Geriatric Medicine : A Person Centered Evidence Based Approach

Older adults represent the most rapidly growing demographic in the U.S. and in many developed countries around the world. The field of geriatric medicine is still relatively young, and is only recently seeing a significant increase in peer reviewed literature. Medicare and Medicaid expenditures related to older adults are nearly a trillion dollars/year in the US. How our healthcare system cares for older adults, and how those older adults navigate an increasingly complex system, is of the utmost importance. According to the Institute of Medicine, physicians and other healthcare professionals receive an inadequate amount of training in geriatric medicine. Geriatric medicine is based on the concept of delivering person centered care with a focus on function and quality of life. It is essential that physicians, nurse practitioners, physician assistants, pharmacists, social workers and other health care professionals all be knowledgeable about the geriatric approach to care.

Geriatric medicine varies from most other fields in medicine. While many specialties function on the basis of evidence-based literature, geriatricians and other clinicians caring for older adults must integrate relatively limited evidence with variable physiological changes and complex psychosocial determinants. Geriatricians are used to caring for 90 year olds with multiple chronic illnesses. Their variable physiology leads to uncertain responses to pharmacotherapy, and their personal goals and wishes need to be incorporated into any plan of care. Practicing geriatric medicine requires the ability to see patterns. But it goes one step further, as the rules are constantly in flux. Every patient is an individual with particular needs and goals. In order to provide true person centered care to older adults, one has to incorporate these factors into the decision making process.

The proposed handbook is designed to present a comprehensive and state-of the-art update that incorporates existing literature with clinical experience. Basic science and the physiology of aging create a background, but are not the main focus. This is because every chapter has been written through the lens of "person centered care." This book is about focusing on what matters to the person, and how that is not always about pathology and physiology. The reader generally will not find simple solutions to symptoms, diseases and syndromes. In fact, the key to caring for geriatric patients is the ability to think both critically and divergently at the same time. Geriatrics encompasses multiple disciplines and spans all of the subspecialties. It requires knowledge of working within an interdisciplinary team. It requires an appreciation of how quality of life varies with each individual and creates treatment and care plans that also vary. And most of all, it requires a firm commitment to first learning who the person is so that all of the necessary data can be analyzed and integrated into a true person centered plan of care. This book aims to serve as an unparalleled resource for meeting these challenges. Updated and revised from the previous edition, this text features over 40 new peer-reviewed chapters, new references, and a wide array of useful new tools that are updated on a regular basis by interdisciplinary and interprofessional experts in geriatric medicine.

Doctor Michael Wasserman is a geriatrician who has devoted his career to serving the needs of older adults. He serves on the Board of Directors of AMDA--The Society for Post-Acute and Long-Term Care Medicine and Chairs the Public Policy Committee for the California Association of Long Term Care Medicine (CALTCM). He is a member of the Infrastructure workgroup for the National Advisory Committee on Seniors and Disasters. He served as a member of the National Academy of Science's "A Framework for Equitable Allocation of Vaccine for the Novel Coronavirus" Committee and was a member of California's Community Vaccine Advisory Committee. He previously served as Chief Executive Officer overseeing the largest nursing home chain in California. Prior to that, he was the Executive Director, Care Continuum, for the CMS contracted Quality Improvement Organization for California. In 2001 he co-founded Senior Care of Colorado, which became the largest privately owned primary care geriatrics practice in the country, before selling it in 2010. His books, "The Business of Geriatrics," and "Primary Care for Older Adults: Models and Challenges" were published in 2016 and 2017. In the 1990's he was President and Chief Medical Officer for GeriMed of America, a Geriatric Medical Management Company, and developed GeriMed's Clinical Glidepaths in conjunction with Drs. Flaherty and Morley of St. Louis University's School of Medicine Geriatric Division. In 1989, in the Journal of the American Geriatrics Society, Doctor Wasserman published "Fever, White Blood Cells and Differential Count in Diagnosing Bacterial Infection in the Elderly," the findings of which are now part of the McGeer Criteria, used widely in nursing homes to evaluate residents for infections. Dr. Wasserman is a graduate of the University of Texas, Medical Branch. He completed an Internal Medicine residency at Cedars-Sinai Medical Center and a Geriatric Medicine Fellowship at UCLA. He spent five years with Kaiser-Permanente in Southern California where he founded Kaiser's first outpatient Geriatric Consult Clinic. Dr. Wasserman was a co-founder and owner of Common Sense Medical Management (CSM2), a case management company that helped manage high risk beneficiaries of Cover Colorado. He was formerly a Public Commissioner for the Continuing Care Accreditation Commission. Dr. Wasserman was a co-founder of MESA (Medicare Experts and Senior Access) a multiyear grant from the Colorado Health Foundation to train primary care physicians in how to effectively care and bill for Medicare patients. He served on the Thousand Oaks Council on Aging and was the lead delegate from the State of Colorado to the 2005 White House Conference on Aging. He also co-chaired the Colorado Alzheimer's Coordinating Council. Dr. Wasserman has previously served on the Boards of Wish a Lifetime From AARP, The Denver Hospice, and the American Geriatrics Society's Foundation for Health in Aging. In 2003 he received the Francis T. Ishida Award for Customer Service from CMS, the Centers for Medicare & Medicaid Services. In 2022 he was the recipient of the Dan Osterweil Outstanding Leader in Post Acute and Long Term Care Award, from CALTCM. AMDA--The Society for Post Acute and Long Term Care Medicine honored him with the William Dodd Founder's Award for Distinguished Service in 2022.

Deb Bakerjian is the Associate Dean for Practice and a clinical professor at the Betty Irene Moore School of Nursing at UC Davis. Dr. Bakerjian was a Pat Archbold Predoctoral Scholar and Claire M. Fagin Postdoctoral Fellow at UCSF where she was also an assistant adjunct professor as well as a Gordon and Betty Moore postdoc at UC Davis. She earned a PhD in Nursing in 2006 and Master's in Science of Nursing in 1992, both from UC San Francisco School of Nursing and her Family Nurse Practitioner and Physician Assistant certificate from UC Davis Department of Family and Community Medicine. Her doctoral study, "Utilization of Nurse Practitioners in Nursing Homes: A Comparison with Physicians," received the 2006 Dissertation of the Year Award at UC San Francisco. Prior to coming to academia, Dr. Bakerjian owned a collaborative practice for over 20 years that provided care to nursing home residents. She is active in both state and national organizations associated with older adults, quality improvement and patient safety. She is the incoming Chair of the Health Sciences section of the Gerontological Society of America. She is also on the Expert Panel on Aging and the Edge Runners National Advisory Council for the American Academy of Nursing, the Chair of HealthImpact the California nursing workforce center, and a past president of the California Association of Long Term Care Medicine as well as the Gerontological Advanced Practice Nurses Association. Her research focuses on healthcare workforce development, patient safety and quality improvement, and interprofessional education and collaborative practice in primary care, with a focus on older adults. Her study of the impact of music on patients with dementia was the first study on Music and Memory in older adults and included how nursing homes could implement a Music and Memory program as a Quality Assurance Performance Improvement project. Currently, she is the PI for several HRSA funded grants on workforce development including Advanced NP PRACTICE, one of the first federally funded Primary Care Nurse Practitioner Residency programs; IN-LMC, a new grant that will provide funding to develop and implement a Nurse-Led Mobile Clinic to provide care to underserved populations; and a grant to enhance the knowledge of public health nursing in prelicensure nursing students. She also has funding from the Department of Labor to start a faculty residency program to facilitate experienced graduate nurses into becoming faculty. She is the co-PI on a project that enables consumers to compare nursing homes and other LTC organizations. Dr. Bakerjian is also the Editor-in-Chief of Geriatric Nursing journal, a co-Editor-in-Chief of The Textbook of Adult-Gerontology Primary Care Nursing: Evidence-Based Care for Patients Across the Lifespan as well as the AHRQ PSNet website. She has published multiple book chapters as well as over a hundred manuscripts and peer reviewed abstracts. She has also received many honors including being inducted as a Fellow in the American Academy of Nursing, the American Association of Nurse Practitioners, the Gerontological Society of America, and into the Western Academy of Nursing.

Sunny Linnebur, Pharm.D., BCGP, BCPS, FCCP, FASCP is a Professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. Dr. Linnebur graduated with her Doctor of Pharmacy degree from the University of Kansas in 1999 with Highest Distinction. She then completed a PGY1 residency at the Veterans Affairs Medical Center in Denver, Colorado and a PGY2 Primary Care Residency at the University of Colorado. Since 2001, Dr. Linnebur has provided clinical pharmacy services in geriatrics at the University of Colorado Hospital Seniors Clinic, where she also precepts pharmacy students and residents. Her research and clinical areas of interest include transitions of care, cardiovascular disease, health promotion, osteoporosis, vitamin D, dementia, and urologic disorders. She is an active member of the American Geriatrics Society where she serves on the Expert Panel for the AGS Updated Beers Criteria(R) and is a Past President. Dr. Linnebur is also a member of the American Board of Internal Medicine Geriatric Medicine Board.

Sharon A. Brangman, MD, FACP, AGSF, Distinguished Service Professor, Chair, Department of Geriatrics, Director, Center of Excellence for Alzheimer's Disease, SUNY Upstate Medical University, Syracuse, New York. Dr Brangman is a graduate of Syracuse University and earned her medical degree from SUNY Upstate Medical University in Syracuse, New York. She completed internal medicine residency and geriatric fellowship training programs at Montefiore Medical Center in the Bronx, New York. She is board certified in internal medicine, geriatric medicine, and hospice and palliative medicine. Dr. Brangman is a SUNY Distinguished Service Professor and Chair of the Department of Geriatrics at SUNY Upstate Medical University. Prior to this appointment, she had been the Division Chief of Geriatrics for 20 years. She is the founding director of the geriatrics fellowship program and served in this role for 30 years. Dr. Brangman is also the director of the Center of Excellence for Alzheimer's Disease, is Medical Director of the Transitional Care Unit on the Upstate Community Campus and directs the Equity Research Core at SUNY Upstate Medical University. Dr. Brangman was a member of the Board of Directors of the American Geriatrics Society for ten years, and completed terms as President and Chair of the Board. She also served as Chair of the Board of the Association of Geriatric Academic Program Directors, after completing a term as its President.

Matteo Cesari is Professor of Geriatrics at the University of Milan (Milan, Italy; currently on leave) and Scientist at the Ageing and Health Unit of the World Health Organization (Geneva, Switzerland). He had previously worked at the Catholic University of the Sacred Heart (Rome, Italy), at the Wake Forest University (Winston Salem, NC, USA), at the University of Florida-Institute on Aging (Gainesville, FL, USA), and at the University of Toulouse (Toulouse, France). His research activities have always been focused on the frailty condition and on strategies aimed at preventing the disabling cascade in older people. His most recent activities are focused on the integration of care for older persons to promote healthy ageing. Dr. Cesari is among the most cited researchers (h index 90), having published more than 600 articles in scientific peer-reviewed journals in geriatrics and gerontology. He has also played roles of coordination and responsibility for scientific journals, medical societies, and international task forces in the field.

Sunny Linnebur, Pharm.D., BCGP, BCPS, FCCP, FASCP is a Professor, Department of Clinical Pharmacy, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences. Dr. Linnebur graduated with her Doctor of Pharmacy degree from the University of Kansas in 1999 with Highest Distinction. She then completed a PGY1 residency at the Veterans Affairs Medical Center in Denver, Colorado and a PGY2 Primary Care Residency at the University of Colorado. Since 2001, Dr. Linnebur has provided clinical pharmacy services in geriatrics at the University of Colorado Hospital Seniors Clinic, where she also precepts pharmacy students and residents. Her research and clinical areas of interest include transitions of care, cardiovascular disease, health promotion, osteoporosis, vitamin D, dementia, and urologic disorders. She is an active member of the American Geriatrics Society where she serves on the Expert Panel for the AGS Updated Beers Criteria(R) and is a Past President. Dr. Linnebur is also a member of the American Board of Internal Medicine Geriatric Medicine Board.