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Dr. Yoram Maaravi, Change Agent in Caring for the Elderly

Dr. Yoram Maaravi, the Hadassah Medical Organization’s Director of Geriatric Rehabilitation

"It's the best thing to do in medicine; it's fulfilling, fascinating, challenging, and rewarding," says Dr. Yoram Maaravi, the Hadassah Medical Organization's Director of Geriatric Rehabilitation, in describing his career as a geriatrician at Hadassah's Hospital on Mount Scopus.

Proud to be a 10th generation Jerusalemite, Dr. Maaravi decided to become a doctor when he was in the third grade and read some books about physicians. "I was captivated by the characters," he said. And that's when he knew what he wanted to be.

Initially, Dr. Maaravi served as an army physician. When he reached the age of army-mandated "retirement," he found himself in search of a new specialty. Dr. Maaravi ended up choosing endocrinology and internal medicine, but he found his true niche in geriatrics.

Why is geriatrics so special to him?
"Being able to wake up in the morning looking forward to what you have to do during the day, even though you know you will be back home at midnight, is not something you can achieve easily," Dr. Maaravi says.

Dr. Maaravi travels around the world "nonstop," whether it is to Dallas or South Korea, to tell his colleagues abroad about Hadassah's geriatric model, through which geriatricians are the conductors of an elderly patient's care.
The physicians share perspectives on pressing issues of the specialty, such as ethics, end-of-life care, rehabilitation in old age, and functioning among the elderly. "Anyone who copies our unique system will improve the care of elderly people dramatically," Dr. Maaravi says.

The Hadassah model begins with a Geriatric Emergency Program--the first such program in the world. When an elderly patient comes to Hadassah's Emergency Room, a geriatrician is called to evaluate him. "It's important that the elderly be treated by people who understand their diseases and complexities," Dr. Maaravi explains.

Dr. Maaravi sites the example of an 85-year-old man who comes to a hospital emergency room after having fallen during a trip to the bathroom in the middle of the night. The physician determines that the patient has a broken leg. In a typical hospital emergency room, he says, the patient would be given orthopedic surgery, sent to rehabilitation, and then be returned home. Because of the Geriatric Emergency Program at Hadassah Hospital-Mount Scopus, however, the scenario is very different. The physician in the ER immediately contacts a geriatrician when the elderly person first arrives at the ER. The geriatrician comes to the ER to speak with the patient to determine why the man fell. He identifies the various problems that could have caused the fall--checking the patient's eyesight, investigating whether, perhaps, he has the beginnings of Parkinson's disease. He will ask the man why he got up in the middle of the night to go to the bathroom and question him as to whether he is on a diuretic or has a prostrate problem. Following this diagnostic workup, the geriatrician will treat each problem and if not eliminate it, he will at least improve the clinical situation for the patient.

With this broader type of intervention. Dr. Maaravi relates, falls go down by 50-60 percent.

By the same token, a geriatrician understands that the aging process brings with it certain differences in the manifestation of a disease. As Dr. Maaravi explains, pneumonia, for example, will often present as confusion in the elderly, rather than with a cough as is typical in younger patients.

Through its special geriatric program, Hadassah collaborates closely with programs in the community for the elderly. "If I am able to prevent a patient from being admitted to the hospital and instead have him treated properly within the community, I am very happy," says Dr. Maaravi.

Dr. Maaravi's vision is that "we take steps to improve care of the elderly worldwide." To that end, he wants to recruit more people to train as geriatricians and work in geriatrics. He is now also working on founding a Geriatric Education Center with the goal of educating more physicians about how to care for the elderly better, whatever their specialty.

Compassionate, well-trained staff coupled with cutting-edge technology makes rehabilitative care at HMO world-class . Patients who suffer a stroke or traumatic brain injury, or have orthopedic or neuromuscular conditions, are among the primary beneficiaries of the multidisciplinary rehabilitation care at Mount Scopus.

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Current emergency services do not have the proper set up for elder care, he points out, "and without the proper set-up, you can't succeed." With a program like Hadassah's, however, Dr. Maaravi reports, elderly patients are being readmitted much less to the ER and their overall functioning in the long run is improved.

For many years, Hadassah's Geriatric Emergency Program was the only one in the world.
Last year, Mount Sinai Hospital in New York opened the first one in the United States. "We are impacting health care systems around the world," says Dr. Maaravi, "both in the way they look at the elderly and the way they innovate services."

For the last 23 years, Hadassah has been involved in the Geriatric Longitudinal Study of Aging. The study follows elderly people who were born in the same year. Every five years, the researchers contact them and investigate such factors as their medical history, performance on cognitive tests, quality of life, as well as the effect of post-retirement work and volunteering on their overall well being. The study has revealed that those who keep working, whether as a volunteer or paid worker, are doing significantly better.

Hadassah is also collaborating with a neuroimmunology laboratory at Harvard Medical School, where one of Hadassah's geriatricians is now researching a vaccine for Alzheimer's disease. The plan, Dr. Maaravi relates, is to begin a new, large-scale study of at least 1,000 individuals who are 90 years of age and older to determine how their genetic profiles relate to the development of certain diseases.

Thinking about Hadassah's support around the world, Dr. Maaravi recalled an incident while he was in Boston for a conference. He and some colleagues went to a coffee shop for lunch. At the entrance sat an elderly woman at a small table, asking for donations to Hadassah. When he introduced himself as Hadassah physician, "she almost burst into tears." I felt like she was family," Dr. Maaravi says.

"I admire the dedication of the Hadassah people who are so far away," he notes. "They don't always know exactly what we do. They don't always know how important it is to us what they do. In my view, this is our oxygen--knowing there is such a large body of people that is so dedicated in their support of our work here."

Date: 10/30/2013

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