Hi, my name is Peter Reed and I'm the director of the Sanford Center for Aging at University of Nevada, Reno.
And i'm delighted that you are going to have an opportunity in your fellowship in geriatrics
to spend some time in our geriatrics clinic that we have here at the center.
At first, I'd like to express my regrets that our schedules did not align in a way that enabled us to meet
in person for me to share about the center with you and to tell you about the clinic and the different kinds of
things that we're doing and certainly to give you the opportunity to ask me questions and have some
dialogue. So I'd like to say that at any time that you're here, feel free to pop in my office and we can touch base.
And I'll be happy to answer any questions or share anything about what we're doing that you aren't able to
pick up from this brief orientation. So, what I'd like to do in this brief video is share a little bit about the
Sanford Center for Aging. Who we are. Where we came from. What we do.
And then specifically talk about the Sanford Center geriatric specialty clinic.
The Sanford Center for Aging was formed in 1993 with a generous gift from Graham and Jean Sanford.
Jean had experienced difficulty with her mother navigating the aging services that were available in our community.
And so she gave the gift to the university to create an aging center that would be dedicated to supporting elders in our community.
So unlike a lot of centers around the country, we think we're really unique in that we're not just focused on aging research.
But we have a strong portfolio of community services, clinical services, academical programs.
And tie all of those things together, really to fulfill our mission. And the mission of the Sanford center is to
enhance the quality of life and well-being of all elders through translational research, education, and community outreach.
And we really live that mission every day. The word "for" in our name "Sanford Center for Aging" is not an accident.
Here at the center, we believe in a philosophy that aging is a good thing. We are very pro aging.
And so we do everything we can to enable elders to live well as they age. So I want to tell you
a little bit about the community programs because they're going to be an opportunity for you to connect clients with resources.
The folks that you're seeing here in the clinic are going to have all kinds of different needs.
And these are perhaps some of things that you want to connect them with to help them to get the support that they need.
So in our portfolio, we have a variety of different things. We have direct services programs, civic engagement
programs. As well as community wellness iniatives. So the first is called senior outreach services.
The senior outreach services is funded by the state of Nevada for us to engage volunteers in providing
one on one in home companionship and assistance to low income, vulnerable elders. Many of whom are home-bound.
So this is an opportunity, really, to get people the support that they need to maintain their independence
and remain in the community. We also offer the Retired and Senior Volunteer Program or RSVP.
And this is a program in Washoe County where we recount elders as volunteers and then connect them
with any one of 40 different community agencies that we have partnerships with where they will go and provide volunteer service.
And this is really important when you find someone who potentially has minimal physical or cognitive disabilities
but is socially isolated and perhaps bored or lonely. And this gives them a chance to get back
into the community and give back and develop that sense of meaning and purpose. We also offer chronic disease
self-management programs. These are based on the model that was developed at stanford university
so they're evidence based peer support programs to give people the skills and knowledge
that they need to really have the self efficacy and empowerment to take control of their own conditions, themselves.
And with those, we do offer a general chronic disease managmente program for folks with any chronic conditions.
We also periodically offer disease specific programs. we have diabetes self-management.
We have a program for cancer called cancer thriving and surviving. we also offer strength
and conditioning program called fit and strong. So those are great opportunities to connect people
with things that truly can empower them to manage their own situation.
Finally in our portfolio of community programs, we offer medication therapy management. And this engages a
certified geriatric pharmacist in looking at all of the medications someone is on, doing a comprehensive
review and really looking for potential negative interactions. Trying to address issues of polypharmacy.
This is hugely important. As you know, so many elders are on multiple medications. We had a client a couple
of years ago that was on 42 different prescription drugs prescribed by 7 different doctors. And it's really
challenging just to even figure out where to start with something like that. But the goal of our pharmacist
overall, is to try to reduce the number of medications that people are on. So that represents the community
programs that we offer here at the Sanford Center. But then of course, as you go through this experience, you're
going to learn about all of the other community support and services that are offered by our community partners.
And we're going to find ways to get you engaged in helping to connect people with those services.
Just briefly in terms of the other initiatives here at the Sanford center, we also offer a gerontology academic
program. We have a minor and a certificate in gerontology that we make available to undergrads here
on campus as well as to professionals in the community who want to come back and learn more about aging and
aging services. We also have a portfolio of research that primarily includes program evaluation research. We do
our internal program evaluation. And then we also receive contracts from the state and other partners to
help to evaluate the quality of their programs. That also includes the clinical research that we're doing. So we do
our own surveys with all of the clients that come through our geriatric specialty clinic and we're doing thirty day,
six month, and one year follow ups with them. As i talk about in a minute, when i discuss the clinic, you'll see
that this is an innovative model that we've created here. So we're trying to document the impact that it's having
in people's lives in enhancing the quality of life.
So now i want to shift to our geriatric specialty clinic because this is where the bulk of your work is going to be happening.
Though i wanted you to have a bit of familiarity with what's having across the full Sanford Center for Aging.
The Sanford Center for Aging is a unit within the University of Nevada, Reno School of Medicine.
And we're delighted to be a part of such a great team of clinicians, researchers, academics, and people who are
serving our community. I know the school overall is really committed to community outreach. And we feel
like our clinic plays a central role in helping to fulfill that aspect of the mission.
The Sanford Center Geriatric Specialty Clinic was launched in 2015 after an extensive multi-year planning process.
When the Sanford Center took it on to develop a geriatric clinic and start offering clinical services, we wanted to do so collaboratively.
So we engaged multiple different planning committees from across the School of Medicine as well as multiple
other schools and disciplines across campus. Ultimately, we had about 18 different disciplines represented in our
committee structure that planned the clinic. The first thing that we started with in our planning process was to
determine what our values were going to be. Now, I know, every organization you go into has their values on
the wall like integrity and accountability and transparency. Not that those aren't important but a lot of
times, they're just on the wall. And people don't live and breathe them every day.
But our values truly inform all of the decision making that takes place in how we develop and deliver the
clinical services that are a part of what we're offering. So we spent probably three or four months just wrestling
with what our values should be for the clinic. And I'm going to make sure you get a copy of those values.
But i want to highlight two of them, in particular, that are directly relevant to the work you are doing. The first is
that we strive to offer an elder driven partnership within the services we are delivering. So when we developed
that, we viewed it really as an evolution beyond person-centered care or patient-centered care. The idea is that
"yes", from a patient-centered perspective, we want to individualize the services based on the needs of that person.
But from that perspective, often times, it's really the experts or the providers that are gaining all of that
information about that individual and then giving them the instructions on what they should do to best meet
their needs. In this case, through an elder-driven partnership, we recognize that everyone has a role in
making the assessment and the recommendations that come out of that assessment come to life
and be successful in meeting the needs of the individual clients. And that includes the client them self, as well as
potentially, a family care partner who may accompany them on the visit within the clinic.
By including the client them self in the planning process to make decisions about what steps they're going to take
to maintain their well-being, It gives them an opportunity, not only for input, but also really to be invested in the recommendations
because if we as practitioners provide specific recommendations to someone but they're rolling their
eyes and don't feel like it's something that they can actually achieve then the likelihood that they're going
to take steps to fulfill those recommendations is greatly diminished. So we really make decisions based on the
input, priorities, values, and preferences of the individual client. The client comes first.
So the next value that I'd like to share is our interdisciplinary team approach. Now i know as a
geriatrician, you're probably very familiar with interdisciplinary approaches to clinical services because
that's a core and central part of geriatrics in general. But here in the Sanford Center, we not only do that
horizontally by engaging as a team with our geriatrician, social worker, and pharmacist to come together to
review the client situation, to get to know that client as well as possible, and to develop recommendations.
That also happens vertically because we have trainees from all of those disciplines that are participating in the clinic as well.
So I recall telling our medical director two years ago when we were first hiring our first medical director in this clinic.
I recall saying to him that we really value the expertise that you have, you have tremendous experience,
you're a physician and a geriatrician, but we also view a second year MSWU intern as having as much to provide
in terms of direct observation of the clients that their opinions matter as well. That no one's opinion carries
more weight than the other. But that we work as a team to recognize that everyone has seen something a little
bit different and that everyone brings that perspective into the discussion about how we can best help those clients.
So again, we'll show the values document with you so you can read all of the values that are informing this
clinic but in elder driven partnership and in interdisciplinary team approach are really critical to the
experience that you're going to be having here.
So now let me tell you what we do. Our core service is a comprehensive geriatric assessment within the clinic
And that can last perhaps three to four hours for each client. So we really have the time to be present and to listen.
In doing so, the client is going to interact, again, with a geriatrician, so they'll interact with you who is going
to be conducting that geriatric medical assessment. But there are other elements that will brought in by the other
disciplines that are going to be a benefit to you as well. We have a certified geriatric pharmacist that conducts
the medication therapy management. So you can look at the medications that that person is on and then consider
them in consultation with the expertise of this geriatric pharmacist.
We also have a social worker and a team of social service professionals who are going to try to understand
understand the psychosocial needs of the client but also try to dig into what their life story is and the kind of things that they enjoy.
And so by bringing all of those different perspectives together. All of which is guided by our medical assistant
as he helps to shepherd the clients through the overall experience. Then our number one priority is, as i said, to
get to know each person as well as possible. Then the team works to develop a set of recommendations.
They're provided to the client as they leave the visit. But they're also sent back to that client's primary care provider.
We do not provide primary care here at the geriatric specialty clinic. We view it as a comprehensive specialty
consult that gives recommendations and priorities for treatment and follow up back to their primary care provider.
The primary care provider is then the one who's going to follow up on making any medication changes or connecting them with other medical referrals that are
required based on the recommendations that we have outlined. However, our social services team is going to
follow up on the community based supports and services that are recommended to connect this
individual with the kinds of things that they need in the community to enhance their quality of life and to help them maintain their independence.
The other thing that we offer as a follow up to the comprehensive geriatric assessment is chronic care
management. So for anyone who comes to the clinic, if they have two or more chronic conditions, which is
pretty much everyone that comes through the clinic then they have the opportunity to opt in to our chronic care
management program. And if they do, then our geriatrician, in particular, will take the lead in working
with our providers to develop a more formal care plan that includes specific recommendations for each of the
different chronic diseases. Then our medical assistant, our pharmacist, and the geriatrician are going to follow up with them every thirty days.
And give an opportunity for that person to share the extent of which the recommendations are really being
successful in meeting their needs or if there are other things that we need to do to tweak and to treat that.
We also offer medicare annual wellness visits as a core service. So this is different from the comprehensive assessment.
Because in the comprehensive assessment, someone is going to come in and spend three to four hours with us.
With the wellness visit, they come in and only meet with the geriatrician. And they may spend up to an hour with us.
And that's something that we also use as our one year follow up to the comprehensive geriatric assessment.
So that's a critical component of what we're doing as well.
As other opportunities for you and your experience here, you may also have the chance to participate in our
telemedicine. So we've developed a model of our comprehensive geriatric assessment that we can do in 90 minutes via remote technology
to see patients who are out in rural communities. So their primary care provider is on the remote end with them
in a clinic setting and then they stream in our team who goes through the full comprehensive assessment
and then provides those recommendations back to that individual as well. And in that way, we're able to take this service
out of Reno and really serve all of northern Nevada which is exciting. We also use telehealth technology
to provide education to rural providers through an initiative called Project Echo. And as part of your
experience as a geriatric fellow doing a rotation through the Sanford Center, you're going to have an opportunity
to develop your own educational presentation and to deliver that to rural providers through Project Echo.
So you can see that there are a lot of different experiences that you are going to be able to have in your
one month here at the Sanford Center. And we really try to work as a team. Again, everyone's opinion is valued,
everyone's perspective is respected and we hope that you are going to fit nicely into that team and have an
opportunity to learn about comprehensive geriatric specialty services as a compliment to your larger fellowship experience.
So I invite you to jump in with both feet to take part in this as something that is hopefully new and innovative and complementary to the rest of the work that you
are going to be doing. And ultimately, all of it is intended to enhance the quality of life and well-being of elders
in our community. And I'm grateful that you've chosen to have an opportunity to come and spend some time with us here at the Sanford Center for Aging.
Part of UNR Med. Thank you.
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