The Glennan Center for Geriatrics and Gerontology LEAD Virginia
October 16, 2009 1
History Created in 1996 to embody academic ggeriatrics at EVMS. Center of Excellence at EVMS focusing on prevention prevention, intervention and research, research education and thoughtful and compassionate care for older people. people
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Mission To serve older adults by advancing the art off their health care through g leadership in geriatric and gerontologic education and academia.
C d Credo Harvesting Wisdom and Good Health 3
In 1990, Dr. John Franklin, Professor of Internal Medicine and Dr. Desmond Hayes, y , Professor Familyy and Community Medicine recognized the growth of the older population and their need for specialized care and created a required 2 week clerkship for all 4th year medical students. 4
The geriatric clerkship provided impetus within EVMS and the community to advance geriatric education d i andd to create a division di i i of ggeriatrics within the Department p of Internal Medicine, which is now The Glennan Center for Geriatrics gy and Gerontology 5
Dr and Mrs Dr. Mrs. John Franklin Founder of EVMS and The Glennan Center
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History July 1, 1996- Glennan Center opens with 4 pphysician-faculty y f y members,, a postp doctoral fellow, a laboratory/research director,, 3 ancillaryy staff, ff, a colonyy off monkeys and the geriatric clerkship. July July 1, 2009 2009-
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Faculty and Clinical Providers
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8 Faculty 4 Physicians (3 FT FT, 1 PT) PT), 1 Ph Ph.D, D and 3 Masters Masters-level level educated
Rex Biedenbender, Biedenbender MD
Marissa M i Galicia-Castillo, G li i C till MD
Yupingg Deng, g Ph.D.
D. Michael Geller,, MD
Madeline Dunstan, MS
Sharon Reed, MD
Christianne Fowler, GNP Robin Wallace, PA-C
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Additional Staff-7 Office Administrator (1) Financial Financial Analyst (1) Medical Assistant (1) Cl Clinical l Research R h Coordinators C d (3) Clinical Research Associate with the Driver Research and Evaluation Laboratory (1). 10
Endowments 8 named endowments
John Franklin Chair of Geriatrics by John and Lillian Norfleet The Glennan Center Endowment by Mrs. Virginia g Ferguson g The Lillian and Gideon Welles Grime Endowment ffor Geriatrics and Gerontology by Rosemary Jordan The Rosemary, y, Fenton and Garnett Jordan Professorship in Geriatrics
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Endowments Sue Faulkner S F lk Scribner S ib Distinguished Di ti ih d Professorship Th Milton The Milt Donn D F Family il library lib endowment The Douglas C. C Powers, Powers M.D. M D Endowed Research Professorship by Mrs. Douglas Powers The Jack V. and Clare S. Cook Award for Excellence for research from the estate of Clare S. Cook 12
Education Geriatric Clerkship- 2 weeks –4th year-9 clerkships per year. Senior Electives- 3 students-4 week rotations in either Palliative Care of Geriatrics Skilled Nursing Care. Geriatric-Internal Medicine- 3 week rotation for 3rd year med students. Introduction to the PatientPatient 1 afternoon, afternoon small groups of 6 students, and fellows serving as Small Group leaders. SAGE-Student SAGE Student Association of Geriatric EnthusiastsEnthusiasts Student club meets monthly during the school year. MPA program- 4-6 week block rotations-8 per year, new one weekk intensive i t i LTC rotation t ti (PAGE) (PAGE), andd 10 geriatric lectures. 13
Resident Education Geriatric Medicine Fellowship- one year program, one fellow currently enrolled, 13 completed the program, 8 successfully completed the exam in geriatrics. All graduates Internal Medicine Boarded. Geri Med Combined Residency ProgramGeri-Med Program 1 enrolled (PGY-2). Resident Geriatric Rotation ffor Portsmouth Naval, Internal Medicine, Family Medicine and Combined FM/IM residents (average 30 residents annually). y) 14
Conferences Geriatric Sit Down Rounds One hhour program on the2 O h 2ndd Tuesday T d off each h month at noon in Hofheimer Hall. Presentation by either Glennan Center residents or Family Medicine Residents. Geriatric case studyy allows audience to enhance knowledge of geriatric medicine, current modalities of evaluation and care management and appreciation of resources for older adults. Open to community partners affiliated with Open agencies and organizations providing services 15 to senior adults.
Conferences Weekly Didactics Each Tuesday at 8 am and 9:15am (except second Tuesday), faculty and trainees gather for various didactics and lectures. Conferences designed to fulfill accreditation requirements for the geriatric fellowship fellowship.
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Clinical Care 4 clinical programs at EVMS 8 facility/community based
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EVMS Driver Research and Evaluation-Dr. Geller, Glennan Center Research Coordinators and Associate Director off Education Memory Assessment Clinic Clinic-Dr. Dr Biedenbender Biedenbender, and consultants from Hampton Roads Behavioral Health Memory Consultation C l Clinic-Dr. Cl Reed, d Gl Glennan Center C Research Coordinators and Associate Director of Education Primary Care and Acute Care Geriatric Clinic-Dr. Sharon Reed and Robin Wallace, Wallace PA-C 18
Facility and Community Berger-Goldrich Berger Goldrich Home at Beth Sholom Village (SNF and LTC) Chesapeake Place (Assisted living living-memory) memory) Chesapeake Harbor’s Edge (Continuing Care Retirement Community) Lake Taylor Transitional Care Hospital The Memory Center (Assisted living) Oakwood Nursing and Rehabilitation Center Odyssey Health Care (Hospice) Sentara Norfolk General Hospital (Palliative 19 Care Consultation Service)
Clinical Research 6 active studies, 6 recently completed enrollment Active and Open: Annual Fluzone, Diabetes (Johnson & Johnson for better glycemic control in LTC), Rivastigmine (Novartis, Excelon ® patch in ALF and LTC facilities), and Pandemic Influenza (Sanofi-Pasteur), H1N1 Influenza (Sanofi-Pasteur), Fluzone with JVRS100 adjuvant dj t (Juvaris). (J i) Active and Closed: EPIX 202, EPIX 203, West Nile (Acambis), (Acambis) Rotavirus, Rotavirus Zostavax and Focus. Focus 20
Other Research Research, Grants and Contracts Facultyy and staff ff engaged g g in scholarlyy activities, research, contributing to the literature. Received career development awards, GACA, Hartford, AMDA, MAPS, and other scholarshipsAMDA Futures, Futures the National Highway Traffic and Safety Administration, Alzheimer’s research award from national and state organizations, NIH, VDMV, AARP AARP. 21
Other Service and Education Intramural and extramural activities Leadership roles in professional organizations at the local, state and national levels. Volunteers to advocate and work towards improving our community. Pursuing additional credentials, degrees, certifications and other educational ventures. All designed to further knowledge, knowledge skills and abilities to develop and improve capacity for meetingg the challenges g off education, research and clinical care. 22
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What is Old? Who is Old ? Chronological aging Time Time since birth
Biological aging Age-related Age related changes in structure/function 60 years old, but look 30 30 years old, ld but b t look l k 60
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Stratify the Aging Population Near-Aged Young Old (Middle) Old
55-64 65 74 65-74 75-84
sometime called Old Old
Old Old
85+
sometimes called Oldest Old
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Life expectancy: average vs. maximum usual aging: aging aging w/ disease relates to average life expectancy
normal aging: aging process without disease/trauma l t to relates t maximum i lif expectancy life t
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“aa lot of living after 65 65” life expectancy in 2005 @ birth b h @ birth 1900
@ 65 @ 75
Males 75.2 2
Females 80 80.4
46.3
48.3
47.3
17.2 17 2 10.8
20.0 20 0 12.8
18.7 18 7 12.0
Table 26. CDC. Health, United States, 2008. used 2005 data http://www.cdc.gov/nchs/hus.htm
Both 77.8 8
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STRULDBRUGS: “Immortals” with a red spot on forehead Guilliver’s Travels live forever but but progressive senescence progressive cognitive loss/dementia “ d i d andd hated “...despised h d by b all…” ll ” The Sleepless Library. Gulliver’s Travels. Jonathan Swift. Part 3, Chap 10. http://www.ibiblio.org/ais/sllgt310.htm 29
Aging Pyramid & support of older people % of pop. vs. age
less younger ppeople p to support older people
Due to: baby boomers-1946-64
Males
Females
1900
Age →
1900: classic aging pyramid 2030: “squaring” of aging pyramid
1970
% of population
2000
2030
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http://www.cdc.gov/nccdphp/aag/aag_aging.htm
31 Modified from http://www.agingstats.gov/chartbook2000/4
Concern: For 60% of people 65+: SS is the vast majority (65-83%) of total income Indica 8: Key ator 9. Old der Americcans 2008 Indica 006 data ators… bassed on 20 http:///www.agingstats.govv/agingstatsdotnet/ main_ owerPointt link _site/defau ult.aspx Po
Sources of income for older people
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Gender @ age 80+ worldwide: many more older women than men
33 Exec. Summary. World Population Ageing 2007, United Nations http://www.un.org/esa/population/publications/WPA2007/wpp2007.htm
9 States have > 14% of their pop 65+ ii.e., at least l 1 out 7 people 65+
6-ND 6 ND 14.6%
4-ME 4 ME 14.8% 3-PA 15 2% 15.2%
7 7-SD SD 14.3% 5-IA 14.7%
USA 12.6% or 1 out of 8 people 65+
2-WV 15.5%
9-AR 14.0%
High % total population 65+ due to: ↑ migration young, ↓ fertility rates &/or ↓ mortality,
VA 11.8%; bottom 11
1-FL 17.0%
8-HW 14.3%
Fig. 4 & Data from Fig. 6. AoA A Profile of Older Americans: 2008 based on 2007 data. http://www.aoa.gov/AoAroot/Aging_Statistics/Profile/2008/index.aspx Word link
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Virginia is in the lowest 10
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Thousand $$ Fig. 1. G Geographicc Variation in Health Ca are Spendin ng CBO. Fe eb. 2008. http://ww ww.cbo.govv/ftpdocs/89 9xx/doc897 72/toc.htm
Great state variability i bilit in i per capita health care spending spending, 2004
Geriatrician
1 Shortage
Nationally: 20,000 needed; 7,100 actual Only ~350 in training per year
Vi i i 500 needed; Virginia: d d 146 actuall ~10 geriatric fellowships/yr
Greatest Greatest barrier: financial disincentives: Medicare reimbursement e.g., 21% cut to MD’s required by current law in 2010, unless Congress prevents cuts cuts, as it has in the past2
Need to modify Medicare payment system 1Report
on the Access to and Availability of Geriatricians. Virginia Joint Commission on Health Care. 2007. Document # 75. http://leg2.state.va.us/dls/h&sdocs.nsf/4d54200d7e28716385256ec1004f3130/e 7f2470f73d64d8c852572910069eb2f?OpenDocument 2National Health Expenditure p Projections…Centers j for Medicare/Medicaid Services. http://www.cms.hhs.gov/NationalHealthExpendData/downloads/proj2008.pdf 36
Thank you! Madeline Dunstan, MS Associate Director of Education Glennan Center for Geriatrics and Gerontology Eastern Virginia Medical d l School S h l 825 Fairfax Avenue, Hofheimer Hall, Suite 201 Norfolk VA 23507 Norfolk, Phone: ((757)446-7040 ) office ff Direct Phone: (757)446-7436 FAX: (757)446-7049
[email protected] 37
