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Mission/Goals
of Program
"The
overall mission of the GEM Program is to enhance the quality
of life for selected elderly veterans by improving clinical
care, promoting geriatric education and providing sites for
geriatric clinical research" (DVA VHA G-2, M-5 part VI, Aug
25,'92)
Goals
The
use of comprehensive geriatric assessment (CGA) with interdisciplinary
team care assessment and management of medical, rehabilitation
and psychosocial issues contributing to geriatric syndromes,
in an inpatient setting have been clearly shown to (Rubenstein
et al, Aging vol 1,'89):
- Improve
Diagnostic Accuracy
- Improve
Placement
- Improve
Functional Status
- Improve
Affect or Cognition
- Reduce/More
Appropriate Medications
- Improve
Access to Home Care/Community Services
- Reduce
use of Hospital Services
- Reduce
Medical Costs
- Prolonged
Survival
Scope
of Care
Care
on the inpatient GEM unit consists of patients who:
Require
CGA -recent recognition of geriatric syndromes and/or rapid
deterioration of functional status, with continued assessment
or care needs and who have a good to fair probability of returning
to an independent setting in the community (home or residential
care). These referrals may be from acute medical or surgical
beds, or outpatient clinics or home care programs.
Focused
Geriatric Management -Patients who receive care in the Senior
Patriots Geriatric Clinic who have assessment and management
of problems that may jeopardize independent function, but
do not require the intensity of service of an acute medical/surgical
unit; and who because of physical, mental or logistical issues
cannot be managed in an outpatient setting
EXCLUSION
CRITERIA: Intensive monitoring, terminal disease, well documented
irreversible dementia, severe behavior problems, primary need
is nursing home placement, nursing acuity greater than subacute
level staffing, lack of rehabilitation potential.
Members
of the team include Geriatric Medicine (Attending, Fellow,
Medical Intern), Nursing, Social Worker, Geriatrics Clinical
Pharmacist Specialists, Geriatric Neuropsychologist, and include
trainees supervised from their primary areas (Optometry, Dental,
Audiology, Speech Pathology, Occupational Therapy, Physical
Therapy), and the Geriatric Nurse Practitioner. Patients received
focused or comprehensive assessment, development of an interdisciplinary
team care plan for assessment and management, screening of
common geriatric syndromes, and therapy as needed. The status
and subsequent discharge planning frequently are accomplished
with family meetings with the full team.
Types
& Ages of Patients Served
Patients
should be >65 yrs old (occasionally some are younger with
geriatrics issues, but almost always >60), with a mean age
of 80+ years. Patients have a high incidence of osteoarthritis,
cardiovascular disease, pulmonary disease, diabetes, with
many geriatric syndromes.
Scope
and Complexity of Patient Needs
Patients
usually have significant co-morbidities with much cardiovascular
disease, COPD, diabetes with polypharmacy issues (non-adherence,
drug-disease interaction, untoward reactions, or ineffective
response), and other Geriatric Syndromes ("failure to thrive",
weight loss, falls or Change In Mobility in the Elderly (CHIME),
acute confusion state + unrecognized cognitive impairment,
with significant psychosocial issues (mood disorders, poor
motivation, impaired or burdened caregiver, lack of resources).
Many of these patients are surprisingly independent despite
significant underlying disease and advanced age.
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