Healthy older adults have needs that require specialized attention, but add in an emergency situation, and these needs are compounded. Taking a comprehensive approach, hospitalist Andreea S. Xavier, MD, works with Charles L. Maddow, MD, to improve the care of older adults in emergency settings. In recognition of their specialized efforts, Xavier and Maddow were appointed the inaugural holders of the Wyatt Ranches Distinguished Professorships in Geriatric and Palliative Medicine in 2020.
Maddow describes the aging process as a deterioration of homeostasis. “A young person is in a state of homeostasis, where conditions stay the same, and the body can absorb a lot of trauma. Their physiology will ramp up to accommodate it,” explains Maddow. “An older patient is already cutting into that physiological reserve just to maintain function.”
This puts older adults at different risks than younger patients, which requires specialized training for health care professionals to identify different risk factors and approaches to care—just like children and pediatric care. Until fairly recently, people 65 and older were treated just like other adults. However, as we learn more about their specific needs, our understanding has changed. Maddow’s goal is to teach the knowledge and skills of geriatric emergency care to prepare health care professionals to appropriately treat the increasing number of older adults in our communities. UTHealth houses one of the few academic programs that specializes in geriatric emergency medicine.
“I introduce this concept and make sure our students and health professionals know what to do with those differences—such as identifying early pre-shock states because older adults hide it well, or working with pharmacists to identify when there is a better alternative to a medication,” he says. “It’s a huge honor and responsibility to hold the Wyatt Ranches Distinguished Professorship, which is helping me with this training initiative. There’s so much to be done, and I’ve been given a great tool with which to get it done.”
When an older adult arrives in the emergency room to receive outpatient care, Maddow will conduct an assessment to determine the patient’s needs. If the patient needs to spend time in a hospital, then Maddow transfers care to Xavier. “There’s a lot of communication between the hospitalists and the frontline emergency providers,” says Maddow. “It’s really collaborative.”
In addition to serving on faculty in the Department of Emergency Medicine, Xavier is the Medical Director of the Hospital Medicine Team at Memorial Hermann-Texas Medical Center. The team cares for geriatric patients across the hospital. Xavier is using funds from the Wyatt Ranches Distinguished Professorship to educate faculty, students, and residents on the unique needs of older adults.
Together, the geriatrics team and the Hospital Medicine Team established a certification program for acute care providers. This 13-month interdisciplinary course will provide essential geriatric health training to professionals from across disciplines, including topics such as prescribing age-appropriate medications, recognizing the difference between illness and normal aging, and managing multiple chronic conditions. The first phase began in October 2020.
“I’m honored and humbled by this great opportunity to hold the Wyatt Ranches Distinguished Professorship,” reflects Xavier. “I see it as an avenue to improve the way we care for older adults and to implement patient-centered care, especially as we transition care from outpatient to inpatient settings.”