Share ThisEditor's Update: This article was first published October 10, 2018. It was most recently reviewed and updated February 20, 2024.
In our Ask a Doc series, we sit down with physicians and other clinical experts, including those at Allegheny Health Network (AHN), for a chat on an important health topic. In this post, AHN’s Dr. Lyn Weinberg discusses her work with older adults.
We’re getting older in the U.S. The nation’s median age rose from 28 in 1975 to 38.8 in 2020, and the number of people 65 or older grew from 35 million in 2000 to 55.8 million in 2020.
As our population continues to age, it’s vital that health care systems adapt to meet the needs of older patients. To start, Dr. Lyn Weinberg of Allegheny Health Network (AHN) stresses that preconceived notions of what aging looks like must be discarded.
“Older adults span a wide range of health and abilities,” she says. “Every day I see 85-year-olds who are in great shape and working or volunteering in their spare time with many years ahead of them. Every day I also see 85-year-olds who are in hospice. One treatment might work well for one patient, but not for the other. It’s so important to treat each patient personally and individualize their care.”
Dr. Weinberg, director for the Geriatrics Division at AHN, works to operationalize and standardize geriatric care across the network while also continuing to practice. During our conversation, Dr. Weinberg discussed her work with AHN, how she approaches geriatric care, and her vision for geriatric care delivery.
Nikki Buccina: Being a younger doctor, what’s it like to provide cross-generational care?
Dr. Lyn Weinberg: There’s a special bond between younger and older generations, and I love the relationships I’ve been able to form with my patients and their families. When I had both my kids, I could see that it definitely brightened my patients’ days to share in those life events with me. I had patients bring me gifts, knit things for me — it made that connection even closer.
Nikki Buccina: Are health care providers who specialize in geriatric care in high demand?
Dr. Lyn Weinberg: I would say geriatricians are in high demand, but the supply is short and there may never be enough geriatricians to meet that demand. In my role, I like to focus on educating clinical trainees and other primary care doctors, as well as specialists, on quality geriatric care, because it’s going to be delivered by almost all health care providers.
I believe that as a geriatrician, it’s also my responsibility to be an educator. I want to help all health care providers better understand care delivery for older adults and the nuances within that — it’s why I’m so passionate about incorporating geriatrics education into residency training. We have a very robust geriatric curriculum for our resident trainees here at AHN, including a specialized Geriatrics track within our Internal Medicine residency program. I went through a formal fellowship as part of my training.
Nikki Buccina: Can you talk more about what a fellowship in geriatric medicine entails?
Dr. Lyn Weinberg: A fellowship in geriatric medicine is one to two years of training beyond internal medicine. It focuses on issues that affect older adults, and the curriculum that falls outside of typical medical training, dipping more into the psychosocial area.
In particular, it looks at how to navigate an older adult through the health care system and place a focus on available resources, as well as looking at issues that affect older adults like falls, dementia, low vision, or even urinary incontinence.
Another important part of this training focuses on how to best manage polypharmacy in older adults. One way to define polypharmacy is any patient who is taking more than four medications, which is pretty much everybody in geriatric populations. It can be a major factor in health-related complications, so in a training program someone may cover how to ask questions in practice like “how can we cut this down?” or “is there something we should be using instead?”
Lastly, providers learn more about the best methods to manage end-of-life issues and frailty.
Nikki Buccina: What drew you to working with older adults?
Dr. Lyn Weinberg: I just have always felt a special connection with older adults; it may have stemmed back to time I spent volunteering in a nursing home, starting when I was about 11 years old. I also love the complexity of care in older adults. There are standardized guidelines in medicine about how to take care of heart attacks, hypertension, you name it, but many of those guidelines came out of research and studies which didn’t include real-world geriatric patients. So, when I’m working with older patients, it’s really about individualizing their care and going one step beyond the guidelines.
I also enjoy working with families to meet end-of-life goals for the patient, and the way caring for older adults relies heavily on multidisciplinary teams. It’s not just about what I think, it’s also the professional opinions of therapists, social workers, pharmacists and more.
Nikki Buccina: What is your perspective of palliative and end-of-life care?
Dr. Lyn Weinberg: The word palliative in medicine means to relieve suffering, and that should be part of everyday practice for all providers. My training in Geriatrics has given me the skillset to manage complicated symptoms, especially in individuals living with dementia and other advanced illnesses which are common in older adults. As for end-of-life care, I find it rewarding to work alongside a patient and their family to make sure the patient dies with dignity. If they have goals to die at home without pain, it’s crucial that we do everything we can to meet those goals.
It has also been important for me to recognize that one patient’s idea of good quality of life or death with dignity can be very different from another, and it’s our job to elicit what matters most to our patients and their families and tailor the care to their values and wishes. There are some patients who need to feel that they’ve tried every aggressive measure at the expense of what I would consider to be a good quality of life. As I’ve become more experienced in my role as a geriatrician, I’ve learned to meet people where they are and support them through whatever they decide for themselves.
Nikki Buccina: You were instrumental in standing up the HELP program at AHN. Can you tell us more about why you thought it was important to implement this national program and where you’re going with it?
Dr. Lyn Weinberg: Throughout my residency, fellowship and beyond, I saw some of the hazards of hospitalization for older adults. When they are admitted, the process is normally that they’re put to bed, restricted from walking (which stems from a fear that they will fall), and they can quickly become deconditioned. Especially when you take into account the new faces, new sounds and alarms, interrupted sleep patterns and even different medications, all of this can lead to older adults becoming extremely disoriented, which can cause delirium, or acute confusion.
It’s heartbreaking to see older adults get worse in the hospital instead of better. Despite our best efforts, there remains a very real risk with older adults that they may leave better in some aspects of their health, but functionally with more disability than when they came into the hospital.
The HELP program is great because it focuses on the prevention of delirium and acute confusion in older adults. It’s a common-sense, age-friendly approach. We have volunteers who help seniors stay awake during the day so they can sleep better at night, give them a newspaper so they can read the date, have conversations with them — it’s a strategic approach to keep their minds active and engaged throughout their stay. It’s just good care, and I look forward to the day when it is the standard in all hospitals.
We started HELP at AHN West Penn Hospital, and we also introduced it at AHN Allegheny General Hospital (AGH). It’s been going extremely well.
(See sidebar to learn about recognition of the program as a Center of Excellence in 2023. To learn more about HELP, watch Dr. Weinberg’s presentation below, hosted by Sunnybrook Health Sciences Centre in Canada for World Delirium Awareness Day, March 16, 2023.)
Nikki Buccina: What program or initiative, outside of HELP, are you excited about in terms of AHN improving care for seniors?
Dr. Lyn Weinberg: We have had a formalized program with the trauma surgeons at AGH since 2016. When patients who are 75 years or older are admitted to the hospital for trauma service, they are also now seen by one of our geriatric practitioners who will then follow them throughout their entire stay.
The majority of trauma-related admittance for older adults is caused by falling. The trauma surgeons are amazing at managing the injury, but always appreciate further guidance on managing the cause of the older adult’s fall. Our geriatric practitioners are able to talk to the patient about their health goals, or if the situation is severe enough, their end-of-life goals. This has been an extremely successful program and we are excited to have recently expanded it to Forbes Hospital.
Additionally, we have embarked on important work in the area of supporting patients living with dementia and their caregivers in the community. Receiving a diagnosis of dementia is devastating for a patient and their family, much like being diagnosed with cancer. In this country we have made amazing strides in cancer care with wraparound services that are provided to patients and their families right at the moment of diagnosis, such as social work interventions, support groups, and help with nutrition. Unfortunately, there is not much available in the way of structured supports for those who are facing a dementia diagnosis or already living with dementia, and the existing resources in the community can be costly and difficult to navigate. Caregivers can feel especially unseen and overwhelmed, and this not only affects the patient’s health, but it is well known that caregivers also suffer poor health effects as a result of the stress and time spent caring for their loved ones.
I’m so excited to report that here at AHN, we are changing the landscape around this issue. With a generous grant from the Hillman Foundation in 2022, we launched the Aging Brain Care program, a comprehensive care initiative integrated into primary care. In this program, a specialized multidisciplinary team provides coaching, education, and behavioral health support to caregivers of patients living with dementia. For the past year, we have been piloting this program in specific regions of Pittsburgh, and preliminary data indicate a reduction in measures of dementia symptoms and caregiver stress. We are looking forward to seeing this grow further. The need for these services on a large scale is now being recognized by Centers for Medicare and Medicaid Services.
Nikki Buccina: Is there ageism in the U.S. health care system?
Dr. Lyn Weinberg: It’s huge. Ageism can be found at every level of care and with all older adults, but it can easily happen with patients who have experienced cognitive decline, especially if the patient develops delirium. To take just one example, if a patient is a little confused one day during his or her stay, some doctors may quickly jump to assuming the patient has dementia. If a chronic condition like dementia is on your chart — it doesn’t just go away.
So a year later, I may see that same patient who has dementia diagnosis on the chart and they’re completely fine, but with a label of dementia, the patient might not be a candidate for certain treatments or surgeries because of that.
It’s important that clinicians take their time with older adults and be patient. It can be difficult, especially when working with a patient who may have low hearing or other challenges, but it’s important to ensure the highest quality of care.
Nikki Buccina: Is there an area where providers could focus more when it comes to improving care for older adults?
Dr. Lyn Weinberg: I hope to guide other providers to keep the big picture in mind. Older adults have a lot of different medical issues going on and some of them see a variety of specialists. Even with the best of intentions of clinicians, a patient’s care can quickly become fragmented.
We need to ensure that with geriatric patients we’re focusing on the individual person, taking into account their unique goals and values, and we’re looking at the whole picture of their health as we approach their care plan. It’s a rewarding thing to work with these patients and their families in this season of their lives and to look beyond just the medical aspects of their care, but also care for their psychosocial needs as well.
Dr. Lyn Weinberg has been a geriatrician with the Allegheny Health Network since August, 2013, and is now the director of the geriatrics division for AHN Primary Care Institute. Specializing in Geriatric Medicine and Internal Medicine, she is affiliated with West Penn Hospital, Allegheny General Hospital, Forbes Hospital and Temple University Hospital. She graduated from the Jefferson Medical College of Thomas Jefferson University in 2009.
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