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New Program Addresses Complexity of Older Patients

Massachusetts General

A 72-year-old patient is losing weight. His primary care provider believes the cause may be a stomach virus he recently contracted, but it is hard to be certain – the weight loss has been gradual, not sudden.

The patient is referred to the Senior Health Geriatric Consultation Program, where he has a 90-minute appointment with a physician who specializes in geriatric medicine. During the evaluation, the physician has ample time to ask the patient about both medical and nonmedical issues. The patient confides his arthritis makes it difficult for him to go the grocery store, and as a result, he has been skipping meals. The physician recommends the patient sign up with Meals on Wheels, which delivers meals to clients’ homes. 

The above is a single example of how geriatric patients with complex issues may benefit from the new MGH Senior Health Geriatric Consultation Program, which was launched Oct. 1. The initiative, led by Katherine Hesse, MD, MSW, a physician in the Geriatric Medicine Unit, offers 90-minute consultations for patients ages 65 years and older experiencing either a new or existing health problem.

“Many older people have lots of problems, and it’s very hard for their primary care provider to be able to evaluate all of them in a routine visit,” says Hesse, who has more than 30 years of experience in the field. “These consults give me an opportunity to sit with a patient and his or her family members and hear what their concerns are, try to make sense of what is sometimes a very complicated situation, and provide advice to improve the patient’s quality of life.”

Family members are encouraged to attend and participate in the discussion. “Once the issues are identified, the family often has suggestions about how they can help resolve problems,” Hesse adds. After the visit, she sends an overview of the assessment and recommendations to the patient, his or her family members and the primary care provider to ensure everyone is on the same page. 

Previously, consultations were available sporadically, when a patient had a particularly complex situation. But now Hesse is able to offer the service to a broader spectrum of patients.

“It’s really something I love doing,” says Hesse. “I love puzzles, and I love to see these patients who have complicated stories and try to put all their concerns together to see what’s going on and make recommendations. There’s something about it that’s really rewarding.”

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