Let’s say you are 80 years old and about to undergo surgery. Perhaps it was an unexpected fall that placed you in the emergency department and you’ll need an orthopedic surgeon to repair your hip. You’ll undergo anesthesia during the procedure and afterwards will likely require rehab.
All of the physicians who might care for you—from the ER doc to the anesthesiologist to the physical medicine/rehab physician—have spent years and years of training to specialize in their discipline.
But do they know about the drugs that should be avoided in older patients? Do they appropriately assess for frailty or cognitive impairment? Do they understand the risk factors for post-operative delirium (an acute state of confusion) and how to mitigate them?
Cory Rieder, PhD, left, with Dr. David H. Solomon. Dr. Rieder will receive the David H. Solomon Memorial Public Service Award,, named for the geriatrics pioneer who died last year.
One of the highlights of our year is the annual meeting of the American Geriatrics Society (AGS). AGS is a long-time grantee and partner of ours and their yearly meeting is an opportunity for us to learn about the latest scientific advancements in geriatric care and get valuable “face-time” with our grantees and scholars.
The AGS meeting is also a time for health professionals with geriatrics expertise to acknowledge each other’s hard work and accomplishments. In addition to the highly energizing support we all receive just from being around like-minded colleagues, formal awards given by the society help to inspire and motivate all of us by spotlighting important work that is making a difference in the lives of older adults.
A hospital emergency department can be a chaotic and dangerous place for older adults, resulting in poor outcomes, distress, and dissatisfaction for them and their families.
We’ve had several posts on Health AGEnda related to emergency department (ED) care of older adults (See Building a Better Emergency Department for Older People, Collaboration Across Departments and Foundations Leads to Improved Emergency Care , and Can EMTs Improve Outcomes for Older Adults Leaving ER?). Older people use emergency rooms in greater numbers than younger adults, and once admitted are more likely to have an emergent or urgent condition, be hospitalized, and be admitted to a critical care unit.
Fortunately, there’s a growing cadre of passionate emergency medicine physicians with geriatrics expertise who are trying to improve emergency care for older people. This is happening in part through the American Geriatrics Society’s Geriatrics for Specialists Initiative and the Jahnigen Scholars program, which we’ve funded for years. The Atlantic Philanthropies and others have supported the Jahnigen Scholars as well as work in specialty nursing care, reaching out to emergency nurses to build their geriatrics expertise.
For 20 years, the Hartford Centers of Excellence (CoE) in Geriatric Medicine have been supporting the development of geriatrician faculty at schools of medicine across the country. These scholars have become researchers, educators, and clinicians, helping transform academic medicine to better prepare the next generation of physicians to care for older adults.
As we forge ahead with our new strategic plan to rapidly change health care practice to improve the health of older adults, our funding for the Centers is winding down. We are now intent on helping current CoE scholars and alumni, in addition to our academic superstars in nursing and social work, utilize their geriatrics expertise to change health care delivery for the benefit of older adults. We believe this is best achieved by helping them to connect and collaborate.
We are pleased that many of our existing grants are aiding in this transition. Funds within the CoE program, administered by our grantee the American Federation for Aging Research (AFAR), have been repurposed to bring together CoE Scholars and support their work to improve care for older adults. In doing so, we are offering five $40,000 grants to fund collaborative pilot projects.
Happy Boxing Day! This holiday season we got an unexpected gift in geriatric medicine.
One of the most easily counted indicators of the success of geriatrics in medical education is the number of graduating resident physicians choosing additional training in geriatric fellowship programs. Each year, the Journal of the American Medical Association compiles the number of trainees in residency and fellowship programs, and the past two years, I’ve graphed the trends and stirred the tea leaves to try to divine the future of the field. (Read Decline in geriatric fellows defies pay boost: +10% = -10% from 2012 and Falling Leaves, Falling Numbers from 2011.)
Last year, I was concerned and puzzled by what looked like continuing and consistent declines in first-year geriatric fellows in Internal Medicine (IM) and Family Medicine (FM) based programs, despite improving financial incentives. This year, there is an abrupt improvement, with first-year fellows in IM and FM rising by almost 20 percent.
Dr. Stephanie Studenski
If you follow our blog, you know that the John A. Hartford Foundation is now spending our time and money putting geriatrics research and knowledge into practice to change health care delivery for older adults. We are able to do this because for decades we’ve funded outstanding scientific investigators in the aging field through scholars and fellows programs, most of which continue today.
Scholars who attended the recent Dennis W. Jahnigen Career Development Award and T. Franklin Williams Scholars retreat or the Paul Beeson Scholars annual convening, had the privilege of hearing Dr. Stephanie Studenski, a renowned geriatrics researcher, deliver a powerful presentation about the need for senior academic leaders to make room for the next generation. Stephanie—a professor of medicine and director of research at the University of Pittsburgh’s Division of Geriatric Medicine and program director of the Pittsburgh Pepper Center—has an inspiring message and one that is not typically shared.
Dr. Wes Ely tests a patient for ICU delirium. Click on the photo to listen to or read a Nashville NPR report on Dr. Ely’s study on ICUs and delirium.
Going to the hospital can be scary, especially if it’s for a critical illness. Unfortunately, it turns out we have even more to be worried about — long-term cognitive problems.
An important study was published earlier this month showing that going to the intensive care unit ICU) can do new and lasting damage to the brain. And delirium, a potentially preventable state of confusion that too often occurs in the hospital, plays a major role in having worse outcomes.
Two years ago, I wrote a blog titled Confused About Post-Operative Confusion about my father’s experience with post-op delirium after he had triple bypass surgery. It obviously struck a chord with many.
Even now, it consistently remains one of the most-visited pages on our website, and has drawn 26 comments from people who are caregivers themselves and whose relatives experienced symptoms of delirium similar to my father. And more comments continue to be posted even after two years. Usually our blogs receive comments from grantees/policy people, professionals, etc. It is less common that our blogs reach caregivers.
What we’ve discovered is that there are many caregivers and others faced with similar circumstances who are hungry for information on post-op delirium and are finding my blog post through various internet search engines.
Dr. William Dale, author of “Geriatrics Saved His Life!” The story took top prize in this year’s John A. Hartford Foundation Heroes of Geriatric Care Story Contest.
Too often when older adults enter the health care system, we hear stories about them not receiving recommended care, such as medications reviews, fall prevention assessments, and depression screenings. Older adults also experience too many adverse events in the hospital, poor handoffs between care settings, and preventable hospital readmissions.
And too many times, they enter this system lacking the advocates who can expertly provide or coordinate their often complex care.