UVA School of Medicine

2014, is the latest addition to UVa's continu- um of care for older adults in the region. this comprehensive approach to addressing the complex needs of older adults is one of the hallmarks of geriatrics as a medical specialty. The Uniqueness of Elder Care "Older people are different," says geriatrician Richard lindsay, MD, an emeritus professor of the UVa school of Medicine. "they re- quire a totally different mindset." Older patients are much more complex than younger people. a patient may come to see the doctor for a persistent cough, but he or she may also have multiple chronic dis- eases: diabetes, hypertension, osteoarthritis, osteoporosis, mental illness. Maybe there is also a bit of dementia or other cognitive con- cern. Maybe the person has trouble hearing or needs a walker to get around. Maybe there are psychological and economic issues too. Geriatricians must juggle all these concerns, but they also need to consider treatment in the context of the person's living situation and consider their social support. "Geriatricians look at the patient as a whole and also in relation to the society in which the patient lives," says seki Balogun, MBBs, di- rector of UVa's geriatric medicine fellowship program. this juggling is often a challenge, and geri- atrician Balogun sometimes thinks of herself as a quarterback. as a primary care provider attending to these complex needs of older adults, she often finds herself in the middle of the health care huddle, trying to negotiate the best plan of care with a team of diverse medical specialists and others. "i'm trying to put everything together for this patient who has several chronic medi- cal problems and is seeing several specialists focused on their own sectors," Balogun says. "i'm the one who is looking at the person as a whole and seeing how this all fits together for this individual. One size does not fit all." Medications are often the focus of this quarterbacking process. age-related changes in kidney and liver function mean that drugs aren't metabolized and excreted in the same way by an older patient as they are in some- one younger. in addition, an elderly patient with hy- pertension, osteoarthritis and diabetes, for example, may be prescribed any number of medications to treat these chronic conditions. How these drugs interact with each other in an older patient may cause unexpected reac- "We recognize that most medical students won't go into geriatrics, but it's important that every student have some exposure to the basic principles of geriatric medicine. No matter what specialty they go into, they will be dealing with older adults. They will need these skills." – seKi baLogun, mbbs, FeL '03 20 Vitals Spring 2016

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