Q: What interests you about the field of geriatrics?

A: I view Geriatrics as a unique field of practice that can make marked improvements in the quality of life of our ever growing population of elders, is wide open for research, and is ripe for developing better evidence based medicine practices. As an osteopathic medical student, I have found instances in which I can offer older patients relief from pain and injury through osteopathic manipulative treatments, without contributing to polypharmacy. Rather than looking for disease, pursuing health and well-being with individual older patients has already proved to be most rewarding.

Q: Can you share a short story about something interesting that happened to you during your work with geriatric patients.

A: In my second year of osteopathic medical school, visiting a terminally ill family friend with metastatic prostate cancer in a nursing home's hospice unit, my friend and former childhood teacher asked me if there was anything I could do help him feel more comfortable with his pain. He was experiencing pleurtic pain (pain upon inhalation) in his posterior mid thoracic to lower lumbar paraspinal muscles. He chest was barely moving as breathed shallowly and cautiously, with occasional deep breaths that elicited an auditory groan of pain, painful wince and guarding of his back musculature. His pulse oximetry readings were in the 80-85% range, he was disoriented, and exhibited signs of venous and lymphatic stasis.

Applying the Osteopathic Tenets, I examined him, and then treated him with Osteopathic Manipulative Treatments. Immediately, his pain was alleviated, he could breathe more easily, color and warmth returned to his extremities, and was more alert and attentive to his surroundings. His next pulse oximetry reading was 96%. For the next three weeks he remained highly interactive with visiting family and friends and slept better at night before passing away in his sleep.

Although an individual experience, this final lesson taught to me by my teacher is evidence enough to me that Geriatrics is a field that has enormous potential for growth in redefining and rediscovering health and well being for each of our patients.

Q: What do you see as the most important issue facing caregivers (either professional or family members) for older persons today?

A: The greatest challenge is access to appropriate, high quality care. From the stance of family members caring for the older healthcare consumer, access to fellowship-trained geriatricians who have committed their understanding and expertise to the unique care of the older patient is limited by geography, cost, and the lack of qualified and dedicated physicians. From the stance of the physician, whether already trained and in practice, currently in training, or still considering medicine as a career, the cost of malpractice insurance, the immense cost of undergraduate and graduate medical education, and the ever-decreasing level of reimbursement weigh heavily on the selection of geriatrics as a specialty. Ultimately, coming together to meet the healthcare needs of the patient, for the benefit of the patient, and not the benefit of a third party, is what we must face and strive for.

Q: How do you hope that your research will benefit the field of geriatrics?

A: Delirium is a common, costly and morbid sequellae noted immediately after surgery for many older patients. In looking for pre-operative indicators of post-operative outcomes, the currently unclear pathophysiology of delirium may be elucidated, as well as interventions designed and implemented. Preventing the older patient's risk of developing delirium, and preserving their cognitive and attentive abilities so that they can remain highly interactive with family and their surroundings not only improves/preserves quality of life, but also reduces hospitalization and care requirements, benefiting not only patient with a decreased risk of nosocomial complications, but also less financial burden on the health care delivery system.