Division Spotlight

Highlighting our community and achievements.

The Department of Medicine is the largest department in the University of Washington. Throughout the year, we will highlight each of our divisions and programs to acknowledge their achievements and history, providing a place for us to learn more about each other.

Our latest spotlight is on our Division of Gerontology and Geriatric Medicine

History

An expanding awareness of the special care needs of older patients became common in the United States and European medical systems in the years following World War II.

At the University of Washington, a section of geriatrics developed organically among like-minded physicians in the Division of Endocrinology in the 1960s.

Dr. Itamar Abrass
Dr. Itamar Abrass

In 1977, the discipline of gerontology separated from the Division of Metabolism and Endocrinology, and the Division of Gerontology and Geriatric Medicine was established under the leadership of prominent endocrinologists, including Ed Bierman, Bill Hazzard, and Itamar Abrass.

The focal point of the new division was at Harborview Medical Center, with establishment of the SeniorCare Program in the 1980s. Later that decade, momentum built to establish geriatrics as a formal added qualification within internal medicine, followed by formal recognition as a subspecialty.

Special advanced training in fellowships began in the late 1980s and continues today, with our division training four fellows per year, whom we hope will be the next generation of leaders in geriatrics.

Geriatric Medicine fellows, 2016-17
Geriatric Medicine fellows, 2016-17 (Marissa Black, Yan Chen, Judy Yee Kwok,Toral Parikh)

Growth

Geriatrics at the VA

Along with the development of geriatrics at Harborview, a strong geriatrics clinical and research initiative became a funded mandate within the VA Health Care System. The Geriatrics and Extended Care [GEC] Program, and the Geriatric Research Education and Clinical Center [GRECC] grew alongside the initiatives at Harborview, and the division grew at both sites.

The Seattle GRECC is now one of the most prominent research centers within the entire VA Health Care System.

Palliative medicine

Palliative and supportive medicine services. Photo Clare McLean/UW Medicine.

Just as the geriatrics strength grew organically in the Endocrinology Division half a century ago, the palliative medicine strength at UW is, to a large extent, in the Geriatrics Division.

In the past decade, the hospice and palliative medicine movement has grown steadily and this has led to robust programs at all UW Medicine medical centers and the VA.

Palliative medicine crosses many specialties. No one owns it, and everyone owns it.

Several departments and divisions share the palliative medicine work, but much of the clinical, research, and educational initiatives are housed in the Geriatrics Division, including the palliative medicine fellowship program.

Under the leadership of Dr. Wayne McCormick, the Palliative Medicine Fellowship was developed in 2009 to meet the health care needs of an aging population and address severe and chronic illness affecting individuals of all ages.
 

Palliative Care fellows, 2016-17
Palliative Care fellows, 2016-17 (Laura Buck, Edward Dropcho, Lindsay Gibbon, Efrat Lelkes, Amisha Mehta)

Clinical care

Senior care

The SeniorCare Program was initially conceived in 1976 by the UW Long Term Comprehensive Care Committee. In 1979, we began the outpatient clinic portion (now known as the Senior Care Clinic) and in 1980 the inpatient program (now known as Medicine G) was started. 

The Senior Care Clinic at Harborview, directed by Dr. May Reed, provides primary care and consultative services for patients aged 65 years and older with a geriatric syndrome such as cognitive impairment, falls, gait instability, frailty, and/or functional decline.

Fall prevention

The Fall Prevention Clinic provides falls/mobility assessments and treatment planning to patients aged 65 and older, or younger patients, as needed. Our goals are to serve those who have not yet fallen, but may be at risk, and to manage care for those with a history of falls in order to prevent subsequent falls with serious injury.

UW Long Term Care Service

The UW Long Term Care Service started in 1990. We currently have 12 affiliated skilled nursing facilities as well as several assisted living facilities and group homes to specifically accommodate patients discharged from the University of Washington Medical Center, Harborview Medical Center, and the VA Puget Sound Health Care System.

Dr. Thuan Ong currently leads this medical team – consisting of ten physicians and six nurse practitioners as well as several support staff – that cares for over 600 patients in nursing homes, assisted living facilities, adult family homes and in house calls.

UW Long Term Care Service
UW Long Term Care Service

Recent advances in research

Improving care for older adults through collaborative education

The University of Washington is one of 44 organizations around the country that has been awarded a Geriatrics Workforce Enhancement Program (GWEP) grant from the U.S. Department of Health & Human Services (HHS). HHS has awarded $35.7 to improve care for older adults.

Dr. Elizabeth Phelan directs the UW program – the Northwest Geriatrics Workforce Enhancement Center (NW GWEC) – which is a collaboration of partner organizations across the state.

NW GWEC will engage and train primary care providers in geriatrics and Alzheimer’s disease and related dementias (ADRD) via case-based learning and support of practice-based quality improvement projects. 

Insulin to treat dementia

Alzheimer’s disease and other, similar forms of dementia have become one of the most severe socioeconomic and medical burdens impacting modern society. 

Dr. William Banks is part of a research group studying intranasal compounds to treat dementia. The group has made a promising discovery that insulin delivered high up in the nasal cavity goes to affected areas of brain with lasting results in improving memory.

Benefits of testosterone treatment in older men

Dr. Alvin Matsumoto, who was interim head of the Geriatrics Division from 2012-15, studies testosterone levels in older men. The "Testosterone Trials", recently published in JAMA and JAMA Internal Medicine, reported the effects of testosterone treatment in older men (with low testosterone) on cognitive function, cardiovascular function, bone density and anemia.

The researchers found that testosterone treatments improved bone density and anemia, but did not improve patients' cognitive function, and it increased the amount of plaque buildup in the participants' coronary arteries. 

Improving end-of-life care

Dr. Joan Teno joined the faculty in 2015. Her research focus is on measuring and evaluating interventions to improve the quality of medical care for seriously ill and dying patients.

Dr. Joan Teno
Dr. Joan Teno

Her research has shown that some lifesaving devices may prolong suffering without a clear benefit. Many patients and family members would like care to focus on comfort rather than on medical goals such as survival and organ function. 

She has also found that one in eight dying patients receiving Medicare-funded hospice care were not visited by hospice staff in the last two days of life. 

“It is critical that dying hospice patients receive the needed professional visits in the last days of life to ensure that death is as comfortable as possible and the family receives the support they need to take care of their loved one,” she said.

Dr. Teno recently presented: "Embracing complexity at the close of life: Why advance directives are not enough" at Medicine Grand Rounds. 

The future 

In the near future, the Geriatrics Division will gradually expand its clinical services to all UW Medicine entities, including the medical centers, clinics, and post-acute care settings. The research initiatives will grow in brain research (particularly Alzheimer’s disease), geriatric oncology, and other areas.

There are now 30 faculty members, with strong research and training programs for all disciplines. Our clinical leaders are developing expansion of UW post-acute care initiatives in concert with the growth of accountable care organizations, and helping the medical centers with early consultative intervention in geriatrics and palliative medicine.

Our vision and mission for the future

Grow

Grow the clinical research programs in geriatrics by collaborating and interdigitating with existing research programs.

Build

Build collaborative, blended consultative geriatrics and palliative medicine programs in key areas, including orthopedics, trauma, and palliative care.

Develop

Develop programs that promulgate “primary geriatrics” training, such that geriatrics care principles permeate all pertinent UW medical and surgical specialties and sub-specialties, even as we increase awareness of the value of sub-specialty geriatrics consultation.