Advancements in Geriatric Care at Ohio State

The seismic shift in global demographics, particularly the rapid growth of our older adult population, presents both a profound societal challenge and an incredible opportunity for innovation in healthcare. It’s not just about living longer, is it? It’s about living better, with dignity, independence, and a quality of life that extends well into our golden years. And that’s precisely where institutions like the Ohio State Medical Center are stepping up, carving out a reputation as pioneers in transforming geriatric care.

Here, a palpable wave of innovation is truly redefining what’s possible for older patients. They aren’t just reacting to the demographic tsunami; they’re proactively shaping a future where aging doesn’t automatically mean a decline in care quality. Central to this ambitious transformation are programs like the highly effective Cancer and Aging Resiliency (CARE) Clinic and the rigorous Geriatric Surgery Verification (GSV) program. Each initiative, meticulously designed, zeros in on the often-overlooked, distinct needs of our aging populace, moving us closer to a healthcare system that truly understands and respects the complexities of later life.

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The Imperative for Specialized Geriatric Care

If you think about it, the healthcare landscape historically hasn’t been optimally geared for older adults. Most medical training, for a long time, focused on acute illnesses in younger populations, or very specific organ systems. But our senior citizens, they’re a different ballgame altogether. They often present with multiple chronic conditions simultaneously, a phenomenon known as comorbidity. This isn’t just a matter of managing one illness; it’s about navigating a delicate web of diabetes, heart disease, arthritis, and perhaps some cognitive decline, all at once. It’s complicated, to say the least.

Then there’s the issue of polypharmacy – the use of multiple medications. It’s a common scenario where an older adult might be taking half a dozen, or even more, different pills prescribed by various specialists. Can you imagine the potential for drug-drug interactions, side effects, and simply the burden of remembering to take them all correctly? It’s a logistical nightmare for many, and frankly, a significant risk factor for adverse health events. The rain lashes against the windows, and the wind howls like a banshee, that’s how complicated polypharmacy can get, metaphorically speaking, when everything goes wrong.

Furthermore, older adults often experience atypical presentations of serious illnesses. A heart attack might not manifest with the classic chest pain but rather with confusion or just a general sense of weakness. Delirium, a sudden change in mental status, is incredibly common and often signals an underlying medical issue, but it can be easily missed or misattributed to ‘just old age.’ And what about frailty? It’s a distinct clinical syndrome, characterized by decreased strength, endurance, and reduced physiological function, which significantly increases vulnerability to adverse health outcomes. Traditional healthcare models often fall short here, simply because they weren’t built with these nuances in mind. We’ve got to do better, haven’t we?

This is precisely why Ohio State’s commitment to ‘age-friendly’ healthcare isn’t just good practice; it’s absolutely essential. It represents a fundamental cultural shift, a recognition that specialized knowledge, tailored approaches, and a deeply empathetic understanding are not luxuries, but necessities, for this burgeoning segment of our population. We can’t simply layer geriatric care onto existing structures; we need to integrate it, weave it into the very fabric of how we deliver health services.

The Cancer and Aging Resiliency (CARE) Clinic: A Holistic Approach to Oncology

Imagine receiving a cancer diagnosis in your seventies or eighties. It’s a terrifying prospect at any age, but for older adults, it comes with an entirely different set of considerations. How will treatment impact your existing health conditions? What about your independence, your ability to live at home? These aren’t trivial concerns; they’re central to a person’s well-being. This is the profound space the CARE Clinic, established in 2016, seeks to address, providing a comprehensive, one-stop experience for older adults navigating the choppy waters of cancer treatment.

When a patient, let’s call her Mrs. Henderson, steps into the CARE Clinic, she’s not just another medical record number; she’s a whole person with a lifetime of experiences and unique health challenges. The clinic’s unique model brings together an interdisciplinary powerhouse team during a single, comprehensive two-hour visit. Think about the convenience alone: instead of shuttling between half a dozen appointments on different days, often feeling utterly exhausted and bewildered, everything happens under one roof. It’s a streamlined process, designed with the patient’s comfort and ease in mind.

So, what happens during this intensive two-hour visit? Mrs. Henderson consults with an entire multidisciplinary squad, each member playing a crucial role in piecing together her personalized care puzzle:

• The Pharmacist: This isn’t just about dispensing pills. The pharmacist meticulously reviews Mrs. Henderson’s entire medication list, looking for potential drug interactions, assessing for medications that might no longer be necessary (a process called de-prescribing), and ensuring appropriate dosages, especially considering age-related changes in metabolism and kidney function. It’s a critical safeguard against adverse drug events that can be devastating for older adults.

• The Physical Therapist: Functional decline is a major concern with cancer and its treatments. The physical therapist assesses Mrs. Henderson’s gait, balance, strength, and overall mobility. Are there risks of falls? Can prehabilitation – exercises before treatment – improve her ability to tolerate chemotherapy or surgery? They’re crafting a plan to keep her moving and as independent as possible.

• The Nutritionist: Malnutrition is surprisingly common in older cancer patients, often exacerbated by treatment side effects. The nutritionist screens for nutritional deficiencies, provides tailored dietary advice, and helps develop strategies to maintain weight and muscle mass, which are vital for fighting cancer and recovering from treatment.

• The Audiologist: This might seem an unusual addition, but think about it: if Mrs. Henderson can’t hear her doctors or nurses clearly, how can she possibly follow complex instructions for her care? The audiologist assesses hearing function, recommends assistive devices if needed, and ensures that communication barriers don’t compromise her understanding and adherence to treatment.

• The Nurse Case Manager: This individual is often the patient’s anchor, coordinating all aspects of care, educating Mrs. Henderson and her family about what to expect, and connecting them to crucial community resources, whether it’s transportation, financial assistance, or emotional support groups. They’re the central nervous system of her care.

• The Hematologist or Medical Oncologist: This specialist, Dr. Ashley Rosko, for example, then synthesizes all this information. As medical director of the Oncogeriatrics program, she’s not just looking at the tumor; she’s looking at Mrs. Henderson as a whole, understanding her ‘age-related deficits’ – perhaps a touch of frailty, mild cognitive impairment, or specific social circumstances – and crafting a cancer treatment plan that truly aligns with her overall health status and personal goals. It’s precision medicine, but through a geriatric lens.

Dr. Rosko herself emphasizes the clinic’s dedication to understanding these age-related deficits, stressing, ‘It’s about more than just treating the cancer; it’s about treating the person with cancer, understanding their unique vulnerabilities, and creating personalized care plans that ensure they maintain their quality of life as much as possible during a very challenging time.’ It really is a thoughtful approach, isn’t it?

The CARE Clinic consciously aligns its services with the ‘4Ms’ framework of the Age-Friendly Health Systems initiative, a blueprint for delivering high-quality, age-friendly care:

• What Matters: This is foundational. It means understanding and aligning care with Mrs. Henderson’s specific health goals, preferences, and values. Does she prioritize living long, or living well with less aggressive treatment? What are her biggest concerns? The team asks, and truly listens.

• Medication: As touched upon, this involves a thorough review of all medications, ensuring they don’t compromise what matters to the patient, cause adverse effects, or contribute to polypharmacy. Sometimes, the best medicine is less medicine.

• Mentation: This focuses on preventing, identifying, and managing dementia, delirium, and depression. Regular cognitive assessments ensure that any changes are caught early and managed appropriately, which is crucial for treatment adherence and safety.

• Mobility: Ensuring Mrs. Henderson can move safely and maintain her function is key to independence. This includes assessing for fall risks, encouraging safe ambulation, and implementing interventions to maintain strength and mobility throughout her treatment journey.

By focusing on these four pillars, the clinic doesn’t just assess patients; it provides tailored, proactive interventions that work in tandem with the oncology care. This holistic, consolidated approach is undeniably uncommon in healthcare. Too often, patients are referred to a dizzying array of specialists, creating fragmented care and unnecessary stress. Ohio State, however, consolidates this vital expertise, making the CARE Clinic’s model a truly unique and deeply effective example of integrated care. It’s really quite brilliant.

Elevating Surgical Standards: The Geriatric Surgery Verification (GSV) Program

For an older adult, surgery isn’t just a medical procedure; it’s a major life event. The risks of complications like delirium, infections, or functional decline are inherently higher for this population, leading to longer hospital stays, increased readmission rates, and sometimes, a permanent loss of independence. Recognizing these complexities, Ohio State isn’t just hoping for better outcomes; they’re actively building a framework for them by working towards certification in the Geriatric Surgery Verification (GSV) program by the American College of Surgeons (ACS).

This isn’t some token gesture; it’s a rigorous, comprehensive undertaking. The GSV program sets forth an impressive 32 distinct standards for geriatric surgical care, covering the entire patient journey – from the moment a surgical need is identified, through the operation itself, and deep into the postoperative recovery phase. Dr. Courtney Collins, a clinical assistant professor of Surgery at the Ohio State College of Medicine, is spearheading this monumental effort. Her team is diligently implementing these standards, driven by a clear mission: to markedly improve the quality of care and, crucially, the outcomes for geriatric surgical patients.

What does this look like in practice? It begins long before the patient even enters the operating room. The initiative places a heavy emphasis on proactive preoperative screenings. This isn’t just a quick check of vital signs; it’s an in-depth assessment designed to identify patients at a higher risk of complications. Imagine a detailed questionnaire, perhaps during an initial visit or even a focused phone call, delving into critical areas that are often overlooked in standard pre-op assessments:

• Nutrition: Is the patient well-nourished? Malnutrition significantly increases surgical risk and slows recovery.

• Cognition: Is there any cognitive impairment? This is a major risk factor for postoperative delirium, which can have long-lasting effects. Screening for this allows for preventative strategies.

• Mobility: What’s their baseline functional status? Can they walk independently? Are they at risk of falls? This informs rehabilitation plans and discharge planning.

• Social Support: Who’s at home? Do they have a caregiver? What resources are available post-discharge? This ensures a safe transition home and reduces readmission risk.

• Medication Review: Similar to the CARE Clinic, a thorough review to manage polypharmacy and ensure medications are appropriate for surgery and recovery.

• Patient Goals: What are their expectations for surgery and recovery? This facilitates shared decision-making, ensuring treatment aligns with their values.

These comprehensive screenings allow the surgical team to stratify risk much more effectively and to implement targeted interventions before surgery. For instance, if malnutrition is identified, nutritional support can begin weeks in advance. If a patient is at high risk for delirium, specific preventative protocols can be put in place. It’s about being proactive, not reactive, which makes all the difference.

Beyond the individualized patient care, the GSV program places a significant premium on data collection and analysis. This isn’t just about ticking boxes; it’s about continuous improvement. Institutions pursuing GSV certification must systematically gather and review patient data – everything from surgical complications and length of stay to readmission rates and functional recovery at three and six months post-op. This granular data allows the team to identify trends, pinpoint areas for improvement, and really understand what’s working and what isn’t.

This process involves regular, often monthly, reviews by a dedicated geriatric surgery quality committee. This committee, typically comprised of surgeons, geriatricians, anesthesiologists, nurses, and other allied health professionals, delves deep into the data. They provide invaluable feedback to care providers, highlight best practices, and, crucially, engage in focused quality improvement (QI) projects based on their analysis. For instance, if data reveals a higher-than-expected rate of post-operative delirium in a particular patient group, the committee might launch a QI initiative to standardize delirium prevention protocols across all surgical units.

Moreover, the program mandates active community outreach projects. Why? Because improving geriatric surgical care extends beyond the hospital walls. These initiatives might involve educating local primary care physicians on identifying surgical risks in older adults, providing information to senior centers on prehabilitation, or offering workshops to caregivers on supporting recovery. It’s about building a continuum of care and awareness.

Finally, a cornerstone of GSV is the relentless focus on education for healthcare professionals. This isn’t just for surgeons; it’s for nurses, anesthesiologists, physical therapists, and other staff members. The training covers patient goals, advanced screening techniques for geriatric vulnerabilities, and sophisticated management strategies for high-risk conditions like delirium or frailty. It ensures that everyone involved in an older patient’s surgical journey is speaking the same language and working from the same evidence-based playbook. It’s an ambitious undertaking, but one that promises substantial returns in human well-being.

Transforming Emergency Care: Beyond the Immediate Crisis

Walk into almost any emergency department (ED) in the country, and you’ll likely see older adults making up a significant, and often disproportionate, share of the patient population. These aren’t always straightforward cases. Older adults in the ED present unique challenges: atypical disease presentations (a ‘silent’ heart attack, as mentioned earlier, or a UTI presenting as confusion), increased risk of polypharmacy-related issues, and a higher vulnerability to hospital-acquired complications like delirium or functional decline. It’s a high-stakes environment where a rapid, accurate assessment is critical, but a traditional approach can easily miss the subtle cues unique to an aging physiology.

Ohio State has been at the forefront of tackling these challenges head-on. In 2019, the medical center proudly earned the distinction of becoming the first in the Midwest to achieve Geriatric Emergency Department Level 1 Accreditation. This isn’t merely a plaque on the wall; it signifies a deep, systemic commitment to optimizing the ED environment and processes for older adults. What does Level 1 Accreditation entail? It means:

• Specialized Staff Training: ED personnel, from physicians to nurses to support staff, receive specific training in geriatric emergency care, focusing on recognizing atypical symptoms, understanding geriatric syndromes, and communicating effectively with older patients and their families.

• Enhanced Screening Protocols: Standardized screening tools are used to identify common geriatric vulnerabilities like cognitive impairment, fall risk, functional decline, and social determinants of health at the point of entry into the ED.

• Environmental Modifications: The physical space itself is designed to be age-friendly. Think better lighting, non-slip floors, comfortable seating, and clear signage – small details that make a huge difference to a vulnerable older person in a chaotic environment.

• Interdisciplinary Care: A team-based approach ensuring that social workers, pharmacists, and geriatric specialists are either embedded in the ED or readily available for consultation.

• Robust Discharge Planning: Tailored discharge plans that prioritize safety and continuity of care, connecting patients with appropriate community resources and follow-up appointments, aiming to prevent return ED visits.

Building on this significant achievement, Dr. Lauren Southerland, a driving force in this area, recently received a substantial $800,000 K23 award from the National Institutes of Health (NIH). This prestigious grant is a testament to the crucial importance of her research: evaluating the implementation and effectiveness of multidisciplinary geriatric assessments specifically within the ED’s observation unit. This isn’t just an academic exercise; it’s a focused effort to understand if these targeted, comprehensive screenings, applied in the immediate aftermath of an ED visit, can truly impact the long-term quality of life for older patients.

The study’s premise is compelling: if we can identify vulnerabilities like early cognitive decline, nutritional deficiencies, or social isolation during that critical observation period, and then intervene proactively, can we prevent a cascade of negative outcomes? Dr. Southerland’s research meticulously tracks patient outcomes, including return visits to the emergency department, subsequent hospitalizations, and most importantly, functional status and quality of life at home. The ultimate goal? To extend these impactful interventions to other hospitals, even those with fewer resources, thereby improving outcomes for a much broader patient population across the country. Imagine the ripple effect this could have; it’s genuinely transformative.

The Ripple Effect: Ohio State’s Broader Commitment and Future Outlook

The initiatives at Ohio State Medical Center – from the precision oncology of the CARE Clinic to the structured excellence of the GSV program and the innovative emergency department care – aren’t isolated islands. They represent a cohesive, overarching commitment to fundamentally advancing geriatric care. It’s about recognizing that older adults deserve not just care, but integrated, research-driven care that respects their unique circumstances and supports their desire for independence.

This isn’t an easy path. Implementing such comprehensive programs requires significant institutional buy-in, continuous training, and a willingness to challenge established norms. Yet, Ohio State has embraced this challenge, fostering a cultural shift from fragmented, reactive care to collaborative, proactive, and truly age-friendly practices. It’s an evolving journey, of course, but the momentum is undeniable.

What does this mean for you, whether you’re a healthcare professional, a caregiver, or perhaps an older adult yourself? It means that institutions like Ohio State are setting new standards, raising the bar for what quality geriatric care should look like. They’re demonstrating that by focusing on personalized treatments, comprehensive assessments that extend beyond a single diagnosis, and a relentless pursuit of continuous quality improvement, we can make aging a journey that is not just longer, but richer, healthier, and more dignified.

Ultimately, this is about more than just medical protocols or accreditation badges; it’s about the human element. It’s about ensuring that our elders, who have contributed so much, continue to experience life with vitality and purpose. Ohio State isn’t just responding to the needs of an aging population; they’re helping write the playbook for how we all can age better. And that, I’d argue, is a story worth telling.