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.
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.
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.
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.
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.
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.
With 500 beds, 19 stories (five underground) and state-of-the-art technical equipment, the Tower is the most advanced medical facility in the Middle East.
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.
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
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.
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.