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HMO’s Geriatric Unit: Special Support for the Frail Elderly

Prof. Gideon Friedman, Director of Hadassah’s Geriatric Unit.

The Hadassah Medical Organization's Geriatric Unit--unique in Israel--was created to assess the needs of the frail elderly and provide them with the holistic care they need.

The Unit was launched in 1991 thanks to a significant gift from the Bessie and Louis Stein Foundation. Mr. Stein, of Philadelphia, was an advocate of this new approach to caring for the elderly and his daughter, Ruth Nathanson, has maintained the family support of the Unit now that her parents have passed away. The Unit is comprised of an inpatient geriatric consultation team, an outpatient clinic, and a research laboratory. The multidisciplinary team includes three physicians--all specialists in internal as well as geriatric medicine--two nurses, a social worker, a physiotherapist, an occupational therapist, and a dietician. As necessary, the staff consults with other specialists, particularly psychiatrists and neurologists.

The goal of the team is to reach as many elderly patients as possible. Therefore, unlike most such units elsewhere in the world, Hadassah's Geriatric Unit initiates contact with most elderly patients in the hospital, rather than rely on referrals. Its staff assesses the medical, functional, social, cognitive, and mental needs of these patients (mainly aged 75 and over), and then formulates a personalized program of care.

To ensure that the influence of the Geriatric Unit is widespread, the geriatric specialists are automatically informed when an elderly patient is admitted to the hospital. Using a structured questionnaire, the staff gathers information about the patient. Then, the staff performs a geriatric assessment, based on the person’s responses to this initial questionnaire. Next, the team makes recommendations to the staff on the hospital ward about optimal care for this patient. These recommendations become a part of the patient’s discharge papers and, when the patient leaves the hospital, he or she is given a copy. Another copy is sent to the patient’s family practitioner.

The Outpatient Clinic is open once a week. Physicians in the community send their patients to the clinic for a functional evaluation, a patient will come in for a follow-up consultation once leaving the hospital, or an elderly individual may just come in for help on his own. The entire geriatric team will examine this patient and provide recommendations, just as the specialists do when the individual is an inpatient.

The Geriatric Unit team also teaches at the Hadassah-Hebrew University School of Medicine and the School of Nursing, giving lectures as well as providing clinical teaching. They also make themselves available for presentations to the public within the local community.

Since 1994, there has been a residency program in geriatrics at Hadassah, with the goal of creating academic geriatric specialists who will become leaders in this field. In addition, the Geriatric Unit team has designed a comprehensive, 60-hour multidisciplinary gerontology/geriatrics course for hospital professionals, through which they have educated over 100 participants.

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Every other year, the Geriatric Unit hosts an International Geriatric Conference on Aging in the Mediterranean and the Middle East, where professionals in the region exchange ideas and expertise and discuss the health challenges faced by the elderly. The Unit’s particular research focus is aging and atherosclerosis, from the perspective of molecular and biochemical changes. For example, they are investigating the expression of a particular protein in patients with dementia or traumatic brain injury. They are also looking into a gene mutation as it may affect a person’s risk for developing cardiovascular disease and vascular dementia.

The Geriatric Unit team is also engaged in various clinical research projects. The Ministry of Retirees awarded the Unit a grant to investigate delirium among the hospitalized elderly, in cooperation with the Department of Social Work Services, the Psychiatric Department, and the Department for Internal Medicine C. In another study, the Geriatric Unit is helping to assess the impact of having a migrant live-in home care worker stay with the elderly patient during hospitalization. The geriatric specialists are looking into the potential conflicts associated with the workers’ presence in the hospital as well as their participation in the medical management of the elderly patient.

Because of their extensive knowledge and experience in assessing and treating elderly adults who are at risk for mistreatment, either at home or while in institutional care, the Geriatric Unit team collaborates with health care professionals in both the hospital and the community to detect elder abuse and intervene when the elderly are mistreated.

Date: 7/24/2013

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