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.”