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In Vivo
GERIATRICS

By 2030, the proportion of elderly in the United States is estimated to rise to 19.6 percent of the population, up from 12.4 percent today. The need for doctors trained in geriatric medicine will also rise. To keep up with the health demands of this rapidly increasing population, the Department of Medicine, with strong support from the New York- Presbyterian Hospital, is creating a new division at CUMC to integrate a core of sub-specialists with more broadly trained geriatricians who will care for both sick and healthy
Healthy Aging
The need for geriatric medicine is expected to rise dramatically in the coming years.
older adults, as well as to educate physicians and other health care practitioners.

Leadership of the Division of Geriatric Medicine and Aging will be shared by Mathew Maurer, M.D., Irving Assistant Professor of Medicine, and Evelyn C. Granieri, M.D., MPH, MSEd., a nationally recognized educator in geriatric medicine who was until recently director of geriatrics at Bronx VA Medical Center.

Though Columbia already has a number of world-class programs in aging – including the Stroud Center for Studies of Quality of Life, the Columbia Center for the Active Life of Minority Elders, the Taub Institute for Research on Alzheimer’s and the Aging Brain and the Clinical Cardiovascular Research Laboratory for the Elderly – this is the first time the university has established a place where medical care for the whole patient, as well as education, can be centered.

“Our new division in medicine is really just icing on a very big cake,” Dr. Maurer says.
The division is being created at a time when geriatric medicine faces a crisis. Last year the American Geriatrics Society calculated that the United States has only half the number of geriatricians it needs. The division will help address this need both by training new board certified geriatricians and also by sensitizing doctors in different specialties to geriatrics issues.

“Few physicians-in-training want to go into geriatrics,” Dr. Granieri says. “NBC Nightly News ran a segment recently in which they asked an entire first-year medical class how many were interested in geriatrics. The whole class laughed. Instead of just bringing new doctors to geriatrics, we will also bring geriatrics to doctors. There is a unique body of knowledge about older adults that needs to taught; it’s not acquired simply by taking care of people in this age group.”

Caring for older adults also requires more attention to the “whole person,” not just their diseases. “Take the example of dialysis,” Dr. Maurer says, “Different issues come up for a person on dialysis who is over the age of 70 than for someone in his 40s. For the older patient you have to think about mobility issues and how they’ll get to the dialysis center, or if neurocognitive problems impede the treatment plan and medication compliance, along with whether social supports are adequate.”

New Approach to Care of Elderly

The aging of the baby boomers – who have just started to enter their 60s – will also force geriatrics specialists to take more preventative roles in healthcare. Traditionally, geriatricians are not consulted until the patient is frail, homebound or institutionalized. “Baby boomers don’t want to be seen as frail old people, they want a healthcare system that will help them maintain their function and keep them fit,” Dr. Maurer says. The division’s co-chiefs want to reverse the traditional model and promote a more proactive approach, one in which the geriatrician acts earlier to prevent functional decline in healthy older people. They also wish to develop a model of care that will assist patients and their caregivers in transition from one care level to another.

The division’s research objectives parallel its clinical objectives, with an emphasis on quality of life, understanding the basic biology of aging and age-related diseases and challenging accepted notions of normal aging. For example, conditions that used to be considered normal, such as incontinence or losing one’s teeth, are now considered pathological. “Fatigue is often considered ‘normal’ in older people, but is it really? It could be due to anemia, depression, thyroid disease, deconditioning or several other diseases. We have the depth and breadth of faculty at Columbia to forge new interdisciplinary programs to not only define what’s normal and not normal for an 80-or 90-year-old, but to develop new models of cutting edge clinical care, ” Dr. Maurer says.

The Division of Geriatric Medicine and Aging is now just starting to recruit new geriatrics physicians and other practitioners to put this new philosophy into practice in the coming years. The division will be based at the Allen Pavilion of New York-Presbyterian Hospital. The Allen has long been recognized as the “Ivy League of Community Hospitals” with a multidisciplinary staff that constitutes the Division of Allen Medicine. Since its opening in 1988, the Allen Pavilion has distinguished itself as providing the highest quality clinical care in a convenient and comfortable manner to the older population in the surrounding community, at long-term care facilities and throughout the tri-state area.

“This is a very exciting time in geriatric medicine,” says Michael J. Fosina, executive director of the Allen Pavilion. “With the aging of society, the Division of Geriatric Medicine and Aging will allow both our medical school and hospital to become national leaders in geriatric medicine. Basing the division at the Allen will bring academic physician expertise to our local community. We fully expect this division will make the Allen Pavilion and Columbia the geriatric providers of choice in the New York metropolitan area and nationally.”

“There is already widespread recognition of the excellence of the many subspecialties at the Columbia campus of New York-Presbyterian Hospital that address specific health problems of older adults; the Division of Geriatric Medicine and Aging now adds the missing element of interdisciplinary approaches to the care and study of aging,” Dr. Maurer says. “The division’s integrative emphases dovetail perfectly with the existing subspecialties whose predominant patient base is the growing population of older adults.”

The division will have both inpatient and outpatients programs and expects to be able to start seeing patients in July 2006. Initial activities will focus on transitional care for vulnerable older adults and outpatient programs for both consultative and primary care.

“Columbia has trailed behind other academic medical centers in establishing aging as an academic pursuit, but now we all expect great things from this new division,” says David Brenner, M.D., chairman of the Department of Medicine.

—Susan Conova

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