Articles, Blog

50 years of Geriatric Medicine at Johns Hopkins Medicine

December 20, 2019


[MUSIC] I met my husband at the [UNKNOWN] park. It was the last Sunday in August in 1943. That Sunday Which I didn’t want to go
anyway, but my sister talked me in to it. Happened to be a group of men down there
that I did some gymnastics with. We were just really showing off, cuz
everybody comes around and watches us like your in a show, and I kinda had him picked
out for my sister, cuz he was so tall. And I’m so little, but didn’t work out
that way. [MUSIC] Sherry’s my daughter, and she came to live
with me after my husband died. The best part about my moving back here
was that my mother was able to maintain her
independence, and she’s very independent. She may be 91, but she’s sharp as a tack,
and capable of doing just about anything I can do except drive and
things that take really good eye sight.>>Ideally, as people live longer, they
also live healthier. And so, instead of being sick for 16 years
and being kept alive by a bunch of medicines and interventions, people would
be living longer and being healthier.>>The need to take care of an older
population in a more efficient way. In a way that brings greater value to
care. Is, is very important for the entire society, cause we can’t afford to do
otherwise.>>We’ve reached a point now where many of the answers to the contemporary
problems of American health care are the very problems
that geriatricians have been working on for the
last. Three decades. [MUSIC] From the seeds that [UNKNOWN] planted, the
fruit has grown principally on a unique campus, which has been the
Johns Hopkins Baby Medical Center, which not only houses the vast of the
majority of the faculty in the division of geriatric medicine but has
aging expertise in surgery. The orthopedic surgery in oncology, in
psychiatry, in anesthesiology, and we also are the home of the National
Institute of Aging on this very campus, so, in many
respects, it’s the Silicon Valley of aging care and
research, right here.>>Where else can you be where you can
be with the Patients Safety Institute and
collaborating with the Center on Aging. And working with the School of Public
Health, all three trying to work together to find solutions to the
problems that older adults face.>>We have an infrastructure to promote
this collaboration, we meet every week for an hour and a half as a
division. The big scientists, the clinicians, the
clinical researchers, the educators. And we talk about. Our challenges. You can do research, you don’t need to be
in an academic medical center. But being in one creates a more highly
defined research question and tempers your investigations to the
realities of need.>>I see my patients, I know what they
are going through, I know what. Diseases and what syndromes they are
suffering from. I see the whole picture. It helps me also to focus my research
question. Helps me to think more carefully about designing the intervention, about
treatments.>>I think as a fellow, the role of
research here is unique. Because you get to work with world
renowned researchers who go internationally to talk about their
geriatrics research. And yet, they all are so invested in
their, in their trainees that, you know, our mentors
are always very hands-on. They’re always able to answer questions if
we have them. And so, I think that’s something that we
don’t find in other places a lot. I also feel like they do a lot of what I’m
interested in is more of the translation of bench
research into bedside care. [MUSIC]>>We have tried to figure out what the
biology is that makes some older people frail, and makes him more vulnerable to
getting sick and to dying. So in the [UNKNOWN] of healthy aging we’re
looking at syndrome of frailty, what makes an older
individual more frail. Through the work of Dr. Jeremy Austin we
have found that one of the cytokines, one of the hormones in the body is the driving force leading to that, to that
frailty phenotype.>>Mitochondria are the tiny
intracellular components that produce energy And what we have found over the years is that these mitochondria become more and more
dis-regulated with aging.>>And we think now there are ways to
modulate it with aging, where you improve that energy
production in aging individuals.>>Understanding that biology within
the next decade, or maybe two That we will be much better able to
intervene. In a way that allows us to maintain some
of that youthful resilience that we all have even
into very old age. [MUSIC]>>Another example is our Hospital at
Home program. Remember older people, extremely
vulnerable. Hospitals highly complex, highly technical
environments. So the concept we had, was well why don’t
we take the hospital out of the loop?>>The two times I’ve been here, the
main problem is the.>>So by providing ongoing longitudinal
care in the home, you can really provide much better care at
much lower costs. Slowly but surely people are catching on that understanding people in their own
environments. In the home visit is one of the best ways to really get to know that patient as a
person. And knowing that patient is a person is
one of the most important ways of providing medical
care for her or for him.>>In geriatric medicine, we’re caring
for the frailest and those with multiple active
medical conditions. And we manage them long term. So it isn’t a day or two of managing a A bronchitis or week or two managing
pneumonia. We’re managing things like congestive
heart failure that will be life long. It’s very rewarding for us, and very
meaningful and important to the older adults we
serve.>>I am now getting emails and calls,
literally on a daily basis. You know? We’re interested in this model that we
talk about it. We’re interested in adopting this model. Will you help us?>>We’ve created a curriculum and
published it. So that other training institutions can do
this same kind of thing if they want to.>>And clearly it’s going to be much
cheaper for us as a society to take care of them at home, rather than to
wait until they get so sick. That they come to the emergency room and
they are admitted. So the model of physician house call that we’ve had on the Hopkins Bayview campus
for 40 years really will be informing the way healthcare will work in the United States
going forward. We’re not recreating an old fashioned
model. We’re showing the way forward. [MUSIC] Ultimately patients need to be part of the
healthcare team. And they need to understand their
illnesses.>>About 15 years ago we came up with
this Simple notion to utilize interactive patient education to deliver
them a tailored information in an effective way which is
guided by [INAUDIBLE].>>So they’re sitting in a hospital bed, they’ve got a tablet device similar
to an iPad, where they’re not only reading
about their illnesses, but they’re being quizzed
on it. It allows people who have often very low
health literacy to get educated, about diseases and medications that are
important for them to know about.>>Another important objective is that
healthcare is complicated for older people especially people that have eligibility Needs that our population
does. So they utilize a lot of health care. So a lot of what we do is designed to
preserve autonomy for the older adult but also to
control health care utilization. Help keep health care costs down. So the pace program gets involved and
tries to. Support those individuals so that they can meet that personal goal of staying at
home. [MUSIC]>>The Shapera Center was founded about
a year ago to help improve the care of older adults
through education. So at our very core, we’re really about
making the experience for older people and their families better
in the health care system. But using the method of educating the
people who take care of them.>>It’s been a dream of mine and a
dream of many of our faulty that to be able to develop curriculum programs
that would actually translate what you’ve
learned into physician’s practices. If you go out right now on the web and try to find a foundation or a government
entity that would fund that kind of research You might be able to
cobble together some of it but you wouldn’t be able to
cover it all. Through the generosity of of grateful patients and families of patients, we’ve
been able to put together a program like our Shapiro Geriatric Medical
Education Center.>>I don’t think American medicine and
American geriatric medicine would be anywhere near the level it is now
without philanthropy. It’s the ability to think outside the box. It allows you to do something that’s not
traditional.>>Philanthropic gifts are critical to
our scientific mission. Often times the new ideas are very difficult to fund through normal NIH
mechanisms. So some of the gifts that we’ve received
over the years have really allowed us to begin doing research
that otherwise wouldn’t have been done.>>Mason Lord is the real giant whose,
shoulders we stand on. Even though he died at age 39, I think his
impact to us was powerful. He really forecast the American medical
scene in a very present way that’s remarkable to
me. It must have been his two primary values
were respecting the dignity of the individual as a patient and, and those that were quite disabled and in,
incapable. Taking care of themselves, and empowering
them. And I believe that was unique, at least a
unique perspective at a time when, disabled individuals were sometimes
institutionalized.>>Mason Lord is a mentor to me that
I’ve never personally met. But he’s been valued on this campus as a
leader. A leader in society. A leader is first a person, and a doctor
second. And he valued the care and, and help of
the most vulnerable of Baltimoreans. And that’s what we do everyday here.>>Mason Lord began to envision a
different future. And we’re very proud of how we’ve built
upon that legacy. What I get most excited about is, is
seeing that research portfolio sort of take off and other
people pick it up. The junior investigators, other
investigators from around the country and around the world, and having them sort of
take some of our, our ideas and studies and really
expand on them and make a big difference in the lives of
older adults. That’s the most exciting thing to me right
now because I think that’s where we can make a really
big difference. Where just affecting the dozen people that come through our primary care training
every year. Well they go out and work in a practice and influence the way that that practice
functions, or they go out to another academic center and
say, hey why don’t you guys do it this way? So that’s, that kind of dissemination
through practice.>>It’s about trying to do things better, trying do things in an exemplary
way. Trying to take care of a population that
have enormous needs, in a way you’d want to be taken care of, or our parents
want to be taken care of. And you gotta just start. Baby steps at a time and do the right
thing. And if you have an institution that’s
behind you, and nurturing you and supporting you
It’s possible. [MUSIC] [BLANK_AUDIO]

2 Comments

  • Reply watchinvideo Last May 7, 2013 at 2:00 pm

    I'm very proud of the Director of the Division of Geriatric Medicine and Gerontology, my Uncle Chris.

  • Reply Denise Kelly May 8, 2013 at 1:55 pm

    A wonderful presentaton, I am so proud to be a part of this wonderful and caring group.

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