With an eye to the future, the UNLV School of Medicine is expanding its geriatrics program to handle a projected significant increase of Nevada residents ages 65 and older.

In November the school 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.

Dr. Ji Won Yoo, an assistant professor in the school’s department of internal medicine and a University of Michigan fellowship-trained geriatrician who is serving as director for the fellowship, is heavily involved in planning for the fellowship, which is expected to be operational in July 2020.

An Increasing Need

“The need for more geriatricians in Nevada cannot be overstated,” Yoo said, noting 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.

Dr. Ashley Sarasan, who in 2018 completed a geriatric fellowship through Minnesota’s Mayo Clinic, recently was hired to work with Yoo in developing the fellowship program, which will include a state-of-the-art clinic.

“It’s exciting to help bring this program to fruition,” said Sarasan, an assistant professor in the department of internal medicine. “We will be developing geriatricians who are so badly needed and giving seniors the help they need.” 

Statistics provided by government agencies show the very real need for more geriatricians:

• 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 that time.
• 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 that number is expected to climb to more than 1 million in the next 15 years.
• Nevada has a patient-to-geriatrician ratio of about 10,424 to 1 while the national average is 6,980 to 1.

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.

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. 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.

An Holistic Approach

“A geriatrician takes a more holistic approach,” Sarasan 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,” Sarasan said. “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.”

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.

Community Partnerships

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, he said. In addition, UNLV schools and colleges will be tapped for their expertise. For instance, the Howard R. Hughes College of Engineering can help 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 could deal with dental problems.

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