“As a geriatrician, I believe in respecting the wishes of older adults, as well as learning from their valuable wisdom and experiences,” says Dr. Elisa Gil-Pires, medical director at Charles E. Smith Life Communities (CESLC). “Every patient has something to teach the physician as long as you’re willing to listen.” Dr. Gil-Pires’s insights reflect CESLC’s philosophy of respect for the dignity of each individual. Geriatric care is geared to the changing nature of older adults’ health needs.
Dr. Gil-Pires leads our medical team serving over 1,000 older adults, including short-stay patients at the Post-Acute Care Center at Hebrew Home of Greater Washington (HHGW), skilled nursing at Hebrew Home of Greater Washington, assisted living at Landow House and Cohen-Rosen House, independent living at Ring House and Revitz House and primary care practice for Rockville area patients at Hirsh Health Center.
Her background in geriatric care allows Dr. Gil-Pires to provide subject matter expertise in health initiatives such as Nexus Montgomery. Nexus Montgomery is a network of hospitals in Montgomery County that works to improve the health of the community by supporting coordinated services and addressing the medical and social factors that contribute to health and well-being.
Dr. Gil-Pires was also instrumental in establishing CESLC’s partnership and collaboration with the National Institutes of Health Hospice and Palliative Medicine Fellowship.
Why Is Geriatric Care Important?
The American Geriatrics Society lists many geriatric specialties, from neurology to cardiology to anesthesia and podiatry. Geriatric doctors are experts in the aging process and the impact of aging on illness, drug therapy, health and rehabilitation. There are also geriatric nurses, pharmacists, psychiatrists and social workers.
According to the American Geriatrics Society, there are a few areas that older adults may require age-specific care:
- Symptoms for a disease may look quite different in an older adult than in younger people. For example, the National Council for Aging Care cites differences in pneumonia symptoms. When a younger person gets pneumonia, they generally have a high fever and a cough. However, when an older person gets pneumonia, they often have a low fever and could experience some confusion. A geriatric doctor or nurse will understand these differences, recognize the disease and effectively treat the person.
- Older people may also have more difficulty describing their symptoms. The symptoms they are trying to talk about are often more subtle than their past experience with the same illness. The diseases themselves can cause confusion in an older person and communication may be further complicated if the person has a condition such as Alzheimer’s Disease, according to the American Geriatrics Society.
- As we age, we are more likely to develop one or more chronic conditions. When an acute disease attacks an older adult who also has chronic illnesses, the care team needs special knowledge to develop a treatment to address the disease without interfering with treatment for the ongoing conditions, according to the U.S. Department of Health and Human Services and other sources.
- Older people develop syndromes, a combination of symptoms that are linked, but may look like separate illnesses, as described in articles published by the National Center for Biotechnology Information. A geriatric doctor, nurse or caregiver understands the connection between the symptoms and recognizes them as one malaise.
- Aging can cause changes which alter the way a medication behaves in the body, including the rate of absorption, the effectiveness and the side effects, according to articles in Health Affairs journal. Salivary glands diminish, leading to dryness of the mouth and making it difficult to take a pill. Changes in the stomach or intestinal system can slow the rate at which an older person absorbs a medication. Changes in body fat and muscle can alter the distribution of drugs through the body.
- Medications for different conditions always have to be coordinated carefully, but older people are often dealing with more chronic conditions and are more vulnerable to polypharmacy, the taking of multiple medications that interact in unintended ways. The American Geriatrics Society cautions that a doctor needs to be aware not only of how the various medications interact with each other but also how they interact with the disease now that the person is in a different age range.
- In an older adult, an infection can lead to rapid dehydration and a condition called delirium, which causes the person to become confused and disoriented, especially when confronted with the uncertainty and unfamiliarity of a hospital stay. Delirium can be caused by anything from constipation to a heart attack, and it can further damage an older person’s health and increase the length of hospitalization, according to the Journal of the American Geriatric Society. A geriatric doctor or nurse is better able to recognize what is happening in an older body and treat the condition appropriately. A geriatric caregiver knows that delirium can be alleviated by keeping the person mentally stimulated and oriented to reality and taking an individualized approach to their needs.
- Aging affects people differently in the emotional sense as well, the information center Senior Advisor points out. For some, it can bring contentment and a new cheerfulness, for others sadness, fear, anger or depression. Geriatric providers and caregivers are often responsible not only for the physical well-being but also for the mental and emotional well-being of the older people in their care.
Aware of these changes with aging, geriatricians can provide more accurate diagnoses, more selectively prescribe medications and provide better disease management for the aging community.
Collaboration Leads to Improved Outcomes
According to the Merck Manual, patients and caregivers should be included in team meetings when appropriate. Families of an older adult need to arrange for a safe living environment that provides social contact, a proper diet and some sort of exercise or activity. All caregivers need to know the medication schedule, menu plan, daily schedule and symptoms or behaviors that warrant a call to the doctor. Managing the entire team of family and caregivers is an important part of geriatric care. Care management is especially helpful for family members who live far away and crucial for seniors with round-the-clock care needs and multiple caregivers. Communication is essential among health care providers, family members and caregivers to ensure that patients’ needs are met.
At Charles E. Smith Life Communities, care is coordinated on-site, with proven results. Under Dr. Gil-Pires’ leadership, HHGW was designated a U.S. News 2017-18 Best Nursing Home by U.S. News & World Report in 2017. HHGW has a five-star quality rating from the Centers of Medicare and Medicaid Services. HHGW and Landow House are also recipients of the 2017 Bronze Commitment to Quality Award from the American Health Care Association and the National Center for Assisted Living for dedication to improving the lives of residents through quality care.
“I am passionate about helping patients improve their quality of life,” says Dr. Gil-Pires. “My care philosophy is to treat each patient like I would want a provider to treat myself or a family member, with the most compassionate and effective care possible.”