Ambulatory Practice

Harry and Jeanette Weinberg Geriatrics Ambulatory Practice

The geriatricians at the Geriatric Ambulatory Practice of Montefiore Medical Center are all board-certified physicians, and include internists and family physicians with additional subspecialty boards in geriatric medicine. Our outstanding multidisciplinary team includes geriatricians, geriatric psychiatrists, nurse practitioners, nurses and social workers, who provide both primary care and consultations. If additional consultations are required, Montefiore offers an extensive range of subspecialty health services, including: Montefiore Einstein Center for Heart and Vascular Care, Montefiore Einstein Center for Cancer Care, Women's Health at Montefiore, Montefiore Einstein Center for Transplantation and Surgery at Montefiore.

Services Provided:

• 24-hour coverage
• Hospital care with the Geriatrics Inpatient Service at Montefiore
• Medication management
• Physical examinations
• Treatment of acute and chronic medical problems
• Laboratory testing
• Skilled home care referrals
• Vaccinations

Treating the Whole Person: Comprehensive Care for Older Adults

The geriatrics team assesses and treats all the different types of conditions affecting the older person's health and well-being, including:

• Common medical illnesses such as high blood pressure, high cholesterol, heart conditions, arthritis, emphysema and diabetes
• Changes in functioning that can impact well-being and independence, such as the ability to walk and manage one's own care, such as falls, balance problems, osteoporosis, urinary incontinence and sleep disturbances
• Geriatric syndromes
• Memory loss, depression, dementia, Alzheimer's disease and related issues that affect patients and their families

The Geriatrics Evaluation

Montefiore geriatricians begin with a complete patient evaluation, including physical health and ambulation, examination of memory, medication usage and nutrition. The assessment and recommended plan are discussed with the patient and caregivers. A Montefiore geriatrician coordinates care, which may include:

• Management of medical problems and age-related conditions
• Psychiatric and medical evaluation and treatment of Alzheimer's disease, other dementias and depression
• Social work consultations for supportive counseling and coordination of community services and entitlements
• Coordination of home care and rehabilitation services
• Evaluation for nursing home placement

Aging and Memory Evaluation and Care

Our multidisciplinary team, including geriatricians, nurse practitioners, social workers and geropsychiatrists, specializes in the medical and psychosocial evaluation and ongoing care of older adults who have dementia. Our physicians consider the patient's family life when evaluating and determining a care plan for memory loss, depression, Alzheimer's disease and other dementias.

• Physicians address frequent issues that families face, including:
• How do we get help?
• How do we manage our loved one's behavior?
• How should we handle decision making such as medical, financial and legal?
• What should we do when a patient starts wandering at night?
• Should we consider new drugs and clinical trials?

Information about support programs is provided to assist patients and their families.

Falls Assessment Program

More than one-third of community-dwelling adults who are age 65 or older fall every year. In half of these cases, the falls are recurrent. They carry a risk of hospitalization, functional decline and nursing home placement. Most falls are multifactorial and need close attention to various risk factors in individual patients. As the number of community-dwelling adults over 65 has increased significantly, we added a Falls Assessment Program in the Geriatrics Ambulatory Practice. The Program provides assessments of patients with a history of or risk factors for falls. The evaluation includes:

• Detailed history and physical examination with emphasis on medication review
• Test for vision and hearing impairment
• Assessment of gait and balance

After the evaluation, recommendations are made to reduce a patient's risk for falls and, if appropriate, patients are referred to specialists in other disciplines. For patients seen as consultations, recommendations are communicated to the primary care provider.

Comprehensive Bone Center (Osteoporosis Evaluation)

One-third of women and one-fifth of men over age 50 will experience osteoporotic fractures. The effects of osteoporosis can be minimized through early diagnosis and a specialized program that includes medication, diet and exercise. The Geriatrics Ambulatory Practice Bone Center focuses on metabolic bone diseases in older adults, providing:

• Screening for primary and secondary causes of osteoporosis
• Advice regarding nutrition and exercise
• Treatment with medications
• Fracture prevention
• Opportunities to participate in osteoporosis research programs