Profiles in Geriatrics

The interdisciplinary nature of geriatrics provides the opportunity for physicians to learn from and collaborate with nurses, social workers, pharmacists, therapists, and gerontologists, thereby broadening our clinical perspectives and enriching our professional experience. I have encountered no other medical specialty with such scope and breadth, or colleagues with such intellectual curiosity and deep humanity. In turn, our patients, many of whom have multiple medical, functional, behavioral, and psychosocial issues, benefit from the comprehensive care that only geriatricians have the expertise to provide. These unique aspects of the practice of geriatrics have sustained my passion, curiosity, and interest in our field for the last 20 years.

Since fellowship, my interest has consistently gravitated towards the brain and memory disorders. To me, the brain is a fascinating organ whose inner functioning remains a mystery to modern medicine. It seems that the more answers we get, the more questions arise. The more discoveries we make, the deeper its mysteries get. For decades we have generally accepted that amyloid plaques are the cause of the progressive neurodegeneration and loss of cognition and function in Alzheimer’s disease. Now that we have a way to effectively clear amyloid from the brain and yet the disease continues to march forward, we accept that there are other processes—inflammation, atherosclerosis, tau, microglia—that are involved. The same can be said about other conditions like frailty and delirium. 

The complexity of age-related diseases keeps geriatrics researchers busy and clinicians humble in accepting that there will always be mysteries whose solutions are just beyond our reach. Indeed, ‘to cure sometimes, to relieve often, to comfort always’ still holds true for the treatment of age-related conditions. With my interest in memory, I chose geriatrics over other related specialties like neurology and psychiatry because it is only with the broad scope of geriatric medicine that I can address the entirety of my patient’s challenges. When I see a patient for a memory evaluation, as a geriatrician I can unravel the functional, psychological, and social challenges that often dwarf the challenges from their cognitive deficits. From gait and balance to medications and sleep, being a geriatrician memory specialist provides me with a whole person view of the challenges of my patient that have their root in the brain but extend well beyond it. I consider my patients and caregivers as dyads whose health and outcomes are closely intertwined, making it possible for me to form lasting relationships with my patient’s entire family.

As I reflect on my AGS membership experience thus far, I can’t help but look back at the first meeting I attended in Chicago when I was a research fellow. Besides the inspiring plenary talks, the stimulating research presentations, and the rows upon rows of posters, an indelible memory was the air of friendship and collaborative spirit that pervaded the hallways and the conference center. Everywhere I looked, I saw signs of a community coming together. The small group huddled in a discussion, the one on-one meetings between junior and senior geriatricians, and most of all the tight hugs and huge smiles akin to the meeting of long-lost friends impressed upon me the reason why I need to be part of AGS. All these years of being a member has only reinforced that decision. Thanks to AGS, I have had the privilege of being mentored by some of the geriatrics research greats—Inouye, Lipsitz, Kiel, Reuben—but it’s the geriatrics mentoring greats—Fabiny, Gillick, Mosqueda, and countless others—who had the greatest impact in my career path. By gentle nudging, thoughtful questioning, and intent listening, these geriatrics mentors have helped me discover my interests and explore my true passions. Now I am doing the same for more junior geriatricians, hopeful that I can impart some wisdom and provide guidance in their journey.

Why am I a member of AGS? It’s been my professional home for decades—a constant community beyond the four walls of my current institutional home. It’s where I met my mentors, teachers, mentees, and friends. This is why now—over 20 years later—I continue to look forward to every AGS meeting with a similar degree of curiosity and excitement of the new things I will learn, the novel ideas I will hear, and the friends—new and old—that I will have the opportunity to meet.

My inspiration to become a geriatric nephrologist came to me during my nephrology fellowship. I’d encountered some difficult clinical scenarios that centered around older adults on dialysis who had repeatedly been admitted from nursing homes, and whose families wrestled with the complicated decision to start dialysis. 

It wasn’t until I was exposed to the idea of geriatric nephrology during my fellowship curriculum that I realized there was a way to specifically care for older adults who had kidney disease, and that there were abundant research opportunities that focused on the field. Since then, I have been very interested in the care of older adults, their mobility and cognitive impairment, and about learning the principles of geriatric medicine. 

Although I didn’t complete a geriatrics clinical fellowship, I had deep exposure to geriatrics through my advanced fellowship in geriatrics administered through the VHA. 

I’ve been an AGS member since 2017—it took my first trip to an AGS Annual Meeting to convince me that the resources and community AGS offers is a great fit for me and my career goals. I enjoy meeting and networking with the community of healthcare professionals whose  drive for improving care for older adults is similar to mine. That’s particularly inspiring for someone like me who’s bridging geriatrics to nephrology. Professionally, my membership means I’m presented with opportunities for career development, mentoring, and collaborations through AGS. 

As a very special benefit of my AGS membership, I recently was honored by winning the Arti Hurria Memorial Award! This really means a lot to me. I know how bright Dr. Hurria’s star shined, and I can only strive to have my research have as huge an impact as hers did. 

A normal day in my life looks like at least a couple of hours writing for a manuscript or a grant. The rest of my day may be interpreting research findings, attending research meetings, or seeing patients in my clinic. I have been grateful for my geriatric nephrology clinic at the Durham VA healthcare system because it allows me to incorporate geriatric principles into caring for older people with chronic kidney disease. It fuels my research.

I find it very rewarding to be in a position to view clinical care from both perspectives, geriatrics and nephrology, and to give that unique lens to my patients. 

My time away from work is primarily spent with my family. Things are really challenging in the world today on top of building a research program, so some things that keep me steady are practicing mindfulness and journaling every day. 

My inspiration to become a geriatrician struck between my first and second year of medical school, when I worked in a rural hospital near where my family had homesteaded generations earlier. I assisted a doctor who did it all—nursing home rounds, house calls, hospital visits, you name it. Because the older folks stayed in that small town for their medical care, most of his patients were older adults. I fell in love with those people and realized I would be happy spending the rest of my professional career working with them.

During my second year of medical school in 1974, I’d read a letter in The Lancet by a doctor from Central Middlesex Hospital in London. He made the point that training students of various professions together was the right way to teach geriatrics. At the time, there was no training in geriatrics for medical students and certainly no inter-professional training in this country, so I sent him an airmail letter and eventually I went to London to study geriatrics as a senior medical student. I never looked back.

Upon my return to the U.S., I became an AGS member during my internal medicine residency in 1976. Though I’ve enjoyed different AGS activities at different points in my career, as I think back across my 40-some years of membership, one of the most enduring benefits has been the collegiality and support that I get from other members, as well as the bountiful resources the AGS provides. I’ve learned so much from the many projects I’ve participated in, and it’s wonderful to be among so many like-minded people who are on the cutting-edge of our field. I particularly take delight in the annual meetings, where I get to network with friends and colleagues and participate in the scientific sessions and symposia. Even if I can’t attend something I’m interested in, I can review the presentations and slide sets online. I love how accessible and user-friendly the AGS has made our meetings.

Right now, I’m engaged with the Geriatrics Workforce Enhancement Program (GWEP) Coordinating Center, which will support centers of geriatrics education that will become epicenters for addressing shortages in the geriatrics workforce. The Coordinating Center is so tied to the AGS vision and mission—for a least a decade, we’ve recognized that, because there won’t be enough geriatricians to meet the needs of the burgeoning older adult population, we need to raise the level of geriatrics expertise across professions as well as in primary care. This will help ensure that older adults will have the quality health care they need and deserve.

While raising the bar of geriatrics knowledge for all providers is essential, there remains a critical need for geriatricians and geriatric health professionals to lead the field in training and research. And that is the biggest challenges we face in geriatrics. Though we know that geriatricians are among the most satisfied physicians, conveying the “joys of geriatrics” to medical students and people in training in a way that draws younger people into the field remains elusive. I work with students across the disciplines and share with them the fact that geriatrics is fun, interesting, challenging, and rewarding. It’s a great career that doesn’t wear out or get boring. Also, the rewards are multiplied because you’re not only caring for older people but also often caring for families and caregivers.

Finally, I’d like people to understand how constantly fascinating geriatrics is as a career. There’s no such thing as a boring day in the clinic, and there’s not a day when I don’t learn something new. And you’re dealing with extraordinarily interesting people who are grateful for everything you do for them. When you improve an older adult’s functioning by just 15 percent, they view that as a huge success.

I grew up in my family’s trailer park in rural Arizona raising cattle and sheep. If you told me then I would be a geriatrician one day, I would not have believed it. My first encounter with octogenarian
healthcare was with my Great Aunt Mary, who was my surrogate grandmother growing up, and taught me how to “eat like a lady.” When I was 9 years old, we went to visit her, but this time was different. The color was gone from her body, her hair was grey, and her eyes were closed. I was too afraid to talk to a woman I loved dearly. I didn’t know it then, but this was my first experience with home hospice. She died an hour after I left. 

I carried the guilt of being afraid to say goodbye with me as I decided to go to college. I was involved in scientific research and interested in physiology, but something was missing. So, sort as of an amends for my 9-year-old self, I started volunteering for a hospice agency. My life changed in those years. I learned the value of a story, and what amazing stories they were. I learned about the struggles older adults face and how to hold their hands through it. I didn’t have the language at the time, but I learned to focus on what mattered most. I finally found the missing piece: passion. 

In medical school, I sought out ways to increase my knowledge of healthcare for older adults. I found a mentor in Dr. Mindy Fain at the Arizona Center on Aging who taught me all about frailty and how care for the older adult requires complex understanding of the physiology of aging. She introduced me to the American Geriatric Society and accompanied me to my first meeting as a medical student in 2018. At that meeting I met many additional mentors including Dr. John Burton and members of the Johns Hopkins University Division of Geriatrics, who eventually became my colleagues during my residency at Johns Hopkins Bayview and subsequent fellowship with the division. 

Over the years since that first meeting, I have been blessed to attend several in person meetings despite the pandemic, and to meet so many friends and colleagues across the country that make a difference for older adults ever day. This is why I am an American Geriatric Society member and have been since I was a student. It’s the people. There is a passion that is palpable in the AGS across all fields of geriatrics given the unifying goal of improving the health, independence, and quality of life of all older people. For instance, I may be researching ways to make surgery safer for older adults, but at the AGS I can not only share my piece of the puzzle, but also see the awesome work my colleagues are doing across fields, putting our pieces together to make a beautiful picture.  

My joy I feel being a part of this community has led me to become involved in leadership and I am now starting my time as the new American Geriatrics Society Early Career Professional Ex Officio Board Member. I have finished my Clinical Geriatrics Fellowship and am now completing two years of research training as a Post-Doctoral Research Fellow supported by the NIA Training Program in Health Services and Outcomes Research for Aging Populations T32 under the mentorship of Dr. Cynthia Boyd and Dr. Esther Oh. I will also be pursing an MHS in Clinical Investigation at the Johns Hopkins Bloomberg School of Public Health. 

I look forward to many years of forming great pictures of the future of geriatrics with my friends and colleagues in the AGS. As I look back on all the lessons my Great Aunt Mary taught me, I now know the value of her story and focusing on what mattered most to her in that time - being home surrounded by loved ones - was the most pivotal. It just took me some time and mentorship from other geriatricians, like those you meet in the AGS, to learn it. P

"From the time I was a little kid, I’ve enjoyed science and learning about the human body. I knew that I wanted to be a physician at the age of five, because it seemed like such a great way to help others. Once I realized that being a doctor combined science, the body—and helping others—I knew it would be the perfect career trifecta for me. 

During medical school, I had some amazing experiences helping care for older adults, and in my family medicine residency I was struck by the joy I felt when working with the geriatric population. I appreciated the wisdom and stories older adults shared with me, and their care often required me to think critically when I encountered their complex medical conditions and the many drugs they often took. Those experiences inspired me to pursue additional training in geriatric medicine to provide the very best care I could for this amazing patient population.
 
At my current job at the University of Florida, I split my time between inpatient geriatric consults and the outpatient geriatric clinic. It’s rewarding because I have the opportunity to work with medical students, residents, and geriatric fellows in each of these settings. Being a part of an academic institution allows me to participate in research as well, which I hope to get more involved in next semester. 

I joined AGS as a family medicine resident in 2019, because I wanted to learn a bit more about the Society as I prepared to apply for my geriatric fellowship. 

I’ve gained so much from my membership! For example, as a fellow last year, I was a part of the Fellows-In-Training section which provided me with networking opportunities and career guidance as I embarked on the interview process for faculty positions. For the upcoming year, I’m excited to be Chair of the FIT Committee, because I truly believe the key to our future success as a specialty is not only attracting people passionate for geriatrics but providing them with the tools they need to be successful.

I attended my first AGS Annual Scientific Meeting last year, and was I honored to present my research project, “Vitamin D Supplementation After Fracture,” as a virtual poster presentation. I thoroughly enjoyed listening to the various speakers and presentations and look forward to the chance to connect with folks in-person at #AGS22 in Orlando.

The meeting offers change-your-practice types of learning experiences. One of the most interesting talks I attended discussed the risks associated with long-term use of proton-pump inhibitors (PPIs), and after attending the lecture I became something of a champion for deprescribing unnecessary PPIs in the nursing home for the rest of my fellowship year.

In my off hours, I enjoy volunteering at my church, dancing, and spending time in nature. I’m an avid jogger and completed three marathons in three different states in the past few years and aim to do my next marathon in 2022." 

"I guess you could say that becoming a doctor was in my genes—my father is a private practice solo physician in Wausau, Wisconsin and my mother was an emergency medicine nurse. I grew up in the healthcare system, and for as long as I can remember, I’ve wanted to go into medicine. 

I became inspired by geriatrics during my med school training at the Medical College of Wisconsin, where I was lucky enough to have amazing mentors. In fact, in my very first year, Dr. Edmund Duthie, MD, the chief of MCW’s Division of Geriatrics/Gerontology, introduced me to AGS—he was a member of long standing—during the early weeks of classes.

As my interest in geriatrics grew, I found myself wanting to learn more about the field. The school had an apprenticeship program—you got to pick one specialist with whom you spent clinical time during your first and second year. I chose Dr. Angela Beckert, who’s now MCW’s program director in the internal medicine geriatrics track. So, between Dr. Duthie and Dr. Beckert, I got an indelible introduction to the field of geriatrics.

My personal life also paved the way for my decision to enter geriatrics. Very sadly, during medical school, my mother was diagnosed with Younger-Onset Alzheimer’s disease. The challenges that came from this difficult family experience led to my interest in working with people who have neuro-cognitive impairment, and geriatrics combines that interest with an internal medicine focus.

I’m finding the field extremely rewarding. Recently, I was appointed as the American Medical Association’s Resident and Fellow Section chair—and as exciting as that appointment is, it’s even more exciting because I’m the first geriatrics fellow to hold that post. It’s an honor to be elected and to represent my field next year.

Another rewarding aspect of my career is working with trainees. I enjoy mentoring them—helping them publish and encouraging them to get involved in healthcare advocacy and policy.

For me, membership in the AGS was invaluable when I was a trainee. And I’m sure that my AGS membership will be even more valuable when I’m a young physician starting out to practice. 

Of course, another huge benefit of AGS membership is the Annual Scientific Meeting. Due to the pandemic, my first meeting was a virtual one—but we all made it work. I volunteered with organizing the Residents’ Section activities, I moderated a Q & A session with geriatrics fellows, and I presented one of my clinical vignettes. Now that I’m 20 weeks pregnant, I’m not sure if I’ll be able to make it to #AGS22 in Orlando in May—but I’m sure going to try!

I feel that the best part about AGS membership is how it enables us to advocate for older adults. It gives us a seat at the table where the decisions about our patients’ welfare are made.

As busy as my professional life is, my personal life is also happily hectic. My husband and I are the proud dog parents of four rescue pups, who keep us active walking and playing outside. We also love to cook and try new recipes together, and we enjoy kayaking and cycling."