STEP-HI Study

Healthy Aging

Dr. George Kuchel

According to the U.S. Census Bureau, the number of Americans over 65 is expected to almost double by 2060. An aging population means caring for more Americans living with cancer, obesity, and Alzheimer’s disease, among other challenges. UConn Health Journal asked gerontologist Dr. George Kuchel about the key phases of geriatric care.


Dr. George Kuchel Director, UConn Center on Aging; Travelers Chair in Geriatrics and Gerontology, UConn School of Medicine


Q

Why should a patient see a geriatrician?

At our multidisciplinary geriatric clinic, we see older adults who wish to maintain their health, function, and independence, as well as those facing a crisis. Geriatricians are specialists on the complex issues arising from having multiple coexisting chronic diseases, multiple medications, and multiple providers. We work with each patient and their family and referring physician to come up with an optimal plan that meets their unique needs and goals.


Q

What is the Center on Aging doing to address the unique challenges related to hospitalization in this population?

At most hospitals, nearly half the inpatients are 65 years old and older. To raise the overall level of care for these patients, we bring together all of the providers they need — physicians, nurses, physical therapists, social workers.

With older adults, the greatest challenges associated with hospitalization include delirium, falls, and declines in mobility. We’re actively involved in several National Institutes of Health–funded research efforts to improve outcomes after hospitalization, including the Starting a Testosterone and Exercise Program after Hip Injury, or STEP-HI, study to improve function in women who’ve broken a hip. A few years ago, we joined the NICHE program (Nurses Improving Care for Healthsystem Elders), a nursing-led multidisciplinary strategy to improve outcomes for hospitalized patients. None of this can be accomplished without engagement and leadership by nurses.


Q

What makes older patients more likely to be readmitted during post-op/recovery?

Bed rest leads to loss of muscle strength, which happens quickly in older adults. Many people continue to need monitoring or help with medications after hospitalization, which may require a stay in an intermediate facility for rehabilitation. When transitioning from one institution to another, there’s potential for some real gaps in care, such as medication errors.

Transitional care programs like the ones at our partner rehabilitation facilities — where one of our physicians provides care during post-acute rehabilitation — help to overcome these challenges. The physician’s work is integrated with the work of the discharge planners and the care team here; they’re familiar with the protocols; and they have access to our electronic medical record system. There’s seamless communication and a continuity of care. We’ve seen noticeable reductions in our hospital readmission rates among patients under the care of our physicians in skilled nursing facilities. The best example of this is at Avon Health Center, where we’ve seen a 77% reduction in the 30-day readmission rate in the three-plus years we’ve had a physician assigned there.