This past weekend I sat with some of the top leaders in geriatrics and heard them rail against usual care for older adults by specialists and non-geriatrically trained generalists. They complained bitterly about oncologists who wildly overtreat the frail and yet undertreat the vigorous, cardiac procedures done without patient benefit, and silo mentalities that predictably put complexly ill people on trajectories of misadventure, hospital readmission, and decline.
However, in public, I know that most professionals will not break the white-coat wall of silence and denounce their colleagues for inappropriate care. And so, the fact that non-geriatrically informed care doesn't have to be our usual care escapes most people. Unless you've been very lucky and seen someone receive geriatrically skilled, compassionate, and patient-centered care, you don't know what you're missing. And it is very hard to create demand for things that no one knows.
As I thought about this problem, I realized that I had also heard many of those same railing voices talk about how to deliver good care to older adults—not in a conference room or a big meeting, but all by myself while running on the treadmill at my local Y. Not an hypoxia-induced hallucination, but really real.
For the past three years, the Journal of the American Medical Association (JAMA) has run a special feature series, “Care of the Aging Patient: From Evidence to Action,” with the sponsorship of The SCAN Foundation. These papers report actual patient case stories (like the ones we still need for our Heroes of Geriatric Care Story Contest! :) ) and then use literature reviews and expert analysis to describe what current best practices should be.
Moreover, because each entry in the series is intended to be a practical lesson in how to change patient care, they have been frequent fodder for the JAMA/Institute for Healthcare Improvement "Author in the Room" webinar series that works to translate new papers in the literature into action through conversation and discussion with a wide audience. Turns out that these are one of my favorite things to listen to on my IPod at the gym.
The papers are collected on the JAMA site (you might need a subscription) but the Author in the Room series can be found on the IHI website and the podcast version can be found on iTunes.
Here’s the list so far and audio link where available. Note—I’ve marked in italics all of the authors who have led Hartford Foundation-funded centers/project or been scholars in one of our development programs. If I've missed anyone, let me know. We are proud to be associated with leaders doing so much to improve care.
1. Medical Care for the Final Years of Life: “When You're 83, It's Not Going to Be 20 Years”
David B. Reuben, MD
JAMA. 2009;302(24):2686-2694
2. The Patient Who Falls: “It's Always a Trade-off”
Mary E. Tinetti, MD; Chandrika Kumar, MD
JAMA. 2010;303(3):258-266.
3. The Older Adult Driver With Cognitive Impairment: “It's a Very Frustrating Life”
David B. Carr, MD; Brian R. Ott, MD
JAMA. 2010;303(16):1632-1641.
4. Incontinence in Older Women
Patricia S. Goode, MSN, MD; Kathryn L. Burgio, PhD; Holly E. Richter, PhD, MD; et al.
JAMA. 2010;303(21):2172-2181.
5. Managing Medications in Clinically Complex Elders: “There's Got to Be a Happy Medium”
Michael A. Steinman, MD; Joseph T. Hanlon, PharmD, MS
JAMA. 2010;304(14):1592-1601
6. Comprehensive Primary Care for Older Patients With Multiple Chronic Conditions: “Nobody Rushes You Through”
Chad Boult, MD, MPH, MBA; G. Darryl Wieland, PhD, MPH
JAMA. 2010;304(17):1936-1943
7. Finding the Right Level of Posthospital Care: “We Didn't Realize There Was Any Other Option for Him”
Robert L. Kane, MD
JAMA. 2011;305(3):284-293
8. Finances in the Older Patient With Cognitive Impairment: “He Didn't Want Me to Take Over”
Eric Widera, MD; Veronika Steenpass, MD; Daniel Marson, JD, PhD; et al.
JAMA. 2011;305(7):698-706
9. Elder Abuse and Self-neglect: “I Don't Care Anything About Going to the Doctor, to Be Honest. . . . ”
Laura Mosqueda, MD; XinQi Dong, MD, MPH
JAMA. 2011;306(5):532-540
10. The Physician's Role in Patients' Nursing Home Care: “She's a Very Courageous and Lovely Woman. I Enjoy Caring for Her”
Steven C. Zweig, MD, MSPH; Lori L. Popejoy, PhD, APRN; Debra Parker-Oliver, MSW, PhD; et al.
JAMA. 2011;306(13):1468-1478
11. Hospitalization-Associated Disability: “She Was Probably Able to Ambulate, but I’m Not Sure”
Kenneth E. Covinsky, MD, MPH; Edgar Pierluissi, MD; C. Bree Johnston, MD, MPH
JAMA. 2011;306(16):1782-1793
12. Hearing Deficits in the Older Patient: “I Didn't Notice Anything”
James T. Pacala, MD, MS; Bevan Yueh, MD, MPH
JAMA. 2012;307(11):1185-1194
13. Hip Fracture Management: Tailoring Care for the Older Patient
William W. Hung, MD, MPH; Kenneth A. Egol, MD; Joseph D. Zuckerman, MD; et al.
JAMA. 2012;307(20):2185-2194
14. Older Adults With Severe, Treatment-Resistant Depression
Jürgen Unützer, MD, MPH, MA; Mijung Park, PhD, RN
JAMA. 2012;308(9):909-918
The following two talks are not specifically on this article, but are related to the topic:
Diagnosis and Treatment of Depression in Adults with Comorbid Medical Conditions
Effectiveness of Collaborative Care for Adults with Alzheimer's
15. Caring for the Older Person With Chronic Obstructive Pulmonary Disease
Terri R. Fried, MD; Carlos A. Vaz Fragoso, MD; Michael W. Rabow, MD
JAMA. 2012;308(12):1254-1263
16. Nonpharmacologic Management of Behavioral Symptoms in Dementia
Laura N. Gitlin, PhD; Helen C. Kales, MD; Constantine G. Lyketsos, MD, MHS
JAMA. 2012;308(19):2020-2029