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Bridging the GAP

Bridging the GAP
USC pharmacist Bradley Williams and Andrus volunteer Betty Sims

Rekindling the romantic spark between a 90-year-old wife and her 94-year-old husband was just another day at the office for the Geriatric Assessment Program (GAP), a cross-campus project with interdisciplinary roots at USC.

“This is especially valuable for older adults with multiple health problems and for people who are uncertain that their health problems are being fully and accurately diagnosed,” said USC Davis School of Gerontology professor Bob Knight.

A free resource, GAP turns the multiple, often-complicated office visits made by aging patients into a single consultation with a medical team that spans USC’s professional scope.

Based at the on-campus Tingstad Older Adult Counseling Center and convening on Tuesday afternoons, GAP unites the Department of Psychology and the USC schools of gerontology, medicine, pharmacy and dentistry to provide patients with a convenient and rigorous evaluation performed by a geriatrician (Patricia Harris), geropsychologist (Knight), geriatric social worker (Anne Katz), geriatric pharmacist (Bradley Williams) and geriatric dentists (Piedad Suarez Durall and Roseann Mulligan).

“I’ve never had an opportunity like this before,” said participant Barbara Merkel. “In this day and age, where else are you going to get a real live pharmacist or doctor to actually listen to you without checking their watch?”

According to Harris: “As the population ages, we need to take into consideration the complexity of their care, the needs of caregivers and the growing need for support in the community to keep elders safely at home for as long as possible.

“We need more emphasis on the aging population if we are going to serve them well as they live into their 90s and beyond.”

While GAP is not intended to replace a patient’s primary care physician, it can offer vital health and diagnostic reinforcement through a specialized geriatric lens.

“Most providers are not experts in the care of older adults, and they can use [the information provided by GAP] as guidance to maximize the benefits received by their patients,” Williams said. “It is important for older adults who may feel overwhelmed by their health problems to consider the value of seeing multiple experts in one place at one time, working together, to offer them recommendations.”

Accompanied by a family member (if they choose), the patient brings in the contact information for their primary care physician, their medical records and all of their medication in its original bottles. (If they are unable or unwilling to locate these items, they are still seen.)

Patients receive the undivided attention of the clinicians for an average of two and a half hours, and then make their follow-up visits with their primary doctor. If possible, GAP will provide a follow-up to the initial assessment, but the program stresses this point: It is in no way meant to replace a patient’s needs in primary care.

“We get a lot of positive feedback from the patients and have been successful in connecting many of them with ongoing services at USC,” Knight said.

Along these lines, the team has been able to make a difference in areas, such as oral health, that many older adults may let fall by the wayside as they age.

“For many older adults, their overall oral treatment is often complicated by their medical conditions, medications and mental status,” Mulligan said.

In fact, GAP was able to help three patients, who could not otherwise afford dental treatment, receive a complete set of dentures through a grant from the L.A. Care Special Patients Clinic at the Ostrow School of Dentistry of USC.

Social work is another aspect that is crucial to the well-being of older adults. In fact, the social worker is the first contact the patient has, and in many ways becomes his or her virtual lifeline.

“We do a home assessment and complete a bio-psycho-social intake. We work within a systems model to connect the person to various resources in the community, including in-home help, Meals on Wheels, day care, legal referrals and individual, family and group counseling,” Katz said.

Anyone attempting to navigate the health care delivery system can speak to how dehumanizing, impersonal and confusing the experience can be. By putting a friendly group of familiar faces at the center of GAP, the program has gone a long way toward fostering goodwill between patients and care providers, as well as helping participants feel more invested and empowered in their own health outcomes.

“I became good friends with Dr. Katz,” said participant Phoebe Heywood. “Every time I come around, she asks for me. I didn’t even feel embarrassed, and I learned a lot.”

Positive word of mouth has helped the program grow in esteem among participants, as well as students, and they regularly take part in the GAP examinations.

“I’m hoping that we can use GAP to encourage students to pursue geriatrics as a professional focus,” Williams said. “There is a great need and too few providers to meet that need.”

Meanwhile, students and patients aren’t the only ones benefiting from this brain trust.

The clinicians’ teamwork more than anything else represents the changing goals of GAP, and the success of the program shows just how traditional attitudes toward older adults’ medical treatment are evolving.

“This interdisciplinary group reflects where health education is going – teamwork to provide more efficient and comprehensive treatment,” Durall said.

Bridging the GAP

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