Medical teams evaluate and educate older adults, looking for ways to enhance their quality of life
"I'm an old man, but I try to live a healthy lifestyle," says George Perry, one of more than 400 St. Louisans to take advantage of a new School of Medicine initiative designed to help older adults live healthier, more productive lives. "I have my good and bad days like everybody else. But the health care team told me some things about bone health, exercise and my medicine that might bring me a few more good days down the road."
This new healthy aging initiative, offered by the Community Outreach Program in the School of Medicine's division of geriatrics and nutritional science, identifies and treats factors that may contribute to disability among older adults. The goal of the program, led by Stanley J. Birge, MD, professor of medicine, is to improve quality of life and promote independent living.
For the past year, teams of physicians, medical students, pharmacists, physical therapists and social workers have been presenting information about healthy aging and performing free medical and functional assessments and bone density examinations at senior housing developments and community centers across the St. Louis area.
"By meeting with, evaluating and educating these older adults, we hope to find ways to improve quality of life for each of them," says Kimberly Sieve, the program's administrative director.
"We have found that the principal causes of disability among older adults in our community are obesity, osteoporosis and depression," says Sieve. "The outreach evaluates mood, physical function (including measures of strength, balance and ability to perform routine daily activities) and bone density. In addition, a pharmacist looks at each participant's list of medications to identify potentially harmful drug interactions."
Staff also take along a machine that can detect weakened bones. Called peripheral Dual Energy X-ray Absorptiometry (pDEXA), the test involves taking a type of X-ray of the wrist or forearm.
According to Birge, vitamin D deficiency often is the root of osteoporosis and frailty in older adults. Staff work to intervene by providing four-month supplies of calcium and vitamin D supplements for seniors who get low scores on the bone density screening test and who show signs of vitamin D deficiency.
When problems are identified, elderly people also are referred into other interventions run in conjunction with OASIS, a nonprofit educational organization designed to enhance quality of life for older adults.
Because many studies have shown that even very frail people can improve their physical function with physical activity, team members often encourage people to begin exercising regularly.
"In the frail elderly, a physician should be consulted before beginning any exercise program, and osteoporosis should be considered," says Birge.
In addition to screenings, the new initiative allows medical students, residents and fellows to learn new skills related to geriatric medicine.
"When possible, we use student volunteers to help at our events," Sieve says. "Nationally, there is a shortage of medical students who plan to go into geriatric medicine at a time when the population of seniors is exploding. We hope these screening programs make our medical students more aware of and sensitive to the issues facing seniors."
Volunteer David A. Yawitz was instrumental in launching the program and acquiring the pDEXA machine it uses to identify problems, and he's often on site to educate older adults about osteoporosis.
"I attend all of the screenings because I'm a very 'hands-on' person," Yawitz explains. "And I think it's great that we've been able to put this together and take services where they are needed. I think we are making a real difference in the elderly population living in our community."
A native St. Louisan, Yawitz and his wife spent 16 years living in California, where she was diagnosed with osteoporosis and he dedicated himself to learning about the disease.
"My best friend was a rheumatologist, and he used to teach me about osteoporosis on Sunday afternoons sitting by a Koi pond," Yawitz recalls. "The more I learned, the more I could see how devastating the disease could be and how great the need was for screening and intervention."
He became involved in outreach and osteoporosis screening on the West Coast and, when the family moved back to St. Louis, Yawitz went to work to design and organize the effort, joining forces with Samuel Klein, MD, the Danforth Professor of Medicine and Nutritional Science and chief of the division of geriatrics and nutritional science.
He recently created the David A. and Linda S. Yawitz Community Outreach Fund to support the effort. Other support for the program comes from Barnes-Jewish Hospital, BJC Healthcare, the Atkins Foundation and the Kilo Foundation.
"Without the generosity of the Yawitz family, charitable foundations and our medical center, we couldn't provide these unique services, which we hope will improve the quality of life in older adults," says Klein.
The hope is to identify problems that might have been undiagnosed previously and to help people coordinate and streamline care for problems of which they're already aware.
It's probably not surprising that the pDEXA screenings have uncovered osteoporosis in most older adults who have taken part. It's one of the most common and underdiagnosed diseases in the elderly population. What's a bit more surprising is the finding that many of these older adults also are depressed.
"It's not a scientific sample by any means, but our depression screenings have revealed that about one in four older people is depressed," says Monique M. Williams, MD, instructor of medicine and of psychiatry, who directs the mood component of the outreach effort. "That's important, because untreated depression is a huge risk factor for disability."
At 82, Perry says he's lucky: He isn't overweight or frail, and he doesn't have serious problems with diabetes, high blood pressure or the other scourges of old age. But he's an excited participant in the screenings. "At my age, you've got to do what you can to help things along," he says.