A Vision for the Future of Geriatrics:
R. Sean Morrison, MD
Ellen and Howard C. Katz Chair of the Brookdale Department of Geriatrics and Palliative Medicine
Since its founding as the nation’s first department of geriatrics in 1982, the Brookdale Department of Geriatrics and Palliative Medicine within the Icahn School of Medicine at Mount Sinai has transformed clinical care for older adults and medical training for the clinicians who treat them. Today, The Mount Sinai Hospital is ranked No. 1 in the nation by U.S. News & World Report for the third consecutive year, and it continues to lead the field as the U.S. population ages.
According to the U.S. Census Bureau, by 2030, baby boomers will be older than age 65, one in every five Americans will be of retirement age, and, for the first time in U.S. history, adults over 65 will outnumber individuals under age 18. R. Sean Morrison, MD, Ellen and Howard C. Katz Chair of the Brookdale Department, believes that the future of medicine lies in rethinking health care models. “We need to redesign a health care system that focuses on the needs of older adults and their caregivers, rather than on the needs of middle-aged adults, which is where it’s focused now,” he says.
The Brookdale Department has created many of the clinical models of care replicated across the country, including the Mount Sinai Visiting Doctors and Hospitalization at Home programs, which provide in-home care from a team of doctors, nurses, social workers, and other professionals. There has also been an emphasis on creating programs that treat older adults with multiple chronic conditions in community settings, including outpatient practices, nursing homes, and Veterans Administration hospitals.
“Our outpatient practices and inpatient models essentially integrate geriatrics and palliative care into the DNA of medicine,” says Dr. Morrison. “That’s the direction we want to continue in over the next five to ten years.” Palliative care is specialized medical care for people living with a serious illness. This type of care is focused on
providing relief from the symptoms and stress of the illness. The goal is to improve quality of life for both the patient and the family.
The Brookdale Department has the largest, most comprehensive fellowship program in the country and has trained one in five specialists nationwide. It has transformed the way such clinicians are trained by incorporating geriatrics and palliative care into the curriculum. The training begins in medical school and has shifted its emphasis to training not just skilled clinicians, but leaders in the field.
“One of the biggest challenges the medical community faces is addressing disparities and access to care,” says Dr. Morrison. “How do we do that? First, we must continue to train clinicians who mirror the population that we’re caring for. We must identify through research the specific needs of patients and families to ensure that there’s equitable access to care for them. And finally, we must continue to work on health care reform.
“As we look to the future,” he says, “our goal is to continue to grow the Brookdale Department and to ensure that we are providing the highest quality of care for the people in our community while serving as a national model for others.”
From Martha
This summer, the Brookdale Department of Geriatrics and Palliative Medicine was once again recognized for extraordinary contributions to the care of older adults, persons with serious illness, and their loved ones. U.S. News & World Report ranked The Mount Sinai Hospital as the No. 1 Best Geriatrics Hospital in the nation for the third consecutive year. The report also listed Mount Sinai Beth Israel, Mount Sinai Morningside, and Mount Sinai West among the High Performing Geriatrics Hospitals, or top 10 percent ranked.
While these rankings are impressive, they are not surprising. The Brookdale Department and our Martha Stewart Centers for Living have been at the forefront of high-quality care for older adults and their loved ones for decades. And the work that is developed here is consistently replicated throughout the nation.
I have been a partner to Mount Sinai in this work for fifteen years now, and it is deeply rewarding to support the Brookdale Department’s mission and continuous advancements. I am so proud of the Martha Stewart Centers for Living and their work to improve the health and quality of life for older adults, persons with serious illness, and their caregivers. The clinicians, educators, researchers, and multidisciplinary team members work tirelessly with unparalleled commitment and compassion. To each of them, I offer my most profound gratitude and admiration.
In light of this, I would like to encourage all to join me in supporting our health care heroes. If you are interested in donating to our work, please visit http://giving.mountsinai.org/ geriatrics.
Sincerely, Martha
Meeting the Health Needs of Aging 9/11 Responders:
By 2030, the majority of responders to the attacks on the World Trade Center (WTC) on September 11, 2001, will be over the age of 65 and at risk for age-related health issues. Mount Sinai, which has the largest World Trade Center Health Program, recently received a federal grant to study how aging affects rescue and recovery workers in an effort to improve their medical care, health outcomes, and overall quality of life.
WTC responders were exposed to high levels of toxicants and intense psychological trauma in the emergency response and cleanup following the collapse of the Twin Towers. These hazards can accelerate the aging process, and responders are at increased risk for chronic diseases, premature aging, and age-related syndromes. Data from Mount Sinai’s WTC Health Program Clinical Center of Excellence show that a substantial proportion of general responders meets the criteria for frailty.
In medical terms, frailty is a clinical state of increased age-related vulnerability that presents as functional and cognitive decline, poor outcomes after hospitalization or surgery, and increased disability. Despite its importance in the care of older adults, frailty has not been routinely assessed among responders.
Fred Ko, MD, Associate Professor of Geriatrics and Palliative Medicine, developed the WTC Clinical Frailty Index to measure signs and symptoms of aging in a collaboration with co-lead investigators of the study William Hung, MD, Professor of Geriatrics and Palliative Medicine, and Katherine Ornstein, PhD, MPH, Adjunct Associate Professor of Geriatrics and Palliative Medicine.
“This is the first time a geriatrics lens has been placed on a WTC cohort as we assess frailty, previous exposure, and premature age-related deterioration in physiological function,” says Dr. Ko. “In addition to learning more about the aging process experienced by responders, we believe the study will result in the adoption
of evidence-based interventions to promote healthy aging and mitigate risk factors of frailty and its adverse outcomes. Ultimately, it will lead to the improved clinical care of responders.”
The $2.4 million, four-year, interdisciplinary study is funded by the National Institute of Occupational Safety and Health (NIOSH), part of the U.S. Centers for Disease Control and Prevention.
“Results of this study will be instrumental in improving the care for aging responders through partnership with Mount Sinai’s nationally recognized geriatrics and palliative care programs,” says Dr. Hung. “As we mark the 21st year since the World Trade Center tragedy, those impacted by this are aging, and to be able to understand how to best support them through the aging experience is really a fantastic opportunity.”
A Letter
Brookdale Researchers Awarded $2.4 Million Grant to Study Frailty
“Ultimately, it will lead to the improved clinical care of responders.”
Provider Spotlight: Nisha Rughwani, MD
Medical Director of the Geriatrics Ambulatory Practice at Mount Sinai Morningside
Nisha Rughwani, MD , grew up in Hong Kong and saw firsthand how her grandmother’s age affected her care.
Although her grandmother lived to age 99, Dr. Rughwani recalls the distress that came with any illness her grandmother encountered. “She’s just old,” the doctors would say. But Dr. Rughwani knew that there were many substantial things that could have been done nonetheless.
“What I love about working with older adults is that it’s not all medical. You’re trying to put together their medical, social, emotional, and mental health. You’re trying to take care of all of it,” says Dr. Rughwani,
Medical Director of the Geriatrics Ambulatory Practice at Mount Sinai Morningside, who began her career as a Family Medicine Physician in the United Kingdom.
When she and her husband moved to America, Dr. Rughwani sought the complexity of chronic disease management and applied to the Geriatrics Fellowship at Mount Sinai.
In 2007, Dr. Rughwani joined the Brookdale Department of Geriatrics and Palliative Medicine at the Icahn School of Medicine at Mount Sinai faculty and has subsequently served in various clinical, educational, and quality improvement capacities over the years.
In 2018, she was appointed Medical Director of the Brookdale Department’s newest outpatient practice at Mount Sinai Morningside. In short order, she oversaw
the practice’s transformation into a fullservice, multidisciplinary clinic with a Falls Prevention Program, geriatrics co-management team, palliative care services, geriatric psychiatry consultations, and more.
“I love working in a team and having the support of a multidisciplinary team, where everyone’s expertise is so valuable to the care of that patient and their family,” says Dr. Rughwani. With an eye toward the future, she hopes to continue increasing the size and scope of the Geriatrics Ambulatory Practice and diversify its services.
Following the opening of this practice, Mount Sinai Morningside received esteemed designation as an Age-Friendly Health System Participant by the Institute for Healthcare Improvement.
Kudos: Special Faculty Awards and Achievements
Shahla Barharlou, MD, was reappointed Chair of the Society of General Internal Medicine Geriatrics Commission.
Joyce Fogel, MD, and Rosanne Leipzig, MD, received a grant renewal from the UJA Federation for their work with dementia-friendly naturally occurring retirement communities.
Judy Howe, PhD, was elected as Vice President for the Gerontological Society of America.
Noelle Marie Javier, MD, was appointed to the American Geriatrics Society Ethics Committee.
Alexander V. Kalicki, BS; Kate A. Moody, BS; Emily Franzosa, DrPH; Peter M. Gliatto, MD; and Katherine A. Ornstein, PhD, MPH, received a Journal of the American Geriatrics Society Editors’ Choice Award for their paper titled “Barriers to Telehealth Access Among Homebound Older Adults.”
Reena Karani, MD, MHPE, was awarded a 2022 Icahn School of Medicine at Mount Sinai Jacobi Medallion.
Amy S. Kelley, MD, MSHS, was appointed Deputy Director of the National Institute on Aging.
Nisha Rughwani, MD, was appointed to the American Geriatrics Society Quality and Performance Measurement Committee.
Addressing the Physical, Psychological, and Social Needs of Aging HIV Patients
At the start of the AIDS epidemic, it was hard to believe that young patients would live to become older adults. Yet many people with HIV are now living well into their 70s, and face complications of HIV in addition to conditions of normal aging.
“The unique needs of the aging HIV population demand a new model of care that addresses needs not typically encompassed by traditional primary care, HIV, or geriatrics practices alone,” says Nathan E. Goldstein, MD, Site Chair of the Brookdale Department at Mount Sinai Downtown. “In addition to physical conditions, these patients deal with the stigma of HIV that still exists in our society and the societal stigma around aging, which increases their levels of stress and hardship.”
In partnership with Mount Sinai’s Institute for Advanced Medicine, the Brookdale Department has created a unique program to meet the physical, social, and psychological needs of this population. Supported by the Keith Haring Foundation, Mount Sinai launched a pilot program within the Peter Krueger Clinic, which placed a geriatrician, social worker, nurse, and pharmacist in the practice for added patient support.
The program, run by Angela Condo, MD, Assistant Professor
Brookdale Department of Geriatrics and Palliative Medicine
Icahn School of Medicine at Mount Sinai One Gustave L. Levy Place, Box 1070, New York, NY 10029 212-659-8552 mountsinai.org/care/geriatrics
@MSHSGeriPalCare
of Geriatrics and Palliative Medicine, showed success when measuring patient experiences and outcomes.
A new three-year grant from the federal Health Resources and Services Administration will allow the program to expand across the Mount Sinai Health System. The grant will add a community health worker to the team, and create a curriculum that trains HIV providers in the care of older adults.
To learn more about the Geriatrics HIV Program, please contact the Peter Krueger Clinic at 212-420-2620.
Sally Parisi-Esposito, RN; Dale Mandelman, RN; Angela Condo, MD; and Deborah Alonzo, PCA