Division of Medicine. Department of Geriatric Medicine. Staff. Jerry Ciocon, M.D., F.A.C.P., F.A.C.A., A.G.S.F. Diana J. Galindo, M.D.

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1 Division of Medicine Department of Geriatric Medicine Staff Jerry Ciocon, M.D., F.A.C.P., F.A.C.A., A.G.S.F. Diana J. Galindo, M.D. 1

2 Chairman s Letter We are all getting older, and providing the care for older and frail persons with multiple issues is a great opportunity. My vision is to deliver the best of care to optimize functional status and to maintain independence through comprehensive geriatric assessment. We are committed to improving the care of the elderly through evidence based, outcomes driven practice, and to expanding the geriatric knowledge through research and education. Services In our practice, a cadre of health care providers including physicians, physical and occupational therapists, nutritionists, speech therapists, pharmacists, and social workers have a specific role in the care of an older person. This facilitates a comprehensive multidisciplinary approach. The following services are offered: - Gait and Balance assessment - Assessment of Dementia and Depression - Management of Polypharmacy (multiple medications) - Pain management - Urinary incontinence management - Optimization of functional decline - Management of the frail and older person in home setting Geriatric Medicine and Rehabilitation There is clear evidence that rehabilitation decreases complications of functional decline and increased patient well-being. The Geriatric Medicine department continues to support an active rehabilitation and exercise program for patients with chronic disease and acute disorders. In addition, the department is also involved in the education of the staff on rehabilitation, and the consultation and primary care services both at the HEALTHSOUTH Rehabilitation Hospital and the Sunrise Health and Rehabilitation Center (a skilled nursing home). This approach provides a unique blend of Rehabilitation Medicine provided by a physiatrist (rehabilitation medicine), psychiatrist, psychologist, social services, physical and occupational therapists, and Geriatrician services. This team provides teaching on the following issues: Geriatric Medicine evaluation and discharge management. Disease states seen in frail and older adults with gait and balance disorder, and functional decline. Memory loss and psychological disorders. Pain management to optimize function. Management of polypharmacy. Geriatric Medicine Inpatient Care (GIC) Our comprehensive approach includes the provision of the following services: - Care for frail and older persons with acute medical issues. - Hospice care for terminally ill older persons. 2

3 - Consultation services for frail and older persons requiring surgical procedure or intervention. - A team approach with a Board Certified Geriatric Medicine attending physician, fellows, medical residents, medical students, nurses, physical therapist, speech therapist, and pharmacist. - Clergyman is unique for the care of older and frail persons. This group approach improves decision making and facilitates collaborative execution of the plans. - The Geriatric academic fellowship program, in conjunction with cardiology, pulmonary, gastroenterology, and renal fellowships drive excellence: as repeatedly demonstrated, hospitals with academic programs have an overall decrease in mortality. - Continued education of the nursing staff by medical educators. Public Education The Geriatric Department is committed to educating older persons and their caregivers on common issues experienced with aging. Previous Community Lectures include discussion on memory loss, falls, urinary incontinence, pain management, skin breakdown, fatigue and frailty, and other topics related to aging. We are active in presenting papers, research outcomes and didactic lectures to the American Geriatrics Society (symposium on use of Alternative medicine in older adults), Florida Geriatrics Society (Pain management and trigger point injections for the seniors), UPMASA University of the Philippines Medical Alumni Society in America (lecture on diabetes in older adults), American Medical Women s Association (discussion on frailty) and lectures given to staff of the nursing home and rehabilitation hospital where our staff attends and follows patients. Research Aging comes with changes and situations for which standard answers are often not available. This stimulates query and leads to interest in research. In our department it is very common to see patients with uncontrolled hypertension. Several clinical research studies have been completed and some are still ongoing. We were participants in the following clinical research studies: the National Institutes of Health (NIH)-sponsored Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT); the INternational VErapamil-Trandolapril STudy (INVEST); and the ONgoing Telmisartan Alone and in combination with Ramipril Global Endpoint Trial: a large, simple randomized trial of an Angiotensin II Receptor Antagonist (Telmisartan) and an ACE-Inhibitor (Ramipril) in patients at high risk for cardiovascular events (ONTARGET) and including a parallel study "Telmisartan Randomized AssessmeNt Study in ace-intolerant subjects with cardiovascular Disease" (TRANSCEND). The effect of herbal substances for common colds was also looked at. A multicenter, double-blind, randomized, parallel, placebo-controlled study of the safety and 3

4 efficacy of chronic oral Beraprost Sodium in patients with intermittent claudication and a randomized, double-blind, placebo-controlled study of PROCRIT (Epoetin Alfa) on clinical outcomes in elderly patients with anemia of chronic disease were also completed. A prospective placebo-controlled trial using microgalvanic stimulator for treatment of drug age-related macular degeneration was also done. The Department of Geriatrics is currently involved in the NIH-sponsored research on anemia in older persons with hip fracture: the Transfusion Trigger Trial for Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) Study and the FOCUS Cognitive Ancillary Study. Caring We are here to care for frail and older patients: Caring guides our everyday activities. The patient survey results in the Department of Geriatric Medicine showed that most of our patients are satisfied or very satisfied with us, and most would recommend us to their family and friends: In fact, word of mouth has been one of the best sources of patient referral to us in the last few years. These graphs show the results of an independent survey of our Geriatric Medicine department physicians: Frequency (%) Frequency (%) 100% 80% 60% 40% 0% 100% 80% 60% 40% 0% 3% Provider Show Concern (N=115) 77% No Definitely Not Yes Somewhat Yes Definitely 7% Dr. Spent Enough Time (N=103) 18% 75% No Definitely Not Yes Somewhat Yes Definitely Our patients are extremely satisfied with the care they receive at our Clinic: 4

5 Frequency (%) 100% 80% 60% 40% 0% 5% Patient Overal Satisfaction 10% 85% (1-3) (4-6) (7-10) Testimonials by our previous Clinic patients I am writing this letter to tell you about the wonderful care my father received when he was seen at the Geriatric Medicine Department at Cleveland Clinic Florida. He was attended promptly with respect and given a very clear explanation of what was wrong with him BF. I just wanted to express to you again my sincere appreciation for the way you handled my complex geriatric issues and providing me the best options to cope with my difficulties. G.E.S. Testimonials in the Nursing Home and Healthsouth Rehabilitation Hospital This is a sampling of the recent comments made by patients and families under our care in Nursing Home and Healthsouth rehabilitation Hospital in Sunrise, FL (Sites of Geriatric Medicine services and fellowship rotation): Excellent Care thoughtful and kind. I felt I was treated like the only patient in this facility. Providing excellent care made a difference in our father s recovery and the team approach is very helpful. God bless your staff and helpers. I am very grateful to the staff s dedication. My family and I are deeply appreciative to the professional care that was given in the Cleveland Clinic Hospital Hospice care. Thanks to the many nurses who came in contact with me, nothing can hold a candle to you all. I will never forget any of you and I will always be grateful. I wish to express my appreciation for the efforts of nurses June Axe and Kenia Maria Peret (nurses at the Geriatric Medicine department) who took care of my mother numerous times and each time kept us informed and updated. They did not overwhelm us or speak down to us but spoke to us like we were family. We were so grateful to share the moments that we could with our mother in the unit when her time was up and we want to say thank you for all the allowances you made for us. It meant a lot to us for she felt our love and yours during a scary time. God Bless you all. 5

6 Excellence Outpatient Geriatric Medicine Clinic Multiple studies have demonstrated that comprehensive Geriatric assessments lead to recognition on active medical issues, geriatric syndromes that can lead to significant morbidity and mortality and prolong independence and cut down hospitalization and institutionalization (nursing home placement). This is provided by our department and appropriate services are made available to optimize care and recovery of the frail and older adults. Inpatient Geriatric Medicine and Hospice Care Frail and older persons usually stay longer at the hospital with acute illness or after undergoing surgical intervention. Geriatric Medicine services deal with medical, psychosocial and economic issues to optimize recovery during hospitalization. Having access to a skilled nursing facility and a rehabilitation hospital, where the attending geriatricians follow patients from the Cleveland Clinic Florida Hospital, makes the continuity of care feasible for frail and older adults. A moment in life will come when further care causes more harm and suffering. In this situation, Geriatric Medicine provides care for the terminally ill, frail and older patient and helps support to the family. Care of FRAIL and Older Patients at the Cleveland Clinic Florida Cleveland Clinic routinely has superior outcomes in terms of important geriatric metrics such as vaccination, evaluation of poly-pharmacy and dementia assessment. We simply provide better care: As shown by the graphic representation on recent survey from a sample of our patient population, majority of our patients rated our services as good to excellent Review of a sample of patients seen in our outpatient from our outpatient service from July to December 2006 and compared to national statistics. 6

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