Geriatrics Research Focuses on Evidence-based Care Models

Massachusetts General Hospital has pioneered a systematic assessment of gaps in dementia care to address the unmet needs of the growing older adult population. This assessment will inform research focused on the development of care models and tools that involve all stakeholders in a patient's medical and social environments.

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"The numbers of people over 65 and over 85 are growing in proportion relative to the rest of the population," says Christine S. Ritchie, MD, MSPH, the Mongan Institute's Minaker chair in Geriatrics and director of research for the Division of Palliative Care and Geriatric Medicine at Mass General. "Our living longer stems, in part, from medical advances keeping us alive with conditions that in the past would have led to our immediate demise. This brings the reality that more of us as we age will spend significant time living with at least one serious illness. Despite this, older adults and those with serious illnesses have been systematically excluded from clinical studies, leaving every aspect of their care with significant gaps."

Improvements to Geriatrics Care

Mass General's comprehensive assessments have identified a number of care gaps in geriatrics, including:

Diagnosis

According to the Alzheimer's Association, only 16% of primary care physicians screen for dementia. As a result, about half of all people with the disease are not diagnosed at the onset of symptoms. As dementia progresses without treatment, patients are more likely to lose control over their futures. Lack of treatment also often affects safety and caregiver strain, resulting in potentially preventable medical costs. Mass General is developing programs to engage primary care physicians in proactive diagnosis and disclosure as well as EMR-based Alzheimer's prediction tools. This work supports a new Massachusetts law requiring clinicians to be trained in Alzheimer's diagnosis and to conduct appropriate patient and family disclosures.

Diagnostic Disclosure 

Physicians may not have the appropriate tools and methods for guiding encounters with dementia patients. Without thoughtful and compassionate discussion, patients are often left without the knowledge necessary to evaluate and access appropriate care options. The resulting depression and sense of isolation can challenge the person with dementia and their caregiver.

Treatment

Clinical care is generally based on studies conducted in younger populations. In older patients, following guidelines based on research in younger adults may be ineffective for reasons including the effects of other chronic conditions, a patient's functional status or because clinical standards do not align with a patient's cultural or social values. Ineffective treatment based on age-inappropriate clinical standards may harm patients and result in unnecessary hospitalizations.

Care for Caregivers 

By all estimates, caregivers in the United States log billions of hours caring for loved ones with dementia. Caregivers struggle with dramatic life changes and significant uncertainty about their own futures. A lack of tools can hinder the effectiveness of the time they commit to their family member and prevent them from participating in society in a more holistic way. Depression and burnout follow, with additional individual and societal costs.

Multidisciplinary Geriatrics and Dementia Research Identifies Effective Approaches

Mass General is uniquely positioned to tackle research for this kind of complex and highly heterogeneous population. In order for research and testing to reflect the dynamic and multifaceted environment of elder care, Mass General works with an array of partners—medical researchers, physicians, social scientists, anthropologists, patients, caregivers and advocacy organizations—to identify and address geriatric and dementia care gaps at all levels.

"We're fortunate to have a progressive and engaged health care system here in Boston," Dr. Ritchie says. "With the help of partners in the community, we can employ rapid and agile testing of interventions and evaluate their impact."

Applied Research Will Influence Policy Change

Dr. Ritchie's work focuses on the development of geriatrics care models that allow for individualization. Aging populations become more heterogeneous as they get older. Geriatrics care tailored to individuals' medical histories, health conditions, values and social environments is critical for success in this field.

"This work will promote improvements in clinical care and quality of life for seriously ill older adults and contribute to reductions in their cost of care," says Dr. Ritchie.

She intends for her heavily integrated applied research to be a catalyst for the alignment of clinical and social care with policy and reimbursement methodologies. As health care evolves into a value-based environment where health systems are held accountable across all care settings, integrated and individualized approaches have become more readily accepted.

Mass General's continued research will help define the most effective models and accompanying social and community support for geriatrics care. The seriously ill older adult and their care teams will have the right tools to navigate through extended illness with knowledge and dignity.

The Center for Aging and Serious Illness

As a result of findings, Mass General is establishing the Center for Aging and Serious Illness to provide a forum for additional innovative research. The center's goal is to develop an evidence base for geriatrics and palliative care and provide a forum where experts can convene around research questions, offer training in age- and condition-specific methodologies and provide opportunities for collaboration in an underrepresented area of research.

"Long life is a gift and offers opportunities to give back in a number of ways," says Dr. Ritchie. "Our goal is to develop medical tools and social and community support systems for every adult with serious chronic illness, allowing them to live as long as they can, as well as they can."

Learn more about Geriatric Medicine at Mass General

Refer a patient to Geriatric Medicine