Consulting Practice Aims to Advance Geriatric Care, Training

The chief of geriatrics and palliative medicine is helping to create a UBMD inpatient consulting geriatrics practice.

He is partnering with Susan M. Glose, PhD, ANP, clinical assistant professor of medicine, and hospitalists at Erie County Medical Center, led by Rebecca K. Calabrese, MD, clinical assistant professor of medicine.

The team will initially work to enhance care for frail elders admitted to the UBMD hospitalist medicine service and then begin to assist patients throughout the hospital.

As the service develops, the care team will engage UB medical students, residents and fellows in state-of-the-art care for older adults.

In geriatric medicine, “the emphasis is on maintaining and preserving the patient’s ‘healthspan,’ or the highest possible quality of life and level of functioning,” says Troen.

“Elders may have multiple medical problems,” so the multidisciplinary, comprehensive perspective that geriatricians provide is crucial, he adds.

“Geriatric symptoms don’t fit neatly into distinct categories — that’s why we call them a syndrome,” he explains.

Geriatricians work with patients and their families to identify the root causes of symptoms and determine whether any are reversible, says Troen, a practicing geriatrician who also has an appointment with the VA Western New York Healthcare System.

“For example, frailty is a core element of geriatric practice. We need to diagnose what is causing the frailty just as we would diagnose what is causing confusion or delirium.”

Some cognitive declines, such as confusion and memory loss, may be caused by acute illnesses or conditions that are reversible if caught early enough, says Troen. 

Reversible conditions include urinary tract infections, vitamin B12 deficiency, pneumonia or hypothyroidism, all of which are common in the elderly. Cognitive symptoms also can be caused by heart attacks, stroke and some infectious diseases.

Comprehensive assessments help physicians, including primary care practitioners, to provide optimal care for elderly patients.

It’s essential to consider all four domains: medical, psychological, functional and social, Troen emphasizes. 

Interventions depend on the patient’s unique set of needs, he adds.

“Supportive services — such as assistance with preparing food, maintaining a checkbook or transportation — may be provided by an agency or a family member,” Troen says, noting that more than 95 percent of older Americans choose to live at home or with relatives.

Therefore, “it takes a village to care for the elderly,” he says, paraphrasing a popular proverb.

As the older population grows locally and nationally, the need for quality geriatric care and assessment will increase significantly.

Nearly 16 percent of Western New Yorkers are age 65 and over — compared to 13.3 percent nationally — giving the region the 10th highest percentage of older adults among large U.S. metropolitan areas.

Statewide, the 65-and-over group is expected to grow by 40 percent during the next 20 years.

Troen advises family members and care providers to be alert to declines in an older person’s abilities to perform activities of daily living, including basic (dressing, eating, ambulating, toileting and hygiene) and instrumental (shopping, housework, accounting, food preparation and transportation).

“Unfortunately — and not necessarily as part of normal aging — some of us start losing those capabilities as we grow older.”

“If there is a decline in any one of these, I would recommend a comprehensive geriatric assessment to help distinguish reversible causes of decline from irreversible ones,” says Troen.

Troen is a co-investigator for the SUNY Network Aging Partnership. This statewide collaborative pools resources to conduct interdisciplinary research on aging, focusing on the connection between frailty and dementia.

Also a molecular biologist, Troen’s own research has focused on vitamin D and osteoporosis.