Geriatric Medicine Associates:
Geriatric Medicine Associates (GMA) is a non-profit group dedicated to enhancing the health of older persons. The physicians, geriatric nurse practitioner, and social worker at GMA offer a variety of clinical services to older patients including:

· comprehensive geriatric assessment
· in-hospital consultation
· comprehensive longitudinal care
· end of life symptom control
· coordination of determination of competency
· medication education and compliance
· decubitus ulcer program
· falls analysis and prevention
· continence training
· functional assessment
· advance directives counseling
· nursing home information
· family and caregiver counseling
· community resource information
· screening for dementia and depression
· education on dementia and related issues

The comprehensive geriatric assessment program is available to all elderly persons in an outpatient or inpatient setting and is especially valuable to those whose physical, functional, or emotional status has become unstable. Patients are evaluated by a multi-disciplinary team including geriatricians, a geriatric nurse practitioner, a geriatric social worker, and fellows in geriatric medicine. This assessment is available on a consultation basis or as a first step in ongoing primary care. It includes referrals to community services, and counseling for family members.

The complete outpatient assessment, which usually requires three visits, includes assessment of:

· medical history
· cognitive and emotional status
· ability to function independently
· physical status
· social history and social supports
· medications

A written summary of the assessment and recommendations will be provided for patients receiving ongoing care elsewhere.

In-hospital consultation involves the multi-disciplinary team at Texas Medical Center hospital, including The Methodist Hospital and St. Luke's Episcopal Hospital. This service is recommended for those geriatric patients with multiple medical problems and complicated discharge planning needs. Consultation service includes assistance with psychosocial problems and special nursing issues. This service involves the multidisciplinary team at Texas Medical Center hospitals, including The Methodist Hospital and St. Luke's Episcopal Hospital.

Additionally, physicians and nurse practitioners from GMA provide medical oversight to several long-term care facilities near the Texas Medical Center.

Geriatrics and Extended Care Service (G&EC):
The future of veteran care in the United States is inextricably bound to care of the geriatric patient. Through the Geriatrics and Extended Care Service at the Houston Veterans Affairs Medical Center, we offer a continuum of care to older veterans by using in-house and contract services as needed. As a primary teaching hospital for Baylor and other Texas Medical Center institutions, the programs described below also are serve as training sites for geriatric fellows and students of medicine, nursing, social work, pharmacy, and dietetics.

The home care program offers a variety of services including at-home clinical care, end-of-life home care, caregiver education, respite and home-maker visits. The interdisciplinary Home Based Primary Care (HBPC) team assesses and provides medical care, skilled nursing services, rehabilitation therapy, social work services, and dietetic services with a focus on supporting and teaching the caregiver to care for the patient. Service is available for up to one year. The HBPC program also coordinates caregiver support groups and senior companion services for our older veterans.

In-patient care accommodates those older veterans who require higher levels of medical attention. The Intermediate Care Unit serves patients who no longer require acute care, but who need additional time for observation and continuing therapy prior to returning home. The Geriatric Evaluation and Management Unit (GEM) consists of designated hospital beds, primary care clinics and a consult service run by an interdisciplinary team. Targeted older patients are evaluated and treated for functional, medical, and psychosocial programs that impede their reaching the highest level of functioning in the least restrictive environment.

Transitional Care Units provide extended care for patients who can benefit from intensive rehabilitation, skin care or other special nursing care not possible through our HBPC program or contract program with community nursing homes. The primary function of this clinical area is to provide necessary interim care, support and rehabilitation as the individual moves from home care to a required acute hospitalization and back to home again. Typical lengths of stay are three to six months. Palliative/End-of-Life care is offered for terminally ill patients unable to be maintained at home.

Faculty & Staff
Roy G. Smith, PhD, Director