Golden Care: The Changing Face of Geriatric Medicine

Dr. Mary Rudyk a geriatrician with Wilmingtons Senior Health Center and a member of the Physicians Group at The Davis Community has an interesting take on her duties as a physician. “My job is to keep you from going into the hospital ” she says. “I want to keep you as healthy as possible for as long as possible and allow you to live a normal productive dignified life.”

Dr. Rudyk and her fellow physicians and staff at Senior Health Care work closely with patients and specialists to determine the best course of action then act as a kind of central command around which their entire course of care revolves.

“Its vital for patients like mine who often see several specialists to have someone with medical knowledge to be in charge of their overall care ” she says. “I know my patients histories tendencies and issues and act as a gatekeeper through whom the specialists pass.”

This new role reflective of the paradigm shift in gerontology allows for more effective uses of patients resources saving them from repeating tests that are expensive as well as physically and mentally exhausting. She believes as do many in the medical community that the Electronic Medical Records acts proposed by President Bush and funded by President Obama will lead to a streamlining of care as records are more readily available to treating and consulting physicians. Dr. Rudyk says those days are “far in the future” and doubts any changes will impact her patients in the short-term. “But ” she says “thats what Im here for.”

Even with these changes in geriatric care Dr. Rudyk says the biggest change we can make is the simplest one: Treat everyone with dignity.

“We can reduce all of the big fears of seniors falls dementia incontinence depression by treating them with respect and decency ” she says. She explains that acting with respect and decency equates to looking out for our fellow man. Going for a walk with a grandparent asking an elderly neighbor to join you for dinner or engaging a senior in meaningful conversation helps keeps them fit and socially active. “This helps with depression which can help with dementia which keeps people healthy for longer ” explains Dr. Rudyk.

“In the end we have to get back to the art of curing ” she says. “Caring bedside manner and a personal touch still go a long way.”

The Web of Care

Long fascinated with the biology of aging Dr. Marsh Fretwell of Elderhaus and the Physicians Group at The Davis Community started practicing medicine in 1977 when as she says “our knowledge was shallow and our quality of care was adequate at best.”

Dr Fretwell shares Dr. Rudyks sentiment that decency and respect go a long way toward helping seniors in all aspects of their health saying “Theres a web of care connecting the physical mental emotional and spiritual dimensions of people. Health is a pathway to all four dimensions.”

“If we look at the whole picture of health in an aging population we find that genetics plays a part but wellness plays a bigger part. When people engage in what we know is healthful they stay healthier for longer ” she says. “Its the ounce of prevention pound of cure adage come to life.”

When Dr. Fretwell lists health issues concerning seniors she draws the lines connecting the four dimensions. Memory loss ties to emotional struggles. Emotional struggles lead to stress which makes it harder for the body to recover from injury or illness. A long illness leads to depression and anxiety both of which have ties to dementia. All of it can break the spirit of a patient driving them to become inactive and lose the desire to stay healthy.

The bottom line she says is keeping active. The benefits of exercise cannot be understated. They include promoting an appetite by burning calories that need replacing; getting a needed dose of vitamin D; helping with stress and self-discipline; strengthening muscles and bones to aid in coordination and balance; and for those who exercise with a group providing the necessary mental stimulation and social engagements that help stave off depression and anxiety.

Muscles and Bones

The physicians at Wilmington Orthopaedic Group treat a large number of seniors for injuries to and rehabilitation of their bones and joints. Dr. Dax Steele the most recent addition to the group specializes in hip and knee reconstruction procedures often associated with seniors.

Dr. Steele says that in seniors some of the biggest factors regarding bone and joint injury are previous injuries that have worsened over time; the normal wear and tear associated with aging; and accidental injury including falls sprains and tears. New treatment options for prior injuries are developing quickly becoming less invasive and more durable. Both factors he says help recipients of joint replacements and arthroscopic surgeries recover faster and maintain a high quality of life longer.

With the normal wear and tear associated with aging comes the development of arthritis (the loss of cartilage on and around joints) and issues like osteoporosis (the loss of calcium in the bones). Dr. Steele says that medications treating both conditions are advancing rapidly and treatment methods change as new research is brought to light. “With osteoporosis where the loss of estrogen after menopause causes bones to lose calcium at an accelerated pace the standard treatment was hormone replacement therapy. Now new medications forego the introduction of estrogen and instead help the bones retain calcium ” he says.

According to Dr. Steele many of the accidental injuries common among seniors could be avoided by exercising more as well as more cautiously. Dr. Steeles thoughts on exercise are twofold: If you dont exercise start; the benefits to balance coordination and strength of muscles and bones will help you stay on your feet or recover faster should an injury occur. If you do exercise listen to your body. “When youre younger its one thing to play through the pain but as we get older we need to listen to our bodies and stop when we feel that pain we would have ignored at 20.”

At Bodies in Balance Physical Therapy the four therapists on staff see many seniors for joint replacement rehabilitation tears sprains breaks arthritis and balance/vertigo issues. Beth Connell who holds her doctorate in physical therapy from the University of North Carolina Chapel Hill says they see many injuries associated with falls.

“People arent required to do as much physically now especially post-retirement ” Connell says. “We lose muscle mass bone density balance and coordination at accelerated rates as we grow older. Many of these things are reversible to a degree and we work with senior patients to help them regain what theyve lost over time.”

Connell says that balance is easily lost but also easily regained. “When dizziness goes away and balance is restored patients feel more confident. They work harder and show faster improvements motivated by the positive changes they see.”

Bodies in Balance has high-tech equipment like the SMART Balance Master which measures your center of balance and determines where you begin to lose balance based on the visual stimuli it provides. This technology aids in therapy treatments but the old fashioned hands-on approach is still at the forefront.

“We try to treat therapy in a realistic way ” Mrs. Connell said. “By helping our senior patients regain balance and strength by walking up and down our stairs and doing other exercises that relate to everyday tasks they gain the confidence strength and agility to get back to their lives.”

Mrs. Connells biggest piece of advice comes as no surprise exercise. “Find some exercise you enjoy and do it with a friend ” she says. “It does the body and the spirit good.”

A New Approach

As healthcare moves toward more wellness-centered care methodology and philosophy its no surprise to find the face of long-term care changing from the cold industrial nursing homes of yesteryear to the inviting community-based care facilities of the future. At The Davis Community a long- and short-term care facility in Porters Neck the changes in philosophy are driving changes to the architecture of their facilities and the roles caregivers play in the lives of their residents.