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Making the Rounds with Founding Dean Dr. Barbara Atkinson
 Issue 183 - Feb 19, 2019
Friends and Colleagues, 

Thanks to advances in modern medicine, Americans are living longer. By 2030, people 65 and older are expected to account for almost 20 percent of the population. That means many men and women will be able to enjoy their golden years doing whatever makes them happy. But increased age can bring additional health challenges, including heart disease, arthritis, osteoporosis, dementia and hypertension. Often, the best way to deal with these challenges is through geriatricians, specialists just for seniors. Unfortunately, the American Geriatrics Society says our nation has less than half the geriatricians necessary to properly take care of the elderly. I am pleased to say that the UNLV School of Medicine is now working toward a fellowship program that will turn out more specialists for older Americans. Today, we're introducing two UNLV Medicine geriatricians who are developing what will be Southern Nevada's first ACGME Accredited Geriatrics Fellowship program, which will include a state of the art geriatrics clinic.
Barbara signature, first name only
Building a Geriatrics Program to Serve Southern Nevada's Aging Population
Dr. Ji Won Yoo and Dr. Ashley Sarasan, UNLV Medicine Geriatricians who will help build the first ACGME Accredited Geriatrics Fellowship program in Southern Nevada
The statistics provided by government agencies show that in Nevada there is a very real need for more geriatricians, primary care doctors who have additional specialized training in treating older patients: 

--Interim projections estimate that between 2000 and 2030, Nevada’s 65 and older population will increase by more than 260 percent.

--Only two other states, Alaska and Arizona, will see an increase of more than 200 percent during this time period.

--Between 1999 and 2009, Nevadans 65 and older had the second largest increase in the country -- 47.9 percent.

--By 2030 Nevada’s 65 and older population is projected to jump from 12.1 percent to 18.6 percent.

--Nevada has about 350,000 adults over the age of 65 and this is expected to go over 1 million in the next 15 years.

--Nevada has a patient to geriatrician ratio of about 10,424:1, while the national average is 6,980:1.

“The need for more geriatricians in Nevada cannot be overstated,” said Dr. Ji Won Yoo, an assistant professor in the UNLV School of Medicine Department of Internal Medicine and a University of Michigan fellowship trained geriatrician.

He noted that geriatricians have been trained to handle many different challenges of aging, so patients don’t have to continually visit a series of doctors to receive care. It’s not uncommon, he said, for geriatricians to visit infirm patients in their homes, not only to address medical conditions but also to find ways to make a home safer from falls or even fires.  
"Often times, patients are confused at the number of physicians and specialists they need to see. I try my best to avoid having my elderly patients go around seeing multiple different specialists if they don’t absolutely need to."
In November, under the direction of then Gov. Brian Sandoval, the UNLV School of Medicine received approval for $2.3 million in grant funding to support expansion of the critical care surgery and critical care medicine fellowships, and to support a geriatrics fellowship. As program director for the fellowship, which is expected to be operational in July 2020, Dr. Yoo is now heavily involved in planning. “There is much to do,” he said.

Just a couple months ago, Dr. Ashley Sarasan, who in 2018 completed a geriatric fellowship through Minnesota’s Mayo Clinic, was hired to work with Yoo in developing the fellowship program that will include a state-of-the-art clinic. Like Dr. Yoo, she is an assistant professor in the UNLV School of Medicine Department of Internal Medicine.

“It’s exciting to help bring this program to fruition,” said Dr. Sarasan, who said more medical staff must be hired to ensure that the clinic meets the community’s needs. “We will be developing geriatricians who are so badly needed and giving seniors the help they need.”

According to the American Geriatric Society (AGS), about 30 percent of the 65-plus patient population would best be served by having a geriatrician providing care. AGS suggests that a geriatrician be consulted when an older person’s condition causes significant impairment and frailty. Often these patients tend to be over 75 and are coping with a number of disabilities and diseases, including cognitive problems. AGS also says a geriatrician should be consulted when the patient’s condition is causing the caregiving team, including family members and friends, to feel significant stress and strain.

Dr. Sarasan said geriatricians are experts in seeing the big picture and are well-versed in drug side effects. Too often, she said, a patient may be getting multiple medications from different doctors and they can have side effects that are detrimental to the patient’s health. She said a geriatrician will prioritize the medications in terms of necessity. During conversations with the patient and family, the geriatrician learns which conditions must be treated the most aggressively, developing a care plan that helps a patient be as functional as possible. Sometimes all that is needed to give a senior a better quality of life are new glasses or hearing aids. “We need to take everything into account,” Dr. Sarasan said. 

“A geriatrician takes a more holistic approach,” she said, adding that such a specialist schedules much longer appointments with a patient to understand each medical condition. Geriatricians, she noted, are adept at treating patients who are managing five to eight chronic conditions. “As a geriatrician, my primary goal is to reduce the disease burden, improve quality of life, stop inappropriate medications in the elderly and focus on being the go to person for my patients. Often times, patients are confused at the number of physicians and specialists they need to see. I try my best to avoid having my elderly patients go around seeing multiple different specialists if they don’t absolutely need to. “  

Dr. Yoo pointed out that geriatricians frequently work as part of an interdisciplinary team that includes nurses, physical therapists, occupational therapists, social workers and mental health professionals. He said the fellowship program and the geriatrics clinic will work out affiliations with a number of community organizations, including the Nevada Adult Day Healthcare Center, Volunteers in Medicine of Southern Nevada and the Cleveland Clinic Lou Ruvo Center for Brain Health. In addition, UNLV schools and colleges will be tapped for their expertise. For instance, the Howard R. Hughes College of Engineering can provide equipment that would help a stroke victim with his gait, the William S. Boyd School of Law could help with legal issues that arise in a patient’s life, and the UNLV School of Dental Medicine can deal with dental problems.

“Every patient who is seen (by a UNLV geriatrician) first gets a comprehensive geriatric assessment covered by Medicare,” Dr. Sarasan said. “We also provide patient and caregiver education for dementia, frailty, age related comorbidities and end of life care. We address socio-economic issues like access to food, grocery, physician clinics, making advance care planning. We work very closely with our community resources like nursing homes, assisted living centers, senior apartments, rehabilitation and hospices.

Dr. Yoo knows what he wants to do with the geriatric program -- “improve processes and outcomes...for vulnerable adults who can easily lose...healthy and happy lives.”
To make an appointment with Dr. Yoo or Dr. Sarasan: 702-671-5060
There are more than 7,500 certified geriatricians in the U.S. But the nation needs an estimated 17,000 geriatricians to care for about  12 million older Americans , according to American Geriatric Society projections.

All previous issues of  Making the Rounds with Founding Dean Dr. Barbara Atkinson , are available on our website.
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