Geriatric Program addresses seniors

Do PCPs have time for a full exam?

Senior citizens and their families are getting help in identifying and coping with the medical and social needs of the elderly through a Geriatric Assessment Program offered by Geisinger Health System, with headquarters in Danville, PA.

Robb McIlvried, MD, director of the Geriatric Assessment Program, says, "The Geriatric Assessment Program addresses some of the geriatric issues that the primary care provider doesn't have the time or the resources to focus on. Our multidisciplinary team is experienced in geriatric care and conducts a thorough assessment to identify the specific needs of the patient and develops a customized plan to help the patient and family member manage those needs."

The team includes a board-certified geriatric physician, a registered nurse experienced in geriatrics, a social worker, and a pharmacist.

About half of the patients who go through the program are referred by their primary care physician. The rest are self-referred or are brought to Geisinger by their family members who have recognized that there are problems and heard about the program from an acquaintance or found it by searching the Internet.

At the beginning of the assessment, the entire team meets with the patient and family, then the patient and family members meet individually with each discipline. Members of the team review the patient's medical history and medication regimen. They conduct a thorough physical examination of the patient and a social assessment with the patient's family. Then the entire team meets with the family again, discusses the outcomes of the evaluation, including any diagnoses, explains the treatment options, and makes recommendations. They forward their findings to the patient's primary care physician, and they emphasize the importance of follow up care.

Many times the assessment uncovers mental health issues, either longstanding, unrecognized, or never addressed. Cognitive impairment or dementia is the No. 1 issue that the geriatric assessment uncovers, a diagnosis that often surprises the family, McIlvried says. "Dementia is very common," he says. "It's striking how many times the family has no idea that there is a problem or just thinks the patient is a little forgetful but have no idea how impaired he or she is."

Unless patients are accompanied by family members, primary care physicians often overlook the possibility of dementia, McIlvried says. "A cognitive assessment takes a minimum of 20 to 30 minutes," he says. "Primary care physicians don't have time to conduct the assessment, then explain the diagnosis and treatment option or to further evaluate the patient to address safety issues such as driving and conditions in the home."

When tests show that a senior has cognitive issues, the social worker and the rest of the team help family members deal with changes that are going to occur as the patient's cognitive problems progress. They support the family in making arrangement as the condition worsens. "We talk to the family about how to address safety issues with patients who have cognitive impairments," he says. For example, the team might recommend that a family member remove all the medication from the patient's home and bring it over on a daily basis to make sure the senior isn't making mistakes in medication. They might recommend disconnecting the stove or taking away the car keys.

In all cases, the team evaluates whether the patient is able to live safely at home alone or whether they should move to an assisted living center or a skilled nursing facility. They inform the family of options for services in the home, such as home health visits or meals on wheels, which can enable the senior to continue to live alone. "Often we uncover issues that require additional support from the family or a caregiver," he says.

Patients and family members are asked to bring in all of the medications, including over-the-counter products and herbal remedies the patient is taking for the pharmacist on the team to review. "We want them to bring the bottles and not just a list. Many times, we find out that they are taking duplicates or a medication they don't really need," he says.

When appropriate, the social worker on the team helps the family identify a skilled facility or personal care home for the patient. The social workers helps families pursue guardianships, powers of attorney, and advance directives, and they intervene when the team discovers that a senior is being exploited by a family member or scammed by someone outside the family.

In most cases, the patients and family members make just one visit to the program.

"It depends on what we find and what recommendations we make," McIlvried says. "If we are making a lot of recommendations, we may bring the family back in a couple of months for another assessment. Most of the time, they just need to follow up with the primary care physician."