Itamar B. Abrass MD
Professor & Division Head, Phone 206-744-9100
itamar@u.washington.edu

G. Thomas Cartmill
Administrator, Phone 206-744-9104
tomcart@u.washington.edu

Rose E. Flores-Winders
Office Assistant, Phone 206-744-9100
rfw3@u.washington.edu 

Mary M. Cross
Fiscal Specialist, Phone 206-744-9102

mmcross@u.washington.edu

Milestones
of the
Division of Gerontology and Geriatric Medicine

Thanks to Dr Edwin Bierman, the development of geriatric medicine at the University of Washington closely parallels the development of geriatric medicine in the United States.

The history starts with the creation of the National Institute of Child Health and Human Development (NICHD) by congressional mandate early in the Kennedy Administration. Dr Robert Aldrich, Head of the Department of Pediatrics at University of Washington, was enlisted to become the first director of the NICHD. Part of the mandate of the Institute was human development from birth to old age and a branch was created to generate research in this area. Dr Aldrich thought the University of Washington could profitably be in the forefront of this effort, and as a result of his urging, the University formed a committee of gerontology with Dr Robert G Petersdorf as its chairman. The committee was impressed with the opportunity to develop a strong research and teaching program in gerontology. They recommended an interdisciplinary, interdepartmental gerontology research center program, which then was established in the Department of Medicine.

Dr Bierman was recruited to head this effort and Dr Petersdorf placed its development within the Division of Metabolism at the VA hospital, which became the Division of Metabolism and Gerontology. The "Gerontology Research Center" concept began as a program project grant. The existence of this multidisciplinary program was an important factor in the recruitment of Dr Carl Eisdorfer as Chairman of the Department of Psychiatry in the early 1970’s. He set up a Division of Psychogerontology in the Department and, thus, began a close collaboration for the development of an aging center at the University of Washington and interdigitation between the two Departments. This culminated in the successful competition and award of one of the first Geriatric Research, Education and Clinical Center to the Seattle and American Lake VAMCs, and the establishment of the Institute on Aging at the University.

In the mid to late 1970’s, consideration was given toward development of the clinical side of the program for the University, i.e., geriatric medicine. As was planned for many years, the Division of Gerontology and Geriatric Medicine was formally established in 1977, taking it out of Metabolism and Endocrinology. Dr William Hazzard was appointed the first Division Head, coincident with the decision to base the Division at Harborview Medical Center.

Dr Hazzard continued the strong research tradition of the program while initiating the clinical and training components of the Division. An inpatient geriatric assessment unit was established, which today continues to be one of very few non-VA-based units. The clinical program also included a consultation service, ambulatory care clinic, and nursing home follow-up program. The geriatric medicine fellowship program, one of the first in the country, began as one year of clinical geriatrics. Additionally, medicine residents had one month rotations on the service, and a medical student elective was established. The program at the VA continued to focus mostly on research. The national demand for academic leaders in geriatrics was growing, so several individuals, first Marsha Fretwell (‘81), then Bill Hazzard (‘82), and then Jeff Halter (‘84), were recruited to establish new programs at other institutions, Rhode Island, Hopkins, Michigan, respectively.

After interim stewardship by Dr James LoGerfo, Dr Itamar B Abrass was recruited to head the Division in 1984. Since Dr Abrass’ arrival the geriatrics program has grown at all its sites - Harborview Medical Center, the Seattle and American Lake sites of the VA Puget Sound Health Care System (VAPSHCS), and the Boise VAMC. The faculty has grown to 26 full-time faculty members with research spanning the broad spectrum of geriatrics/gerontology including ethics, health services, epidemiology, clinical, animal, and cell and molecular biology research. This has been accomplished at these multiple sites, in no small part, by the leadership of several individuals, including in the past Robert Schwartz and Dan Dorsa at the Seattle VA and Bernard Roos at the American Lake VA, and presently by Alvin Matsumoto and Gerard Schellenberg at the VAPSHCS/Seattle, Stephen Plymate at the VAPSHCS/American Lake, and Barry Cusack and Robert Vestal at the Boise VAMC. Of particular note is the strong biomedical research program established at the Boise VA under Dr Vestal’s leadership, with national and international recognition in multiple disciplines including gerontology, despite the distance and relative isolation of their program from the University.

The program has also expanded clinically, particularly over the past two years. The Harborview inpatient unit has continued but the case mix acuity has increased while the length of stay has shortened. The consultation and ambulatory services have also expanded. The major recent change has occurred in community based activities under the direction of Dr Wayne McCormick. A formal affiliation has been established with six traditional nursing homes, one AIDS long-term care facility, two assisted living facilities, and two home-care agencies with Division faculty as physicians of record so that the full continuum of care is available to HMC, UWMC, and VA patients. The average daily census of the long-term care program has grown to over 325. Ambulatory care clinics staffed by nurse practitioners have been established in five community housing settings. All these sites have not only improved patient care, but become the base for research and training in long-term care. Similar programs including an assessment and treatment unit, ambulatory care, consultations, home-based primary care, and nursing home care have been established at the VAPSHCS/Seattle.

The training program has also changed. In 1984 the fellowship was expanded to a two to three year program with two to three candidates entering each year. All the graduates have continued in geriatrics and the majority have chosen academic careers. Internal medicine residents have regular rotations on the geriatrics services, and the student elective is often over-subscribed.

July 1, 1990 we became an accredited program with the American Board of Medical Specilties - Accreditation Council for Graduate Medical Education (ACGME). University of Washington School of Medicine, Department of Medicine, Division of Gerontology and Geriatric Medicine.

The future brings great challenges to the Division with a growing older adult population, shrinking resources, and a move to managed care. However, with the strengths of the individuals in the program, and the structure we have developed, we believe we can meet the challenge and look forward to it.

The University of Washington is committed to providing access, equal opportunity and reasonable accommodation in its services, programs, activities, education and employment for individuals with disabilities.  To request disability accommodation in the application process, contact the Disability Services Office (at least ten days in advance) at:  (206) 543-6450/V, (206) 543-6452/TTY, (206) 7264 (Fax), or e-mail at dso@u.washington.edu.