May 30, 2008

Elderly patients’ needs at heart of new consult service

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Elderly patients’ needs at heart of new consult service

A new consult service at Vanderbilt Medical Center embraces the adage “respect your elders.”

Doctors from any hospital department are now able to request a special consult for patients age 65 or older.

“As people live longer with chronic diseases, they have a greater risk of being hospitalized,” said Laurence Solberg, M.D., chief of the new Geriatrics Consult Service. “Hospitalized elders with geriatric syndromes have specific needs that a geriatrician is trained to assess and manage.

“The Geriatrics Consult service ensures this expertise is available to all doctors and patients in the hospital.”

The program has two major thrusts: consults about geriatric syndromes for inpatient doctors, and ongoing treatment follow-up for the patient and his or her family while in the hospital.

“Through the Vanderbilt-Reynolds Education Center, we have now developed an electronic consult order and dedicated a physician to now permit greater availability and better documentation of geriatric care recommendations,” said James Powers, M.D., a member of the geriatrics consult team.

A consult 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 all medications; and development of a care plan.

It retrieves important information from a patient's medical record, “including fall and skin risk assessments, nutritional information, advance directives and data on residence and caregivers,” Powers explained.

“We will also be able to electronically track reasons for consultation and follow-up information, as well as link the consulting physician to geriatric information pertinent to patient care.”

“Our goal is to focus on the complicated, complex issues, not only medical but social and economic issues, too,” said Ralf Habermann, M.D., a consulting geriatrician.

“It will be a good service to put a different pair of eyes on elderly patients and get a little bit different input. We can help with the big picture.”

The service also tackles the difficult task of explaining the patient's situation to families, many of whom are agonizing over how to care for their aging loved ones.

“They wonder, 'How did Mom decline so fast?' There's a rapid progression in older patients,” Solberg said.

“The drop over the edge isn't very far. We hope to prevent a decline from taking place.”

Yet the goal of the service isn't to treat all senior patients.

“We don't have enough geriatricians,” Solberg said. “There's a critical shortage. The most efficient use of our knowledge is not to take care of older patients ourselves, but to help others take care of them.”

He estimates that 65 percent of older patients will have three or more geriatric syndromes, which include conditions such as dementia, incontinence, malnutrition, frailty and delirium.

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

The service is available from 8 a.m. to 4 p.m. each weekday, and can be reached by placing an order through the computer or by paging 831-6539.