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Older Patients Require a Comprehensive, Coordinated Approach to Healthcare |
"Someone has to be the quarterback, helping to decide what is necessary and making sure all aspects of the patient's health and well-being are addressed in a coordinated way."
 Addressing the healthcare needs of older adults demands a comprehensive, coordinated approach that balances their medical needs with the circumstances of their lives. A majority of older persons have at least one chronic disease, making management of such conditions as heart failure, hypertension,osteoarthritis and diabetes a key component of care, says Sonja Rosen, M.D., a geriatric specialist at UCLA Medical Center, Santa Monica. At the same time, a substantial numbers of older patients also have difficulty performing basic and more advanced activities of daily living, complicating matters.
"If, for example, you give a prescription to a patient who can't manage medications because he or she is cognitively impaired, that prescription does no good," Dr. Rosen notes. "Geriatricians take care of the whole patient, not just the disease, and part of that is understanding what's going on in the patient's home and community."
It is important for physicians to understand a patient's goals for care. "The goals of someone who is highly functional and maybe even working part-time into their 80s or 90s are likely to be very different from the person who is wheelchair- or bed-bound and dependent in their activities for daily living, or from someone with dementia," Dr. Rosen says.
When what a patient wants can't be achieved, "we need to bring the medical realities into the discussion. But when patients have identified realistic goals, it is our responsibility to be their advocates in achieving them," says David Reuben, M.D., chief of the UCLA Division of Geriatrics.
A comprehensive patient history is important and enables the physician to focus on answering the  patient's questions, addressing concerns and going over areas that need further exploration. An initial outpatient visit may also include an assessment of the patient's medical and cognitive status; an exam to gauge depression and anxiety; and an analysis of functional and physical abilities, social and caregiver support, spirituality issues economic factors, environmental issues and quality-of-life/well-being. Advance directives may also be discussed.
A comprehensive assessment also should include a full gait and balance evaluation. If a patient is at risk for falls, physical therapy or use of an assisted walking device may be recommended, Dr. Rosen says, as well as a home visit from an occupational therapist to ensure the home environment is free of hazards.
If the patient appears to have one or more geriatric syndromes — complex conditions that typically involve multiple body systems — referral to a geriatrician with special training in diagnosing and managing these syndromes may be indicated. Common geriatric syndromes include dementia, delirium, incontinence, sensory impairment, malnutrition, osteoporosis, social isolation, falls, immobility, pressure ulcers and problems caused by being on many interacting medications.
Many acute conditions present differently in older patients, Dr. Rosen notes, particularly if there are comorbidities. An older patient with an infection, for example, may not have a fever or an elevated white blood cell count. A patient who is cognitively impaired might seem only lethargic when he or she is experiencing a stroke or heart attack.
It is important for older patients to have a physician who looks at the big picture. "Sometimes a patient will go from one specialist to another, without one person who is monitoring everything," Dr. Rosen says. "Someone has to be the quarterback, helping to decide what is necessary and making sure all aspects of the patient's health and wellbeing are addressed in a coordinated way."
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New UCLA Program Improves Care, Reduces Stress for Dementia Patients and Caregivers |
 David Reuben, M. Today, 5.4 million Americans are living with Alzheimer’s disease, including more than 480,000 people in California. Alzheimer’s and other types of dementia produce symptoms severe enough to reduce a person’s ability to perform everyday activities. Caring for these patients is a complex undertaking, and patients sometimes fall through the cracks, says David Reuben, M.D., chief of the UCLA Division of Geriatrics, and director of the new UCLA Alzheimer’s and Dementia Care Program designed to provide comprehensive, patient- and family-centered care to those
affected by dementia.
“There are still gaps in the care provided to dementia patients,” says Dr. Reuben. “After the diagnosis, patients and their families suddenly find themselves in a situation in which they must face a debilitating, incurable disease with no idea how to access appropriate resources to help them through this journey.”
Dementia is caused by irreversible damage to brain cells. Symptoms include memory loss, communication and language difficulties, diminished reasoning and judgment and impaired visual perception. Some patients experience major personality and behavioral changes, including agitation, aggressiveness, depression or psychosis. Patients survive four to eight years, on average, following an Alzheimer’s diagnosis but may live much longer. The severity of problems increases as the disease progresses.
“Patients need to be continually monitored for complications,” explains Dr. Reuben. “At UCLA, we have excellent geriatrics, neurology, psychiatry, psychology and other clinical programs necessary in treating dementia, but patients need help getting to the right resources at the right time.”
 Patti Davis The new program will serve as an entry point into dementia care at UCLA Health System, as well as to social-support and other community-based resources. Access to clinical and social-support services, as well as opportunities to participate in clinical trials, will be coordinated by a dementia-care manager with expertise in addressing the unique needs of patients and caregivers.
“I have met so many people who don’t know where to go next,” says Linda Ercoli, Ph.D., UCLA’s director of geriatric psychology. “Using this new model of care, we will guide them, educate them and support them so they don’t get lost along the way.”
Dr. Ercoli will coordinate the education and support components of the program, including a series of expert lectures on topics addressing the difference between senility and dementia, managing dementia with and without medication, long-term care planning, research and caregiver burnout. A new caregiver support group, Beyond Alzheimer’s, was founded by Dr. Ercoli and President Ronald Reagan’s daughter Patti Davis. Nearly 50 percent of Alzheimer’s-disease caregivers eventually develop depression or other health problems.
“The caregiver support group is an incredibly powerful way for people to get in touch with their feelings, discuss problem-solving strategies and become more knowledgeable about the disease,” Dr. Ercoli says. |
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ALL ABOUT AGING: How To Identify Symptoms Of Depression |
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By HONG-PHUC TRAN, MD, UCLA HEALTH SYSTEM
Now that holiday festivities are over and the New Year is well underway, I would like to talk about an important topic that can impact the quality of life for many elderly people – depression.
Depression is a common medical condition that can be easily treated. However, many patients and their loved ones often are reluctant to talk about depression because of a lingering social stigma. Of the 35 million Americans aged 65 or older, more than 6.5 million – almost 20 percent – are affected by the condition, and depression is twice more common in women than in men.
Read the full article at the Santa Monica Mirror.
Dr. Hong-Phuc Tran is a board-certified geriatrician with the highly ranked UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371. |
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ALL ABOUT AGING: Ten Tips For A Healthier 2012 |
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By DR. SONJA ROSEN, MD, UCLA HEALTH SYSTEM
Best wishes for a happy and healthy New Year! What better time than now to resolve to achieve better health? My resolutions are to 1) exercise every day with my family, 2) start practicing the cello again, and 3) continue to read more literature.
Read the full article at the Santa Monica Mirror.
Dr. Sonja Rosen is a board-certified geriatrician with the highly ranked UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371. |
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ALL ABOUT AGING: Helpful Habits For A Good Night’s Sleep |
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By JAMES DAVIS, MD, UCLA HEALTH SYSTEM
Sleep problems are among the more common complaints I hear from my patients. They all long for the perfect night’s sleep. They want to fall asleep quickly, sleep through the night, and awaken refreshed and ready to tackle the day. They want to “sleep like babies.”
Read the full article at the Santa Monica Mirror.
Dr. James Davis is a board-certified geriatrician with the highly ranked UCLA Geriatrics Program in Santa Monica and Westwood. For more information, call 310.319.4371. |
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