Interviewing the Experts on Aging

Posted by David Sobel on July 25, 2008

Last week we sat down with two geriatricians at Tockwotton Home to record their thoughts on the current state of nursing homes and what might be on the horizon for eldercare of the baby boomers. Both are physician educators as well as policy advocates in the nursing home reform and quality improvement world.

Dr. Besdine is one of the foremost geriatric practitioners and researchers on the elderly in America today, currently holding the position of Director of the Center for Gerontology and Health Care Research at Brown University as well as Professor of Medicine and Chief of Geriatrics at Lifespan Hospitals. Dr. Gravenstein is the medical director for Tockwotton Home as well as Clinical Director of the national nursing home Quality Improvement Organization Support Center (QIOSC) at Quality Partners of RI. Both are advisors to the Nursing Home of the Future Program.

The poignant commonality that these two individuals seem to share is their passion for the treatment of perhaps those most in need of continuing care-the elderly. Dr. Gravenstein and Dr. Besdine gravitated toward the elderly during their training simply by chance - both described how their most challenging and interesting patients during residency were all seniors and how the elderly have treatment needs unlike any other demographic.

As an emergency medical technician, I have been taught that pediatric patients are not simply miniature adults and in fact have their own needs and treatment plans. What I am learning is that as we age and become elders, we take on a different set of complexities unlike the physiological plateau of adulthood.

“Healthy aging, in the absence of any diseases, changes the way our organs function. Every organ, every system, every tissue. These changes...result in a reduced capacity for older people to successfully respond to stress, and so what we find that when disease is superimposed on aging, the response to that disease is very different in older people. The clinical symptoms may be different, the laboratory values different, the imaging tests showing differences,” said Dr. Besdine during the interview.

Additionally, as Dr. Gravenstein pointed out, the seniors of tomorrow will not be the same as our elderly population today - as we create the means of living longer, we will have older seniors who are more sick for a shorter period of time at the end of their lives. All of this adds up to a need for continued geriatric education and a dynamic care model for the nursing home of the future.

What struck me most, however, about geriatric care and Dr. Besdine and Dr.Gravenstein’s philosophies is that it all comes down to relationships between the practitioner, the resident and their family. Case in point: While walking with Dr. Gravenstein through the skilled nursing wing, he stopped to speak with a resident and her daughter. While I talked to the resident, they talked pharmacology, edema, congestive heart failure. The daughter expressed concerned her mother’s belly pain, causing Dr. Gravenstein to perform an abdominal exam on the resident. I now see the importance of patient advocacy through family - the resident wasn’t able to furnish much information about her medical history except her present pain. The interactions between these different people create a web of relationships that is both flexible and resilient. 

Eldercare is more important than ever before with the “Silver Tsunami” on the way as Dr. Besdine put it. Not only must we train the geriatricians, gerontologists, nurses and other healthcare deliverers of tomorrow, but we also must think about our own roles as advocates for our parents, conduits to caregivers, and as potential inhabitants of nursing homes in the future.