Division of Gerontology and Geriatric Medicine

Program

Training Sites

arborview Medical Center HMC is the site of the primary divisional offices, and the SeniorCare Program has been established as a high-priority by the Hospital Board of Trustees. The SeniorCare Program includes an inpatient geriatric unit of twelve beds located on the internal medicine ward service. The emphasis on the unit is an interdisciplinary approach to the management of acute and subacute manifestations of chronic disease in elderly patients; and a strong emphasis is placed on the team approach to patient care. The unit has specially assigned physical therapists, occupational therapists, recreational therapists, social workers, nutritionists, clinical pharmacists, and nursing staff who work in conjunction with the physician staff. The unit's physician staff includes two medicine residents (R-1 and R-2 or R-3 level). The R-1 is responsible for the day-to-day medical supervision of patients on the service, and the R2/3 supervises the R-1 and sees consultations. The fellow is responsible for the consultation service and oversees the work of the residents in conjunction with an attending physician.

Patients 65 years and older who have multiple medical and/or psychosocial problems, are transferred to this service if they are felt to have significant potential for developing a higher level of function at discharge than might otherwise occur without the benefit of an interdisciplinary team. Also, patients who are living in the community, but who are experiencing major problems which threaten their current level of independence, can be admitted for an intensive inpatient evaluation including psychiatric and rehabilitation services.

The active consultation service includes the pre- and post-operative medical management of all patients 65 years and over on the Orthopedics and Urology Services. Consultations to other surgical and medical services are of the more traditional type with advice but not direct responsibility for management.

Members of the Department of Rehabilitation Medicine, the Division of Neurology, and the Department of Psychiatry regularly participate in teaching and team conferences. There is a active geropsychiatry program at Harborview. Fellows also participate in the geriatrics clinic each week.

Department of Veterans Affairs, Puget Sound Health Care System, Seattle Division. The clinical and research training programs at the Seattle VAPSHCS are associated with the Geriatric Research, Education and Clinical Center (GRECC). Clinical opportunities include the following: a Geriatric Evaluation Management (GEM) Unit providing intensive evaluation and short term interdisciplinary rehabilitation; a multidisciplinary consultation team for elderly medical/surgical inpatients with complex medical, behavioral and social problems; an outpatient geriatric clinic providing longitudinal outpatient management; a nursing home rehabilitation program which strives for eventual home placement; and a community home outreach care program. A special relationship exists with the strong geropsychiatry group.

University of Washington Medical Center The geriatric clinical activities at UWMC are focused on an active consultation service for elderly medical/surgical inpatients. This activity is integrated with the general medicine consultation service.

Long-term Care Service. Formal affiliations have been established with 13 nursing home facilities to specifically accommodate patients discharged from either the University of Washington Medical Center or Harborview Medical Center. This service is directed by a full-time faculty member of the Division of Gerontology and Geriatric Medicine, with the assistance of a nurse practitioner. The clinical and teaching program includes longitudinal care for a panel of patients, weekly attending rounds, and twice-monthly conferences on clinical problems in nursing home care or management issues of a nursing home practice. There is also a one- month block experience to reinforce interdisciplinary team care and to learn skills related to the role of a medical director of such facilities.

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