UT Houston Responds to Need for More Geriatric Specialists

As the country faces a critical shortage of health care workers to meet the needs of millions of aging baby boomers, researchers and clinicians at The University of Texas Health Science Center at Houston are rising to the challenge by training and educating those who will be on the front lines of care.



Carmel B. Dyer, M.D.
That response includes a new geriatric fellowship at The University of Texas Medical School at Houston; the interdisciplinary Houston Geriatric Education Center established with a grant from the U.S. Department of Health and Human Services; the Center on Aging and a geriatric nurse practitioner program at The University of Texas Health Science Center at Houston School of Nursing; and the addition of geriatric specialists across the university.

The Institute of Medicine of the National Academies reported in April 2008 that the nation faces an impending health care crisis as the number of older patients with more complex needs outpaces the number of geriatric specialists. Between 2005 and 2030, the number of older adults in the country will nearly double.

“We’re very concerned about whether the country is prepared. People are calling us every week asking for help for their parents,” said Carmel B. Dyer, M.D., professor and director of the Division of Geriatric and Palliative Medicine, part of the Department of Internal Medicine at the medical school.

“One of my reasons for going into medicine is that I want to be relevant,” said Faith Atai, M.D., who along with Suparna Chhibber, M.D., will begin her geriatric fellowship in July. “So the fact that there’s a shortage of geriatricians attracted me to the fellowship. I’m already in primary care and as my patients age, I want to be able to take care of them.”

Treating geriatric patients requires special skills, Dyer said.



UT Houston gerontological nurse practitioner Sabrina Pickens examines patient Susan K. Searle while her son, John R. Searle, Ph.D., observes.
“You must know how to take care of older patients who have multiple medical conditions, have functional impairments or memory changes and react to medications differently than middle-aged adults,” said Dyer, who is the Roy M. and Phyllis Gough Huffington Chair in Gerontology. “You must be able to help your patients and their families access community resources, maintain independence through medical and non-medical means and help recognize and even prevent mistreatment including financial exploitation.”

The geriatric fellowship builds on an effort begun in 2007 with the establishment of the new Division of Geriatric and Palliative Medicine in the Department of Internal Medicine and the recruitment of Dyer.

The goal of the fellowship is to train board-certified geriatricians to teach geriatrics to other clinicians and trainees as well as to become expert clinicians in the care of older patients in a wide variety of settings including hospitals, clinics, nursing homes, private homes and rehabilitation centers.

“Dr. Atai and Dr. Chhibber are great candidates and we’ve very excited about having them join us,” said Kathryn Agarwal, M.D., director of the Geriatric Fellowship Program. “They will focus on the differences in care for the very frail elderly, who have more multiple chronic illnesses as well as functional decline and cognitive problems such as dementia.”

The division now includes five geriatric and palliative physicians and three geriatric nurse practitioners, and a sixth physician is expected to join the team in July. Dyer, chief of Geriatric and Palliative Medicine at Lyndon B. Johnson General Hospital, has established clinical teaching programs at LBJ and Memorial Hermann - Texas Medical Center. The physicians and nurse practitioners also see patients at UT Physicians clinics and make house calls, as well as work with Adult Protective Services to ensure the safety of their patients.

“We are building on the already great work done at the Center of Aging, School of Nursing, and the Department of Family and Community Medicine in the medical school,” Dyer said.



Sharon K. Ostwald, Ph.D., professor in the Center on Aging at The University of Texas Health Science Center at Houston School of Nursing, works with students during the 2008 Interdisciplinary Student Team Competition in Elder Abuse and Neglect, which was hosted by the Houston Geriatric Education Center (HGEC). The HGEC trains interdisciplinary students, residents and faculty in the care of older people, especially the frail elderly.
The Center on Aging, established in 1987 by the nursing school, is part of the interdisciplinary Houston Geriatric Education Center (HGEC), which focuses on the needs of the most vulnerable elderly.

While the fellowship will train geriatric physicians, the HGEC trains interdisciplinary students, residents and faculty in the care of older people.

The center recently held the 2008 Interdisciplinary Student Team Competition in Elder Abuse and Neglect. Thirty students from 10 different disciplines from UT Houston, the University of Houston and Texas Woman’s University participated.

“One of the goals of this competition is for the students to learn about elder abuse, neglect and exploitation,” said Sharon K. Ostwald, Ph.D., professor in the Center on Aging and holder of the Isla Carroll Turner Chair in Gerontological Nursing. “Another goal is for the students to learn more about working with an interdisciplinary team. We really hope that students will see the value of each other’s contributions and learn to consult other disciplines in their real practice.”

Ostwald and Dyer are co-principal investigators of the $650,000 grant that established the HGEC, which includes geriatric specialist Tom Cole, Ph.D., professor and director of the John P. McGovern, M.D. Center for Health, Humanities, and the Human Spirit, and June Sadowsky, D.D.S., assistant professor at The University of Texas Dental Branch at Houston.

Cole works with medical students in clinical applications, teaching them to integrate care into the life story of the patient.

“Older people want to be healthy for a reason. They want to be whole, to be connected,” Cole explained. “If you are doing rehabilitation, for example, it’s not about just learning how to button the shirt. It’s about learning how to button the shirt so you can go out and play with your grandson.”

Sadowsky, who did her fellowship training in geriatric dentistry at Audie L. Murphy Memorial Veterans Hospital and the UT medical and dental schools in San Antonio, calls herself a “geriadontist.”

Sadowsky, who has treated dental patients in nursing homes, teaches dental students about the differences in treating the elderly. One of challenges, she said, is that as people age, they don’t make as much saliva, which can cause gum problems and tooth decay. Products with alcohol will make the problems worse.

As the need for dental geriatric specialists increases, she wants to do more.

“I dream about having a geriatric course and then a dental geriatric fellowship,” Sadowsky said.

“Over the next several years, the deman d for physicians, nurses, and dentists who understand the needs of the elderly will grow exponentially,” said Brent King, M.D., executive vice dean for Clinical Affairs at the UT Health Science Center at Houston. “Likewise, the aging population is expected to place new demands upon our scientists and public health officers. We are preparing now to meet these challenges by training the geriatric specialists of tomorrow.”