explore there. Very simple. Very easy. Non-painful for people who are hesitant about that practice. It’s worth exploring.

This is part of those healing therapies that many people are probably not aware of and probably wondering what is that going to help? We do see in our practice frequently that acupuncture and massage are really critical for many patients who experienced both acute and chronic pain. Sometimes, you try one and you don’t like it, and it’s just not something that vibes with you, and that’s okay. You try a different thing. Being able to talk with patients about the range of options that we have to try to improve function, flexibility, and activity is helpful when thinking about the non-medication based interventions

There’s so much to explore, but could also also see how it can become a little bit difficult to navigate. You’ve got to go see my acupuncturist and go to physical therapy and get some massages here and there. And there’s a lot to advocate for yourself.

Dr. Jacob Strand: You’ve hit an important point which is the advocacy overall. This is slightly editorializing. Our health care system doesn’t do a good job of matching what’s going to best benefit the patient to what is available because there’s so much stuff that’s available and it’s not all coordinated. That’s why a program like this podcast is so important because the more information we can get into the hands of patients and their caregivers, the better to act as advocates for asking those questions like what else is available? What other treatments in our area can we try? Self advocacy is one piece.

Systems that are doing this well are advocating on behalf of their patients. One of the things I feel so lucky about is to be part of such a big team because our nurses in our outpatient palliative care clinic really take on this role. They will sit down with a patient, talk with me about what our goals are, and then they’ll start to say, “I think we should refer you here. And here is a great massage therapist who lives a couple of miles from your house. And here’s the coverage that you can get from Medicare for this number of sessions,” or, “Hey, this is what that’s going to cost. Does that seem like it’s going to work? Oh, okay. It doesn’t. Let’s try this instead.”

That’s where good clinics and good healthcare groups are using community advocates, nurse navigators, and other members of the team to help do some of that advocacy as well. That’s an important part. The last piece I’ll say is, for folks who live far away from a lot of healthcare centers that gets really challenging. One thing we are learning more and more about is the value of virtual-based interventions, even for managing pain.

We’re going to see more and more over the next three to five years on which patients benefit from this the most and what things we can do reliably. I’m always an optimist. Hopefully our healthcare system and the payment models that we have with insurance and so forth will start to catch up.

Dr. Christina Chen: Let’s just touch on therapeutics. There’s a concern and fear of the opioid epidemic, but safe use of medications or a combination of medications, I think it’s helpful for people to know it’s okay.

Dr. Jacob Strand: What’s helpful to know is that all medications are tools. They are not inherently good nor bad. They can be used badly and they can be used for some people really meaningfully. Many of them have side effects that we have to manage. We’re constantly weighing the benefits and burdens of any individual therapy. That’s how I first and foremost think about them myself and talk about them with my patients. Is this tool going to be helpful for us or not?

If it becomes more harmful than it is helpful, then we get rid of it and we look for something different. When we think about particular in patients who are aging, what we see is that a lot of the non-opioid based treatment for the non-opioid medications is really a basket of medications that are topical creams that you can get over the counter, many of which are very helpful. Some people really find benefit, creams like lidocaine containing creams or menthol based containing creams. Some have mild anti-inflammatories in them.

My general rule for folks is, unless there’s an obvious reason not to do it, of which are individualized to each person, topical creams and patches – if you can afford them, and you can find them in your area – I say try them out because some people will find them useful for managing aches and pains. They can also be a nice distraction. In certain circumstances they can, but in most circumstances, they’re not going to cause a lot of side effects.

One word that I would say about topicals though, that has come up over the past decade, is that compounding pharmacies over the years have really expanded the number of topicals. They take lots of medications that are often given by mouth or through an IV and put them into creams. The cost can be substantial. There’s been a couple of good controlled studies that have shown that there’s not a lot of good benefit for these compounded creams for most patients compared to placebo. Caution is needed because they can be really expensive for patients and maybe not provide the same benefit as a 5 cream over the counter.

Dr. Christina Chen: Darn, I was putting a lot of hope in that.

Dr. Jacob Strand: I know. And I do have some patients for whom they do work and there’s sort of mechanistic reasons for their pain why they work really effectively. But let’s just try all of these creams instead of the pills. It hasn’t panned out unfortunately. Then there’s a whole list of non-opioid medications that people are generally taking by mouth that are very helpful. They’re often medications that started out as a treatment for something else that we’ve adopted into treatment for pain.

Some are antidepressants that are actually really effective for certain types of nerve pain. We counsel patients that we’re not going to give this to them because we think they’re depressed, we’re giving it to them because we use it as a pain medication. Here are the side effects to look out for and so forth.

Talking with a clinician about some of those non-opioid medications is important. For folks who are aging, like our older adults, one of the challenges is that the side effects from those medications might be just as bad as side effects from opioids. One time I had a patient tell me, “Well doc, why are you jumping right to oxycodone for this pain that I’m having?” And I said, “Because these other four medicines that we would normally try first are actually going to make you sicker because your kidneys aren’t working very well. Your liver is not working very well. And these are the side effects that you’re gonna have.” Sometimes you’ll see clinicians who may not use those medications because they might be causing more problems than they’re helping by avoiding an opioid.

Then, just to briefly touch on opioids, they are strong painkillers. They used to be called narcotics. Unfortunately that term just really doesn’t define what these medications are. Opioid is the term we use. Opioids are tools and and they, like any tool, have been poorly used in a lot of settings and have caused a lot of harm, and we won’t go into all of that today, but for some people, they still are an important tool for helping them with a good function and quality of life and that it can be done safely.

There are medications in that class that have actually emerged over the last several years that we think are much more effective and safe, particularly for our older adult patient population. That is something to talk to your clinicians about. One example is a medication called buprenorphine, which is a medicine that can be delivered in a very low dose through a patch. It is much safer as it relates to some of the really scary complications of opioids than some of its cousins. The goal all of the time is that we’re constantly learning and we’re constantly trying to figure out the lowest dose, the safest dose and the shortest period of time we have to use something to manage that pain.

Dr. Christina Chen: Can you share maybe just one story of a patient that you felt did really well, who has a success story with the pain experience?

Dr. Jacob Strand: I’ll share one that maybe is a little bit atypical. Because it’s not the “had pain, everything got better, lived a happy life ever after.” That’s something that I think people in general understand that the world is more complicated than that.

I’ll share the story of a gentleman who was in his eighties who had been diagnosed with metastatic prostate cancer and had done some initial treatments. And then the cancer was not growing really fast, but also didn’t seem to be responding. He had gotten sick on some of the treatments that he used. Some of them were causing him to be really tired. He just decided, “I’m going to not take any more treatments related to the cancer other than things affecting my quality of life.” That was something where initially we didn’t know how long he was gonna live, but he had some very specific goals.

He wanted to be able to play with his grandkids. That’s a common one that I hear. He also wanted to be able to take a trip with his kids to a very special lake that they had in their family memories. And he wanted to be able to continue to go down, for as long as he could to get coffee with some of his friends he had made in the neighborhood once a week.

We kind of laid out that maybe some of those were going to be harder than others, but let’s start with the basics of being able to go down and get coffee with friends. And what was limiting him was really significant back pain. And what I really learned a lot from and really appreciated about this discussion was that he had had a family member who had overdosed on opioids.

He just said, “Look, it’s just too emotionally hard for me to even consider taking those medications based on what I saw.” And he could rationalize that not everybody who takes those medications will have addiction or a substance use disorder from it. But it was just too painful to conceive of.

We did a number of things. We did massage and acupuncture because fortunately he lived in a town that had people who did that and he had saved up some money and he thought, “My life expectancy may not be as long. So I’m going to spend some of that money.” It wasn’t a lot of money, but he felt comfortable about that decision.

We used some over the counter pain medications that he could take. Just two extra strength Tylenol twice a day, and he felt like that helped, and their local YMCA had a special to get in to do water aerobics, and so he did some water aerobics, and he didn’t have the stamina, but he could do some of it. And even the act of doing a couple of those things made him feel like he was taking some control. It wasn’t that he was kind of stuck in a health care system.

He was doing some things for himself. And he got to play with his grandchildren more frequently. Still hard for him, but it was something he could do more frequently. He was able to go down to the lake. It was later than he wanted, and he was in a wheelchair, and when I asked him about that, I said, “Oh, was that disappointing?” He said, “You know what? I used to think I’d never wanted to be in a wheelchair. I never wanted to use a walker, but those things allowed me more independence because I was able to get outside my house and go do the thing that was really important. A lot of people associated a loss of independence for him if he wasn’t using them.

For me that made me feel really really proud that he was able to share that with our team. That through my relationship with him in our practice, it was also something where again, we needed to stay away from some of those medications. Until the very end of his life, where he was okay with that. It was just a conversation over time. It wasn’t something where we needed to convince him to take something. It was, “We’re going to talk about this over time and you’re going to guide us.” It felt very much in that model that we idealize, which is that shared patient model where we’re each bringing something to the table and learning from each other. That was a really special case that I still think about and teach to our trainees.

Dr. Christina Chen: That really warms my heart and it makes me so happy to hear that you feel proud of him because it was your journey too, as his physician, to see him meet his goals and that you feel that sense of pride that he was able to do that. As a palliative medicine provider, what do you think you’ve learned about the concept of healthy aging through the eyes of that practice and what does aging forward mean to you?

Dr. Jacob Strand: What I have learned and I am continuing to learn is what that idea of aging forward looks like. It has a very different lens depending on that person’s stories and how they’ve journeyed thus far to that process of aging. Sometimes we have in our minds a sense that, “Well, I don’t want them to have to go through X.” We hear this a lot. We don’t want to go to a nursing home, and I have seen that for many people, that journey and what quality of life means to each individual. It varies so much that I don’t know that there is not a right way.

Really the only right way that I’ve been able to figure out is that if we are able to partner with people to help them be able to explain to us what quality of life and function means to them, then that’s when we’re meeting those goals, not the goals that I think that they should have. And I know that sounds obvious in some ways, but all of us have this view that there are things we want for others that we care about, whether it’s our family or patients that we take care of. Yet we just have to be curious enough to know that that may and will look very different for individual people as they age forward.

Dr. Christina Chen: Thank you for sharing those wonderful pearls with us today.

Dr. Jacob Strand: Thanks for having me. And thanks for doing this.

Dr. Christina Chen:That’s all for this episode. Hopefully you’re feeling a little more informed, inspired, and empowered. If you have a topic suggestion for a future episode, you can leave us a voicemail at 507-538-6272. We might even feature your voice on the show! For more “Aging Forward” episodes and resources, head to mayoclinic.org/agingforward. Thanks for listening, and until next time, stay curious and stay active.