Geriatrics
Future Geriatrics Site: http://www.bmc.org/geriatrics/
The Geriatrics Section is celebrating its 30th anniversary, having been created in 1977. Dr. Rebecca Silliman has served as its third Chief since 2000.
Research Activities
The Section has two major research groups, with collaborations with many other sections and departments.
Dr. Silliman leads a research group that conducts research on breast cancer etiology, disparities in breast cancer therapy, and the consequences of those disparities. Current grant funding includes two R01s and a K05 that support mentoring and research collaborations both at BU and across the nation. Research findings published during this academic year highlight the untoward consequences of undertreatment of breast cancer in older women. Dr. Silliman serves as Vice-chair of the Research Committee of the American Geriatrics Society, serving also as the Chair of the Abstract Selection Committee for the annual national meeting. She also is an associate editor of the Journal of Gerontology: Medical Sciences.
The second research group in the Section is led by Dr. Thomas Perls, Director of the New England Centenarian Study. Current projects focus on the heritability of exceptional longevity; the compression of disability vs. morbidity with exceptional longevity; and genetic association studies. Funding from the National Institute on Aging (NIA) is supporting the “Long Life Family Study”, a collaboration of Boston University, Columbia University, University of Pittsburgh, and University of Southern Denmark. Through the identification and enrollment of 1,000 families, investigators will determine the familial aggregation and modes of transmission of exceptional survival within families, and to characterize the phenotypes associated with exceptional survival for eventual genetic linkage analysis. In addition to working with Dr. Perls on this project, Dr. Lara Terry, first with K08 funding and now with Paul Beeson Career Development Award funding (also from NIA), is pursuing a program of investigation focused on the offspring of centenarians, with particular emphasis on the delayed development and expression of age-related diseases.
Efforts to create linkages between the Section and other research groups at Boston University continue. Dr. Shalender Bhasin, Chief of the Section of Endocrinology, Diabetes, Nutrition, and Weight Management, is an important collaborator. Under his leadership, we, along with investigators from Tufts University and the Joslin Clinic, submitted a Claude D. Pepper Older American Independence Center grant application to the National Institute on Aging (NIA). In addition, a collaboration between Drs. Michael Paasche-Orlow (General Medicine) and Dr. Timothy Bickmore (Northeastern University) has resulted in a new R01 from NIA (Silliman, principal investigator) to increase walking for exercise among low literate older adults.
Dr. Silliman is also the co-principal investigator (Karen Freund, MD, Director of the Center of Excellence in Women’s Health is principal investigator and program director) of the BU Building Interdisciplinary Research Careers in Women’s Health program (K-12). Dr. Angela Jefferson, one of our second year scholars, was awarded a Paul Beeson Career Development Award from the NIA, increasing BUMC’s current number of Beeson Scholars to two. The Geriatric Medicine Fellowship Program (see also Education Activities below) also provides opportunities for interdisciplinary research collaborations. Over the past five years, seven fellows have completed the Master of Science in Epidemiology or the Master of Science in Health Services, mentored by faculty members in the Clinical Epidemiology Research and Training Unit (Dr. David Felson), the Alzheimer’s Research Center (Dr. Robert Green), and the Center for Health Quality, Outcomes, and Economic Research at the Bedford VAMC (Dr. Dan Berlowitz), in addition to our own faculty. The Summer Institute in Geriatric Medicine, funded by the NIA and designed to provide a week-long intensive research experience, draws a class of 20 medical students from across the United States to the Boston University Medical Center campus in June of each year. A competitive renewal application was funded for five years as of May 1, 2006 (Silliman, principal investigator).
Clinical Activities
Boston University (BU) Geriatric Services at Boston Medical Center, the clinical program of the Geriatrics Section, has as its primary goal to provide ongoing primary care and case management to older Boston residents. Other goals include the provision of geriatric consultative services to BMC primary care physicians and specialists, and to promote geriatric education through the comprehensive training programs described below. A collaborative practice model is used, with care provided by geriatricians, clinical nurse specialists, nurse practitioners, registered nurses, and a social worker. BU Geriatric Services cares for approximately 2,000 patients in a range of settings, including the Geriatric Ambulatory Practice, the Home Care Program, the Nursing Home Program and the Geriatric Inpatient Service.
The Geriatric Ambulatory Practice (GAP) cares for older adults who are able to use available transportation. The number of patients served has increased significantly over the past five years, and has required a concomitant increase in physician sessions. Currently, approximately 1,000 patients are cared for during 9 geriatrician sessions/week, 1 Geriatric Medicine fellow session/week, and 1 registered nurse session/week. Additionally, the GAP holds 2 Geriatric Assessment sessions per month.
The Home Care Program, with its roots in the historic Home Medical Service created in 1875, cares for approximately 575 homebound frail elders living within the City of Boston. Many are eligible for nursing home placement, but are able to remain at home through an extensive network of formal and informal nursing and personal care services. BU Geriatric Services clinicians work in close collaboration with patients’ other caregivers, including the certified home health agency, community agencies, and family and friends. We have gained considerable experience with a special capitated program for patients with both Medicaid and Medicare and have expanded the use of Logician via wireless access to patients’ homes. Our most recent JCAHO accreditation visit took place in January 2007; we received no Requirements for Improvement (RFIs). The site visitor had never given a perfect rating before and noted that our program is a “national model.”
The Nursing Home Program cares for approximately 425 patients in 10 Boston nursing homes, also using a nurse practitioner-physician collaborative model. Patients enrolled in the program typically require long-term care, and many are patients who were initially cared for in the Geriatric Ambulatory Practice or in the Home Care Program. The program also cares for short stay patients with skilled nursing or rehabilitation needs. Logician implementation is nearly complete in the Nursing Home Program, but has been challenged by technical issues related to remote computer access in the nursing home setting.
BU Geriatric Services is also responsible for the Geriatric Inpatient Service and most Section physicians annually undertake two two-week rotations as the attending physician on the Firm. The service admits 24/7; the housestaff team of a resident and two interns is complemented by a nurse practitioner from the Section. Whenever possible, patients within any of the Section’s programs who require inpatient care are admitted to our service. In the academic year 2006-2007, we had 853 discharges.
Education Activities
All medical students participate in the geriatrics curriculum that has been added to the required third year Family Medicine Clerkship that has on-line, small group discussion, and home visit components. Emphasis is placed on Geriatric Assessment skills development. During their mandatory four-week fourth year Geriatrics and Home Medical Care Clerkship, students are exposed to interdisciplinary care in a variety of practice settings, including patients’ homes, ambulatory clinics, senior centers, and nursing homes. These precepted clinical experiences allow them to practice their Geriatric Assessment skills and are complemented by a defined curriculum that is delivered via case-based seminars as well as on-line directed learning exercises.
Four clinical geriatrics experiences are included in our residency program: 1) all Primary Care interns participate in a two-week block experience designed to introduce them to community-based services and our interdisciplinary primary care team model of geriatric care; 2) 26 residents per year complete a four-week outpatient rotation in geriatrics, whose sites include homes, nursing homes, and a Program of All-Inclusive Care of the Elderly (PACE) site; 3) an additional two to five residents in the Primary Care Training Program elect to follow home care or nursing home patients as a “second clinic” over one to two years; and 4) 26 interns and 13 residents per year form the housestaff team for the Geriatrics Inpatient Service.
Since its inception in 1988, the Geriatric Medicine Fellowship (Sharon Levine, MD, Program Director) has trained academic geriatricians, the majority of whom are practicing in underserved areas. There are both one-year and two- to three-year training options. In 1991, with the support of a Bureau of Health Professions (BHP) Faculty Training Grant in Geriatric Medicine and Dentistry, the fellowship expanded to include dental fellows, and in 2000 further expanded to include psychiatry fellows. A renewal grant was funded in September 2007.
The fellowship includes a strong mentored research component, with all two-year fellows completing a research project that fulfills the thesis requirements for an MSc in epidemiology or health services through the BU School of Public Health. The Section also co-sponsors a Geriatric Oncology Fellowship in collaboration with the Section of Hematology/Oncology. It continues to grow and serves as a highly regarded national model.
Finally, our John A. Hartford Foundation Center of Excellence in Geriatrics trained another six faculty scholars this year, bringing the total number of trained faculty scholars to 50. A five-year renewal grant was awarded to the Section in April 2007 (Rebecca A. Silliman, MD, PhD, principal investigator). Four faculty scholars have been accepted for the coming academic year, representing General Internal Medicine (including Hospital Medicine) and Family Medicine.
Recent Honors and Achievements
Adam B. Burrows, MD was elected to Board of the National PACE Association and received its Volunteer Leadership Award for work on rural PACE expansion.
Serena Chao, MD, MSc received “best poster” honors at the second annual John McCahan Medical Education Day at BUSM for her poster “Comparison of Online Curriculum to Lecture Format in Teaching Delirium to 4th-year Medical Students.”
Serena Chao, MD, MSc, Daniel Oates, MD, MSc, and Matthew Russell, MD, MSc received Geriatric Academic Career Awards.
Eric J. Hardt, MD was appointed a Robert Dawson Evans Educator.
Sharon A. Levine, MD was appointed Associate Dean for Academic Affairs at BUSM.
