Why Geriatrics?

WesleyHospital

**Update (Click here)

Ted Johnson, MD, MPH

A Potential Vision for Aging Inquiry at Emory

August 18, 2009


Given the many University-wide assets for inquiry on aging, we have the potential to be a top-five national leader in inquiry on aging, given the breadth and depth of the current resources.  Having so many options demands direction.  As one consultant to the Emory Task Force for the Center for Health in Aging said, "You have a great portfolio and lots of opportunities- perhaps too many opportunities.  You need to decide what you want to do."  This letter outlines my proposed sharper focus for the inquiry in aging at Emory. 


Part of what Emory needs to articulate is a vision of the future - a bold and audacious goal.  Despite the ambitious nature of this goal, I believe that Emory is uniquely positioned to accomplish this- in partnership with other community and university programs -over the next 12 years. 


I propose that we commit to eliminating by the year 2020 the need for long-term nursing home institutionalization as a routine destination for older adults in Georgia.


Often an older adult's greatest fear is not dying, but rather it is being admitted to a nursing home.  For geriatricians and gerontologists, this should be the focus of our struggle; this goal should drive our research, clinical, educational, and outreach efforts.  Unwanted nursing home (NH) admission is our "cancer" in geriatric medicine and gerontology to fight.  We should dedicate ourselves to finding a "cure". 


A 12-year framework allows for this goal to be broader in scope than the identifying community alternatives to nursing homes approach (move services from institutions to the homes), but new basic science, translational science, predictive health initiatives, and clinical knowledge on the treatment of the root causes (dementia, stroke, urinary incontinence, congestive heart failure, immobility) that contribute to nursing home admission.  A goal of eliminating the routine need for longitudinal, life-long Nursing Home care for elderly adults is consistent with the message of the 2008 Institute of Medicine report (Retooling for an Aging America- Retooling the Health Work Force) for developing new systems of care, is financially important to many health systems and all payers, provides a focus for clinical demonstration projects (i.e., a pre-nursing home outpatient consultation clinic, for example) and educational interventions.  This goal would resonate with philanthropic partners.


Committing to this goal would move us to develop new research sources and cores that would contribute to the overall mission. Such cores (an National Institute on Aging P30 Claude Pepper Older Adult for Independence Center, an NIA P30 Center in Demography in Aging, a HRSA Geriatric Education Center, a second fully funded VA GRECC for the Atlanta VA, and a VA Health Services Research & Development Center) might have been previously portrayed as final objectives.  Here they act as intermediate steps on the way to the final objective.  


The organizing principles would be to: 1) seek out medical breakthroughs in the treatment of chronic and disabling conditions, such as stroke, dementia, congestive heart failure, Parkinson's disease, and urinary incontinence; 2) develop interventions that stress nutrition and diet and exercise, not just in the very old, but in the frail, young-old individuals (those 60-65) who will in 15 years time potentially be bound for nursing home admission; 3) initiate investigations into the basic biological mechanisms that are the root causes of these conditions, such as inflammation, cell senescence, protein processing, and cell signaling, that allows these conditions to be prevented or the effects to be significantly post-poned; 4) develop care models (such as palliative care) that take elements of care now routinely provided in nursing homes, and more fully develop these programs within the home, community, and alternative institutions; and 5) address social issues, including re-development of our communities, including the incorporation of faith-based communities, development of livable communities where there is easy access to food, health care, and meaningful activity, and supporting care-givers.


This forms the basis for lines of investigation:


  • How to use predictive medicine to identify individuals who are at risk for nursing home placement so that targeted, meaningful intervention strategies can be developed and implemented


  • Develop new, efficacious treatments for chronic diseases and management strategies that will allow better treatment (or enhance patient adherence to treatment) of conditions such as DM, CHF, CAD, urinary incontinence, and obesity.


  • Focus on aspects of communities that allow for older individual to remain in place, including the use of monitoring and assistive technologies within the home, transportation, networking, access to food, and meaningful social integration of elderly individuals into the community


  • Develop and study strategies that support family caregivers who often sustain vulnerable elderly individuals in the home


  • Develop formal clinical care programs through medicine, nursing, and public health within the home (home care programs) and informal programs that sustain community (faith based initiatives)


  • Develop targeted programs in clinical settings (acute medicine, rehabilitation, and palliative medicine) that allow individuals to be directed to settings other than skilled nursing


  • Develop in partnership with colleagues from Law, Business, and Public Health financial models that make remaining in the community as easy as being in the nursing home


**Update

Monday, October 19, 2009, 2:28pm EDT

Forbes: Atlanta ranks No. 1 among America's 'recession proof' retirement markets

Atlanta Business Chronicle

Metro Atlanta ranks No. 1 on a new list by Forbes of America's 40 "recession proof" retirement cities.

Forbes said it considered such factors as average income for seniors, current and expected home prices, job-growth predictions through 2014, the cost of living and median monthly housing cost.

Atlanta ranked 17th for number of sunny days, 17th for income of residents 65 and older, seventh for median home price, 17th for home price change predicted for 2009-2014, 11th for cost of living and 23rd for median housing cost.

Atlanta was followed by Dallas-Fort Worth, Tampa-St. Petersburg, Houston, St. Louis, Austin, Las Vegas, Phoenix, Kansas City and San Antonio.

New York finished last among the 40 cities, with Milwaukee and Boston near the bottom.

Click here for the Forbes report on recession-proof retirement cities.

And click here for the ranking of 40 cities.

10/5/09

Nursing Homes That Belie the Bad Image

By JANE E. BRODY

Published: October 5, 2009

I have often said in no uncertain terms that I never want to be placed in a nursing home unless it is to recover from a treatable illness or injury. I have heard so many horror stories of neglect, mistreatment, understaffing, poorly trained attendants and even corruption. I shared the common perception of a nursing home as the last place you go before you die, and this was not how I wanted to spend my last days.

More (click here)

 

 

 

 

9/26/09

An Interesting article from page 1 of today's NYT which, while having primary emphases Medicaid mechanisms and on ADL-IADL / social aspects of restoring residence in community setting, has major implications for health and public health.

"Helping the Aged Leave Nursing Homes for a Home"

http://www.nytimes.com/2009/09/19/health/policy/19aging.html?_r=1


Here's a classic riff from the piece:


Elizabeth Kamara, 72, spent 18 months in a nursing home after having her left foot amputated because of diabetes. Mrs. Kamara can get around using a walker, but in the nursing home she spent whole days in a wheelchair.

"I just let people do things for me," she said. "They say, 'If you fall, we'll get in trouble. Please sit down.' "



Thursday, August 13, 2009

A healthy practice

Decatur sole practitioner transfers his love of cycling into helping 

clients and coaching other cyclists


By Blane Bachelor, Special to the Daily Report


Literally and figuratively, Kenneth A. ROSSKOPF has gotten a lot of 

mileage out of his passion for cycling. Not only is he a competitive 

racer, he's also a certified cycling coach with USA Cycling and 

founded his own firm, Kenneth A. ROSSKOPF & Associates, to provide 

legal protection to injured bicyclists.


¿I really wanted to get into bicycle law, and I moved into my own 

office in 1989 in Decatur,¿ says ROSSKOPF, a father of four. ¿The 

bicycle work gradually started coming to me because of all my contacts 

in bicycling with various clubs and racing.¿


ROSSKOPF took up cycling in his 40s, while he was living and working 

in the U.S. Virgin Islands. Upon moving to Atlanta in the mid-1980s, 

he's been highly active in competitive cycling, is well-known in 

Atlanta's cycling community and has helped coach several prominent 

U.S. cyclists onto the national scene. In July, ROSSKOPF won his first 

national championship, in the 70- to 74-year-old Masters road race 

division of USA Cycling, and will compete in the Austria Masters World 

Cup this month; he leaves today..


ROSSKOPF spoke to Daily Report about all things bike.


How was it learning the ropes of riding on a Caribbean island?


The races were pretty small, five or six people. They were good 

cyclists. We would race in Puerto Rico and all over the U.S. Virgin 

Islands. I got to know all about competitive cycling, and that was an 

easy way to get into it, without the fear of these huge groups of 

cyclists. It was a neat mixture. And they shared their information 

freely. I learned lots of good tips along the way.


What factor does cycling play in leading a healthy life into your 70s?


Cycling definitely plays a big role. When you get on the bike, age 

seems to melt away. You're out riding with people who are 20, 30, 40 

years younger. You're riding side by side, conversing, and you forget 

you have 30, 40 years on them. That's a great feeling to have every 

day, to be reminded that you're energetic and healthy. My wife is also 

extremely health conscious, so it's been easy to eat right and to get 

the time to exercise.


What's your diet like?


I've studied nutrition for athletes, and so I know the importance of 

low-fat diets. I try to eat very little red meat, low fats, high 

carbs, a good balance of whole grains and veggies, some dairy. I still 

have a little dish of ice cream every now and then.


What do you enjoy most about coaching?


I want to pass on the sport of cycling, because I know how much it's 

benefited me. It's something these kids can do their entire lives. I 

like the competitive aspect of it, and the tactics and strategy of 

racing, and getting kids excited about that. When the kids are into 

cycling seriously, they don't have time for getting in trouble, 

they're healthy, and they remain good friends with each other.


Any plans for retiring?


I don't see retiring. As long as I'm competent to help bicyclists, I 

want to do that.


Blane Bachelor is a freelance writer in Atlanta who contributes to the 

Daily Report.

Kenneth

8/20/09

NY Times articles about Geriatrics


The American Recovery and Reinvestment Act of 2009 called on the Institute of Medicine to recommend a list of priority topics to be the initial focus of a new national investment in comparative effectiveness research. The IOM¿s recommendations are contained in the report, Initial National Priorities for Comparative Effectiveness Research. Many of these first priority quartile areas have to do with caring for the elderly (hearing loss, support to caregivers supporting those with dementia, environmental versus drug therapy for problem behaviors in dementia).  The complete list of priority topics is provided by clicking here.