My very first interaction with Duke occurred during my first year of medical school. Desperate to embark on geriatrics research in 1985 I wrote to someone asking for a copy of the OARS instrument (Older Americans Resources and Services Program famously developed at Duke to measure the impact of services on the functional status of older adults.). Yes, someone sent me a copy in the mail, this was way before e-mail and scanners or faxing were popular. When I finally arrived at Duke for fellowship training in geriatrics I was afforded the privilege of working with Gerda Fillenbaum, PhD, one of the authors of the OARS instrument. Together we embarked on exploring data collected by the Consortium to Establish a Registry for Alzheimer’s Disease. I was particularly interested in the weight changes that many clinicians witnessed in caring for these patients, in particular the tendency to lose weight. As a junior faculty member I continued to explore care for patients with dementia collaborating with Edward Levin, PhD, to understand the potential for nicotine to improve the symptoms of this disease while avoiding potential adverse effects such as weight loss.
However, my passion for academic geriatrics could not be quenched by research alone, I am very much at home at the bedside or in the clinic with older adults and I enjoy sharing this passion with learners. Dr. Robert Sullivan became one of my early clinical mentors, helping me to appreciate the value of caring for patients in the skilled nursing facility. As medical director at The Methodist Retirement Community that was located on Erwin Road, and later at the Croasdaile Village Retirement Community, I sharpened my skills and learned from patients, families and members of the interprofessional team. A Geriatric Academic Career Award allowed me to develop long-term care focused education for our geriatrics fellows, post-doctoral fellows, pharmacy residents, physical therapy residents, geropsychiatry fellows, palliative care fellows, and advanced nursing students. Although we were doing a laudable job teaching them about clinical care in this setting, The Advanced Course in Long-Term Care that resulted ensures a more nuanced curriculum regarding this care setting, in relationship to the larger health system, so our learners are poised to become leaders and change advocates.
Funding from the Reynolds Foundation has allowed me to extend myself into the arena of faculty development. Working with faculty from other institutions to develop their own curriculum in post-acute and long-term care has been a prized endeavor accomplished through the weeklong mini-fellowships that have been offered over the past 10 years. My concern for care environments that meet the needs of many of the oldest and frailest among us has led me to volunteer my time with AMDA The Society for Post-Acute and Long-Term Care Medicine. I enjoy co-directing the Futures Program that brings approximately 60 geriatrics fellows to the annual meeting to learn more about a career in medical direction. I will serve as the president of this professional organization for 2017-2018.
In the wake of health care reform, my expertise in caring for older adults with cognitive and physical disabilities, especially in post-acute and long-term care, has opened doors of opportunity. Duke Connected Care, the newly formed physician-lead Duke accountable care organization is very interested in programs and systematic changes that will improve both the quality and cost of care for older adults with complex care needs. I have been pleased to serve on the operating committee and to help establish a geriatrics advisory group. Working with Dr. Tom Owens, our Duke Health System Chief Medical Officer and his associate Laura Huffman, we have established quarterly conferences that bring together an interprofessional group of Duke leaders from our hospitals and home health care with area skilled nursing facility (SNF) leaders to gain knowledge of best practices and discuss issues of mutual concern. Concurrently, I was asked to lead a Health Optimization Program for Elders (HOPE) to improve care transitions from Duke Hospital to area SNFs. The outcomes of this pilot program have gained attention and funding for hospital-wide expansion. Also the Duke Institute for Healthcare Innovation has funded a portion of this project that will develop interactive on-line education for Duke and SNF staff to continue to improve transitions and care for vulnerable seniors in need of post-hospital rehabilitation.
I am especially blessed to have the opportunity to share my passion for providing and improving care with many Duke undergraduate students, primarily women, many of whom have been referred to me over the years by Deborah Gold, PhD, who provides the first spark for gerontology to so many Duke undergraduate students in the classes she teaches. These interactions with undergraduates and a dense network of professional connections at Duke in part provided by my spouse and fellow Duke faculty member, Leonard White, PhD, a neuroscientist, has led to a growing collaboration with two younger Duke researchers, Cassandra Germain, PhD, and Tobias Overath, PhD, also both neuroscientists. Together over the next year, we will lead a Bass Connections funded program involving three undergraduate students and two medical students to explore the scientific basis of personalized music, a currently popular intervention to improve the behavior and quality of life for older adults suffering from Alzheimer’s disease and other forms of dementia.
Duke is truly a rich environment of experimentation and change that has fueled my career as an academic geriatrician over the past 20 years and I hope to continue to make a difference not just for my own patients but for all the elders in our health care system while providing opportunity and experiences for the professional development of the passionate geriatricians and gerontologists who will eventually take my place.