Specialized service provides caring touch for elderly

Senior patients require a particularly deft and caring touch from their medical team.

Vanderbilt University Medical Center’s new Geriatrics Consult Service offers just that type of expertise and specialized treatment for the elderly and their families, too.

“We can make a difference in these patients’ lives, even if it’s for just one day,” said Laurence M. Solberg, M.D., chief of the service. “We can give them a better quality of life near the end of their lives.”

Doctors from any hospital department can request a consult for patients age 65 and older. About 65 percent of those patients have three or more geriatric syndromes, which include conditions such as dementia, incontinence, malnutrition, frailty and delirium.

Since its inception earlier this year, the service has seen an average of four new patients per week.

The multidisciplinary approach includes physical and mental health assessments; details of the patient’s social and economic status, such as family support and home safety issues; a review of medications; and development of a care plan.

The experiences of two recent patients reveal the need for the specialized service.

An 86-year-old woman who lives a few hours away came to Nashville after fainting in church.

When seen by the Geriatrics Consult Service, the patient was on 14 medications and “feeling very weak,” Solberg said. It turned out she’d recently seen a new cardiologist, and he’d put her on six additional medications.

Like many seniors, she was worried about the cost of those medications.

“Many doctors in the community just don’t think about the fixed income that seniors are on,” he said. “They forget about it, or think it’s going to be covered.”

The cardiologist “put her on all of the latest, greatest medications, and they all cost a ton of money,” Solberg said. “None of them were cheap. To me, that’s always a concern. There may be a generic that will do the job very well and not force the patient to choose between medicine and food.”

The patient left Vanderbilt on four generic medications, which cost a total of $16 per month.

“Here was a woman who was doing fine,” Solberg said. “She didn’t need all of these new medications. There was no thought to how her lifestyle would be affected by this.”

Another important role is also one of the most difficult: dealing with families, many of whom are agonizing over how to care for their aging loved ones.

A 92-year-old patient with Alzheimer’s lived at home with his 87-year-old sister until he suffered a fall recently.

“He really needed more supervision,” Solberg said. “He needed to be in a structured environment. His sister and her children were adamant that he not be placed in a nursing home.”

Despite community services and social work intervention at home, the patient kept returning to the hospital.

“We finally approached them with a real team approach, with therapists and social workers,” Solberg said. “We said, ‘We just really can’t let him go home again. It’s not in his best interest.’’’

The team discussed with the family their fears of nursing homes, and set up tours of three facilities to help them choose.

“We were able to talk to the family about end-of-life issues and about getting the best care for him, even though it wasn’t them caring for him,” Solberg said. “It was better for their mother to see her brother well-cared for and not worry about him all of the time.

“That’s a success story from the geriatrics team, because it made his quality of life better. And it helped his sister, too, because now she doesn’t have to worry about him.’’

An added benefit comes from teaching young physicians about the needs of older patients. All internal medicine residents at VUMC now undergo a geriatric rotation.

“The best thing we get to do is show the younger doctors in training that this is a part of elderly care that they never saw before and didn’t understand,” Solberg said. “Now they get to see it as a real extension of care. They help keep people functional.

“But also, if we can’t keep them functional, we teach them how to deal with family members as they come face-to-face with the reality that their loved one is at the end of their life.”
- LAURIE E. HOLLOWAY